NYS Ambulance services have been subject to numerous changes in Medicaid policy in the last several years. These changes were either unannounced or announced informally through “memo” style communications.
On February 1, 2024, NYS formally incorporated many of those changes into the policy manual, with a retroactive effective date of 08/25/2023.
One of the biggest changes for NEMT providers is that they now need to become “in network” with the statewide Medicaid broker, MAS. The broker will now be responsible for negotiating rates, and managing driver and vehicle compliance.
MAS will also be awarding preferred provider opportunities to transportation providers to take on work for specific facilities or “micro networks.” MAS has done this before, but it seems that the intention is to expand this program.
ModivCare lost their contract to be the Medicaid broker for Long Island and MAS is now the true statewide broker.
In an additional blow to ModivCare, the transportation benefit is being carved out from MLTC’s, meaning that transportation claims for MLTC members will be under the purview of fee-for-service Medicaid (and MAS, for non-emergencies). This change will happen in 2024.
DOH also clarified that prior authorization must generally be obtained prior to transport. The old manual indicated that providers should obtain authorization within 30 days of rendering the service.
There was also a new rule that NEMT providers must now share GPS data, in real time, with MAS. This rule went into effect in April 2023. Ambulance providers are included in this rule. Glaringly, however, MAS does not integrate with any of the software products that the ambulance industry uses. DOH advised that ambulance services may reach out individually to ask that they be excepted from this rule until integrations can be properly established.
The latest manual update also recorded the accident-reporting requirement that went into effect in 2022.
Additionally, the Feb 1 update formalized the fractional mileage policy that has been in effect since 2019, that providers should bill to the nearest tenth of a mile instead of rounding to the nearest whole mile.
Finally, the manual included an update that hospital-to-hospital transfers for higher level of care are emergencies and do not require prior authorization.
We excerpted some of the major changes below. Please email isaac@rvnuems.com if there are any omissions or inaccuracies in this post.
Index of Changes (Excerpts):
Managed Long Term Care Involvement
The Department is transitioning to a Transportation Management Broker. Beginning in 2024, the Department will begin “carving out” transportation from the Managed Long Term Care benefit. The “carve out” will be phased in over several months.
NYSDOH-Contracted Prior Authorization Official
The NYSDOH has contracted with professional transportation management entities to manage transportation on behalf of Medicaid enrollees. Effective on or after August 1, 2023, based on a competitive procurement, non-emergency medical transportation will be transitioned by the State from the current Medicaid Transportation managers to one Medicaid Transportation Broker (Medical Answering Services, LLC or MAS) to ensure that Medicaid eligible individuals receive reliable, high quality NEMT services using the mode that is appropriate for each individual. MAS will assume Medicaid Transportation Broker responsibilities for all counties except Nassau and Suffolk on August 1, 2023. Nassau and Suffolk counties will transition to MAS for all Medicaid Transportation Broker responsibilities on December 1, 2023. The Medicaid Transportation Broker will contract directly with transportation providers to develop an adequate network, ensure compliance with transportation network driver and vehicle requirements, and negotiate fee-for-service transportation provider reimbursement.
The NYSDOH-contracted transportation broker has no vehicles and will not provide transportation in competition with existing Medicaid-enrolled transportation vendors. Transportation vendors will need to agree to and sign a service agreement with the transportation broker in order to participate in their transportation network and receive trip assignments. Medicaid enrollment does not guarantee acceptance in the transportation broker’s provider network. The transportation broker is allowed to utilize all transportation vendors who participate in their network, to whatever extent determined by the transportation broker.
