N.Y. Social Services Law § 365-h: Provision and reimbursement of transportation costs

* § 365-h. Provision and reimbursement of transportation costs. 1. The

local social services official and, subject to the provisions of

subdivision four of this section, the commissioner of health shall have

responsibility for prior authorizing transportation of eligible persons

and for limiting the provision of such transportation to those

recipients and circumstances where such transportation is essential,

medically necessary and appropriate to obtain medical care, services or

supplies otherwise available under this title.

2. In exercising this responsibility, the local social services

official and, as appropriate, the commissioner of health shall:

(a) make appropriate and economical use of transportation resources

available in the district in meeting the anticipated demand for

transportation within the district, including, but not limited to:

transportation generally available free-of-charge to the general public

or specific segments of the general public, public transportation,

promotion of group rides, county vehicles, coordinated transportation,

and direct purchase of services; and

(b) maintain quality assurance mechanisms in order to ensure that (i)

only such transportation as is essential, medically necessary and

appropriate to obtain medical care, services or supplies otherwise

available under this title is provided; (ii) no expenditures for taxi or

livery transportation are made when public transportation or lower cost

transportation is reasonably available to eligible persons; and (iii)

transportation services are provided in a safe, timely, and reliable

manner by providers that comply with state and local regulatory

requirements and meet consumer satisfaction criteria approved by the

commissioner of health.

3. In the event that coordination or other such cost savings measures

are implemented, the commissioner shall assure compliance with

applicable standards governing the safety and quality of transportation

of the population served.

4. (a) The commissioner of health is authorized to assume

responsibility from a local social services official for the provision

and reimbursement of transportation costs under this section. If the

commissioner elects to assume such responsibility, the commissioner

shall notify the local social services official in writing as to the

election, the date upon which the election shall be effective and such

information as to transition of responsibilities as the commissioner

deems prudent. The commissioner is authorized to contract with a

transportation manager or managers to manage transportation services in

any local social services district, other than transportation services

provided or arranged for enrollees of managed long term care plans

issued certificates of authority under section forty-four hundred

three-f of the public health law. Any transportation manager or managers

selected by the commissioner to manage transportation services shall

have proven experience in coordinating transportation services in a

geographic and demographic area similar to the area in New York state

within which the contractor would manage the provision of services under

this section. Such a contract or contracts may include responsibility

for: review, approval and processing of transportation orders;

management of the appropriate level of transportation based on

documented patient medical need; and development of new technologies

leading to efficient transportation services. If the commissioner elects

to assume such responsibility from a local social services district, the

commissioner shall examine and, if appropriate, adopt quality assurance

measures that may include, but are not limited to, global positioning

tracking system reporting requirements and service verification

mechanisms. Any and all reimbursement rates developed by transportation

managers under this subdivision shall be subject to the review and

approval of the commissioner.

(b)(i) Subject to federal financial participation, for periods on and

after April first, two thousand twenty-one, in order to more

cost-effectively provide non-emergency transportation to Medicaid

beneficiaries who need access to medical care and services, the

commissioner is authorized to contract with one or more transportation

management brokers to manage such transportation on a statewide or

regional basis, as determined by the commissioner, in accordance with

the federal social security act as follows:

(A) The transportation management broker or brokers shall be selected

through a competitive bidding process based on an evaluation of the

broker's experience, performance, references, resources, qualifications

and costs; provided, however, that the department's selection process

shall be memorialized in a procurement record as defined in section one

hundred sixty-three of the state finance law;

(B) The transportation management broker or brokers shall have

oversight procedures to monitor Medicaid beneficiary access and

complaints and ensure that enrolled Medicaid transportation providers

are licensed, qualified, competent and courteous.

(C) The transportation management broker or brokers shall be subject

to regular auditing and oversight by the department in order to ensure

the quality of the transportation services provided and adequacy of

Medicaid beneficiary access to medical care and services.

(D) The transportation management broker or brokers shall comply with

requirements related to prohibitions on referrals and conflicts of

interest required by the federal social security act.

(ii) The transportation management broker or brokers may be paid a per

member per month capitated fee or a combination of capitation and fixed

cost reimbursement and the contract shall include, but not be limited

to, responsibility for:

(A) establishing a network of high-quality Medicaid enrolled

providers; provided, however, that in developing such network the

transportation management broker shall evaluate the qualifications of

current Medicaid transportation providers on a priority basis for

participation in its network, and leverage reputable transportation

providers with a proven record of serving Medicaid beneficiaries with

high-quality services;

(B) continuing outreach to Medicaid enrolled providers to assess and

resolve service quality issues;

(C) developing mandatory corrective actions for any Medicaid enrolled

provider that falls under quality performance standards;

(D) establishing a prior approval process which shall include

verifying Medicaid eligibility and reviewing, approving and processing

transportation orders;

(E) managing the appropriate level of transportation based on

documented patient medical need to ensure that Medicaid beneficiaries

are using the most medically appropriate mode of transportation,

including public transportation, which shall be maximized statewide,

including in rural areas; provided that when determining the appropriate

level of transportation, the transportation management broker shall

ensure that patients have reasonable and timely access to medically

appropriate transportation services;

(F) implementing technologies to effectuate efficient transportation

services, such as GPS, to improve match to mode of transportation;

(G) establishing fees to reimburse enrolled Medicaid transportation

providers;

(H) adjudicating and paying claims submitted by enrolled Medicaid

transportation providers;

(I) reporting on performance encompassing all aspects of the

transportation program, including but not limited to Medicaid

beneficiary complaints including the length of time to make a compliant,

wait times related to the receipt of services by a recipient, and

tracking medical justifications to modes of transportation provided;

(J) collaborating with Medicaid beneficiaries and consumer groups to

identify and resolve issues to increase consumer satisfaction;

(K) auditing cancellation data on a quarterly basis to ensure

accuracy;

(L) coordinating medical benefits and transportation with Medicaid

managed care organizations, including development of value based

payments for transportation services; and

(M) such contracts shall include penalties for incorrect denials,

unresolved complaint rates, unfulfilled trips, and any other criteria

determined by the commissioner and specified in the competitive bidding

process.

