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ARIZONA HOUSE OF REPRESENTATIVESFifty-seventh Legislature First Regular Session |
House: HHS DP 11-0-1-0 |
HB 2584: nonemergency medical transportation; study
Sponsor: Representative Bliss, LD 1
Caucus & COW
Overview
Allows the Arizona Health Care Cost Containment System Administration (AHCCCS) to receive funding from nonemergency medical transportation (NEMT) providers and other interested enterprises to cover the costs of an NEMT rate reimbursement study. Outlines guidelines and requirements regarding the study.
History
Currently, AHCCCS covers medically necessary nonemergency ground and air transportation to and from a required medical service for most recipients. Nonemergency transportation is not covered for Federal Emergency Services Members. NEMT must bill the number of trips and the number of loaded miles as units of service on the Centers for Medicare & Medicaid Services' 1500 claim form. Loaded mileage is defined as the distance traveled, measured in statute miles, with a recipient on board the vehicle and being transported to receive medically necessary covered services.
In addition, AHCCCS conducts retrospective audits of NEMT providers to verify that the mileage, medical condition, and specific location are correct and justifiable. AHCCCS recommends documentation of the member’s current medical concern and specific medical service to which member is being transported (AHCCCS).
Provisions
1. Allows AHCCCS to receive funding from NEMT providers and other interested enterprises to cover the costs of an NEMT rate reimbursement study. (Sec. 1)
2. Requires AHCCCS, if a sufficient amount of money is received, to contract with an independent consulting firm for a study of the adequacy and appropriateness of Medicaid reimbursement rates to transportation network companies and NEMT brokers for providing medically necessary nonemergency transportation when transporting members to and from a covered physical or behavioral health service. (Sec. 1)
3. Requires the study to review the costs necessary to meet the requirements for the transportation of members as well as the costs to collect and maintain records of the actual services provided to AHCCCS's policy for NEMT, transportation network companies and the NEMT broker. (Sec. 1)
4. Requires the consulting firm to examine in detail the costs associated with the delivery of services including programmatic, administrative, technology and indirect costs in providing NEMT services in rural and urban areas in Arizona when determining the adequacy of the rates in the study. (Sec. 1)
5. Allows AHCCCS to require its contracted providers and managed care organizations to provide financial data to assist in the study. (Sec. 1)
6. Requires AHCCCS's contracted providers and managed care organizations to provide all data required by AHCCCS. (Sec. 1)
7. Requires the study of reimbursement rates to be completed within one calendar year after AHCCCS receives sufficient funding. (Sec. 1)
8. Directs AHCCCS to provide the results of the study to the Joint Legislative Budget Committee (JLBC). (Sec. 1)
9. Requires AHCCCS to include results of the study in its next capitation rate request immediately following the completion of the study and in its reimbursement rates for NEMT. (Sec. 1)
10. Requires AHCCCS, if results of the study are not completely incorporated into the capitation rate, to provide a report to JLBC within 30 days after setting the final capitation rate that includes the reason or reasons for any difference between the actual rates and those included in the study. (Sec. 1)
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14. HB 2584
15. Initials AG/AB Page 0 Caucus & COW
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