Transportation Provider Requirements and Responsibilities
To participate in the New York State Medicaid program, a provider must meet all applicable Federal, State, County and Municipal requirements for legal operation. In addition to the policies set forth in this Manual, and in other directives related to Medicaid policy, the Medicaid program expects the following of all providers: • All drivers, during their employment, must be at least eighteen (18) years of age and have a current, valid driver’s license from New York or another state to operate the transportation vehicle to which they are assigned. • All drivers and escorts will be courteous, patient, and helpful to all passengers and be neat and clean in appearance. • Driver or escorts must not use alcohol, narcotics, illegal drugs or drugs that impair ability to perform while on duty and no driver shall abuse alcohol or drugs at any time. • At no time will drivers or escorts smoke while in the vehicle, while involved in enrollee assistance, or in the presence of any enrollee. • Drivers and escorts shall provide necessary assistance, support, and oral directions to passengers. • Transportation providers can only provide transportation services that have been authorized by the prior authorization official(s). • Transportation providers shall wait at least fifteen (15) minutes after the scheduled pick-up time before “no-showing” the enrollee at the pick-up location. The network provider shall document all “no shows.” • Rides in duration of less than one (1) hour (barring exceptions based on location or acute circumstances such as inclement weather and unexpected traffic situations). • All vehicles must be registered with the NYS Department of Motor Vehicles, in the appropriate registration class, and be properly insured. • Have two-way radio or cellular phone communication capability. • Provide valid DMV registration with expiration date and valid insurance ID card with expiration date. • Be equipped with properly functioning air conditioner/heater/defrosters. • Each vehicle shall have the ability to properly secure child safety seats, when provided by an enrollee or caregiver. • Be equipped with a properly functioning speedometer and odometer. • Have a clean interior and exterior. • Have a smoking prohibition use notice posted in all vehicle interiors, easily visible to the passengers. • Include a vehicle information packet containing vehicle registration, insurance card, and accident procedures and forms. The accident procedure will include a requirement that the transportation provider informs the Transportation Broker of all accidents and incidents within 48 hours. • Be sufficiently stocked with personal protective equipment for drivers in accordance with OSHA Standards 1910.1030 and 1910.134, and any other applicable statute or regulation. • All vehicles are equipped with GPS capability and transmit coordinates and other related data to the broker as required. • Follow all Cleaning/Disinfection requirements and reporting as outlined by the Department. • Passengers must have their seat belts buckled while they are inside the vehicle. The driver shall assist passengers who are unable to fasten their own seat belts if requested. • The driver shall not put the vehicle in motion until all passengers have been properly secured. • The number of persons in the vehicle, including the driver, shall not exceed the vehicle manufacturer’s approved seating capacity. • Upon arrival at the destination, the vehicle shall be parked or stopped so that passengers do not have to cross streets to reach the entrance of their destination. • If passenger behavior or other conditions impede the safe operation of the vehicle, the driver shall park the vehicle in a safe location out of traffic and notify their dispatcher or 911 to request assistance. Providers of all levels of medical transportation will encounter patients/passengers who may have infectious diseases. To protect the health and well-being of everyone, all providers must follow CDC Standard Precautions for All Patient Care - https://www.cdc.gov/infectioncontrol/basics/standard-precautions.html Transportation providers cannot refuse to pick up a Medicaid member based on their medical condition or status. Any pattern of transport denial linked to an enrollee’s physical appearance, disability, and other protected classes is strictly prohibited. 42 USC 12182: Prohibition of discrimination by public accommodations Additionally, as employers, all transportation providers must abide by OSHA Standards 1910.1030 (Bloodborne Pathogens), 1910.134 (Respiratory Protection), as well as OSHA’s “General Duty Clause”. https://www.osha.gov/laws-regs/regulations/standardnumber/1910/1910.1030 https://www.osha.gov/laws-regs/regulations/standardnumber/1910/1910.134Transportation Provider Requirements and Responsibilities To participate in the New York State Medicaid program, a provider must meet all applicable Federal, State, County and Municipal requirements for legal operation. In addition to the policies set forth in this Manual, and in other directives related to Medicaid policy, the Medicaid program expects the following of all providers: • All drivers, during their employment, must be at least eighteen (18) years of age and have a current, valid driver’s license from New York or another state to operate the transportation vehicle to which they are assigned. • All drivers and escorts will be courteous, patient, and helpful to all passengers and be neat and clean in appearance. • Driver or escorts must not use alcohol, narcotics, illegal drugs or drugs that impair ability to perform while on duty and no driver shall abuse alcohol or drugs at any time. • At no time will drivers or escorts smoke while in the vehicle, while involved in enrollee assistance, or in the presence of any enrollee. • Drivers and escorts shall provide necessary assistance, support, and oral directions to passengers. • Transportation providers can only provide transportation services that have been authorized by the prior authorization official(s). • Transportation providers shall wait at least fifteen (15) minutes after the scheduled pick-up time before “no-showing” the enrollee at the pick-up location. The network provider shall document all “no shows.” • Rides in duration of less than one (1) hour (barring exceptions based on location or acute circumstances such as inclement weather and unexpected traffic situations). • All vehicles must be registered with the NYS Department of Motor Vehicles, in the appropriate registration class, and be properly insured. • Have two-way radio or cellular phone communication capability. • Provide valid DMV registration with expiration date and valid insurance ID card with expiration date. • Be equipped with properly functioning air conditioner/heater/defrosters. • Each vehicle shall have the ability to properly secure child safety seats, when provided by an enrollee or caregiver. • Be equipped with a properly functioning speedometer and odometer. • Have a clean interior and exterior. • Have a smoking prohibition use notice posted in all vehicle interiors, easily visible to the passengers. • Include a vehicle information packet containing vehicle registration, insurance card, and accident procedures and forms. The accident procedure will include a requirement that the transportation provider informs the Transportation Broker of all