A 7329: Relates to transportation management brokers; provides that transportation management brokers are no longer required to manage the transportation services for Medicaid beneficiaries.

  
  STATE OF NEW YORK ________________________________________________________________________ 7329 2025-2026 Regular Sessions  IN ASSEMBLY March 25, 2025 ___________ Introduced by M. of A. PRETLOW -- read once and referred to the Commit- tee on Health AN ACT to amend the social services law, in relation to transportation management brokers The People of the State of New York, represented in Senate and Assem- bly, do enact as follows: 1 Section 1. Subdivision 4 of section 365-h of the social services law, 2 as amended by section 2 of part LL of chapter 56 of the laws of 2020, is 3 amended to read as follows: 4 4. [(a)] The commissioner of health is authorized to assume responsi- 5 bility from a local social services official for the provision and 6 reimbursement of transportation costs under this section. If the commis- 7 sioner elects to assume such responsibility, the commissioner shall 8 notify the local social services official in writing as to the election, 9 the date upon which the election shall be effective and such information 10 as to transition of responsibilities as the commissioner deems prudent. 11 The commissioner is authorized to contract with a transportation manager 12 or managers to manage transportation services in any local social 13 services district, other than transportation services provided or 14 arranged for enrollees of managed long term care plans issued certif- 15 icates of authority under section forty-four hundred three-f of the 16 public health law. Any transportation manager or managers selected by 17 the commissioner to manage transportation services shall have proven 18 experience in coordinating transportation services in a geographic and 19 demographic area similar to the area in New York state within which the 20 contractor would manage the provision of services under this section. 21 Such a contract or contracts may include responsibility for: review, 22 approval and processing of transportation orders; management of the 23 appropriate level of transportation based on documented patient medical 24 need; and development of new technologies leading to efficient transpor- 25 tation services. If the commissioner elects to assume such responsibil- EXPLANATION--Matter in italics (underscored) is new; matter in brackets [ ] is old law to be omitted. LBD09047-01-5 
 A. 7329 2 1 ity from a local social services district, the commissioner shall exam- 2 ine and, if appropriate, adopt quality assurance measures that may 3 include, but are not limited to, global positioning tracking system 4 reporting requirements and service verification mechanisms. Any and all 5 reimbursement rates developed by transportation managers under this 6 subdivision shall be subject to the review and approval of the commis- 7 sioner. 8 [(b)(i) Subject to federal financial participation, for periods on and 9 after April first, two thousand twenty-one, in order to more cost-effec- 10 tively provide non-emergency transportation to Medicaid beneficiaries 11 who need access to medical care and services, the commissioner is 12 authorized to contract with one or more transportation management 13 brokers to manage such transportation on a statewide or regional basis, 14 as determined by the commissioner, in accordance with the federal social 15 security act as follows: 16 (A) The transportation management broker or brokers shall be selected 17 through a competitive bidding process based on an evaluation of the 18 broker's experience, performance, references, resources, qualifications 19 and costs; provided, however, that the department's selection process 20 shall be memorialized in a procurement record as defined in section one 21 hundred sixty-three of the state finance law; 22 (B) The transportation management broker or brokers shall have over- 23 sight procedures to monitor Medicaid beneficiary access and complaints 24 and ensure that enrolled Medicaid transportation providers are licensed, 25 qualified, competent and courteous. 26 (C) The transportation management broker or brokers shall be subject 27 to regular auditing and oversight by the department in order to ensure 28 the quality of the transportation services provided and adequacy of 29 Medicaid beneficiary access to medical care and services. 30 (D) The transportation management broker or brokers shall comply with 31 requirements related to prohibitions on referrals and conflicts of 32 interest required by the federal social security act. 33 (ii) The transportation management broker or brokers may be paid a per 34 member per month capitated fee or a combination of capitation and fixed 35 cost reimbursement and the contract shall include, but not be limited 36 to, responsibility for: 37 (A) establishing a network of high-quality Medicaid enrolled provid- 38 ers; provided, however, that in developing such network the transporta- 39 tion management broker shall evaluate the qualifications of current 40 Medicaid transportation providers on a priority basis for participation 41 in its network, and leverage reputable transportation providers with a 42 proven record of serving Medicaid beneficiaries with high-quality 43 services; 44 (B) continuing outreach to Medicaid enrolled providers to assess and 45 resolve service quality issues; 46 (C) developing mandatory corrective actions for any Medicaid enrolled 47 provider that falls under quality performance standards; 48 (D) establishing a prior approval process which shall include verify- 49 ing Medicaid eligibility and reviewing, approving and processing trans- 50 portation orders; 51 (E) managing the appropriate level of transportation based on docu- 52 mented patient medical need to ensure that Medicaid beneficiaries are 53 using the most medically appropriate mode of transportation, including 54 public transportation, which shall be maximized statewide, including in 55 rural areas; provided that when determining the appropriate level of 56 transportation, the transportation management broker shall ensure that 
