The New York State Office of the Medicaid Inspector General (OMIG) has released Compliance Guidance for use by Transportation providers.
The routine identification of compliance risk areas, relating to the particular type of services being offered by Medicaid providers, is required for certain providers in accordance with the New York State Social Services Law Section 363-d and implementing regulations at 18 NYCRR Part 521. The purpose of the OMIG’s Compliance Guidance is to give examples of compliance risk areas that may be of particular concern to those providing Medicaid Transportation services.
The OMIG’s Compliance Guidance provides the following useful information:
A. Documentation Risk Areas
Do the transportation records contain all required information for each leg of the trip? Are electronic transportation records time-stamped (possible best practice), or do you utilize some other method to show that the records are contemporaneous with the services provided as required? Are transportation services being provided to or from a location where Medicaid covered services are provided?
B. Quality-of-Care Risk Areas
Are the vehicles used to provide transportation services properly maintained, registered, and/or licensed, inspected, and insured? Is personal assistance provided by the driver to the enrollee when necessary, as required? Is the mode of transportation provided designed and equipped to provide nonemergency transport that has wheelchair-carrying capacity, stretcher-carrying capacity or the ability to carry disabled individuals?
C. Billing and Payment Risk Areas
Is prior authorization obtained for all non-emergency transportation services? Is there a process in place to determine if enrollees are covered by a managed care or managed long term care plan that includes transportation within their scope of benefits? Is the correct driver license number and vehicle registration number of the driver and vehicle used to provide the transportation service indicated on the claim? For group rides, are mileage and tolls being claimed as allowed under Medicaid rules? Are all the required claim fields being completed? Are claims submitted in connection to actual services provided and not based on transportation rosters?
D. Credentialing and Workforce Risk Areas
Do all drivers who provide Medicaid transportation services have a valid driver’s license in the appropriate license class (e.g., Class E for taxi and livery drivers) on the date the transportation service is provided? Do all ambulette drivers maintain appropriate driver license endorsements? Do all ambulette drivers maintain 19A Certification as required under Article 19A of the Vehicle and Traffic Law? If applicable, are provider and drivers licensed by local Taxi and Limousine Commissions (e.g., NYC, Nassau and Westchester Counties have TLCs.)
The OMIG Compliance Guidance for Transportation providers is viewable here.
For more information, please contact the author, David R. Ross, who served as Acting New York State Medicaid Inspector General under governors Pataki and Spitzer, as well as General Counsel, Deputy Medicaid Inspector General, and Director of Audits and Investigations for the Office of the Medicaid Inspector General (OMIG). He has represented many Medicaid transportation providers in various matters and can be reached at (518) 462-5601 or via e-mail at firstname.lastname@example.org.