How Will the Updated Medicaid Guidelines Impact NEMT?

09/17/2021

Last updated: 10/16/2023

3 mins read

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NEMT providers across the nation could see their reimbursement rates increase massively in the near future. The Centers for Medicare and Medicaid Services (CMS) sent out an informational bulletin on July 12, 2021, detailing the provisions added to Medicaid’s transportation program, better known as NEMT. While it’s unclear exactly what will change and how soon, CMS has made clear the importance of providing transportation to and from covered services for Medicaid beneficiaries. As such, they’ve highlighted a few points that we broke down below.

How Will the New Guidelines Change Rates?

How will the new guidelines change rates?

We don’t know specifics yet, but depending on the state and region providers operate in, there could be an opportunity for huge rate increases. According to the bulletin, “… when determining and updating state plan rates for NEMT, states should evaluate and set the rates so that beneficiaries will have access to NEMT consistent with the availability of NEMT services to non-Medicaid individuals in geographic areas of the state.” Essentially, Medicaid wants to ensure that there is adequate access and availability of its services for all who need it, with no financial barriers or geographic limitations. Additionally, they want to assure that “… payments are consistent with efficiency, economy, and quality of care and are sufficient to enlist enough providers so that care and services are available under the plan at least to the extent that such care and services are available to the general population in the geographic area.” In a nutshell, if providers aren’t paid a sufficient amount, states run the risk of losing providers, and therefore could run into a staff shortage within the NEMT industry—much like we’re currently seeing in the US service industry.

What Additional Changes are Coming?

Along with potential rate increases, CMS added a new provision specifying driver and provider requirements, which you can read below:

(A) Each provider and individual driver is not excluded from participation in any federal health care program and is not listed on the exclusion list of the Inspector General of the Department of Health and Human Services;

(B) Each such individual driver has a valid driver’s license;

(D) Each such provider has in place a process to disclose to the state Medicaid program the driving history, including any traffic violations, of each such individual driver employed by such provider, including any traffic violations.

Upgrade Your Software to Improve Your Business

There’s no telling when exactly these rate increases will appear, but there’s a way you can improve your business right now: by investing in non-emergency medical transportation software. If you’re ready to boost your company’s efficiency, schedule your free demo with RouteGenie to see our software in action!