2023 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