Non-Emergency Medical Transportation: A stitch in time saves nine
Non-Emergency Medical Transportation (NEMT) is a dedicated transportation service provided to patients and healthcare consumers who experience requisite challenges in availing of medical appointments. According to a CMS guidebook, transportation services were specified as essential Medicaid benefits when the program was created in 1966 to benefit those households or individuals not having a valid driver's license, not having a working vehicle, being unable to travel or wait for services alone, or having a physical, cognitive, mental, or developmental disability.
Medical appointments or other non-emergent treatment are typically the focus of NEMT services. According to the guidebook, CMS defines emergency care as "any incident that puts the health and life of a Medicaid member in serious jeopardy without prompt treatment." The organization also said, "Real emergencies arise when a beneficiary's medical needs are acute and owing to severe symptoms. Symptoms could be caused by a life-threatening incident like uncontrolled bleeding, a heart attack, a car accident, or other significant trauma." Hence, NEMT plays a significant role in avoiding fatal consequences.
According to a transportation survey, approximately 3.6 million people are unable to access medical care or are experiencing delays as a result of a lack of adequate medical transportation. Medical transportation is critical in bringing a patient to healthcare on time during a typical disaster, medical emergency, or other unexpected events. People either omit traveling or request near and dear but these aren’t reliable options especially if they are under time disciplined medical situations. At times, neglecting medical schedules can turn fatal.
In June 2020, an estimated 41% of U.S. adults had delayed or avoided medical care including urgent or emergency care (12%) and routine care (32%) because of concerns about COVID-19. Avoidance of urgent or emergency care was more prevalent among unpaid caregivers for adults, persons with underlying medical conditions, young adults, and persons with disabilities.
Before moving further, it is essential to understand the services available under both non-emergency and emergency services. So the patient and his close ones understand and differentiate the situation. When your medical demands are urgent, it is considered an emergency. Having a heart attack or being gravely hurt in a car accident are two examples. In such instances, you may be transported to the emergency room by ground (ambulance) or air (air ambulance) (medical flight). Emergency transportation does not require prior approval.
Though many people are clear regarding emergency service, the non-emergency indicators are faintly understood. A few common reasons for non-emergency medical transportation include:
Traveling to and from outpatient surgery
Post-surgery follow-up doctor’s appointments
Getting to physician check-ups without the help of family or friends
Transportation for errands or other routine tasks
But why do we need a dedicated NEMT service?
Taxis or mass public transits are not viable solutions for individuals who have undergone surgery or those who are incapacitated. Hence, they or their loved ones look forward to reliable non-emergency medical transportation as a potential alternative. Customized NEMT service eliminates the risk of missing doctor's appointments providing all age groups community for a variety of medical reasons adding comfortable rescheduling and seating.
A skilled medical expert picks up the client, assists them (from bedside if necessary) outside to the ambulance, automobile, shuttle, or van, and assures safe and timely transit to and from a doctor's appointment or other destination via non-emergency medical transportation (NEMT).
Relevant programs and benefits in the USA
Medicaid and Medicare non-emergency medical transportation initiatives (NEMT) are valuable benefits for people who need to commute to and from medical appointments but don't have access to a car. States are required by the Code of Federal Regulations to guarantee that eligible, qualifying enrollees have access to NEMT to transport them to and from providers.
Medicare is a healthcare insurance plan. Medical costs are reimbursed out of trust funds that persons who are covered have contributed to. It generally supports those over the age of 65, regardless of their income, as well as younger disabled people and dialysis patients. Patients pay a portion of hospital and other costs through deductibles. Non-hospital coverage requires only a little monthly cost. Medicare is a government-funded program. It is administered by the Centers for Medicare & Medicaid Services, a federal agency, and is essentially the same throughout the United States.
Medicaid is a government-funded assistance program. It caters to low-income people of all ages. In most cases, patients are not responsible for any of the expenditures associated with reimbursed medical expenses. Occasionally, a minor co-payment is required. Medicaid is a joint federal-state initiative. It differs from one state to the next. It is administered by state and municipal governments following federal principles.
Every state's Medicaid program, however, is unique. Furthermore, each state has the option of establishing and implementing Medicaid waiver programs to cover extra transportation needs. Waiver program rules can also differ from one state to the next, and even within one state's programs. Providers are responsible for understanding and adhering to the unique requirements that apply to each State in which they provide services, as well as each of the programs for which they provide services.
For Medicaid/care-eligible persons, the expense of emergency medical transportation is covered. Hence, the family needn’t worry about the expenses or the quality of the service. Most of the families (91%) are covered under health plans hence ensuring tension with medical transport at the right time and avoiding unnecessary delays.
Medicaid pays for trips to and from the doctor's office, the hospital, or any medical facility where Medicaid-approved care is provided. Because it does not require a medical emergency, this coverage is referred to as "non-emergency medical transportation." If you don't have a working automobile or a driver's license, Medicaid may be able to provide you with transportation. If you have a physical or mental disability or are unable to travel or wait for a trip alone, you may be qualified to get a ride. Depending on your specific condition and demands, coverage for these rides may vary. To qualify for a ride, you may need to seek approval from your state's Medicaid department.
States can either administer NEMT coverage authorization themselves or contract with another business, such as a transportation broker or a managed care company, to do so. Medicaid guidelines require the transportation provider to have a contract with the relevant entity before any services are provided, regardless of who controls NEMT coverage. Even if all other NEMT standards are completed, Medicaid payment will not be accessible if the provider is not under contract.
To ensure smooth NEMT experiences few government agencies develop a network, ensuring efficiency and time consistency. HBSS’s Qryde is one of their technology partners. Through Qryde, they invented Brokered Transportation Technology, which is used by large call centers across the country to manage coordinated transportation across various government departments, including the Center for Medicaid Services (CMS), the Department of Developmentally Disabled, Special Education, Early Intervention, Council on Aging Services, Adult Day Health Transportation, and, most recently, Veterans Transportation. The technology developed provides unique thoughts and approaches for saving millions of dollars in transportation expenditures in multiple states.
So next time you needn’t think twice to avail a health care service or neglect your constant body issues, we got you covered.
