Downey Bill Providing Oversight to Medicaid Transportation Brokerage Program Clears Assembly Panel

Legislation sponsored by Assemblywoman Joann Downey establishing standards in association with New Jersey’s transportation brokerage program cleared the Assembly Human Services Committee on Thursday.

“It is simply not right for patients to be late for their appointments, or miss them all together, through no fault of your own,” said Downey. “Not only will our bill solve this problem by requiring drivers to arrive within 15 minutes of the scheduled pickup time, but it will also save the state a significant amount of money by implementing strict oversight measures to make sure nothing falls through the cracks.”

The Department of Human Services Division of Medical Assistance and Health Services has a contract with a transport broker to provide non-emergent Medicaid transportation (NEMT) to Medicaid beneficiaries, and Medicaid recipients depend on this transportation system to get to doctor appointments, therapy, dialysis and chemotherapy.

        According to a report issued by the US Department of Health and Human Services Office of Inspector General in July 2016, the NJ State agency did not adequately oversee its Medicaid NEMT brokerage program to ensure that the Commissioner of Human Services-approved State Plan provisions were met.

        The bill (A-4131), titled the “Medicaid Transportation Brokerage Program Oversight and Accountability Act,” would seek to remedy this by specifying vehicle safety, staff credentialing and training, and documentation requirements for the Medicaid broker and individual transportation providers.

The Department of Human Services (DHS) would be responsible for designating an employee as an evaluator to conduct a review of the Medicaid transportation brokerage program, on at least an annual basis to determine whether:

  • The vehicles used are fully compliant with all statutory, regulatory and contractual requirements;
  • Transport personnel are properly licensed and qualified;
  • Individual providers consistently maintain all types of required insurance;
  • Prior authorization is being obtained and medical necessity is being documented for beneficiaries who require mobility assistance vehicles;
  • Beneficiaries using transportation services actually receive a covered medical service on the date of transportation; and
  • The nature of services, dates, times, actual miles driven and number of passengers in the load, are being accurately and consistently documented.

Further, the evaluator would be responsible for providing oversight of complaints made by Medicaid beneficiaries and would verify the facts of complaints, catalogue all complaints and determine the amount of monthly liquidated damages that should be imposed on the broker.

The bill also clarifies that a transportation provider would ensure that its drivers and other staff members successfully complete training provided by the DHS or any contracted agency within 6 months of the effective date of the bill.

The DHS would also implement policies and procedures and revise the brokerage contract to ensure that the reimbursement and capitation fees are not paid in excess.


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