Overview of GAO work on Nonemergency Medical Transportation

Transcription

1 Overview of GAO work on Nonemergency Medical Transportation International Conference on Demand Responsive Transportation September 28, 2016 THIS PRELIMINARY WORK OF GAO IS SUBJECT TO REVISION AND SHOULD NOT BE REPRODUCED OR DISTRIBUTED. SOME GRAPHICS MAY BE ENTITLED TO COPYRIGHT. For more information, contact Heather MacLeod, or Lynn Filla-Clark, Page 1

2 GAO s Mission & Work The U.S. Government Accountability Office (GAO) is an independent agency in the legislative branch of the federal government. GAO examines how taxpayer dollars are spent and how government conducts its operations and is commonly known as the investigative arm of Congress or the congressional watchdog. GAO's mission: To help Congress improve the performance and accountability of the federal government for the benefit of the American people. Page 2

3 GAO s Mission & Work Sources of GAO's work: Requests from committee chairmen or ranking members Mandates written into public laws or committee reports GAO initiative GAO carries out its mission through: Oversight preventing and detecting fraud, waste, abuse, and mismanagement Insight making government more efficient and effective Foresight identifying emerging issues Adjudication resolving bid protests and providing legal opinions GAO is known for providing timely analyses that are professional, objective, fact-based, nonpartisan, fair, and balanced. Page 3

4 GAO Reports on Nonemergency Medical Transportation Transportation Disadvantaged Populations: Nonemergency Medical Transportation Not Well Coordinated, and Additional Federal Leadership Needed (GAO ) Nonemergency Medical Transportation: Updated Medicaid Guidance Could Help States (GAO ) Page 4

5 Transportation Disadvantaged Populations: Nonemergency Medical Transportation Not Well Coordinated, and Additional Federal Leadership Needed (GAO ) Various programs can fund NEMT services; total spending unknown 42 Programs in 6 federal agencies may fund NEMT: Health and Human Services (HHS) 21 programs Education 7 programs Housing and Urban Development 6 programs Transportation 4 programs Veterans Affairs (VA) 3 programs Agriculture - 1 program Only HHS provided spending information: Centers for Medicare and Medicaid Services (CMS): at least $1.3 billion in FY 2012 Other HHS programs: over $51 million Page 5

6 Federal Agencies Have Taken Action to Coordinate Transportation Planning but Actions May Not Lead to Increased NEMT Coordination FTA provided guidance for Enhanced Mobility of Senior and Individuals with Disabilities program HHS s Administration for Community Living selected 17 demonstration projects to foster planning efforts in local communities. VA established Veterans Transportation Service to fund VA medical centers to acquire vehicles, hire mobility manager and purchase routing/scheduling software. However, NEMT coordination may not increase Certain FTA programs have coordinated service requirements But human service agencies do not. Page 6

7 Fragmentation, Overlap, and Potential for Duplication of NEMT Services Fragmentation: 6 federal agencies administer 42 different programs that may fund NEMT. Overlap: Programs providing NEMT have similar goals, target potentially similar beneficiaries. Both Medicaid and VA : help beneficiaries access medical services, serve potentially similar beneficiaries, and engage in similar activities. Potential for duplication: Two or more programs provide same services to same beneficiaries. Page 7

8 States and Localities Facilitate Coordination but Two Federal Programs in Selected States Did Not Participate State/Regional coordination efforts Cost and ride sharing One call/one-click centers Medicaid and VA do not coordinate with other agencies' NEMT programs. Federal Medicaid and VA requirements allow NEMT funding to be used only for eligible beneficiaries. Cost or ride sharing increase risk of spending funds on individuals who do not qualify. State Medicaid agencies using transportation brokers contract for NEMT services, not coordination. Page 8

9 Nonemergency Medical Transportation: Updated Medicaid Guidance Could Help States (GAO ) NEMT is provided using a variety of transportation modes Ambulance Wheelchair and standard vans Taxis and limousines Public Transportation Volunteer drivers Personal vehicles States establish their own provider enrollment processes States use varying models: fee-for-service, managed care, and transportation brokers Page 9

