This content discusses the Rhode Island Medicaid Non-Emergency Medical Transportation Program, with a focus on the insights shared during the Rhode Island House Committee on Oversight on March 23rd, 2017. The program aims to provide accessible and efficient transportation services for non-emergency medical needs, addressing vital healthcare accessibility issues in the state.
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Background of NEMT in RI Prior to State Transportation Broker Contract RIPTA provided non-Emergency Medical Transportation (NEMT) services between their Fixed Routes and Elderly Paratransit contracts. RIPTA subcontracted with taxi companies Highest level of service provided was wheelchair Ambulance service coordinated through EOHHS RIPTA invoiced State monthly for the services under the various categories for set amount per ride Bus passes previously received at supermarket (LogistiCare assumed responsibility in December of 2014) Changes Needed CMS required Medicaid to contract with NEMT Broker to ensure transportation services met medical necessity criteria Improved network coverage and better coordination of transportation services 2
Background of NEMT in RI State Broker Procurement Model NEMT Broker Procurement completed in late 2013 Five bids successful vendor was LogistiCare LogistiCare currently operates in 42 states Current LogistiCare Contract Three year-fully capitated arrangement with actuarial set rates for Medicaid Population Contract Period 1 SFY 2014 (2 months) (May 1, 2014- June 30, 2014) June 30, 2015) Contract Period 2 SFY 2015 (12 months) (July 1, 2014- Contract Period 3 SFY 2016 (12 months) (July 1, 2015- June 30, 2016) Contract Period 4 SFY 2017 (12 months) (July 1, 2016- June 30, 2017) Total Contract Period (38 months) (May 1, 2014 June 30, 2017) Category Capitation Payment * Elderly Program Non-Medicaid Total *Capitation payment is equal to the contracted member months estimates times the agreed upon contracted price per member. (Per Member Per Months) PMPMs currently for the SFY 17: Rite Care & Medicaid Expansion Populations at $7.07 Aged/Blind/Disabled population at $ 22.99 CNOM at $20.64. Elderly program has a fixed annual funding of $2.4 million. ** Estimates Actual amounts based on number of members $ 3,989,392** $ 24,452,816** $ 24,866,308** $ 24,955,475** $ 78,263,991 $400,000 $ 2,400,000 $ 2,400,000 $ 2,400,000 $ 7,600,000 $ 4,389,392 $ 26,852,816 $ 27,266,308 $ 27,355,475 $ 85,863,991 3
Medicaid NEMT Utilization TRIPS BY TREATMENT TYPES-ANNUAL CY 2016 Medicaid NEMT Populations Average Membership Mental Health 2% Clinic Visits 2% SFY 2015SFY 2016 207,165 (80.9%) 46,833 (18.3%) 2,069 (.8%) 256,067 (100%) Increase5.0% 219,083 (81.5%) 48,406 (18%) 1,467 (.5%) 268,956 (100%) RIte Care, Medicaid Expansion Follow Up Visits 3% All Other Visits 13% Age, Blind, Disabled Specialist Visit 3% CNOM Substance Abuse 48% Total Dialysis 5% Trip Volume (Including Mass Transit)SFY 2015 SFY 2016 616,092 (51%) 510,180 (42.2%) 82,128 (6.8%) 1,208,400 (100%) Increase19.3% 725,568 (50.3%) 638,412 (44.3%) 77,148 (5.3%) 1,441,128 (100%) RIte Care, Medicaid Expansion Adult Daycare 24% Age, Blind, Disabled CNOM Total *All other visits include: TANF Specialized Transportation for Medical Appointments, Physical Therapy, Physician Services, Psychiatry, Dental, Social Care Counseling and Eye Doctor 4
Non-Medicaid Elderly NEMT Utilization TRIPS BY TREATMENT TYPES -CY 2016 Clinic Visit 2% Non-Medicaid Elderly Population Average Unduplicated All Other* 11% SFY 2015 SFY 2016 Physician Services 3% Total Elderly 1,315 Increase 16.90% 1,537 Dialysis 30% Follow Up Visits 5% Specialist Visit 13% SFY 2015 SFY 2016 Trip Volume (Including Mass Transit) 118,644 149,868 Adult Daycare 24% Increase 26.30% Elderly Meal Site 12% * All other visits are: Eye Doctor, Radiation Treatment, Wound Care, Substance Abuse, Cardiac Rehab and Routine Services 5
