NY Soc Serv L § 365-H (2021)
2021 New York Laws SOS - Social Services Article 5 - Assistance and Care Title 11 - Medical Assistance for Needy Persons 365-H - Provision and Reimbursement of Transportation Costs.

* § 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