Bill Text: NY A07929 | 2021-2022 | General Assembly | Introduced

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Bill Title: Relates to transportation management brokers; provides that transportation management brokers are no longer required to manage the transportation services for Medicaid beneficiaries.

Spectrum: Partisan Bill (Democrat 18-0)

Status: (Introduced - Dead) 2022-01-05 - referred to health [A07929 Detail]

Download: New_York-2021-A07929-Introduced.html

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                STATE OF NEW YORK
        ________________________________________________________________________

                                          7929

                               2021-2022 Regular Sessions

                   IN ASSEMBLY

                                      June 1, 2021
                                       ___________

        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.
                                                                   LBD11003-01-1
        A. 7929                             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. 7929                             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. 7929                             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.