EOHHS Oversight EOHHS holds bi-weekly face-to-face meetings with LogistiCare to review operational, systems & financial functional areas, transportation provider network access, along with quality improvement activities. EOHHS and LogistiCare work closely on a day-to-day basis to discuss any challenges (access, weather, etc.) that may have arisen. LogistiCare employs 60 individuals locally for the Customer Representative Center, Quality Assurance and Mass Transit Units. Training programs for transportation providers and LogistiCare s staff are closely monitored. EOHHS has an assigned team of individuals with various specialties to provide contract monitoring, and quality improvement & performance outcome oversight. EOHHS is evaluating options to improve the quality of service for clients. 6
EOHHS Oversight EOHHS and LogistiCare report to several external committees and/or multi-agency groups. Currently report monthly to a meeting hosted by the Alliance for Better Long Term Care (last Wednesday of the Month) The Lt. Governor s Long Term Care Coordinating Council (Monthly). Upon request the EOHHS & LogistiCare present to various groups as needed. May 2016 LogistiCare Outreach Meeting with SA MH Leadership Council RI March 2016 Training for Nurse Care Managers at Neighborhood Health Plan RI (Several multi sessions) December 2015 Transportation Outreach at Miriam Hospital (HIV Program) April 2015 Neighborhood Health Plan of RI Presentation June 2014 Transportation Outreach at RI Partnership for Home Care at Pocasset Bay (NW Links) June 2014 DEA sponsored the Academy training for information and referral specialists Johnston Senior Center. 7
Complaint Data Consistent with the provisions of its contract with EOHHS, LogistiCare tracks and manages complaints filed against its service delivery. During this SFY16, LogistiCare logged 11,868 complaints in providing both Medicaid and non-Medicaid Elderly transportation services. These complaints represent roughly 1% of all trip reservations made during this twelve month period. SFY16 Driver Complaints SFY16 Rider Complaints Reported Incidents Rider No Show Rider Issue (Complaint about Rider) Rider Fraud and Abuse Total Reported Incidents 3122 754 183 132 125 Type of Complaint Percentage Rider Complaints Percentage Transportation Provider Late Transportation Provider No Show LogistiCare Employee Issue No Vehicle Available (NVA) Transportation Provider Early Transportation Provider (possible) Fraud & Abuse LogistiCare Issue Injury Vehicle Issue (e.g., AC, heat, etc.) Issue with a Facility Rerouted out of time Wheelchair tie down issue Transportation Provider (not one of the above) Total 56.90% 13.80% 3% 2.40% 2.30% 5199 81.40% 1098 17.20% 88 6385 1.40% 100% 80 1.50% 69 44 23 13 11 7 1.20% 0.80% 0.40% 0.23% 0.20% 0.10% 920 16.80% 8 5483 100%
Performance Standards The State may hold back up to 2% of monthly payments if Broker s performance falls bellow quality standards, including but not limited to the standards listed below: Activity Standard Average Speed of Answering call per month Exceeds 3:00 minutes Percent of Calls Abandoned per month Exceeds 20% Percent of Trips Unfulfilled per month Exceeds 5% Percent of Trips with valid Complaints per month Exceeds 5% To date, LogistiCare has substantially met these standards and EOHHS has not withheld monthly payment due to poor performance. 9
LogistiCare Financial Statements Medicaid Population Only Non-Medicaid Elderly Population Only ($ millions) SFY 2015 $ 2.4 ($ millions) SFY 2015 $ 30.3 SFY 2016 $ 2.4 SFY 2016 $ 32.3 Funding ($200,000 x 12 months) Capitation Premium Paid Total Funding % Change $ 2.4 $ 2.4 0.0% $ 3.6 $ 30.3 $ 32.3 6.6% Total Premium % Change Costs of Transportation Providers Costs of Transportation Providers $ 3.0 $ 20.1 $ 22.5 Gross Profit (Loss) % Change Administrative Expenses % Change Pre-Tax Profit (Loss) $ (0.6) $ (1.2) 100.0% $ 0.4 0.0% $ (1.6)* $ 0.4 $ 10.2 $ 9.8 -3.9% $ 4.8 9.1% Gross Profit (Loss) % Change Administrative Expenses % Change $ (1.0) $ 4.4 After-Tax Profit (Loss) % of Total Premium * Additional Funding Needed to Keep Program Operational. * With Premiums of $2.4 million, the non-Medicaid Elderly Transportation Program runs out of funds within seven to eight months (January or February) * Current funding needed in estimated at $1.6 million (with 2%-3% annual growth increase $ (0.6) -25.0% $ (1.0) -40.0% $ 5.8 $ 5.0 Pre-Tax Profit (Loss) $ 3.5 $ 3.0 After-Tax Profit (Loss) 11.5% 9.3% % of Total Premium 10
Deborah Florio Deputy Medicaid Director EOHHS 401.462.0140 Florio.deb@ohhs.ri.gov
