Rhode Island Medicaid NonEmergency Medical Transportation Program Rhode

Rhode Island Medicaid Non-Emergency Medical Transportation Program Rhode Island House Committee on Oversight March 23 rd, 2017

Background of NEMT in RI Prior to State Transportation Broker Contract v RIPTA provided non-Emergency Medical Transportation (NEMT) services between their Fixed Routes and Elderly Paratransit contracts. v RIPTA subcontracted with taxi companies v Highest level of service provided was wheelchair v Ambulance service coordinated through EOHHS v RIPTA invoiced State monthly for the services under the various categories for set amount per ride v Bus passes previously received at supermarket (Logisti. Care assumed responsibility in December of 2014) Changes Needed v CMS required Medicaid to contract with NEMT Broker to ensure transportation services met medical necessity criteria v Improved network coverage and better coordination of transportation services 2

Background of NEMT in RI State Broker Procurement Model v. NEMT Broker Procurement completed in late 2013 v. Five bids –successful vendor was Logisti. Care v. Logisti. Care currently operates in 42 states Current Logisti. Care Contract • Three year-fully capitated arrangement with actuarial set rates for Medicaid Population Category Capitation Payment * Elderly Program Non-Medicaid Total 3 Contract Period 1 SFY 2014 (2 months) (May 1, 2014 June 30, 2014) Contract Period 2 SFY 2015 (12 months) (July 1, 2014 June 30, 2015) Contract Period 3 SFY 2016 (12 months) (July 1, 2015 June 30, 2016) Contract Period 4 SFY 2017 (12 months) (July 1, 2016 June 30, 2017) Total Contract Period (38 months) (May 1, 2014 – June 30, 2017) $ 3, 989, 392** $ 24, 452, 816** $ 24, 866, 308** $ 24, 955, 475** $ 78, 263, 991 $400, 000 $ 2, 400, 000 $ 7, 600, 000 $ 4, 389, 392 $ 26, 852, 816 $ 27, 266, 308 $ 27, 355, 475 $ 85, 863, 991 *Capitation payment is equal to the contracted member months estimates times the agreed upon contracted price per member. (Per Member Per Months) PMPMs currently for the SFY 17: Rite Care & Medicaid Expansion Populations at $7. 07 Aged/Blind/Disabled population at $ 22. 99 CNOM at $20. 64. Elderly program has a fixed annual funding of $2. 4 million. ** Estimates –Actual amounts based on number of members

Medicaid NEMT Utilization Trips by Treatment Types-Annual CY 2016 Medicaid NEMT Populations Average Membership RIte Care, Medicaid Expansion Age, Blind, Disabled CNOM Total SFY 2015 SFY 2016 207, 165 219, 083 (80. 9%) (81. 5%) 46, 833 48, 406 (18. 3%) (18%) 2, 069 1, 467 (. 8%) (. 5%) 256, 067 268, 956 (100%) Increase 5. 0% Clinic Visits 2% Mental Health 3% Follow Up All Other Visits 13% Visits 3% [CATEGORY NAME] [PERCENTAGE] Substance Abuse 48% Dialysis 5% Trip Volume SFY 2015 SFY 2016 (Including Mass Transit) RIte Care, Medicaid Expansion Age, Blind, Disabled CNOM Total 4 616, 092 725, 568 (51%) (50. 3%) 510, 180 638, 412 (42. 2%) (44. 3%) 82, 128 77, 148 (6. 8%) (5. 3%) 1, 208, 400 1, 441, 128 (100%) Increase 19. 3% Adult Daycare 24% *All other visits include: TANF Specialized Transportation for Medical Appointments, Physical Therapy, Physician Services, Psychiatry, Dental, Social Care Counseling and Eye Doctor

Non-Medicaid Elderly NEMT Utilization Trips by Treatment Types -CY 2016 Non-Medicaid Elderly Population Average Unduplicated Total Elderly SFY 2015 SFY 2016 1, 315 1, 537 Increase 16. 90% Clinic Visit Physician 2% Services 2% Follow Up Visits 5% All Other* 11% Dialysis 30% Trip Volume (Including Mass Transit) SFY 2015 SFY 2016 118, 644 Specialist Visit 13% 149, 868 Increase 26. 30% Adult Daycare 24% Elderly Meal Site 12% * All other visits are: Eye Doctor, Radiation Treatment, Wound Care, Substance Abuse, Cardiac Rehab and Routine Services 5