(iii) A transportation management broker with which the commissioner

contracts shall file with the commissioner a bond issued by an insurer

authorized to write fidelity and surety insurance in this state, in an

amount and form to be determined by the commissioner. The purpose of the

surety bond shall be to provide the sole source of recourse to providers

of Medicaid transportation services, other than the transportation

management broker, that cannot receive payment for services properly

provided if the transportation management broker becomes insolvent. To

the extent permitted by law, the surety bond shall provide that any

funds that remain after such provider liabilities are satisfied shall be

paid to that state.

(iv) A transportation management broker with which the commissioner

contracts shall provide to Medicaid enrolled providers annually a

conspicuous written disclosure that states the following: "The New York

State Department of Health has contracted with this transportation

management broker to arrange non-emergency transportation for Medicaid

beneficiaries who need access to medical care and services and is paying

the transportation management broker a per member per month capitated

fee or a combination of capitation and fixed cost reimbursement. This

transportation management broker is not licensed by the New York State

Department of Financial Services as an insurer and is not subject to its

supervision as an insurer. This transportation management broker is not

protected by New York security funds and there will not be any right to

recover against the department of health, department of financial

services, or this state in the event of the transportation management

broker's insolvency.

(v) To the extent practicable, the competitive bidding and contracting

process maybe completed by April first, two thousand twenty-one;

provided, however, such contract may be effective at some date after

April first, two thousand twenty-one, if the process takes longer to

complete.

(vi) Responsibility for transportation services provided or arranged

for enrollees of managed long term care plans issued certificates of

authority under section forty-four hundred three-f of the public health

law, not including a program designated as a Program of All-Inclusive

Care for the Elderly (PACE) as authorized by Federal Public law 1053-33,

subtitle I of title IV of the Balanced Budget Act of 1997, and, at the

commissioner's discretion, other plans that integrate benefits for

dually eligible Medicare and Medicaid beneficiaries based on a

demonstration by the plan that inclusion of transportation within the

benefit package will result in cost efficiencies and quality

improvement, shall be transferred to a transportation management broker

that has a contract with the commissioner in accordance with this

paragraph. Providers of adult day health care may elect to, but shall

not be required to, use the services of the transportation management

broker.

5. Notwithstanding any contrary provision of law, and subject to

federal financial participation, the commissioner of health shall make

adjustments to payments under this section, for the purposes of

providing increased access to Medicaid non-emergency transportation in

rural communities. Up to two million dollars shall be available for such

purposes.

6. (a) The commissioner of health shall require transportation

providers enrolled in the Medicaid program and specified by the

commissioner pursuant to regulation, to report the costs incurred in

providing transportation services to Medicaid beneficiaries pursuant to

this section; provided, however, this requirement shall only apply if

there is no transportation management broker contract authorized in

subdivision four of this section. The commissioner shall specify the

frequency and format of such reports and determine the type and amount

of information required to be submitted, including supporting

documentation, provided that such reports shall be no more frequent than

quarterly. The commissioner shall give all transportation providers no

less than ninety calendar days' notice before such reports are due.

(b) If the commissioner determines that the cost report submitted by a

Medicaid transportation provider is inaccurate or incomplete, the

commissioner shall notify such provider in writing and advise the

provider of the correction or additional information that the provider

must submit. The provider shall submit the corrected or additional

information within thirty calendar days from the date the provider

receives the notice.

(c) The commissioner shall grant a provider an additional thirty

calendar days to submit the original cost report, or corrected or

additional information required pursuant to paragraph (b) of this

subdivision only when the provider submits a written request to the

commissioner for an extension prior to the due date and establishes to

the satisfaction of the commissioner that the provider cannot submit the

cost report or corrected or additional information by the due date for

reasons beyond the provider's control.

* NB Repealed 16 years after the contract entered into pursuant to

this section 365-h is executed

* § 365-h. Provision and reimbursement of transportation costs. 1. The

local social services official shall have responsibility for prior

authorizing transportation of eligible persons and for limiting the

provision of such transportation to those recipients and circumstances

where such transportation is essential, medically necessary and

appropriate to obtain medical care, services or supplies otherwise

available under this title.

2. In exercising this responsibility, the local social services

official shall:

(a) make appropriate and economical use of transportation resources

available in the district in meeting the anticipated demand for

transportation within the district, including, but not limited to:

transportation generally available free-of-charge to the general public

or specific segments of the general public, public transportation,

promotion of group rides, county vehicles, coordinated transportation,

and direct purchase of services; and

(b) maintain quality assurance mechanisms in order to ensure that (i)

only such transportation as is essential, medically necessary and

appropriate to obtain medical care, services or supplies otherwise

available under this title is provided and (ii) no expenditures for taxi

or livery transportation are made when public transportation or lower

cost transportation is reasonably available to eligible persons.

3. In the event that coordination or other such cost savings measures

are implemented, the commissioner shall assure compliance with

applicable standards governing the safety and quality of transportation

of the population served.

* NB Effective 16 years after the contract entered into pursuant to

this section 365-h has been executed