Maryland seeks Medicaid non-emergency medical transportation contractor – State of Reform

The Maryland Division of Well being (MDH) launched a request for proposals (RFP) this month for a non-emergency medical transportation (NEMT) contractor for the state’s Medicaid inhabitants. MDH intends to award a single contract award for a most interval of seven years.

The contract will fulfill necessities beneath the Code of Federal Laws, which mandates that states present NEMT to Medicaid-covered providers as a final resort when the participant has no different technique of transport. 

“The contractor is to guarantee entry to transportation for eligible and certified contributors to and from non-emergency Medicaid lined providers rendered by Medicaid suppliers in essentially the most price efficient and environment friendly clinically applicable transportation mode,” the RFP stated. 

For the previous 2 many years, Maryland has administered NEMT by the native well being departments in every of its 23 counties (with the addition of Baltimore Metropolis), totaling 24 jurisdictions. MDH pays for NEMT providers by pass-through grants. Federal funding additionally helps the NEMT program, with a 50% match of state funds. 

The RFP lists the development of transportation varieties this system would use, primarily based on sufferers’ medical wants. These embody a shared journey ambulatory car, shared ADA-accessible car, ambulance, interfacility switch for tertiary care, and air ambulance service transport. 

Over 946,000 NEMT journeys occurred in fiscal yr 2019, in line with the RFP. MDH sometimes spends $50 million yearly on the NEMT program. The COVID-19 pandemic considerably impacted operation numbers (there have been about 814,000 journeys in FY 2020 and solely 104,000 journeys in FY 2021, principally because of the elevated use of telemedicine). Nevertheless, the RFP notes that restrictions on in-person medical appointments have been lifted since July 1st, 2021. 

“Accordingly, for FY 2022 and past, it’s anticipated that transports will return to the pre-FY20 ranges,” the RFP stated. 

The awarded contractor will work with MDH’s Medicaid Modular Transformation (MMT) Mission to design and develop the procedures and data know-how wanted to offer NEMT providers. Throughout the first part of the operations and upkeep (OM) stage, which is estimated to final a most of 18 months from the contract begin date, the contractor should inaugurate NEMT providers in not less than 9 of the 24 jurisdictions. Throughout the second part, overlaying the 6 months following the completion of the primary part, the contractor should onboard the remaining jurisdictions. 

The NEMT contract can be a part of the Maryland Medicaid Enterprise Programs Modular Transformation (MMT) Program Administration Workplace (PMO), which works to revamp and modernize Maryland’s Medicaid Administration Data system (MMIS). MMT PMO is a multi-year mission anticipated to be totally applied in 2029.

“To efficiently administer the NEMT … the Contractor should seamlessly combine with the legacy MMIS,” the RFP stated. “To make sure that NEMT elements are correctly accounted for in MMT, the Contractor will need to have continuous illustration on MMT workgroups, steering committees, and many others. And because the MMIS transitions beneath MMT, the Contractor should, in lockstep, transition its interfaces and connectivity.”

A pre-proposal convention is scheduled for Sept. fifteenth at 1 p. Jap Time. Members should register by way of Attachment A of the RFP. Questions in regards to the RFP could also be despatched by the Non-Emergency Medical Transportation RFP Inquiry Kind.

Proposals are due on Nov. 1st at 4 pm Jap Time by way of the eMaryland Market Benefit (eMMA). The contract is anticipated to start on Feb. 1st, 2023.