Autos

Non-Emergency Medical Transportation – IHCA – Indiana Health Care Association


Background

Prior to June 1, 2018, all Indiana traditional fee-for-service (FFS) Medicaid recipients living at home or in a nursing facility could arrange transportation to and from medical appointments by calling and scheduling directly with a transportation provider.  This direct communication between the Medicaid recipient, or the recipient’s caregivers, and the transportation provider was efficient and resulted in relatively few problems in service delivery.

On June 1, 2018 Indiana Medicaid began a contract with Georgia- based Southeastrans (SET) for SET to “broker” all Non-Emergency Medical Transportation (NEMT) services for nursing home, assisted living, and community-based Medicaid members.  Indiana Medicaid’s stated reasons for this new approach was to ensure more Medicaid members could access their transportation benefit, to improve the quality of the transportation network through credentialing and vehicle inspections, and to cut down on fraud and abuse through the use of prior authorization before a trip was provided.

In theory, the idea is good and had promised to be very efficient.  In practice, the system has not worked as it was presented and has been very frustrating for residents and staff of nursing facilities.  Here are just a few examples of issues that nursing facility residents and staff have and continue to experience:

  • Missed rides – transportation has been scheduled, but no one shows up to transport the resident.  Usually neither the resident nor facility staff are notified that the ride is not going to occur.
  • Late pick-ups – residents often wait long periods, if not hours to be picked up to and from appointments, assuming the ride occurs at all.
  • Missed appointments – the result of missed rides and late pick-ups are missed appointments, even for routine, standing appointments such as critical dialysis services.  Many treating physicians are refusing to see Medicaid nursing facility residents due to multiple missed appointments.
  • Poor customer service – while call-times for scheduling rides has improved, customer service representatives with Southeastrans are often unhelpful in resolving issues and scheduled rides are still missed.
  • Unknown complaint resolution process– while many complaints have been formally and informally filed with Southeastrans, there is no known resolution to long-standing complaints that continue to occur.

IHCA/INCAL Actions

Prior to the contract with SET and ever since the system has been in place, IHCA/INCAL staff and members have been active with Indiana Medicaid, state legislators and the Governor’s office to discuss the significant issues caused by the brokered system and implement solutions to the issues.

In the 2019 session of the Indiana General Assembly, IHCA/INCAL supported SB 480 that created an oversight commission for the NEMT system and also required additional data reports to be published and made available to the public.  The bill also required SET to post on their website a clear place to file complaints along with the development of a complaint resolution process (see below for these resources).

IHCA staff and members have attended dozens of meetings and workgroups to positively impact the broken system.  A summary of those meetings and workgroups is below.

NEMT Stakeholder Workgroups–Beginning in April 2019, FSSA hosted regular workgroup meetings with a large number of stakeholders, including IHCA members and IHCA staff, other provider groups, transportation provider groups and individual providers, as well as SET.

NEMT Update Meetings with Representative Cindy Kirchhofer–Beginning in May 2019, Representative Kirchhofer began hosting bi-weekly meetings to give OMPP and SET an opportunity to update her their workplan to address stakeholder concerns.

Additional Resources:

SET Resources:

To work within the SET system, as continues to be required in order to obtain Medicaid-reimbursable transportation, below are a list of resources.

If you are interested in enrolling as a Medicaid transportation provider please visit this link to read about the enrollment process.  IHCA/INCAL staff can connect you with appropriate Indiana Medicaid staff to help troubleshoot issues within the enrollment process.



READ SOURCE

This website uses cookies. By continuing to use this site, you accept our use of cookies.