Relates to transportation management brokers; provides that transportation management brokers are no longer required to manage the transportation services for Medicaid beneficiaries.
STATE OF NEW YORK
________________________________________________________________________
3606
2023-2024 Regular Sessions
IN ASSEMBLY
February 3, 2023
___________
Introduced by M. of A. PRETLOW -- read once and referred to the Commit-
tee on Health
AN ACT to amend the social services law, in relation to transportation
management brokers
The People of the State of New York, represented in Senate and Assem-bly, do enact as follows:
1 Section 1. Subdivision 4 of section 365-h of the social services law,
2 as amended by section 2 of part LL of chapter 56 of the laws of 2020, is
3 amended to read as follows:
4 4. [(a)] The commissioner of health is authorized to assume responsi-
5 bility from a local social services official for the provision and
6 reimbursement of transportation costs under this section. If the commis-
7 sioner elects to assume such responsibility, the commissioner shall
8 notify the local social services official in writing as to the election,
9 the date upon which the election shall be effective and such information
10 as to transition of responsibilities as the commissioner deems prudent.
11 The commissioner is authorized to contract with a transportation manager
12 or managers to manage transportation services in any local social
13 services district, other than transportation services provided or
14 arranged for enrollees of managed long term care plans issued certif-
15 icates of authority under section forty-four hundred three-f of the
16 public health law. Any transportation manager or managers selected by
17 the commissioner to manage transportation services shall have proven
18 experience in coordinating transportation services in a geographic and
19 demographic area similar to the area in New York state within which the
20 contractor would manage the provision of services under this section.
21 Such a contract or contracts may include responsibility for: review,
22 approval and processing of transportation orders; management of the
23 appropriate level of transportation based on documented patient medical
24 need; and development of new technologies leading to efficient transpor-
25 tation services. If the commissioner elects to assume such responsibil-
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[] is old law to be omitted.
LBD05652-01-3
A. 3606 2
1 ity from a local social services district, the commissioner shall exam-
2 ine and, if appropriate, adopt quality assurance measures that may
3 include, but are not limited to, global positioning tracking system
4 reporting requirements and service verification mechanisms. Any and all
5 reimbursement rates developed by transportation managers under this
6 subdivision shall be subject to the review and approval of the commis-
7 sioner.
8 [(b)(i) Subject to federal financial participation, for periods on and
9 after April first, two thousand twenty-one, in order to more cost-effec-
10 tively provide non-emergency transportation to Medicaid beneficiaries
11 who need access to medical care and services, the commissioner is
12 authorized to contract with one or more transportation management
13 brokers to manage such transportation on a statewide or regional basis,
14 as determined by the commissioner, in accordance with the federal social
15 security act as follows:
16 (A) The transportation management broker or brokers shall be selected
17 through a competitive bidding process based on an evaluation of the
18 broker's experience, performance, references, resources, qualifications
19 and costs; provided, however, that the department's selection process
20 shall be memorialized in a procurement record as defined in section one
21 hundred sixty-three of the state finance law;
22 (B) The transportation management broker or brokers shall have over-
23 sight procedures to monitor Medicaid beneficiary access and complaints
24 and ensure that enrolled Medicaid transportation providers are licensed,
25 qualified, competent and courteous.
26 (C) The transportation management broker or brokers shall be subject
27 to regular auditing and oversight by the department in order to ensure
28 the quality of the transportation services provided and adequacy of
29 Medicaid beneficiary access to medical care and services.
30 (D) The transportation management broker or brokers shall comply with
31 requirements related to prohibitions on referrals and conflicts of
32 interest required by the federal social security act.
33 (ii) The transportation management broker or brokers may be paid a per
34 member per month capitated fee or a combination of capitation and fixed
35 cost reimbursement and the contract shall include, but not be limited
36 to, responsibility for:
37 (A) establishing a network of high-quality Medicaid enrolled provid-
38 ers; provided, however, that in developing such network the transporta-
39 tion management broker shall evaluate the qualifications of current
40 Medicaid transportation providers on a priority basis for participation
41 in its network, and leverage reputable transportation providers with a
42 proven record of serving Medicaid beneficiaries with high-quality
43 services;
44 (B) continuing outreach to Medicaid enrolled providers to assess and
45 resolve service quality issues;
46 (C) developing mandatory corrective actions for any Medicaid enrolled
47 provider that falls under quality performance standards;
48 (D) establishing a prior approval process which shall include verify-
49 ing Medicaid eligibility and reviewing, approving and processing trans-
50 portation orders;
51 (E) managing the appropriate level of transportation based on docu-
52 mented patient medical need to ensure that Medicaid beneficiaries are
53 using the most medically appropriate mode of transportation, including
54 public transportation, which shall be maximized statewide, including in
55 rural areas; provided that when determining the appropriate level of
56 transportation, the transportation management broker shall ensure that
A. 3606 3
1 patients have reasonable and timely access to medically appropriate
2 transportation services;
3 (F) implementing technologies to effectuate efficient transportation
4 services, such as GPS, to improve match to mode of transportation;
5 (G) establishing fees to reimburse enrolled Medicaid transportation
6 providers;
7 (H) adjudicating and paying claims submitted by enrolled Medicaid
8 transportation providers;
9 (I) reporting on performance encompassing all aspects of the transpor-
10 tation program, including but not limited to Medicaid beneficiary
11 complaints including the length of time to make a compliant, wait times
12 related to the receipt of services by a recipient, and tracking medical
13 justifications to modes of transportation provided;
14 (J) collaborating with Medicaid beneficiaries and consumer groups to
15 identify and resolve issues to increase consumer satisfaction;
16 (K) auditing cancellation data on a quarterly basis to ensure accura-
17 cy;
18 (L) coordinating medical benefits and transportation with Medicaid
19 managed care organizations, including development of value based
20 payments for transportation services; and
21 (M) such contracts shall include penalties for incorrect denials,
22 unresolved complaint rates, unfulfilled trips, and any other criteria
23 determined by the commissioner and specified in the competitive bidding
24 process.
