Bill Text: NY S04862 | 2025-2026 | 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 9-0)

Status: (Introduced) 2025-02-13 - REFERRED TO HEALTH [S04862 Detail]

Download: New_York-2025-S04862-Introduced.html

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                STATE OF NEW YORK
        ________________________________________________________________________

                                          4862

                               2025-2026 Regular Sessions

                    IN SENATE

                                    February 13, 2025
                                       ___________

        Introduced  by  Sens.  BAILEY,  ADDABBO,  CLEARE,  HOYLMAN-SIGAL, MAYER,
          RIVERA, SALAZAR, SEPULVEDA, STAVISKY -- read twice and ordered  print-
          ed, and when printed to be committed to the Committee 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-

         EXPLANATION--Matter in italics (underscored) is new; matter in brackets
                              [ ] is old law to be omitted.
                                                                   LBD09047-01-5
        S. 4862                             2

     1  tation services. If the commissioner elects to assume such  responsibil-
     2  ity  from a local social services district, the commissioner shall exam-
     3  ine and, if appropriate,  adopt  quality  assurance  measures  that  may
     4  include,  but  are  not  limited  to, global positioning tracking system
     5  reporting requirements and service verification mechanisms. Any and  all
     6  reimbursement  rates  developed  by  transportation  managers under this
     7  subdivision shall be subject to the review and approval of  the  commis-
     8  sioner.
     9    [(b)(i) Subject to federal financial participation, for periods on and
    10  after April first, two thousand twenty-one, in order to more cost-effec-
    11  tively  provide  non-emergency  transportation to Medicaid beneficiaries
    12  who need access to  medical  care  and  services,  the  commissioner  is
    13  authorized  to  contract  with  one  or  more  transportation management
    14  brokers to manage such transportation on a statewide or regional  basis,
    15  as determined by the commissioner, in accordance with the federal social
    16  security act as follows:
    17    (A)  The transportation management broker or brokers shall be selected
    18  through a competitive bidding process based  on  an  evaluation  of  the
    19  broker's  experience, performance, references, resources, qualifications
    20  and costs; provided, however, that the  department's  selection  process
    21  shall  be memorialized in a procurement record as defined in section one
    22  hundred sixty-three of the state finance law;
    23    (B) The transportation management broker or brokers shall  have  over-
    24  sight  procedures  to monitor Medicaid beneficiary access and complaints
    25  and ensure that enrolled Medicaid transportation providers are licensed,
    26  qualified, competent and courteous.
    27    (C) The transportation management broker or brokers shall  be  subject
    28  to  regular  auditing and oversight by the department in order to ensure
    29  the quality of the transportation  services  provided  and  adequacy  of
    30  Medicaid beneficiary access to medical care and services.
    31    (D)  The transportation management broker or brokers shall comply with
    32  requirements related to  prohibitions  on  referrals  and  conflicts  of
    33  interest required by the federal social security act.
    34    (ii) The transportation management broker or brokers may be paid a per
    35  member  per month capitated fee or a combination of capitation and fixed
    36  cost reimbursement and the contract shall include, but  not  be  limited
    37  to, responsibility for:
    38    (A)  establishing  a network of high-quality Medicaid enrolled provid-
    39  ers; provided, however, that in developing such network the  transporta-
    40  tion  management  broker  shall  evaluate  the qualifications of current
    41  Medicaid transportation providers on a priority basis for  participation
    42  in  its  network, and leverage reputable transportation providers with a
    43  proven  record  of  serving  Medicaid  beneficiaries  with  high-quality
    44  services;
    45    (B)  continuing  outreach to Medicaid enrolled providers to assess and
    46  resolve service quality issues;
    47    (C) developing mandatory corrective actions for any Medicaid  enrolled
    48  provider that falls under quality performance standards;
    49    (D)  establishing a prior approval process which shall include verify-
    50  ing Medicaid eligibility and reviewing, approving and processing  trans-
    51  portation orders;
    52    (E)  managing  the  appropriate level of transportation based on docu-
    53  mented patient medical need to ensure that  Medicaid  beneficiaries  are
    54  using  the  most medically appropriate mode of transportation, including
    55  public transportation, which shall be maximized statewide, including  in
    56  rural  areas;  provided  that  when determining the appropriate level of
        S. 4862                             3

     1  transportation, the transportation management broker shall  ensure  that
     2  patients  have  reasonable  and  timely  access to medically appropriate
     3  transportation services;
     4    (F)  implementing  technologies to effectuate efficient transportation
     5  services, such as GPS, to improve match to mode of transportation;
     6    (G) establishing fees to reimburse  enrolled  Medicaid  transportation
     7  providers;
     8    (H)  adjudicating  and  paying  claims  submitted by enrolled Medicaid
     9  transportation providers;
    10    (I) reporting on performance encompassing all aspects of the transpor-
    11  tation program,  including  but  not  limited  to  Medicaid  beneficiary
    12  complaints  including the length of time to make a compliant, wait times
    13  related to the receipt of services by a recipient, and tracking  medical
    14  justifications to modes of transportation provided;
    15    (J)  collaborating  with Medicaid beneficiaries and consumer groups to
    16  identify and resolve issues to increase consumer satisfaction;
    17    (K) auditing cancellation data on a quarterly basis to ensure  accura-
    18  cy;
    19    (L)  coordinating  medical  benefits  and transportation with Medicaid
    20  managed  care  organizations,  including  development  of  value   based
    21  payments for transportation services; and
    22    (M)  such  contracts  shall  include  penalties for incorrect denials,
    23  unresolved complaint rates, unfulfilled trips, and  any  other  criteria
    24  determined  by the commissioner and specified in the competitive bidding
    25  process.
    26    (iii) A transportation management broker with which  the  commissioner
    27  contracts  shall  file with the commissioner a bond issued by an insurer
    28  authorized to write fidelity and surety insurance in this state,  in  an
    29  amount and form to be determined by the commissioner. The purpose of the
    30  surety bond shall be to provide the sole source of recourse to providers
    31  of  Medicaid  transportation  services,  other  than  the transportation
    32  management broker, that cannot receive  payment  for  services  properly
    33  provided  if  the transportation management broker becomes insolvent. To
    34  the extent permitted by law, the surety  bond  shall  provide  that  any
    35  funds that remain after such provider liabilities are satisfied shall be
    36  paid to that state.
    37    (iv)  A  transportation  management broker with which the commissioner
    38  contracts shall  provide  to  Medicaid  enrolled  providers  annually  a
    39  conspicuous  written disclosure that states the following: "The New York
    40  State Department of  Health  has  contracted  with  this  transportation
    41  management  broker  to arrange non-emergency transportation for Medicaid
    42  beneficiaries who need access to medical care and services and is paying
    43  the transportation management broker a per member  per  month  capitated
    44  fee  or  a  combination of capitation and fixed cost reimbursement. This
    45  transportation management broker is not licensed by the New  York  State
    46  Department of Financial Services as an insurer and is not subject to its
    47  supervision  as an insurer. This transportation management broker is not
    48  protected by New York security funds and there will not be any right  to
    49  recover  against  the  department  of  health,  department  of financial
    50  services, or this state in the event of  the  transportation  management
    51  broker's insolvency.
    52    (v) To the extent practicable, the competitive bidding and contracting
    53  process  maybe  completed  by  April  first,  two  thousand  twenty-one;
    54  provided, however, such contract may be effective  at  some  date  after
    55  April  first,  two  thousand  twenty-one, if the process takes longer to
    56  complete.
        S. 4862                             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.