S

Michigan

Transportation

Connection MPTA’s Michigan Model Solution

for Non-Emergency Medical Transportation Management

Statewide

Why is MPTA interested in

NEMT management?

S For several years, especially in recent years with the federal Affordable Health Care Act (AHC/”Obamacare”) moving forward, the national transit associations CTAA and APTA have been predicting significant new health care dollars will be available for public transportation use.

S MPTA wants to guarantee that public transit providers across the state have an opportunity to compete competitively for these dollars, while reimbursing agencies at a rate more in line with actual costs.

How Non-Emergency Medical

Transportation (NEMT) is

handled now in Michigan

S NEMT is under the management of the State’s Medicaid

Administration through the Department of Human Services

(DHS).

S Decision-making is left up to each individual county and in

Wayne, Oakland and Macomb Counties, the state has had a

demonstration project for the past several years with

LogistiCare having serviced that contract to date. That

contract has just recently been re-bid by the state.

What is MPTA proposing?

S MPTA has studied this issue for the past three years. We initially

approached the issue just trying to learn how we could be sure

that public transit providers were included as resources for

providing NEMT rides. In many areas they have been excluded.

S This year we have ramped up our efforts toward building a

statewide network of both public agencies and private providers to

compete competitively to secure a statewide management contract

to administer, or “broker,” these NEMT rides.

How does MPTA plan to

proceed?

S MPTA has created a separate 501 (c )(3) charitable non-profit called the Michigan Transportation Connection (MTC) to oversee further development of our plan.

S MPTA will partner with existing publicly-funded programs such as the 2-1-1 Call Centers operated by the United Way Agencies of Michigan, Mobility Managers within transit provider systems and those operated by the Area Agencies on Aging of Michigan, as well as other organizations, to operate our own statewide network.

How does MPTA plan to

proceed?

S MTC will network together both public and private resources in a public/private partnership to maximize existing taxpayer dollars while protecting public transit agency interests and the interests of Michigan-based private carriers.

S MTC will provide all administrative billing, coordination, monitoring of standards and oversight of both public and private providers to guarantee a base level of safe, reliable service.

Medicaid and HMO-based

Clients

There are two major sources of funding available under NEMT.

S Medicaid is administered by the State and funds are paid out through the Department of Human Services (DHS).

S HMO-based clients, also referred to as Health Plan providers, are administered by private health maintenance organizations which provide funds through direct contracts.

The MTC will pursue contractual agreements with both of these sources of funding. We are working with both the DHS and the Michigan Association of Health Plans to determine total potential numbers of clients county-by-county but those numbers are not yet available. Suffice to say the potential is for several hundred clients per county; thousands in the state’s largest counties.

What will the MTC network

look like and how will it

function?

S MTC will begin by identifying all public transit providers that wish to participate in the MTC. Participation will not be mandatory; however, those transit providers that “opt out” of participating will be required to acknowledge that, by opting out, they will be allowing other neighboring public transit providers and private carriers to provide NEMT rides in their jurisdictions. Systems that opt in/opt out initially will have opportunities to opt out/opt in later if they so choose. It is anticipated there will be annual opt-in and opt-out windows.

S The MTC will be comprised of public transit providers and private providers. All administration will be handled from a central office. Mobility Managers will be placed in key regional locations throughout the state (where possible existing mobility managers will be utilized), and the existing statewide 2-1-1 call centers and Area Agencies on Aging (AAA) call centers will be incorporated into the network. People needing rides will contact a call center and the calls will be routed through the Mobility Managers and assigned to the appropriate provider. Direct service requests through transit providers will be coordinated with the MTC to guarantee agencies receive equitable reimbursement.

What will the MTC network

look like and how will it

function?

The MTC Network: Call Centers

Existing 2-1-1 Call Center regions

The MTC Network:

Mobility Manager Regions

MTC: How the Service Flows

(The Client Perspective)

Client

Call Center

Mobility Manager

Agency

MTC Billing

MTC: How the Program Flows

(The Internal Perspective)

State Grant/ HMO Contract

MTC

Mobility Managers

Servicing Agency

MTC

MTC: How It Will Function

S Once the Mobility Managers originate or receive a referral

from a call center, they will determine how best to transport

the client and which public transit providers and/or private

providers can best serve the need. They will contact the

appropriate agencies and process all paperwork, assigning

the ride and notifying the client of their provider and the

arrangements for their ride. The only responsibility of the

service provider will be to pick up and deliver the client to

and from their destination at the assigned time.