 A. 7329 3 1 patients have reasonable and timely access to medically appropriate 2 transportation services; 3 (F) implementing technologies to effectuate efficient transportation 4 services, such as GPS, to improve match to mode of transportation; 5 (G) establishing fees to reimburse enrolled Medicaid transportation 6 providers; 7 (H) adjudicating and paying claims submitted by enrolled Medicaid 8 transportation providers; 9 (I) reporting on performance encompassing all aspects of the transpor- 10 tation program, including but not limited to Medicaid beneficiary 11 complaints including the length of time to make a compliant, wait times 12 related to the receipt of services by a recipient, and tracking medical 13 justifications to modes of transportation provided; 14 (J) collaborating with Medicaid beneficiaries and consumer groups to 15 identify and resolve issues to increase consumer satisfaction; 16 (K) auditing cancellation data on a quarterly basis to ensure accura- 17 cy; 18 (L) coordinating medical benefits and transportation with Medicaid 19 managed care organizations, including development of value based 20 payments for transportation services; and 21 (M) such contracts shall include penalties for incorrect denials, 22 unresolved complaint rates, unfulfilled trips, and any other criteria 23 determined by the commissioner and specified in the competitive bidding 24 process. 25 (iii) A transportation management broker with which the commissioner 26 contracts shall file with the commissioner a bond issued by an insurer 27 authorized to write fidelity and surety insurance in this state, in an 28 amount and form to be determined by the commissioner. The purpose of the 29 surety bond shall be to provide the sole source of recourse to providers 30 of Medicaid transportation services, other than the transportation 31 management broker, that cannot receive payment for services properly 32 provided if the transportation management broker becomes insolvent. To 33 the extent permitted by law, the surety bond shall provide that any 34 funds that remain after such provider liabilities are satisfied shall be 35 paid to that state. 36 (iv) A transportation management broker with which the commissioner 37 contracts shall provide to Medicaid enrolled providers annually a 38 conspicuous written disclosure that states the following: "The New York 39 State Department of Health has contracted with this transportation 40 management broker to arrange non-emergency transportation for Medicaid 41 beneficiaries who need access to medical care and services and is paying 42 the transportation management broker a per member per month capitated 43 fee or a combination of capitation and fixed cost reimbursement. This 44 transportation management broker is not licensed by the New York State 45 Department of Financial Services as an insurer and is not subject to its 46 supervision as an insurer. This transportation management broker is not 47 protected by New York security funds and there will not be any right to 48 recover against the department of health, department of financial 49 services, or this state in the event of the transportation management 50 broker's insolvency. 51 (v) To the extent practicable, the competitive bidding and contracting 52 process maybe completed by April first, two thousand twenty-one; 53 provided, however, such contract may be effective at some date after 54 April first, two thousand twenty-one, if the process takes longer to 55 complete. 
 A. 7329 4 1 (vi) Responsibility for transportation services provided or arranged 2 for enrollees of managed long term care plans issued certificates of 3 authority under section forty-four hundred three-f of the public health 4 law, not including a program designated as a Program of All-Inclusive 5 Care for the Elderly (PACE) as authorized by Federal Public law 1053-33, 6 subtitle I of title IV of the Balanced Budget Act of 1997, and, at the 7 commissioner's discretion, other plans that integrate benefits for dual- 8 ly eligible Medicare and Medicaid beneficiaries based on a demonstration 9 by the plan that inclusion of transportation within the benefit package 10 will result in cost efficiencies and quality improvement, shall be 11 transferred to a transportation management broker that has a contract 12 with the commissioner in accordance with this paragraph. Providers of 13 adult day health care may elect to, but shall not be required to, use 14 the services of the transportation management broker.] 15 § 2. Paragraph (a) of subdivision 6 of section 365-h of the social 16 services law, as added by section 4 of part LL of chapter 56 of the laws 17 of 2020, is amended to read as follows: 18 (a) The commissioner of health shall require transportation providers 19 enrolled in the Medicaid program and specified by the commissioner 20 pursuant to regulation, to report the costs incurred in providing trans- 21 portation services to Medicaid beneficiaries pursuant to this section[; 22 provided, however, this requirement shall only apply if there is no 23 transportation management broker contract authorized in subdivision four 24 of this section]. The commissioner shall specify the frequency and 25 format of such reports and determine the type and amount of information 26 required to be submitted, including supporting documentation, provided 27 that such reports shall be no more frequent than quarterly. The commis- 28 sioner shall give all transportation providers no less than ninety 29 calendar days' notice before such reports are due. 30 § 3. This act shall take effect immediately; provided, however that 31 the amendments to subdivisions 4 and 6 of section 365-h of the social 32 services law made by sections one and two of this act shall not affect 33 the expiration and reversion of such section pursuant to subdivision (a) 34 of section 40 of part B of chapter 109 of the laws of 2010, as amended.