WV Medicaid Recipients can Use Local Ambulance Services

A new state contract to manage an estimated $29.7 million a year in non-emergency transportation costs for Medicaid recipients will allow patients to use local ambulance services, but only if they cannot travel by cheaper modes of transportation.

Concerns by some legislators that local EMS units would lose an important revenue source if they were unable to provide non-emergency transportation caused the Department of Health and Human Resources to suspend the bid process on the contract in December.

The contract was rebid in March, and awarded, effective June 1, to Medical Transportation Management Inc. of Lake St. Louis, Missouri.

Under the company's bid proposal, Medicaid recipients are to use the cheapest appropriate transportation available, beginning with public transit buses, in "areas with significant access to public transit," for patients who live near transit routes and have no mobility issues.

Ambulances can be used for non-emergency transportation, if the patient's medical condition warrants, according to the bid package.

"If a member's medical needs are such that ambulance transportation is required, the CSR (costumer service representative) will refer the member to local ambulance providers in the area," the bid proposal states.

In December, House Minority Leader Tim Armstead, R-Kanawha, called on DHHR to halt the bid process for the transportation management contract, over concerns that local ambulance services and volunteer fire departments might be barred for billing for non-emergency transports, which he said many small ambulance services rely on to remain in business.

"I think it would be useful to this committee to request that, to the extent possible, that contract awarding be held up," Armstead said during the December meeting of the Joint Committee on Government and Finance.

DHHR sought a company to manage Medicaid non-emergency transportation costs after two audits in 2013 blamed a lack of oversight for soaring costs for the program, started in 1987 to encourage Medicaid recipients to utilize medical services.

A legislative audit found that costs increased 74 percent from 2003 to 2012, going from $14.6 million a year to $25.5 million.

That audit found that for a 30-mile roundtrip for a doctor's office visit, some recipients were being reimbursed for $72 taxi fare, when cheaper alternatives were available, including reimbursing a friend or family member for mileage at a total cost of $14.10.

"We project to save between $1 million to $2 million annually for the state," DHHR spokeswoman Allison Adler said Tuesday. "This broker strategy is intended to significantly curb fraud, ensure consumers are protected, and assist in ensuring services are available to consumers."

The DHHR request for bids estimates that nearly 430,000 West Virginians will be eligible for the transportation service, including about 78,500 who received Medicaid coverage under a recent expansion to cover adults with household incomes of up to 133 percent of the federal poverty level.

Two other transportation brokers bid for the contract, Access2Care of Greenwood Village, Colo., and LogistiCare of Atlanta.

Medical Transportation Management isn't expected to begin operating in West Virginia until this fall, since the company will be in the process of setting up a business office in DHHR offices in downtown Charleston, as well as a call center, to be located at 1201 Greenbrier Street.

In its bid package, MTM said it will have a staff of 76 full-time employees in West Virginia.

Nationally, the company has been a Medicaid non-emergency medical transportation broker for 18 years, serving Minnesota, Wisconsin, Texas, and Washington, D.C., among other localities.

Reach Phil Kabler at philk@wvgazette.com or 304-348-1220.

Copyright 2014 - The Charleston Gazette, W.Va.