10 CMS Uses a Range of Activities to Oversee Medicaid NEMT but Some Guidance is Outdated or Otherwise Limited States responsible for daily oversight of NEMT CMS monitors NEMT Reviews, approves state Medicaid plans Issues guidance Conducts program integrity activities Provides technical assistance, clarifies guidance Some outdated CMS guidance Legislative and other changes have affected Medicaid and states NEMT programs Page 10

11 Challenges and How States Addressed Them Challenge: Containing Costs Contributing Factors : Traveling long distances, Need for specialized vehicles Reaching rural locations State actions Implement payment mechanisms such as including NEMT in capitated payments to health plans or setting fixed reimbursement fees; Coordinate with providers and beneficiaries; and Implement policies such as standard limits on travel to see a physician Page 11

12 Challenges and How States Addressed Them Challenge: Maintaining program integrity Vulnerabilities to fraud, waste and abuse Improper payments Obtaining sufficient information when enrolling providers Verifying beneficiary eligibility State actions Review claims Suspend NEMT providers Update and clarify requirements Review protocols Page 12

13 Challenges and How States Addressed Them Challenge: Contracting with and overseeing health plans and transportation brokers Broker: Underestimated needed resources and thus unable to comply with contractual requirements. State: Lacked sufficient information to develop metrics State actions Monitor vendor compliance Review NEMT data Identify compliance issues Page 13

14 Challenges and How States Addressed Them Challenge: Ensuring access Factors affecting supply of providers Geographic location Specialty providers Provider requirements limiting number of providers Beneficiary and provider "no shows" State Actions Broaden NEMT provider networks Reviewed state provider networks Used probationary periods or suspensions Coordinate with health plans Page 14

15 Related GAO Products Nonemergency Medical Transportation: Updated Medicaid Guidance Could Help States. GAO Washington, D.C.: February 2, Medicaid: Efforts to Exclude Nonemergency Transportation Not Widespread, but Raise Issues for Expanded Coverage. GAO Washington, D.C.: January 15, Transportation Disadvantaged Populations: Nonemergency Medical Transportation Not Well Coordinated, and Additional Federal Leadership Needed. GAO Washington, D.C.: December 10, Transportation for Older Adults: Measuring Results Could Help Determine if Coordination Efforts Improve Mobility. GAO Washington, D.C.: December 10, Transportation Disadvantaged Populations: Coordination Efforts are Underway, but Challenges Continue. GAO T. Washington, D.C.: November 6, Public Transit: FTA s Process for Overseeing Compliance with Federal Civil Rights Requirements Incorporates Key Federal Practices. GAO R. Washington, D.C.: July 25, ADA Paratransit Services: Survey of Public Transit Agency Officials on Services and Costs an E-supplement to GAO GAO-13-18SP. Washington, D.C.: November Government Operations: Opportunities to Reduce Potential Duplication in Government Programs, Save Tax Dollars, and Enhance Revenue. GAO SP. Washington, D.C.: March 1, Older Driver Safety: Knowledge Sharing Should Help States Prepare for Increase in Older Driver Population. GAO Washington, D.C.: April 11, Transportation-Disadvantaged Seniors: Efforts to Enhance Senior Mobility Could Benefit from Additional Guidance and Information. GAO Washington, D.C.: August 30, Page 15

16 GAO on the Web Web site: Congressional Relations Katherine Siggerud, Managing Director, (202) , U.S. Government Accountability Office 441 G Street, NW, Room 7125, Washington, DC Public Affairs Chuck Young, Managing Director, youngc1@gao.gov (202) , U.S. Government Accountability Office 441 G Street, NW, Room 7149, Washington, DC Copyright This is a work of the U.S. government and is not subject to copyright protection in the United States. The published product may be reproduced and distributed in its entirety without further permission from GAO. However, because this work may contain copyrighted images or other material, permission from the copyright holder may be necessary if you wish to reproduce this material separately. Page 16