MEDICAID NON-EMERGENCY TRANSPORTATION SERVICES Department of Community Health

1. MEDICAID NON-EMERGENCY TRANSPORTATION SERVICESDepartment of Community Health Presentation to HUMAN SERVICES TRANSPORTATION SUMMIT June 1, 2007 Lynette Baskett-Owens Contracts and Compliance Manager

2. DCH MISSION RESPONSIBLE HEALTH ACCESS Access to affordable, quality health care in our communities Responsible health planning and use of health care resources Healthy behaviors and improved health outcomes

3. Medicaid Non-Emergency Transportation Services In order for the Georgia Department of Community Health (DCH) to further achieve its mission, it is essential that Medicaid members be able to get to and from health care services provided under the Medicaid program. In accordance with the Code of Federal Regulation (CFR) (42CFR431.53), the Non-Emergency Transportation Service program (NET) provides medically necessary transportation for any Medicaid member who has no other means of transportation available to any Medicaid reimbursable service for the purpose of: • Receiving treatment • Medical evaluations • Obtaining prescription drugs • Medical equipment

4. Medicaid Non-Emergency Transportation Services Prior to State Fiscal Year 1997, DCH reimbursed on a fee-for-service basis for NET services to transport Medicaid members, which enabled them to receive necessary Medicaid covered services from enrolled Medicaid providers. Members were able to access these services on demand through direct contact with enrolled NET providers, the County Departments of Family and Children Services and the County Offices of the Division of Public Health. In State Fiscal Year 1997, DCH requested proposals for the implementation of a NET Broker system to administer and provide NET services for eligible Medicaid members. The State was divided into five (5) regions for NET services and a broker was sought for each of the five (5) regions. The program became operational on October 1, 1997.

5. Medicaid Non-Emergency Transportation Services The agreements from the original procurement for services ended in June 2000. The next procurement, in which service contracts became effective July 1, 2000, resulted in two (2) Brokers for the entire State. Those agreements ended in December 2006. As a result of another successful procurement effort there are three (3) Brokers who provide NET services throughout the state. The Brokers are responsible for: • Recruitment and contracts with transportation providers; • Payment administration; • Gatekeeping and verification of need; • Reservation and trip assignment; • Quality assurance; and • Administration oversight and reporting. The Brokers are paid a capitated rate for each eligible Medicaid member residing their region(s).

6. Georgia Non-Emergency Transportation Program CATOOSA FANNIN TOWNS RABUN DADE Region Color Guide North Region (44)* East Region (37)* Central Region (36)* Southwest Region (40)* Atlanta Region (2)* * Number of counties per region UNION MURRAY WHITFIELD GILMER WALKER HABERSHAM WHITE LUMPKIN STEPHENS GORDON CHATTOOGA PICKENS FRANKLIN NORTH DAWSON HART HALL BANKS BARTOW FORSYTH CHEROKEE FLOYD ELBERT JACKSON MADISON POLK BARROW CLARKE OGLETHORPE GWINNETT COBB PAULDING ATLANTA OCONEE HARALSON WILKES WALTON LINCOLN DEKALB DOUGLAS FULTON GREENE TALIAFERRO CLAYTON ROCKDALE COLUMBIA CARROLL MORGAN MCDUFFIE NEWTON HENRY FAYETTE WARREN RICHMOND JASPER PUTNAM COWETA HEARD BUTTS HANCOCK GLASCOCK SPALDING CENTRAL MERIWETHER JEFFERSON BURKE BALDWIN PIKE JONES LAMAR MONROE TROUP WASHINGTON UPSON JENKINS WILKINSON BIBB SCREVEN JOHNSON HARRIS CRAWFORD TWIGGS TALBOT EAST EMANUEL LAURENS TAYLOR PEACH MUSCOGEE BULLOCH EFFINGHAM BLECKLEY MARION HOUSTON TREUTLEN CANDLER MACON CHATTAHOOCHEE MONTGOMERY EVANS SCHLEY PULASKI DODGE DOOLY BRYAN WHEELER CHATHAM WEBSTER STEWART TOOMBS TATTNALL SUMTER WILCOX TELFAIR CRISP LIBERTY QUITMAN LEE LONG JEFF DAVIS TERRELL BEN HILL APPLING SOUTHWEST TURNER RANDOLPH IRWIN WAYNE MCINTOSH BACON COFFEE CLAY CALHOUN DOUGHERTY WORTH TIFT PIERCE EARLY BAKER ATKINSON GLYNN BERRIEN BRANTLEY WARE MITCHELL COLQUITT MILLER COOK LANIER CAMDEN SEMINOLE CLINCH CHARLTON DECATUR GRADY THOMAS BROOKS LOWNDES ECHOLS

7. Medicaid Non-Emergency Transportation Services • As of May 1, 2007, these NET regions ranged in size, by population, from approximately 161,665 to 318,085 Medicaid members. The current Brokers are: • North Region – Southeastrans,Inc. • Atlanta Region – Southeastrans, Inc. • Central Region – Southeastrans, Inc • East Region – LogistiCare, Inc. • Southwest Region –Southwest Regional Georgia Regional Development Center • The Broker system has proven to be a more effective and efficient means of providing transportation to our Medicaid members as opposed to the previous fee for service delivery model. The Broker system provides transportation services in areas of the state where there was no transportation for Medicaid members who had not other transport options prior to 1997. This system has also been successful in reducing and in most cases eliminating fraud and abuse of the NET services for the State of Georgia.