For Medicaid and Medicare patients, making it to an important medical appointment is not
always a simple process. There are transportation barriers preventing patients from
accessing care they desperately need. Introducing, non-emergency medical transportation
(NEMT).
First let’s start with what exactly is non-emergency medical transportation. NEMT is when
the patient’s medical needs are not immediate and the symptoms not severe. According to
the guidelines from the Centers for Medicare & Medicaid Services (CMS), NEMT is not for
life-threatening events like uncontrolled bleeding, heart attack, car accidents “or other
serious trauma [that] may cause the symptoms,”. NEMT providers may use wheelchair
vans, taxis, stretcher cars, and buses.
NEMTs play a crucial role for medical facilities, and of course, their patients.
For patients enrolled in Medicaid, the Code of Federal Regulations has long required that
states make sure that eligible and qualified Medicaid beneficiaries have NEMT to take them
to and from their medical appointments, and Congress clarified the statutory requirement
for this benefit in 2021.
A NEMT, like SendaRide, picks up, delivers, and then returns patients home from medical
appointments for non-emergency care. These transportation services are coordinated via
healthcare clinics. Federal regulations and guidelines for NEMT companies cover
everything from the criteria for drivers and vehicles used to defining the differences
between emergency and non-emergency care needs. However, states have some flexibility
in how they provide NEMT services.
Generally, Medicaid patients are qualified to receive NEMT if:
• They don’t hold a valid driver’s license.
• Their household has no working vehicle available.
• They’re unable to travel or wait alone for their medical care.
• They lack money for gas.
• They have a physical, mental, developmental and/or cognitive limitation.
The Medicaid program is the largest federal program for human services transportation,
spending approximately $3 billion annually on NEMT, the Transportation Research Board,
a part of the National Academies of Sciences, Engineering and Medicine, reports.
Additionally, NEMT is seen as a growth industry as the American population ages. By 2030,
Americans over the age of 65 will make up 21% of the population, up from the current
15%. And by 2060, 25% of Americans will be 65 and above, with the number of people 85
and older tripling.
SendaRide knows firsthand that NEMTs provide a critical service to healthcare providers
by reducing no-show appointments.
While NEMT regulations may vary from state to state, in general:
• NEMT providers need to have a signed contract with Medicaid to offer their
services to Medicaid patients.
• Billing Medicaid for “no-shows” is not allowed and is considered fraud.
• Additional payment for wait times is not covered.
• States may require preauthorization for NEMT services.
• States may require a small copayment, usually from $0.50 to $3.50.
• States may be granted a waiver that can limit NEMT services.
• States may contract with a third-party broker, use Medicaid’s managed care
contracts, or manage its NEMT program directly.
But there are also non-Medicaid patients who may use NEMT services. The Veteran’s
Administration and some private insurers have and do offer NEMT to their patients.
“Although hospitals and health systems traditionally have not focused on transportation
issues within their purview of care delivery, there is a growing recognition that improving
transportation access and support for patients can help improve health outcomes and
lower health costs,” a 2017 American Hospital Association (AHA) report noted.
For patients with extreme barriers to transportation to medical appointments, SendaRide’s
service is the difference between health and illness or even life and death. But how do you
access NEMT services provided by your state?
• Reach out to your provider to request the service.
• Use software designed to connect you with your local NEMT provider.
• A NEMT broker, if used in your state, acts as the central hub, matching
drivers with riders.
NEMT doesn’t only benefit patients. In 2019, Becker’s Hospital Review reported that 3.6
million adults “miss or delay non-emergency medical care annually due to transportation
barriers, and these patient no-shows result in serious financial consequences for health
systems each year.”
SendaRide assists hospitals and clinics in creating, implementing, and managing their
operating systems, knowing that for healthcare clinics to provide the appropriate patient
care and for patients to receive the care they require the first step is for the patient to
arrive on time for their next appointment.
Is your healthcare clinic looking for NEMTs? Contact SendaRide today, to reduce your noshow rates, and to provide the care your patients need