Medicaid broker system to exclude stretcher transports

Jan. 30--Emergency medical services (EMS) across the state breathed a collective sigh of relief Wednesday with the announcement that stretcher transports will not be affected by an impending broker system that will soon handle the state's Medicaid transportation services.

Concerns were raised in the EMS community in November when the West Virginia Department of Health and Human Resources announced a proposed state plan amendment that would potentially remove the duty of stretcher transports from ambulance providers and potentially reallocate the responsibility to another provider.

While stretcher transports have been removed, DHHR Secretary Karen Bowling told the Register-Herald Wednesday that the new state plan amendment had been posted and will involve DHHR's Bureau for Medical Services contracting with a transportation broker to handle all other non-emergency medical transportation (NEMT) services. These services include Medicaid patient transport to doctor's appointments and other non-emergency medical appointments, including dialysis and other common clinical treatments.

Bowling announced that the DHHR's first request for proposal was canceled a few weeks ago, but a new request for proposal is currently in the works and completion is slated for late next week.

"When the (first) contract was canceled, it really wasn't a decision not to pursue the broker system," Bowling explained. "Basically, we had an estimated, budgeted savings in mind and the bids submitted did not result in an adequate cost saving to the state.

"It was our decision to do (cancel) because we felt it was critical that more factors be looked at, particularly with the state being in a budget deficit situation. We needed to realize all the savings that we could."

Bowling explained that implementing a brokerage system was one of many cost-saving recommendations outlined in a recent audit of the DHHR.

According to Public Works LLC, the DHHR's Bureau for Medical Services could save at least $1.5 million a year from the transition to a brokerage system.

"We wanted to stay consistent with that recommendation," Bowling said. Bowling stated that 41 other states currently use a broker system to coordinate their Medicaid NEMT services, and she is confident that savings for both the state and federal government can be achieved with the new request for proposal.

The DHHR and Centers for Medicare and Medicaid Services (CMS) are working closely to see that all quality requirements are met, Bowling stated.

"We received a lot of feedback from various entities about the proposal that we had originally put forth," Bowling said.

Canceling the first contract allowed DHHR to take a second look at the document and take the concerns of stakeholders into consideration, Bowling explained.

Bowling added that the new RFP has been tightened up to ensure that proper service levels will be upheld. The new RFP outlines that brokers will have an obligation to enroll all current qualified providers, as well as to educate the providers and community on how the broker system works.

"We wanted to make sure that was all clearly defined in the RFP," Bowling said.

Bowling explained that after taking a a second look at the NEMT stretcher transports, the DHHR realized that the existing system could continue with the implementation of "a few tweaks."

"We do have the potential to have a good system through Medicaid to ensure that our stretcher transports are meeting the criteria that's outlined by CMS," Bowling said. "It seemed logical for us to take the stretcher transport out of the new RFP.

"We will be dealing with the stretcher transport through the EMS system through our Medicaid system, which is a much more sophisticated way of managing a patient who may need medical transport but it's non-emergent."

Bowling stated that DHHR will continue to work with CMS to describe and define clearly the EMS stretcher transports for NEMT will be monitored.

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Bowling explained that removing stretcher transports from the broker system will allow the broker to focus their attention on the larger aspect of the program, like ensuring that patients are being transported safely and that standards are being upheld.

Ensuring that transport vehicles have been inspected and confirming that drivers have a valid driver's license will be among the broker's many responsibilities.

"Those kinds of things need to be more of the focus of the broker, and we believe there is still significant savings to be involved with that," Bowling said.

Bowling stressed that the biggest issue is securing the safety of the patients that are transported.

"We want to make sure than they're being transported in a safe manner," Bowling said. "I think many of the transports are done in vans that we know have already been certified, and there's a lot of confidence in public transit.

"I think it will be easy for those individuals to meet the CMS requirements because they already do most of the things, like driver's license checks, etc.

"The challenge will be ensuring that anyone traveling by car that we will have a method to ensure that it's safe transport."

While many people have raised concerns regarding an out-of-state broker not being familiar with West Virginia's somewhat challenging landscape, Bowling ensures that only a well-qualified and experienced broker will be selected that can properly understand the state's needs.

In order to procure a qualified broker, Bowling explained that several parameters are written in to the new RFP, such as brokers being required to finish scheduled trips within a certain time frame, maintaining an average wait time of less than 15 minutes and ensuring that all requests are responded to within a specified number of days.

"All of these very specific quality requirements are going to necessitate the broker to understand our landscape and understand how people are transported in our state," Bowling said. "They will not be able to meet the quality requirements or the service level requirements if they don't understand that.

It will behoove them to come into our state and learn about the landscape, the population and how people are transported."

Bowling added that cost savings and meeting the requirements of the federal government are both priorities, but consistently meeting the needs of the state's population will continue to be the DHHR's objective.

"I believe that this system, because it's worked in other states and it's been recommended by Public Works, is a system that can work if we put all the checks and balances in place, and that's what we're attempting to do with the new RFP."

-- E-mail: bunderwood@register-herald.com

Copyright 2014 - The Register-Herald, Beckley, W.Va.