Cumberland Times-News

Local News

December 2, 2013

Brokerage firm bids threaten nonemergency medical transportation

PETERSBURG, W.Va. — The manager of the Potomac Valley Transit Authority is waiting to see how proposals to the state from brokerage firms will impact services for nonemergency medical transportation to Medicaid recipients.

The West Virginia Department of Health and Human Resources will open transportation bids from brokerage firms Friday.

Among those who may feel the financial brunt of the decision are the PVTA, the Hampshire County Special Services Center riders and their families, and other nonemergency transporters such as ambulances.

Many people with Medicaid are eligible for nonemergency transportation and the Affordable Care Act will increase the numbers of Medicaid-eligible people dramatically.

PVTA transports daily more than a dozen workers to and from the Developmental Center and Workshop in Keyser and more than 30 riders daily to the Hampshire County Special Services Center in Romney.

PVTA also transports people to doctor’s appointments throughout the five-county operating areas.

“We bill the state on the basis of the current reimbursement schedule, which is $9 the first 15 miles and 66 cents for each additional mile,” Jay Carter, manager of PVTA, said Monday.

Carter said the state spent $25.5 million for nonemergency transportation in the most recent fiscal year.

The problem that has surfaced is fraud.

“There are people who schedule transportation for a doctor’s appointment and go shopping at Walmart, for instance. Medicaid is trying to get a control on that,” Carter said.

Carter said that a brokerage firm is a “for-profit operation” and reducing the amount of services would increase their profit.

Brokerage firms charge on a capitated rate, or fixed amount of money per patient.

The amount is determined by the ranges of services that are provided, the number of patients involved, and the period of time during which the services are provided.

The broker does not provide the actual transportation service. It contracts with people like PVTA and VIP limousine.

“It’s to the broker’s advantage to pay as little as possible and to reduce the amount of transportation offered,” Carter said.

“First they will take a look at the request for transportation to see if the service is available closer to the doctor. Then they will look to see if the transportation is necessary and will look at the availability of other transportation. They will determine if other transportation is available and finally if the service is eligible.

A waiver program for HCSSC workers has a reimbursement of $8.31 to the center and $8.31 from the center.

“The state can tell the broker they want to see the present reimbursement maintained,” Carter said.

“What we’d like to see done is to continue the service as we have done in the past years, a reimbursement of $9 for the first 15 miles and 66 cents each additional mile. My fear is they may do it under the waiver of $8.31 for a one-way trip,” said Carter.

“I don’t know if we can afford to do that.”

The impact to PVTA will trickle down to the workers at HCSSC and then to the clients they service.

Carter said after the bids are opened, the DHHR will review the services provided by the brokers and score them accordingly.

“Then they will look at the financial aspect. The bid will not necessarily go to the lowest bidder,” Carter said.

He said the DHHR will look at the broker’s history of services as well.

“From what I’ve been told they want to see this come into play as early as the first of April, or the latest the first of July,” Carter said.

Contact Marla Pisciotta at marlapisciotta@

fronter.com
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