Medi-Cal ReimbursementMedi-Cal ReimbursementOpportunities for Public TransitOpportunities for Public Transit

CalACT Spring 2014Margaret Heath

Requirements - Getting Started

Research Medi-Cal non-emergency non-medical transportation (NENMT) to determine how many of the trips your program provides may qualify.

Learn what NENMT is from the prospective of Medi-Cal Administrative Activities (MAA).

http://www.dhcs.ca.gov/provgovpart/Documents/ACLSS/CMAA/CMAA%20Manual%20Revised%202011.pdf

2

Activity D: Non-emergency non-medical transportation (NENMT).

• The term “non-medical” does not refer to the type of vehicle used, but to the condition of the transportation recipient.

• In contrast… “non-emergency, medical transportation” must be provided in ambulances or wheelchair vans, and be supported by a Treatment Authorization Request.

3

Non-Emergency, Non-Medical Transportation

Non-Emergency, Medical Transportation

4

Question:How frequently does a trip

provided by your transportation services fit this description?

“Arranging and/or providing non-emergency, non-medical transportation of a Medi-Cal eligible person to Medi-Cal services, and when necessary, accompaniment by an attendant.”

5

Does your program provide transportation to:

Adult Day Healthcare CentersBehavior Health ProgramsDialysis TreatmentTo/From Nursing Homes

6

Medi-Cal Non-Emergency Non-Medical Transportation (NENMT)

Reimbursement • The actual cost of providing Medi-Cal Non-Emergency,

Non-Medical Transportation may be charged for reimbursement through the Local Governmental Authority ‘s (LGA) MAA program.

• This is a source of revenue for both the LGA and the transportation provider to offset costs of NENMT

7

Medi-Cal Reimbursement Opportunities

NENMT Costs Include: Tokens Taxi Fares Mileage Audited Trip Costs

The reimbursement Gold Coast Transit receives for NENMT Costs is …

50% of Audited Trip Costs In FY 12 our audited trip cost was $29.69/trip

(Reimbursement was for qualifying trips)

9

Locate your local LGA (Local Governmental Authority)

10

Your local LGA is here

http://www.maa-tcm.com/content/lga-contact-information

11

12

Strongly Recommended –PatienceLearn the MAA acronyms/languageBe prepared to explain your current

budget/operations in lay termsUnderstand how your scheduling/reporting

software worksPatience

13

• MOA for MAA Claiming Revenue Compliance.

• Claiming Plan

• Approval Letter

14

• Fixed Route Bus System– 1.85 million annual revenue miles– 3.6 million boardings in FY13

• ACCESS Paratransit Services– 462,927 annual revenue miles– 70,927 boardings in FY13

• GCT’s paratransit is contracted out.

• Contract invoiced on a vehicle revenue hour (VRH) basis

• Cost per trip verified (CAFR)

17

• Patience. GCT’s first contact with the LGA was in October 2010. In FY 14 GCT successfully completed first reimbursement.

• FY 2011/12 Paratransit Operating Budget:$2,037,193 Expenses$ 243,898 Revenues (On-Board/Local Support)(per GCT CAFR for FY ending June 30, 2012)

• FY 12 reimbursement total added $96,217

18

Revenue may take awhile to be realized via reimbursement through the MAA

MAA revenue WILL fluctuate.

Recommend conservative MAA revenue forecasting.

19

20

Margaret Heath

Paratransit & Special Projects Manager301 E Third StreetOxnard, CA 93030

805.483.3959, ext 120

21

Thank you!