accidents and incidents within 48 hours. • Be sufficiently stocked with personal protective equipment for drivers in accordance with OSHA Standards 1910.1030 and 1910.134, and any other applicable statute or regulation. • All vehicles are equipped with GPS capability and transmit coordinates and other related data to the broker as required. • Follow all Cleaning/Disinfection requirements and reporting as outlined by the Department. • Passengers must have their seat belts buckled while they are inside the vehicle. The driver shall assist passengers who are unable to fasten their own seat belts if requested. • The driver shall not put the vehicle in motion until all passengers have been properly secured. • The number of persons in the vehicle, including the driver, shall not exceed the vehicle manufacturer’s approved seating capacity. • Upon arrival at the destination, the vehicle shall be parked or stopped so that passengers do not have to cross streets to reach the entrance of their destination. • If passenger behavior or other conditions impede the safe operation of the vehicle, the driver shall park the vehicle in a safe location out of traffic and notify their dispatcher or 911 to request assistance. Providers of all levels of medical transportation will encounter patients/passengers who may have infectious diseases. To protect the health and well-being of everyone, all providers must follow CDC Standard Precautions for All Patient Care - https://www.cdc.gov/infectioncontrol/basics/standard-precautions.html Transportation providers cannot refuse to pick up a Medicaid member based on their medical condition or status. Any pattern of transport denial linked to an enrollee’s physical appearance, disability, and other protected classes is strictly prohibited. 42 USC 12182: Prohibition of discrimination by public accommodations Additionally, as employers, all transportation providers must abide by OSHA Standards 1910.1030 (Bloodborne Pathogens), 1910.134 (Respiratory Protection), as well as OSHA’s “General Duty Clause”. https://www.osha.gov/laws-regs/regulations/standardnumber/1910/1910.1030 https://www.osha.gov/laws-regs/regulations/standardnumber/1910/1910.134
GPS Compliance Requirement
Effective April 3, 2023, New York State NYSDOH requires all Transportation Providers (TP) to be fully Global Positioning System (GPS) compliant.1 For a trip to be considered fully GPScompliant, the Transportation Provider will submit the starting point, end point, and all GPS coordinates along the trip (“breadcrumb data”) to the Transportation Broker. Transportation Providers must take necessary steps to ensure GPS compliance. The use of GPS data will be used to increase program integrity, ensure enrollee safety, aid in the development of future policies, and assist in the reduction of fraud, waste, and abuse. For Transportation Providers currently using a Third-Party Intermediary (TPI) / Advanced Transportation Management Systems (ATMS) billing or routing software: • Make sure all drivers have GPS capability and that each trip’s GPS data is being accurately routed. • For a complete list of TPIs/ATMS that are compliant with the appropriate brokers software or to ensure that your TPI/ATM is compliant please contact the transportation broker.
Accident/Incident Reporting
An “accident” is defined as a vehicle colliding with another vehicle, a physical structure, an object, a person, or an animal. An “incident” is defined as an occurrence, breakdown, or public disturbance that interrupts the trip causing the driver to stop the vehicle, such as when a passenger or driver becomes unruly or ill. All New York State (NYS) Medicaid-enrolled transportation providers must follow expanded accident/incident reporting protocol. Effective January 1, 2022, all events must be reported using the NYSDOH NEMT Accident and Incident Report. All providers should report these events to the prior authorization official and/or Department, in accordance with the 10 NYCRR Part 800.21: (q) upon discovery by or report to the governing authority of the ambulance service, report to the Department’s Area Office by telephone no later than the following business day and in writing within 5 working days every instance in which: (1) a patient dies, is injured or otherwise harmed due to actions of commission or omission by a member of the ambulance service; (2) an EMS response vehicle operated by the service is involved in a motor vehicle crash in which a patient, member of the crew or other person is killed or injured to the extent requiring hospitalization or care by a physician; (3) any member of the ambulance service is killed or injured to the extent requiring hospitalization or care by a physician while on duty; (4) patient care equipment fails while in use, causing patient harm; (5) it is alleged that any member of the ambulance service has responded to an incident or treated a patient while under the influence of alcohol or drugs while on duty. (r) on or in a form approved by the department, maintain a record of all unexpected, authorized EMS response vehicle and patient care equipment failures that could have Medicaid Transportation Policy manual Effective Date: 08/25/2023 Page 24 of 52 resulted in harm to a patient and the corrective actions taken. A copy of this record shall be submitted to the department with the EMS service’s biennial recertification application. Ambulance providers may submit the Bureau of Emergency Medical Services (BEMS) Reportable Incident Form (DOH-4461) in place of the NYSDOH NEMT Accident and Incident Report. Transportation providers must submit the forms to their transportation brokers within 48 hours of the events. The NEMT Accident and Incident Report and additional detail on reporting requirements are found on the transportation brokers websites. Source: November 2021 Medicaid Update
Electronic Records
The Department will allow transportation providers to comply with these record keeping requirements by: (1) substituting the written signature of the driver providing the transport with a unique identifying electronic signature, and (2) requiring drivers attest that the trip has been completed by using an electronic verification transmission that records both the trip drop-off and pick-up destination coordinates. Therefore, the driver "clicking" to confirm trip completion verification at the end of each ride can be used as long as it satisfies the Department's requirement for a "contemporaneous, complete, acceptable, verifiable" record that the driver has both provided the trip and attested to its completion to support Medicaid claims - and that the transportation provider can produce this documentation with an accurate, system-generated, unmodifiable date and time stamp for each leg of a billable trip, including the pickup and drop-off, for the required six-year period. The use of the electronic signature option does not exempt transportation providers from any of the current record keeping requirements or prospective audit of such record keeping by enforcement agencies. Source: January 2019 Medicaid Update
Reimbursement Fees
The current Medicaid transportation fee schedule is located online at: https://www.emedny.org/ProviderManuals/Transportation/index.aspx The transportation broker is responsible for negotiating reimbursement directly with network transportation providers. The negotiated rates will supersede the current fee schedule.
