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This entry was published on 2021-04-23
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SECTION 365-H
Provision and reimbursement of transportation costs
Social Services (SOS) CHAPTER 55, ARTICLE 5, TITLE 11
* § 365-h. Provision and reimbursement of transportation costs. 1. The
local social services official and, subject to the provisions of
subdivision four of this section, the commissioner of health shall have
responsibility for prior authorizing transportation of eligible persons
and for limiting the provision of such transportation to those
recipients and circumstances where such transportation is essential,
medically necessary and appropriate to obtain medical care, services or
supplies otherwise available under this title.

2. In exercising this responsibility, the local social services
official and, as appropriate, the commissioner of health shall:

(a) make appropriate and economical use of transportation resources
available in the district in meeting the anticipated demand for
transportation within the district, including, but not limited to:
transportation generally available free-of-charge to the general public
or specific segments of the general public, public transportation,
promotion of group rides, county vehicles, coordinated transportation,
and direct purchase of services; and

(b) maintain quality assurance mechanisms in order to ensure that (i)
only such transportation as is essential, medically necessary and
appropriate to obtain medical care, services or supplies otherwise
available under this title is provided; (ii) no expenditures for taxi or
livery transportation are made when public transportation or lower cost
transportation is reasonably available to eligible persons; and (iii)
transportation services are provided in a safe, timely, and reliable
manner by providers that comply with state and local regulatory
requirements and meet consumer satisfaction criteria approved by the
commissioner of health.

3. In the event that coordination or other such cost savings measures
are implemented, the commissioner shall assure compliance with
applicable standards governing the safety and quality of transportation
of the population served.

4. (a) The commissioner of health is authorized to assume
responsibility from a local social services official for the provision
and reimbursement of transportation costs under this section. If the
commissioner elects to assume such responsibility, the commissioner
shall notify the local social services official in writing as to the
election, the date upon which the election shall be effective and such
information as to transition of responsibilities as the commissioner
deems prudent. The commissioner is authorized to contract with a
transportation manager or managers to manage transportation services in
any local social services district, other than transportation services
provided or arranged for enrollees of managed long term care plans
issued certificates of authority under section forty-four hundred
three-f of the public health law. Any transportation manager or managers
selected by the commissioner to manage transportation services shall
have proven experience in coordinating transportation services in a
geographic and demographic area similar to the area in New York state
within which the contractor would manage the provision of services under
this section. Such a contract or contracts may include responsibility
for: review, approval and processing of transportation orders;
management of the appropriate level of transportation based on
documented patient medical need; and development of new technologies
leading to efficient transportation services. If the commissioner elects
to assume such responsibility from a local social services district, the
commissioner shall examine and, if appropriate, adopt quality assurance
measures that may include, but are not limited to, global positioning
tracking system reporting requirements and service verification
mechanisms. Any and all reimbursement rates developed by transportation
managers under this subdivision shall be subject to the review and
approval of the commissioner.

(b)(i) Subject to federal financial participation, for periods on and
after April first, two thousand twenty-one, in order to more
cost-effectively provide non-emergency transportation to Medicaid
beneficiaries who need access to medical care and services, the
commissioner is authorized to contract with one or more transportation
management brokers to manage such transportation on a statewide or
regional basis, as determined by the commissioner, in accordance with
the federal social security act as follows:

(A) The transportation management broker or brokers shall be selected
through a competitive bidding process based on an evaluation of the
broker's experience, performance, references, resources, qualifications
and costs; provided, however, that the department's selection process
shall be memorialized in a procurement record as defined in section one
hundred sixty-three of the state finance law;

(B) The transportation management broker or brokers shall have
oversight procedures to monitor Medicaid beneficiary access and
complaints and ensure that enrolled Medicaid transportation providers
are licensed, qualified, competent and courteous.

(C) The transportation management broker or brokers shall be subject
to regular auditing and oversight by the department in order to ensure
the quality of the transportation services provided and adequacy of
Medicaid beneficiary access to medical care and services.

(D) The transportation management broker or brokers shall comply with
requirements related to prohibitions on referrals and conflicts of
interest required by the federal social security act.

(ii) The transportation management broker or brokers may be paid a per
member per month capitated fee or a combination of capitation and fixed
cost reimbursement and the contract shall include, but not be limited
to, responsibility for:

(A) establishing a network of high-quality Medicaid enrolled
providers; provided, however, that in developing such network the
transportation management broker shall evaluate the qualifications of
current Medicaid transportation providers on a priority basis for
participation in its network, and leverage reputable transportation
providers with a proven record of serving Medicaid beneficiaries with
high-quality services;

(B) continuing outreach to Medicaid enrolled providers to assess and
resolve service quality issues;

(C) developing mandatory corrective actions for any Medicaid enrolled
provider that falls under quality performance standards;

(D) establishing a prior approval process which shall include
verifying Medicaid eligibility and reviewing, approving and processing
transportation orders;

(E) managing the appropriate level of transportation based on
documented patient medical need to ensure that Medicaid beneficiaries
are using the most medically appropriate mode of transportation,
including public transportation, which shall be maximized statewide,
including in rural areas; provided that when determining the appropriate
level of transportation, the transportation management broker shall
ensure that patients have reasonable and timely access to medically
appropriate transportation services;

(F) implementing technologies to effectuate efficient transportation
services, such as GPS, to improve match to mode of transportation;

(G) establishing fees to reimburse enrolled Medicaid transportation
providers;

(H) adjudicating and paying claims submitted by enrolled Medicaid
transportation providers;

(I) reporting on performance encompassing all aspects of the
transportation program, including but not limited to Medicaid
beneficiary complaints including the length of time to make a compliant,
wait times related to the receipt of services by a recipient, and
tracking medical justifications to modes of transportation provided;

(J) collaborating with Medicaid beneficiaries and consumer groups to
identify and resolve issues to increase consumer satisfaction;

(K) auditing cancellation data on a quarterly basis to ensure
accuracy;

(L) coordinating medical benefits and transportation with Medicaid
managed care organizations, including development of value based
payments for transportation services; and

(M) such contracts shall include penalties for incorrect denials,
unresolved complaint rates, unfulfilled trips, and any other criteria
determined by the commissioner and specified in the competitive bidding
process.

