As required by SB 480 from the 2019 session of the Indiana General Assembly a commission of providers, state government, legislative, and consumer representatives met for the first meeting of the NEMT Commission on November 8th. The meeting lasted one hour and was mainly a reporting of current work to improve the system and a preliminary report from an external auditor of SoutheasTrans performance.
FSSA Secretary Jen Sullivan began the meeting with review of 16 workstreams that are working on various parts of the NEMT program in an effort to fix it. Some of the workstreams aimed to help nursing facility residents obtain transportation are just getting off the ground or are in limited pilots awaiting expansion.
It was reported that as of January 1, 2020 FSSA and Indiana Medicaid will be permitted to use a faster process to enroll nursing facilities as transportation providers in the Medicaid program so that nursing facilities who so enroll can be reimbursed for the work they are doing. So far enrollment by nursing facilities as transportation providers has been limited to just 1 entity.
Burns & Associates is the external auditor that presented a preliminary report on its findings. A final report is expected in December. The preliminary report indicated:
- Over 12 months, 9/2018 to 8/2019, 1.153 million requests for rides were made, and 10%, or 115,132 were from nursing facilities or assisted living communities
- Of these requests from NF and AL, 67% were for wheelchair, 15% for stretcher, and 18% for ambulatory
- Of all requests for rides, 10.1% were never completed and another 10.4% were cancelled in advance (outside of 48 hours)
- For NF and AL, 10.7% of needed trips were never completed
- Send backs, particularly those less than 48 hours, continue to be a significant problem with the highest rate of these short-notice send backs occurring in September 2019 – more than 40%.
The preliminary report also examined claims payment issues, complaints, call center performance, and the transportation network. The preliminary report made these recommendations:
- Member compliance (no shows) and provider compliance (send backs) could be strengthened.
- B&A quantified as much as $6.2 million in 12 months where trips were authorized but not billed. It cannot be determined if these were cancellations in advance or cancellations on-the-spot when the driver arrived.
- The claims denial rate is too low versus industry standards. SET is conducting appropriate review of claims but ‘overriding’ some denials per FSSA instructions.
- The rate of paper claims (vs. electronic claims) submitted from providers is high. The use of iPads to record trip information is low.
- The prior authorization for >20 trips and >50 mile trips should be re-examined.
- Many of the monthly reports required by FSSA are not fully informative without additional context. B&A did see reports delivered by SET to FSSA more in real time that are useful for ongoing compliance.
Read the full preliminary Burns & Associates report.
Read FSSA Secretary Jen Sullivan’s presentation.
For all details please visit the NEMT Commission Website.