Legislative Updates

From Jean Jones
DVR/DVS Legislative Information Representative

2009 ~ 2008 ~ 2007

03-11-08

Transportation Alerts

Medicaid to End Medical Transportation for Some Beneficiaries

On February 22 the Centers for Medicare and Medicaid (CMS) issued a new rule that could result in elimination of transportation to medical services for some individuals on Medicaid. The proposed rule interprets a provision of the 2005 federal Deficit Reduction Act (DRA) which gives states added flexibility under Medicaid to design health plans as they wish. CMS interprets the increased flexibility to mean that states can design plans that look like or blend with private health insurance plans.

Before the passage of the 2005 DRA, states were required to offer at minimum a standard benefit package to Medicaid eligible populations. Non-emergency medical transportation - that is, transportation (when needed) to doctor appointments and other outpatient medical treatment - has been part of that standard Medicaid benefit package. The DRA added a new section 1937 to the Social Security Act. This section allows States to amend their Medicaid state plans to provide for the use of benefit packages other than the standard benefit package. These new more flexible benefit packages are called “benchmark” or “benchmark-equivalent” packages. The benchmark health plans can be offered to some Medicaid populations, but not all Medicaid eligible groups are required to enroll in such plans.

CMS in its narrative on the rule says it believes the new flexibility provided in the DRA can be combined with other tools available under Medicaid to strategically align the Medicaid Program with today's healthcare environment to expand access to affordable mainstream coverage; to promote personal responsibility for health and accessing
health care; and to improve quality and coordination of care.

Specifically, CMS writes: “A State has the option to amend its State plan to provide benchmark or benchmark-equivalent coverage without regard to comparability, statewideness, freedom of choice, the assurance of transportation to medically necessary services and other requirements in order to tailor and provide the coverage to individuals.”

CMS writes, “In order to maximize that flexibility (provided in the DRS), we are proposing to interpret the statutory clause ‘notwithstanding any other provision of this title’ to relieve States of the responsibility to assure transportation to and from providers, which is the regulatory requirement at 42 CFR 431.53 that is based on sections 1902(a)(4) and 1902)(a)(19) of the Act.”

The proposed rule further states, “Generally, private health insurance plans do not offer non-emergency medical transportation as a benefit to enrollees. It would be a strong disincentive for States to offer benchmark coverage through private health insurance plans if States had to supplement benchmark benefit plans with additional transportation benefits.”

Under the DRA, a state may not require persons to enroll in a lower-benefit benchmark or benchmark-equivalent health plan if the individual belongs to one of these Medicaid populations:

• Pregnant women required to be covered under the state plan,
• Blind or disabled individuals,
• Dual eligibles (receiving both Medicaid and Medicare),
• Terminally ill hospice patients,
• Institutionalized persons,
• Medically frail persons,
• Children in foster care,
• Persons who are medically eligible for long-term care,
• Certain TANF parents, and
• Women in the breast and cervical cancer program.

Certain other Medicaid eligible groups can be required to participate in the “benchmark” plans. An example would be children and/or families with incomes slightly above 100% of poverty. Children eligible under the basic Medicaid program could be enrolled in the benchmark plans, but states would have to supplement the more meager benchmark plan coverage with screening, diagnosis and treatment (EPSDT) services required by law for children on Medicaid. It is unclear whether medical transportation would be provided to such children under the new rule.

Although it appears that many disabled Medicaid recipients will not face loss of medical transportation due to the new rule, there are likely to be some who are negatively affected. Examples could include individuals who acquire disabilities while covered under a benchmark health plan, and individuals who have not been determined disabled under SSI. VR agencies may have to fill the transportation gap for clients adversely affected by the Medicaid rule change.

LINK TO PROPOSED RULE: http://www.regulations.gov/fdmspublic/component/main?main=DocumentDetail&o=09000064803baf64 

Comments on the proposed CMS rule are due by March 24th.

How to submit comments:

In commenting, reference file code CMS-2232-P and the specific “issue identifier'' that precedes the section on which you choose to comment. To submit electronic comments on specific issues in the regulation go to http://www.cms.hhs.gov/eRulemaking. Click on the link “Submit electronic comments on CMS regulations with an open comment period.'' (Attachments should be in Microsoft Word, WordPerfect, or Excel; MS Word is preferred.)

By regular mail: You may mail written comments (one original and two copies) to the following address ONLY: Centers for Medicare & Medicaid Services, Department of Health and Human Services, Attention: CMS-2232-P, P.O. Box 8016, Baltimore, MD 21244-8016. Please allow sufficient time for mailed comments to be received before the close of the comment period.

State Legislation Affecting Transportation

HB-2947 by Rep. Scott Martin would increase from $3 million to $5 million the amount that is provided annually to the Public Transit Revolving Fund as a result of 2005 legislation (HB-1078) that allocated millions of dollars of state income tax revenue to road construction and maintenance, and a tiny amount to public transit and passenger rail. This bill passed the House General Government and Transportation Committee on 2-20-08. It must next pass the full House. The 2005 law said that income tax revenue going to roads could not be used to replace other state support for roads - such as annual appropriations or other transportation funds - but it did not make the same requirement to preserve other transit or rail funding. A question to ask: Will HB-2947 actually increase annual state funds to the Transit Revolving Fund, or will it merely allow appropriators or ODOT to reduce Transit Fund contributions from other funds?

Community Access: Walking in Oklahoma:

A survey of 501 cities to determine the "best walking city" in America ranks Oklahoma City dead last. The survey by Prevention Magazine and the American Podiatric Medical Association looked at the ten largest cities in each state and the District of Columbia and ranks Oklahoma City 501st.

The best walking city in Oklahoma among those surveyed is Stillwater which ranks 254th. Other Oklahoma cities in the ranking are Lawton at 300th; Edmond at 317th; Broken Arrow at 407th; Tulsa at 409th; Moore at 447th; Midwest City at 465th; Norman at 475th; and Enid at 496th.

The ratings are based on 14 walking criteria including the percentage of adults who walk to work, the number of parks per square mile, the use of mass transit and percentage of adults who walk for fitness. Survey results are available at http://www.prevention.com/cda/article/the-best-walking-cities-of-2007/6cd08169c1903110VgnVCM20000012281eac____/fitness/walking/walking.goals/walking.and.your.health?cm_mmc=Mag_URL-_-2007_April-_-This+Month+Online-_-cities+2007+best+walking+cities .

Have Your Say about Transportation in Central Oklahoma

Every four years the federal government visits Oklahoma City to review and certify how federal funds are used in this region for all forms of transportation. The same is done in the Tulsa area. Part of that visit is an open forum meeting called a “Listening Session.” Anyone in attendance has a moment at the microphone - an opportunity to speak about public transportation in Oklahoma and how Oklahoma’s transportation plans are serving our disability population. The listening session is scheduled for Tuesday, April 22, 4:30 p.m. at Springlake Metro Tech (Carousel Room). More information on this meeting with federal DOT officials is available from the Association of Central Oklahoma Governments (ACOG).