MTC: How It Will Function

S MTC will be establishing agreements with both public and private providers and will be establishing basic standards of service that each provider must meet and maintain.

S MTC’s compliance department will provide service standards training and annual oversight of service provided by every participating agency.

S MTC’s central office will coordinate all necessary billing and administrative paperwork.

MTC: FAQs

Will there be a cost to my agency to participate in the MTC? No.

I am interested in participating but only want to service those clients who I am already transporting locally. Can I do this?

S Absolutely. That’s the basic level of participation and the MTCs goal is to make sure you are receiving reimbursement for those rides at a more equitable rate.

Can I participate at a higher level?

S Yes. You can choose to participate as a regional provider or as a statewide provider. These decisions will be made during the opt-in process.

Will I need more equipment to participate?

S In most cases, “No.” However, if you wish to provide service beyond your current local service area, you may need to consider additional vehicles.

MTC FAQs

I have a volunteer driver program that supplements my normal transit system buses. Can I use my existing volunteer driver program as a part of the MTC service delivery?

S Yes, we would hope that you would combine any existing volunteer driver service into the program.

You refer to participation beyond local service areas. Doesn’t providing over-the-road service to clients constitute a violation of charter regulations?

S We are continuing to check on the legality; however, charter regulations have been modified and relaxed by Congress in recent years and the laws applying to Non-Emergency Medical Transportation under the Affordable Healthcare Act allow for public transportation to service these needs. We will provide you with more complete verification on this before proceeding.

MTC FAQs

How will providing NEMT service impact my state eligible

expenses?

S The provision of rides under MTC will be reimbursed by new

funding available through a new source, and not from the

existing Comprehensive Transportation Fund. You will be

eligible for actual reimbursement of your true cost of providing

the service and, as we envision it, the funds will flow through a

contract between the state and MTC. You will be reimbursed

by the MTC for providing the service and not by MDOT

through the CTF.

MTC FAQs

Will I need special equipment such as oxygen, respirators and/or ventilators and, if so, who pays for those?

S Keep in mind that this is Non-Emergency transportation. In most cases you will not need any new special equipment. In many cases, you are probably already providing rides for the same clients that will come to you through this program. You are just doing it for the cost of a bus fare, rather than the true cost of the ride!

What do you mean the “true cost?”

S NEMT clients may require door-to-door or door-through-door service. They may require an aide to assist them on and off the vehicle, beyond the current expectations of your drivers. You may choose to provide this service and need to determine the true cost of doing so before entering into an agreement with MTC.

MTC FAQs

Who would actually set up a service request? A client or an insurance company?

S Both. It could be an individual or a health plan provider via contract with the MTC or it could be a referral from the DHS.

Who confirms eligibility? The MTC or the agency providing the service?

S The MTC will determine eligibility.

What about liability, especially if providing door-through-door service?

S A service provider’s current insurance, under most cases, should be sufficient to cover liability. The MTC will also likely contract for additional liability coverage. We are continuing to explore existing models in other states.

What if we are assigned a client and, upon arriving, determine that extenuating circumstances prevent transporting that client?

S If a client must be denied service, the responsibility for this decision shall rest with the MTC’s Mobility Manager. A local service provider will not be liable for any final denial of service.

MTC FAQs

What are the timelines for the MTC to be operational? We are operating on a tight timeline. We hope to have all preliminary research and paperwork completed by January 1, 2014.

S Our operational target date is April 1, 2014. However, this will ultimately be decided by the State of Michigan and will be based on securing a contract with the state to provide the NEMT service.

What happens if the state does not contract for service or the MTC does not receive a contract to provide this service?

S We will continue to pursue service agreements for the MTC on a regional and local basis if necessary.

Who will train the Mobility Managers?

The MTC will handle all training and costs associated with the Mobility Managers. A system with an existing Mobility Manager will be able to incorporate costs into the MTC program.

MTC: The Next Steps

In November, we will be contacting each transit provider to

determine, in writing, your interest in participating. As we

determine where gaps in service providers occur, we will

then be contacting private providers to determine their

ability to provide service. Public transit providers will have

the first opportunity for opting in or out of the MTC

network.

S Additional Questions?

For Further Information:

Contact: Steve Gewirtz

MPTA’s NEMT Coordinator

mptasteve@comcast.net

517-816-4096