25 (iii) A transportation management broker with which the commissioner
26 contracts shall file with the commissioner a bond issued by an insurer
27 authorized to write fidelity and surety insurance in this state, in an
28 amount and form to be determined by the commissioner. The purpose of the
29 surety bond shall be to provide the sole source of recourse to providers
30 of Medicaid transportation services, other than the transportation
31 management broker, that cannot receive payment for services properly
32 provided if the transportation management broker becomes insolvent. To
33 the extent permitted by law, the surety bond shall provide that any
34 funds that remain after such provider liabilities are satisfied shall be
35 paid to that state.
36 (iv) A transportation management broker with which the commissioner
37 contracts shall provide to Medicaid enrolled providers annually a
38 conspicuous written disclosure that states the following: "The New York
39 State Department of Health has contracted with this transportation
40 management broker to arrange non-emergency transportation for Medicaid
41 beneficiaries who need access to medical care and services and is paying
42 the transportation management broker a per member per month capitated
43 fee or a combination of capitation and fixed cost reimbursement. This
44 transportation management broker is not licensed by the New York State
45 Department of Financial Services as an insurer and is not subject to its
46 supervision as an insurer. This transportation management broker is not
47 protected by New York security funds and there will not be any right to
48 recover against the department of health, department of financial
49 services, or this state in the event of the transportation management
50 broker's insolvency.
51 (v) To the extent practicable, the competitive bidding and contracting
52 process maybe completed by April first, two thousand twenty-one;
53 provided, however, such contract may be effective at some date after
54 April first, two thousand twenty-one, if the process takes longer to
55 complete.
A. 3606 4
1 (vi) Responsibility for transportation services provided or arranged
2 for enrollees of managed long term care plans issued certificates of
3 authority under section forty-four hundred three-f of the public health
4 law, not including a program designated as a Program of All-Inclusive
5 Care for the Elderly (PACE) as authorized by Federal Public law 1053-33,
6 subtitle I of title IV of the Balanced Budget Act of 1997, and, at the
7 commissioner's discretion, other plans that integrate benefits for dual-
8 ly eligible Medicare and Medicaid beneficiaries based on a demonstration
9 by the plan that inclusion of transportation within the benefit package
10 will result in cost efficiencies and quality improvement, shall be
11 transferred to a transportation management broker that has a contract
12 with the commissioner in accordance with this paragraph. Providers of
13 adult day health care may elect to, but shall not be required to, use
14 the services of the transportation management broker.]
15 § 2. Paragraph (a) of subdivision 6 of section 365-h of the social
16 services law, as added by section 4 of part LL of chapter 56 of the laws
17 of 2020, is amended to read as follows:
18 (a) The commissioner of health shall require transportation providers
19 enrolled in the Medicaid program and specified by the commissioner
20 pursuant to regulation, to report the costs incurred in providing trans-
21 portation services to Medicaid beneficiaries pursuant to this section[;
22 provided, however, this requirement shall only apply if there is no
23 transportation management broker contract authorized in subdivision four
24 of this section]. The commissioner shall specify the frequency and
25 format of such reports and determine the type and amount of information
26 required to be submitted, including supporting documentation, provided
27 that such reports shall be no more frequent than quarterly. The commis-
28 sioner shall give all transportation providers no less than ninety
29 calendar days' notice before such reports are due.
30 § 3. This act shall take effect immediately; provided, however that
31 the amendments to subdivisions 4 and 6 of section 365-h of the social
32 services law made by sections one and two of this act shall not affect
33 the expiration and reversion of such section pursuant to subdivision (a)
34 of section 40 of part B of chapter 109 of the laws of 2010, as amended.