EOHHS Oversight • EOHHS holds bi-weekly face-to-face meetings with Logisti. Care to review operational, systems & financial functional areas, transportation provider network access, along with quality improvement activities. • EOHHS and Logisti. Care work closely on a day-to-day basis to discuss any challenges (access, weather, etc. ) that may have arisen. • Logisti. Care employs 60 individuals locally for the Customer Representative Center, Quality Assurance and Mass Transit Units. • Training programs for transportation providers and Logisti. Care’s staff are closely monitored. • EOHHS has an assigned team of individuals with various specialties to provide contract monitoring, and quality improvement & performance outcome oversight. • EOHHS is evaluating options to improve the quality of service for clients. 6

EOHHS Oversight • EOHHS and Logisti. Care report to several external committees and/or multi-agency groups. • Currently report monthly to a meeting hosted by the Alliance for Better Long Term Care (last Wednesday of the Month) • The Lt. Governor’s Long Term Care Coordinating Council (Monthly). • Upon request the EOHHS & Logisti. Care present to various groups as needed. • • • 7 May 2016 – Logisti. Care Outreach Meeting with SA MH Leadership Council RI March 2016 – Training for Nurse Care Managers at Neighborhood Health Plan RI (Several multi sessions) December 2015 – Transportation Outreach at Miriam Hospital (HIV Program) April 2015 – Neighborhood Health Plan of RI Presentation June 2014 – Transportation Outreach at RI Partnership for Home Care at Pocasset Bay (NW Links) June 2014 – DEA sponsored the Academy training for “information and referral” specialists – Johnston Senior Center.

Complaint Data • Consistent with the provisions of its contract with EOHHS, Logisti. Care tracks and manages complaints filed against its service delivery. • During this SFY 16, Logisti. Care logged 11, 868 complaints in providing both Medicaid and non-Medicaid Elderly transportation services. • These complaints represent roughly 1% of all trip reservations made during this twelve month period. SFY 16 Driver Complaints Type of Complaint Transportation Provider Late Transportation Provider No Show Logisti. Care Employee Issue No Vehicle Available (NVA) Transportation Provider Early Transportation Provider (possible) Fraud & Abuse Logisti. Care Issue Injury Vehicle Issue (e. g. , AC, heat, etc. ) Issue with a Facility Rerouted out of time Wheelchair tie down issue Transportation Provider (not one of the above) 8 Total Reported Incidents 3122 754 183 132 125 SFY 16 Rider Complaints Percentage Rider Complaints Reported Incidents Percentage 56. 90% 13. 80% 3% 2. 40% 2. 30% Rider No Show 5199 81. 40% Rider Issue (Complaint about Rider) 1098 17. 20% Rider Fraud and Abuse 88 1. 40% Total 6385 100% 80 1. 50% 69 44 23 13 11 7 1. 20% 0. 80% 0. 40% 0. 23% 0. 20% 0. 10% 920 16. 80% 5483 100%

Performance Standards • The State may hold back up to 2% of monthly payments if Broker’s performance falls bellow quality standards, including but not limited to the standards listed below: Activity Standard Average Speed of Answering call per month Exceeds 3: 00 minutes Percent of Calls Abandoned per month Exceeds 20% Percent of Trips Unfulfilled per month Exceeds 5% Percent of Trips with valid Complaints per month Exceeds 5% • To date, Logisti. Care has substantially met these standards and EOHHS has not withheld monthly payment due to poor performance. 9

Logisti. Care Financial Statements Medicaid Population Only Capitation Premium Paid Total Premium % Change Costs of Transportation Providers Gross Profit (Loss) % Change Administrative Expenses % Change 10 Non-Medicaid Elderly Population Only ($ millions) SFY 2015 2016 $ 30. 3 $ 32. 3 6. 6% $ 20. 1 $ 10. 2 $ 4. 4 $ 22. 5 $ 9. 8 -3. 9% $ 4. 8 9. 1% Pre-Tax Profit (Loss) $ 5. 8 $ 5. 0 After-Tax Profit (Loss) $ 3. 5 $ 3. 0 % of Total Premium 11. 5% 9. 3% ($ millions) SFY 2015 2016 Funding ($200, 000 x 12 months) $ 2. 4 Total Funding $ 2. 4 % Change 0. 0% Costs of Transportation Providers $ 3. 0 $ 3. 6 Gross Profit (Loss) $ (0. 6) $ (1. 2) % Change 100. 0% Administrative Expenses $ 0. 4 % Change 0. 0% Pre-Tax Profit (Loss) $ (1. 0) $ (1. 6)* After-Tax Profit (Loss) $ (0. 6) $ (1. 0) % of Total Premium -25. 0% -40. 0% * Additional Funding Needed to Keep Program Operational. * With Premiums of $2. 4 million, the non-Medicaid Elderly Transportation Program runs out of funds within seven to eight months (January or February) * Current funding needed in estimated at $1. 6 million (with 2%-3% annual growth increase

Deborah Florio Deputy Medicaid Director EOHHS 401. 462. 0140 Florio. deb@ohhs. ri. gov