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DOH Issues Regulations on Medicaid Transportation Broker Changes

The Department of Health (DOH) published regulations last week to implement changes in the management of the Medicaid non-emergent transportation benefit. Under the State Fiscal Year (SFY) 2020-21 budget, transportation was carved out of the Managed Long Term Care (MLTC) benefit package, effective April 1, 2021. The budget also imposed new quality improvement and oversight requirements on Medicaid transportation providers.

The transportation benefit for Medicaid beneficiaries who are not enrolled in MLTC plans has been managed by one or more transportation management brokers for several years. The SFY 2020-21 budget extended the same treatment to MLTC beneficiaries and gave adult day health care programs the option of using the broker. The budget exempted Programs of All-Inclusive Care for the Elderly (PACE) from the carve-out and gave the Department the discretion to exempt Medicaid Advantage Plus (MAP) plans as well. 

The proposed regulations set forth:

  • Changes to be implemented when the transition to the transportation management broker takes effect;
  • Certain aspects of prior authorization and payment standards, including forms required from ordering practitioner; and
  • Updates to references to the prior transportation program operated in conjunction with local social services districts.

The proposed regulations further provide that prior authorization will be granted only when payment for transportation expenses is essential in order for an eligible Medicaid beneficiary to obtain necessary medical care and services which may be paid for under the Medicaid program. The regulations also include provisions governing a new Medicaid Emergency Triage, Treat and Transport (ET3) model demonstration program, which provides an alternative to hospital emergency department care for Medicaid beneficiaries otherwise transported to the hospital.

The regulatory amendments take effect Oct. 1st.

Contact: Karen Lipson, klipson@leadingageny.org, 518-867-8838