Consider the ideal role of non-emergency medical transportation in addressing the social determinants of health in Medicaid and Medicare populations

0

Medicare and Medicaid programs that serve the most vulnerable Americans facing SDOH barriers can be major enablers of appropriate non-emergency transportation to non-medical sites. But how do we determine what is appropriate and what do we know about transportation services to non-medical sites today?

Non-emergency medical transportation (NEMT) has been part of the Medicaid program since its inception. It was first codified in a regulation in 1973, and Congress reiterated that the NEMT is a mandatory Medicaid benefit in the Consolidated Appropriations Act of the 2020s. Medicare generally does not provide non-emergency transportation, except for the exception of beneficiaries who cannot be transported in a vehicle other than an ambulance.

Health plans that participate in Medicare Advantage (MA) and care providers such as Responsible Care Organizations may choose to offer non-emergency transportation, but are not required to do so. Whether covered by Medicaid or Medicare, most non-emergency transportation is to medical sites; transport to non-medical sites is rare.

The growing attention to social determinants of health (SDH) is increasing attention to the appropriate role of transport to medical and non-medical sites. Although there is a body of research on the value of transportation for medical care, there is little research on the role of transportation in supporting access to non-medical locations (e.g., grocery stores, health centers, etc.). fitness, social services) and how improved access to non-medical sites – medical needs via transportation services can ultimately improve people’s health.

Medicare and Medicaid programs that serve the most vulnerable Americans facing SDOH barriers can be major enablers of appropriate non-emergency transportation to non-medical sites. But how do we determine what is appropriate and what do we know about transportation services to non-medical sites today?

Based on a survey of 91 organizations, the Medical Transportation Access Coalition (MTAC) assessed (1) the value of transportation for vulnerable Medicare beneficiaries by analyzing claims from a regional MA plan and (2) the variety of non-medical sites that Medicaid and Medicare plans and providers support transportation. By undertaking two separate but complementary analyses, we highlight the role non-urgent transportation could play in meeting the SDOH needs of Medicare and Medicaid beneficiaries.

Medicare Advantage Claims Analysis

The actuaries analyzed the claims of a regional MA plan with a large dual plan eligible for special needs (D-SNP) and MA plans for the general health maintenance organization (HMO) market. These plans have an NEMT benefit – with the MA plan benefit increasing the Medicaid NEMT benefit for dual-eligibility beneficiaries. The analysis compared transport users to non-users on a variety of medical and pharmaceutical cost and utilization data elements.

Transport is positively correlated with the use of primary care. Transport users consult their general practitioner 1.5 times more than non-users.

Transport users tend to be sicker than non-users. This assertion is based on the hierarchical condition category codes assigned to them as part of the MA risk adjustment program. The average risk score for transport users is 1.97 compared to 1.35 for non-users, based on the most recent full risk adjustment coding year (2019). This demonstrates that NEMT spending is focused on members with the greatest medical needs.

SDOH Transport Survey

MTAC, with the help of allied members of the coalition, conducted a first-of-its-kind survey of organizations that provide transportation for Medicare and Medicaid beneficiaries. We received 91 responses from organizations that provide transportation for Medicare or Medicaid beneficiaries.

Forty-three responding organizations indicated that they provide non-medical transportation to Medicaid recipients. Respondents provided non-medical transportation to Medicaid beneficiaries for up to 500,000 and as low as 60. Twenty-seven survey respondents provided non-medical transportation to Medicare beneficiaries for up to 500,000 and also less than 100 beneficiaries.

It is important to note that there is no single “consensus” destination served by the majority of responding organizations. Authorized sites for MA plans tended toward destinations with a clear correlation to physical health (eg, grocery stores, fitness centers); Medicaid destinations had a broader scope that often included social services and work destinations.

Organizations frequently place usage limits on their non-medical transportation services. For example, 48% of Medicare respondents limited the number of round trips per period and 33% used prior authorization to limit unnecessary trips. Among Medicaid plans, 41% of respondents chose to implement tools such as prior authorization, while 34% chose to limit trips based on a maximum number of trips per time period.

This study highlights how non-emergency transportation helps vulnerable people access health care and essential services (e.g., grocery stores, fitness centers, social services) and is a driver of health and well-being. to be people. Over time, more research will be needed to understand how these types of interventions directly lead to better health outcomes and impact overall public insurance plan spending. If nonmedical transportation improves the health and well-being of Americans, policymakers should consider funding comprehensive and appropriate transportation based on medical and social needs.

Michael Adelberg is a director of Faegre Drinker Consulting.

Krisda H. Chaiyachati is an assistant professor of medicine at the Perelman School of Medicine at the University of Pennsylvania.

Vincent Giglierano is a Faegre Drinker Consulting consultant.

Share.

Comments are closed.