Enhanced Mileage Accuracy
Transportation providers historically have submitted mileage claims that round the fractional mileage distance from the nearest tenth of a mile traveled to the next highest whole number (e.g., from 2.7 miles to 3.0 miles). The New York State Department of Health (the Department) has determined that the current capabilities of the prior authorization and claims payment systems can accommodate fractional mileage claims that reflect distance to the nearest tenth of a mile. The submission of fractional mileage claims enhances payment accuracy, reduces Medicaid overpayments, achieves alignment with current Medicare mileage reimbursement policy, and better reflects the advent of geocoded trip recording technologies. Effective for dates of service on or after August 1, 2019, claims for loaded mileage must be reported as fractional units to the tenth of a mile (for trips totaling less than one mile, enter a “0” before the decimal point (e.g. 0.9). Rounding mileage units up to the nearest whole number is not allowed for claims with dates of service on or after August 1, 2019. Rounded-up claims may be deemed fraudulent and therefore subject to any recoveries and associated penalties by enforcement agencies. Transportation providers who are unable to comply with the August 1, 2019 fractional mileage reporting requirement, due to software limitations or other reasons, may round mileage units down to the nearest lowest whole number until a time determined by the Department. As always, the Medicaid program will only reimburse transportation providers for “loaded” miles. Loaded miles are those miles during which an enrollee occupies the vehicle. Source: May 2019 Medicaid Update
Preferred Provider Opportunities (PPO)
Preferred Provider Opportunities (PPO) are designed to promote collaboration between medical and transportation providers to improve communication and operational practices that result in better access to healthcare for Medicaid enrollees. Once established, PPOs are monitored by the NYSDOH to ensure Medicaid enrollees’ access to healthcare is being achieved. Regular stakeholder meetings are mandatory to ensure challenges and concerns of all parties are addressed. Furthermore, quality assurance and Medicaid enrollee satisfaction are measured regularly to determine the program’s success in meeting its goals. Expectations: • No PPO Trip Invoice can be refused or reassigned. • Maintain compliance with all NYSDOH Medicaid NEMT Policies and Procedures (i.e., all vehicles are required to provide GPS data for all transports). • On time performance for picking up enrollees - within 15 minutes of scheduled pick-up time. • On time performance for hospital discharges. TP must be at Hospital within 60 minutes of Trip Invoice Assignment. • NYSDOH, Medicaid Provider, and Transportation Providers are required to attend stakeholder meetings regularly. • Excellent, frequent, and appropriate communication between the TP and Medical provider is expected and required.
Emergency Transport from One Hospital to Another Hospital, for a Higher Level of Care Prior authorization is not required – do not contact the Transportation Broker An ambulance may be requested to transfer a patient from one hospital to another hospital, in emergency situations, when the patient requires specialized medical services that are not available at the originating hospital. Examples of this include but are not limited to: transfers to trauma, cardiac, burn, or stroke centers, or to another emergency room. These ambulance transports are considered emergency transports; therefore, prior authorization is not required.
DELETED: All prior authorizations should be sought within thirty (30) days of the date of service. Requests submitted beyond this time are subject to payment disallowance.
INTENTIONALLY OMITTED: ET3 Updates and Congestion Pricing Updates
Transportation Broker Complaints
Medicaid enrollees or their representatives and/or medical providers or their representatives and/or transportation providers may file complaints against transportation brokers to the Department. The Department will review all complaints and investigate credible complaints as appropriate. Confidentiality of complainant-identifying information is maintained to the extent practicable. Complaints are received by the NYSDOH via the following methods: Telephone: (518) 473-2160 Email: MedTrans@health.ny.gov
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