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March 13, 2019: Non-Emergency Medical Transportation Protest Upheld by Department of Administration
In August 2018, the Department of Health Services (DHS) announced intent to contract with LogistiCare Solutions, LLC (LogistiCare) for non-emergency medical transportation (NEMT) services. The procurement that resulted in the intent to award the contract was under protest and appeal.
On February 28, 2019, the Wisconsin Department of Administration issued their decision on the appeal and ordered DHS to rescind the intent to contract with LogistiCare.
As a result, DHS will be issuing a new procurement for NEMT services. The contract with the MTM, Inc. will continue throughout the procurement period. The services that members are eligible for under the NEMT benefit will not change.
DHS is committed to maintaining and improving on current services. DHS will continue to keep members, providers, and all other stakeholders informed throughout this process.
What are NEMT services?
Medicaid programs must ensure members receive transportation to and from Medicaid-covered services when they have no other means to get to appointments and services. Federal Medicaid rules allow states to count transportation costs as a medical expense if the state uses a management model under a competitive procurement process. The NEMT manager acts as a liaison between members and subcontracted transportation providers, such as public transportation services and taxi companies.
Why is DHS issuing a new procurement for NEMT services?
Wisconsin state law obligates DHS to procure vendors on a regularly scheduled basis. NEMT services operate under a five-year procurement cycle; therefore, DHS released a request for proposal (RFP) for NEMT services in January 2018. The procurement process is an opportunity for DHS to continue to improve the program and provide quality controls. For example, the 2018 RFP included the following additional improvements: electronic tracking of rides to better track unsuccessful trips and improve timeliness of services, new call center standards to help address call volume during peak hours, a transportation provider ombuds staff to assist transportation providers with contracting questions and claim processing, new network requirement for specialized medical vehicles to ensure access, and additional language on penalties and liquidated damages to improve contract compliance.
Per state law, a bidder may protest and appeal the decision of the procuring agency if they feel the process used to evaluate the proposal violated administrative code. The result of the 2018 procurement awarding LogistiCare the NEMT contract was under protest and appeal and DHS could not proceed further with the award of the contract until there was a resolution. Now that the Wisconsin Department of Administration issued their decision on the appeal and ordered DHS to rescind the intent to contract with LogistiCare, there will be a new procurement issued for NEMT services.
How has the NEMT management improved?
Since 2012, DHS has revised the NEMT contract to include the following enhancements:
- Additional driver requirements related to background checks, drug testing, and training
- Additional member resources, such as online scheduling, online complaint submission, and a dedicated member ombudsman
- A new call center requirement of a 99.7 complaint-free percentage
- Electronic tracking of rides to better track unsuccessful trips and improve the timeliness of services
- New call center standards to help address call volume during peak hours
- A transportation provider ombudsman to assist transportation providers with contracting questions and claims processing
- Improved network requirements for specialized medical vehicles to ensure access
- Additional language on penalties and liquidated damages to improve compliance
Since 2012, DHS has made the following improvements to the NEMT program:
- Created a Transportation Advisory Council to increase transparency and actively engage stakeholders
- Hired a full-time NEMT contract monitor to provide on-site review of the NEMT manager’s day-to-day operations and to monitor trends and complaints
- Improved transparency and accountability by posting monthly NEMT performance reports to the DHS public website
- Contracted with a third-party NEMT member advocate to help members navigate the NEMT process and help resolve any issues or complaints
- Implemented a new standard to require no more than one unsuccessful trip per 2,250 scheduled rides and no more than one provider late occurrence per 2,250 scheduled rides
Has anything changed for members?
There are no changes for members or the benefits they receive as a result of the decision to issue a new procurement. The current contract with MTM, Inc. will continue throughout the procurement process.
Members in need of NEMT services should continue to call MTM, Inc. at 866-907-1493. Members should continue to contact the MTM, “WeCare” line at 866-436-0457 if they have a complaint about the service they received. For TTY services, members should call 711.