What is Non-Emergency Medical Transportation, Patient Access?

What is non-emergency medical transportation?

Non-emergency medical transportation (NEMT) includes transportation services offered to patients and healthcare consumers who face extraordinary barriers getting to their medical appointments.

NEMT is widely known to serve Medicaid beneficiaries. Transportation services were established as required Medicaid benefits when the program was established in 1966, according to a CMS guide book.

Those barriers can include not having a valid driver’s license, not having a working vehicle in the household, being unable to travel or wait for services alone, or having a physical, cognitive, mental, or developmental limitation.

NEMT services are usually intended for medical appointments or other forms of non-emergent care.

Emergency care is defined as “any event that puts the health and life of a Medicaid beneficiary at serious risk without immediate treatment,” CMS wrote in the guide book.

“Real emergencies occur when the medical needs of a beneficiary are immediate and due to severe symptoms,” the agency continued. “A life-threatening event such as uncontrolled bleeding, heart attack, an automobile accident, or other serious trauma may cause the symptoms”

NEMT providers are required to offer transportation both to and from the appointment, utilize the most appropriate form of transportation, and include coverage for all expenses associated with transportation.

Why do Medicaid, payers cover NEMT?

Transportation is a core social determinant of health, or factor that impacts patient health that is not linked with disease burden or genetic makeup. The social determinants of health account for about 40 percent of patient health, according to a 2017 AHA report, meaning that supporting patient transportation can have a serious impact on patient wellness.

The AHA report noted that 3.6 million individuals – regardless of payer status – do not access medical care because they do not have transportation to appointments. Four percent of children miss medical appointments for that same reason. Additionally, transportation barriers serve as the third leading cause of missing a medical appointment.

Missed appointments impact both patient health and healthcare revenue cycle. Patients who miss appointments may see their health and wellness deteriorate. As a result, healthcare costs can increase.

Patients who manage a chronic illness, for example, need to attend their regular check-ins with their providers. These check-ins ensure the patient’s condition has not worsened and activate any kind of preventive care necessary to reduce the likelihood of a costly medical event. When a patient cannot attend these appointments, they are at risk of getting sicker and costing more healthcare dollars.

What are Medicaid’s NEMT regulations?

As noted, NEMT has been a core Medicaid benefit since the program’s birth. However, this benefit can look different from state to state due to Medicaid’s program flexibility.

Prior authorization agreements, for example, can differ across the country.

“Many States require coverage of transportation services to be preauthorized before the beneficiaries receive transportation,” CMS explained in its guide book.

“States preauthorize transportation in a variety of ways,” the agency continued. “For example, one State may expect a physician to authorize the need for beneficiary transportation, another State may only want to know that the beneficiary’s location drop-off was to a medical appointment, while a third State may expect the medical facility to phone in the medical transportation request before providing services.”

Some states require patients to pay a copayment for the transportation service. This is usually a nominal fee, ranging from $0.50 to $3.50, according to a Kaiser Family Foundation dataset.

State Medicaid programs can also limit their NEMT programs through Medicaid 1115 waivers, according to a 2017 Health Affairs post by Michael Adelberg and Marsha Simon, PhD. Massachusetts recently applied for a 1115 waiver to do away with the “assurance” of NEMT for its Medicaid expansion population, the pair offered as an example.

The state proposed to maintain NEMT for opioid treatment patients, which Adelberg and Simon argued highlighted Massachusetts’ recognition that NEMT is useful for patient adherence to medical treatment.

Going forward, HHS says states can practice more flexibility with their NEMT programs. A March 2017 letter from HHS Secretary Tom Price, MD, and CMS Administrator Seema Verma says states can apply for certain waivers for Medicaid programs such as NEMT.

“States may also consider creating greater alignment between Medicaid's design and benefit structure with common features of commercial health insurance, to help working age, nonpregnant, non-disabled adults prepare for private coverage,” the pair wrote to state governors.

Healthcare professionals and state Medicaid policymakers will need to assess community needs to better understand the role NEMT plays in patient health.

What are other NEMT services, solutions?

Non-emergency medical transportation is a key program for more than just state Medicaid programs. The service has also been offered via the VA and some private insurers.

Should states take advantage of the flexibility offered from HHS going forward, hospitals may need to step in to fill this care gap for patients, according to the same 2017 AHA report.

“Although hospitals and health systems traditionally have not focused on transportation issues within their purview of care delivery, there is a growing recognition that improving transportation access and support for patients can help improve health outcomes and lower health costs,” AHA noted.

Hospitals can design their own NEMT programs by looking at their community health needs assessments. This will help hospitals determine what kind of solution best suit their populations.

Ridesharing partnerships have been an excellent source for hospitals and other healthcare providers to assist patients in need. Many hospitals are joining forces with companies such as Uber or Lyft to allow patients to hail a ride through the familiar smartphone interface.

These programs have proven financially effective, reducing transportation costs for various healthcare entities.

As more healthcare organizations answer the call to address the social determinants of health, they must understand how transportation barriers and NEMT impact patient health. Although Medicaid is a significant NEMT provider, gaps in care may still remain. Healthcare professionals must identify those gaps and determine solutions for filling them.