NEMT Update - March 2017
Key Highlights This Month:
*April Beacham, DHS, reached out to about 23 counties to assist with training on the new mode 4 process. Items of interest are electronic and paper billing, RUCA, prior authorizations, referrals to providers and provider payments.
*Prior authorization is under some discussion as well. The task force is interested in identifying usefulness of and appropriate documentation of prior authorizations. This is related as well to the 30/60 rule.
*30/60 rule. Providers interested in expanding the mileage on this rule especially in rural areas. However, discussion centered around MCO’s contracts already speak to this language. As well, NAMI has concerns as to accessibility issues, meaning that the 30/60 rule encourages and allows for reasonably available access to medical professionals for clients. This rule will most likely remain in effect as is.
*Child seat rules clearly outlined and approved by task force to move forward for legislative approval
*Clarified that hospital discharges to nursing home facilities and nursing home facilities discharges can be done and then the NEMT rules allow for a one-time upgrade approval by the county within 7 days. This allows for the hospitals and nursing homes to transport efficiently and timely.
Requested Actions Needed From MACSSA:
New Trends in This Area:
Hospital, ambulances and provider associations continued pressure to work directly with state for electronic billing options. Legislative Audit has clearly defined the need for a single administrative structure. OIG interest in maintaining county oversight, with state billing system, and provider approvals creating a triad for transparency, reconciliation of billing and circumventing fraud, waste and abuse in a new system that is trying to be client-centered.
For counties that contract out these services, MTM is providing these steps; for counties that continue their operations this new processes can create unintended tensions with providers, and clients.
Issues/Concerns Regarding This Topic:
Concerns in this area continue to be:
need for electronic billing,
prior authorization discussions, training for counties on new modes,
One-time upgrades for Nursing home facility discharges and Hospital discharges
Legislative hearing deadlines for the approved items (child seats, no change to memberships, for example) moving forward.
Contacts(s): Janet Goligowski, Stearns County