(iii) A transportation management broker with which the commissioner
contracts shall file with the commissioner a bond issued by an insurer
authorized to write fidelity and surety insurance in this state, in an
amount and form to be determined by the commissioner. The purpose of the
surety bond shall be to provide the sole source of recourse to providers
of Medicaid transportation services, other than the transportation
management broker, that cannot receive payment for services properly
provided if the transportation management broker becomes insolvent. To
the extent permitted by law, the surety bond shall provide that any
funds that remain after such provider liabilities are satisfied shall be
paid to that state.

(iv) A transportation management broker with which the commissioner
contracts shall provide to Medicaid enrolled providers annually a
conspicuous written disclosure that states the following: "The New York
State Department of Health has contracted with this transportation
management broker to arrange non-emergency transportation for Medicaid
beneficiaries who need access to medical care and services and is paying
the transportation management broker a per member per month capitated
fee or a combination of capitation and fixed cost reimbursement. This
transportation management broker is not licensed by the New York State
Department of Financial Services as an insurer and is not subject to its
supervision as an insurer. This transportation management broker is not
protected by New York security funds and there will not be any right to
recover against the department of health, department of financial
services, or this state in the event of the transportation management
broker's insolvency.

(v) To the extent practicable, the competitive bidding and contracting
process maybe completed by April first, two thousand twenty-one;
provided, however, such contract may be effective at some date after
April first, two thousand twenty-one, if the process takes longer to
complete.

(vi) Responsibility for transportation services provided or arranged
for enrollees of managed long term care plans issued certificates of
authority under section forty-four hundred three-f of the public health
law, not including a program designated as a Program of All-Inclusive
Care for the Elderly (PACE) as authorized by Federal Public law 1053-33,
subtitle I of title IV of the Balanced Budget Act of 1997, and, at the
commissioner's discretion, other plans that integrate benefits for
dually eligible Medicare and Medicaid beneficiaries based on a
demonstration by the plan that inclusion of transportation within the
benefit package will result in cost efficiencies and quality
improvement, shall be transferred to a transportation management broker
that has a contract with the commissioner in accordance with this
paragraph. Providers of adult day health care may elect to, but shall
not be required to, use the services of the transportation management
broker.

5. Notwithstanding any contrary provision of law, and subject to
federal financial participation, the commissioner of health shall make
adjustments to payments under this section, for the purposes of
providing increased access to Medicaid non-emergency transportation in
rural communities. Up to two million dollars shall be available for such
purposes.

6. (a) The commissioner of health shall require transportation
providers enrolled in the Medicaid program and specified by the
commissioner pursuant to regulation, to report the costs incurred in
providing transportation services to Medicaid beneficiaries pursuant to
this section; provided, however, this requirement shall only apply if
there is no transportation management broker contract authorized in
subdivision four of this section. The commissioner shall specify the
frequency and format of such reports and determine the type and amount
of information required to be submitted, including supporting
documentation, provided that such reports shall be no more frequent than
quarterly. The commissioner shall give all transportation providers no
less than ninety calendar days' notice before such reports are due.

(b) If the commissioner determines that the cost report submitted by a
Medicaid transportation provider is inaccurate or incomplete, the
commissioner shall notify such provider in writing and advise the
provider of the correction or additional information that the provider
must submit. The provider shall submit the corrected or additional
information within thirty calendar days from the date the provider
receives the notice.

(c) The commissioner shall grant a provider an additional thirty
calendar days to submit the original cost report, or corrected or
additional information required pursuant to paragraph (b) of this
subdivision only when the provider submits a written request to the
commissioner for an extension prior to the due date and establishes to
the satisfaction of the commissioner that the provider cannot submit the
cost report or corrected or additional information by the due date for
reasons beyond the provider's control.

* NB Repealed 16 years after the contract entered into pursuant to
this section 365-h is executed

* § 365-h. Provision and reimbursement of transportation costs. 1. The
local social services official shall have responsibility for prior
authorizing transportation of eligible persons and for limiting the
provision of such transportation to those recipients and circumstances
where such transportation is essential, medically necessary and
appropriate to obtain medical care, services or supplies otherwise
available under this title.

2. In exercising this responsibility, the local social services
official shall:

(a) make appropriate and economical use of transportation resources
available in the district in meeting the anticipated demand for
transportation within the district, including, but not limited to:
transportation generally available free-of-charge to the general public
or specific segments of the general public, public transportation,
promotion of group rides, county vehicles, coordinated transportation,
and direct purchase of services; and

(b) maintain quality assurance mechanisms in order to ensure that (i)
only such transportation as is essential, medically necessary and
appropriate to obtain medical care, services or supplies otherwise
available under this title is provided and (ii) no expenditures for taxi
or livery transportation are made when public transportation or lower
cost transportation is reasonably available to eligible persons.

3. In the event that coordination or other such cost savings measures
are implemented, the commissioner shall assure compliance with
applicable standards governing the safety and quality of transportation
of the population served.

* NB Effective 16 years after the contract entered into pursuant to
this section 365-h has been executed