KRS 205.5363: Nonemergency medical transportation services -- Annual report.

(1) The provision of nonemergency medical transportation services to eligible

Medicaid enrolled beneficiaries in the Commonwealth shall comply with 42 U.S.C.

sec. 1396a(a)(87), 42 C.F.R. sec. 431.53, 42 C.F.R. sec. 440.170, any other relevant

federal law or regulation, and this section, except that this section shall not apply to

any nonemergency medical transportation services, including transportation via

stretcher, covered by a Medicaid managed care organization.

(2) A nonemergency medical transportation service program administered under this

section and relevant federal law shall:

(a) Be administered under a regional brokerage delivery model;

(b) 1. Utilize a capitated payment model.

2. Capitation payments made to regional brokers shall be:

a. Actuarially sound;

b. Set by an actuary contracted by the Department for Medicaid

Services;

c. Calculated based only on the number of nonemergency medical

transportation service eligible Medicaid enrollees, as determined

by the Department for Medicaid Services in accordance with KRS

205.513(2)(c), within a given region and shall not be based on the

total number of Medicaid enrollees; and

d. Calculated separately for each region with consideration given to

each region's average trip time, average trip distance or average

mileage per trip, and other region -specific factors, including but

not limited to geography, terrain, and population density; and

(c) Require regional brokers to:

1. Achieve an annual medical loss ratio for each state fiscal year as

required under subsection (3) of this section;

2. Provide a remittance to the state of any excess capita tion payments for

any state fiscal year in which the regional broker fails to achieve an

annual medical loss ratio as required under subsection (3) of this

section;

3. a. Ensure that all vehicles used to provide Medicaid -covered

nonemergency medical transportation services are equipped with a

global positioning system device that enables the broker to

determine the precise location of the vehicle at all times when the

vehicle is being operated to provide nonemergency medical

transportation services.

b. Any cost that may be associated with the requirement to equip

vehicles used to provide Medicaid-covered nonemergency medical

transportation services with a global positioning system device

shall be borne by the regional broker and not the Department for

Medicaid Services or any other state agency; and

4. Collaborate with the Department for Medicaid Services, or another

agency in state government or a private entity with which the

department has contracted for the administration of a nonemergency

medical transpo rtation service program, to implement and execute a

performance-based payment model that aligns incentives for Medicaid

enrollees, drivers, regional brokers, and the Commonwealth to improve

quality, reliability, and cost -effectiveness in the nonemergency m edical

transportation service program. The performance -based payment model

required under this subparagraph shall include a two percent (2%)

withhold from each regional broker's capitation amount that can be

earned back in full or in part by the regional t ransportation broker

through achievement of designated performance -based measures which

shall:

a. Be developed in a manner that reflects the unique circumstances of

each region; and

b. Include but not be limited to:

i. Utilization rates;

ii. The number of nonemergency medical transportation service

trips completed;

iii. The number of nonemergency medical transportation service

trips canceled or rescheduled;

iv. The number of delayed nonemergency medical

transportation service trips;

v. Average trip time;

vi. Average miles per trip;

vii. The amount of time required to schedule a nonemergency

medical transportation service; and

viii. Rider satisfaction.

(3) (a) For the state fiscal year beginning July 1, 2026, regional brokers shall be

required to achieve a medical loss ratio of at least eighty-five percent (85%).

(b) For the state fiscal year beginning July 1, 2027, regional brokers shall be

required to achieve a medical loss ratio of at least eighty-seven percent (87%).

(c) For the state fiscal year beginning July 1, 2028, regional brokers shall be

required to achieve a medical loss ratio of at least eighty-nine percent (89%).

(d) For the state fiscal year beginning July 1, 2029, and each state fiscal year

thereafter, regional brokers shall be required to achi eve a medical loss ratio of

at least ninety percent (90%).

(4) Utilization rates for nonemergency medical transportation services, including when

calculated by an actuary under subsection (2) of this section, shall consider only

nonemergency medical transp ortation service eligible Medicaid enrollees, as

determined by the Department for Medicaid Services in accordance with KRS

205.513(2)(c), within a given region and shall not be based on the total number of

Medicaid enrollees.

(5) (a) A skilled nursing facility or hospital shall be permitted to provide

nonemergency medical transportation services for residents of the skilled

nursing facility or patients of the hospital if the transportation service would

be considered a Medicaid -covered service if provided by a driver contracted

by a nonemergency medical transportation service regional broker.

(b) A skilled nursing facility or hospital that provides nonemergency medical

transportation services under this subsection shall be eligible for

reimbursement by the locally contracted nonemergency medical

transportation service regional broker at the same mileage rate as would be

paid to a driver contracted by the regional broker for the same service.

(c) This subsection shall not establish or imp ose upon a skilled nursing facility or

hospital any duty or responsibility to provide nonemergency transportation

services to an individual who is not a resident of the facility or patient of the

hospital.

(6) When submitting data or reports to the Departm ent for Medicaid Services or any

other agency of state government with responsibility for oversight or administration

of the nonemergency medical transportation services, the chief executive officer,

chief financial officer, president, executive director, or another officer of a regional

broker shall attest, to the best of his or her knowledge, to the truthfulness, accuracy,

and completeness of all data or reports at the time of submission.

(7) Beginning in 2027, the Department for Medicaid Services shall c onduct an annual

review of the nonemergency medical transportation service program and submit a

report to the Legislative Research Commission for referral to the Interim Joint

Committees on Health Services and Appropriations and Revenue and the Medicaid

Oversight and Advisory Board by July 1 of each year. The review and report

required by this subsection shall, at a minimum, include information and

recommendations for the following:

(a) Utilization rates;

(b) The number of nonemergency medical transportation service trips completed;

(c) The number of nonemergency medical transportation service trips cancelled

or rescheduled, including the reason for cancellation or rescheduling;

(d) The number of delayed nonemergency medical transportation service trips;

(e) Average trip time;

(f) Average miles per trip;

(g) The amount of time required to schedule a nonemergency medical

transportation service;

(h) Rider satisfaction; and

(i) The performance-based payment model required under subsection (2) of this

section.