TennCare to bid out transportation services

Posted By | April 23, 2006 12:00 am

Kim Swindell Wood
In a move that has been decried by ambulance service directors in the Upper Cumberland as disregarding the welfare of TennCare recipients, the healthcare provider has announced it will be consolidating its non-emergency transportation services to a single vendor system.
TennCare officials announced several weeks ago bids for non-emergency transportation services would open in May 2006.
Non-emergency transportation services include picking up TennCare enrollees who have no other transportation to meet their scheduled doctor appointments. TennCare Bureau’s nine different managed care and behavioral healthcare organizations now provide non-emergency transportation, which all have varying transportation delivery systems.
However, Ron Bennett, White County Ambulance Service director, said this proposed change could not only cause a delay in services, but also cause a financial strain on the ambulance services in rural areas.
“We have approximately 85 counties that are like me,” said Bennett. “We keep just enough people to make everything flow. We don’t have a lot of overkill, and it’s taken years to develop this to where we’re at right now.
“We have services that are A-rated. The 14 Upper Cumberland counties, without an exception, are A-rated services, meaning that they have a paramedic on 95 percent of their runs whether it be a non-emergency or not.
“For years we’ve strived to have these A-rated services. Now, they’re proposing to take and bid this out.”
Marilyn Elam, communications director for TennCare Bureau, said, “You must keep things in perspective.”
“Transportation is less than 1 percent of our total program budget,” said Elam, “so obviously we’ve been dealing with some bigger issues from a fiscal perspective with a $650 million budget hole. Now that those are under control, we are now delving into some of the management areas of our program where we can really improve, and transportation is definitely an area where the program can improve.
“The single vendor is not going to have their own fleet of vehicles. They are going to contract with public transportation companies, with taxicab companies [and] with van services across the state to deliver the service. What the vendor will do – it’ll be at-risk. In other words, they will have financial incentive to use the least costly mode of transportation for that particular enrollee. They will also have a financial incentive to make sure that you don’t have a taxi cab driving somebody from Fentress County to Nashville for dialysis and then waiting on them for three hours and turning around and driving them back. There’ll be one vendor that can coordinate all of the services statewide.
“The single vendor would be in charge of scheduling, and they would have a centralized place for routing the transportation calls. They would create a more uniform and cost-effective system. One of the chief complaints we hear is that it’s just not managed appropriately. It’s more of just whoever they can get on the phone first.”
Bennett said TennCare wants to “do away” with the Community Health Service provider for each area. Upper Cumberland Human Resource Agency is the CSA for White County, as well as several other counties in the Upper Cumberland.
“UCHRA gets all the transports for this area,” said Bennett. “Now, we are sympathetic to two sides – the directors – and I speak for all of them. We all have the same feeling on it. We understand that certain things have happened, and they’ve used some transports that weren’t necessary, but it wasn’t necessarily the CSA’s problem.
Bennett said a typical ambulance costs approximately $225.
“The reason for that is if we could schedule them back to back to back, obviously we could drop them, but that’s not the way it’s done anywhere,” said Bennett.
Bennett said TennCare pays approximately $125 for an ambulance run, which leaves $100 that is still being subsidized by the county.
“One of the hardest things about the way they system works now is TennCare does not really have any direct control or direct link to the current delivery system, because it goes through our individual MCO’s (Managed Care Organization),” said Elam. We have nine of them, and they all do it nine different ways. In fact, there really isn’t consistency in billing. There isn’t consistency in data reporting or scheduling. Even in eligibility screenings there are inconsistencies across the board.
“One single vendor that reports to TennCare is something that we can keep a tighter auditing control over.”
However, Bennett is still concerned about the financial repercussions. Approximately 30 percent of the ambulance service’s budget is generated from TennCare. Approximately half of that 30 percent would qualify for the non-emergency runs. According to Bennett, the ambulance service could lose approximately $100,000 revenue annually if TennCare implements the single-vendor system.
When The Expositor spoke with Bennett on Wednesday morning, he said he received a fax late Tuesday afternoon stating TennCare had decided to “back off” on a portion of its proposal about the single-vendor system. The Expositor had interviewed Elam prior to Bennett’s receipt of the fax.

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