2023 Indiana Code › Title 12. Human Services › Article 15. Medicaid › Chapter 30.5. Nonemergency Medical Transportation › 12-15-30.5-4. Reporting; Duties When Assignment for Request Not Made Within 48 Hours

Sec. 4. (a) A broker must do the following:
(1) Submit monthly reports to the office of the secretary for the office of the secretary to post on the office of the secretary's Internet web site of the following:
(A) A list and map by county of the number of vehicles, by vehicle type, that are contracted, credentialed, and available to provide nonemergency medical transportation in that county.
(B) Based upon a comparison of trip-leg identification numbers issued by the broker to the corresponding claim submitted with that trip-leg identification number, the number of instances in which a requested nonemergency medical transportation for an eligible Medicaid recipient was not provided, including whether:
(i) the instance related to picking up the recipient to go to an appointment;
(ii) the instance related to picking up the recipient from an appointment;
(iii) the instance related to a Medicaid recipient or transportation provider not being available;
(iv) the recipient resides in the community, a health facility, an intermediate care facility for individuals with intellectual disabilities, a hospital, or another location; and
(v) the instance resulted from the transportation request being canceled by the transportation provider more than forty-eight (48) hours before the appointment or within forty-eight (48) hours of the appointment.
(C) A summary of the complaints received by the broker, whether or not the complaints have been substantiated. Information under this clause must include the total number of complaints and whether the complaint related to:
(i) a scheduled ride to go to an appointment;
(ii) a scheduled ride from an appointment; and
(iii) a recipient who resided in the community, a health facility, an intermediate care facility for individuals with intellectual disabilities, a hospital, or another location.
(2) Submit monthly to the office of the secretary for the office of the secretary to post on the office of the secretary's Internet web site a report comparing:
(A) the number of eligible Medicaid recipients; to
(B) the number of contracted and credentialed transportation vehicles, by type and by county, that are available to provide nonemergency medical transportation in a county;
and including the calculation of the ratio of eligible Medicaid recipients to vehicle type.
(3) Submit a monthly report to the office of the secretary that includes the following information for the previous month:
(A) The number of ride requests received and scheduled trip-leg identification numbers issued.
(B) Call center statistics.
(C) Information on claims payments, including claim denial reason codes.
(D) Program integrity referrals.
(E) Information concerning grievances and appeals, including the status of any grievance or appeal that is either open or closed in the month of the report.
(b) If the broker has not assigned a transportation provider to a request for nonemergency medical transportation within forty-eight (48) hours of the time in which the transportation is to be provided, the broker shall do the following:
(1) Take steps to notify the:
(A) Medicaid recipient for which the request was made; and
(B) health facility, if the Medicaid recipient resides in a health facility;
that a transportation provider has not yet been assigned.
(2) Continue to make every effort in securing transportation for the Medicaid recipient and immediately notify the recipient described in subdivision (1)(A) and, if applicable, the health facility described in subdivision (1)(B), when transportation has been assigned.
(3) Document whether the notice required under subdivision (1) was communicated to the Medicaid recipient or a person on behalf of the Medicaid recipient, and the method of communication.
As added by P.L.116-2019, SEC.4. Amended by P.L.156-2020, SEC.56.