We Will Correct America.
All Legals Process Needs Times Knowledge and FUNDs
THE UNDENIABLE PETITION NEEDS YOUR SUPPORT
ONE MOVEMENT FOR WIN-WIN-WIN PROJECT
INTRODUCTION
The proposal for submission to the MEDCAC committees requests a definitive decision regarding the widespread adoption of Non-Emergency Medical Transportation (NEMT). This initiative stems from the recognized efficacy of NEMT as an investment for insurance providers, primarily due to its proven ability to mitigate missed medical appointments, which are a significant contributor to increased medical expenditures, increasing Insurance Providers' Profitability.
The "One Movement For Win-Win-Win Project" petition will articulate the rationale for this transition and challenge the antiquated position of Medicare and MEDCAC committees in their reluctance to include NEMT within the National Coverage Determination (NCD).Thereby freeing our Hospitals and Healthcare Providers from a victim status.
#SILENCE VICTIMS HosPITALS & Healthcare PROVIDERS
Annually, audiences receive correspondence from their insurance providers as health check-up vouchers or incentives of $25-$50 for hospital check-ups, representing a reallocation of profits back to policyholders. Their applicability towards NEMT fees further augments the value of these vouchers, as an additional client incentive could magnetize clients to become policyholders for each policy.
Current Policy
Annual Cost: Business Expenses + Total Annual Payout + $150 billion.
Adding NEMT into the Insurance Provider's National Coverage Determination(NCD),
Revised Policy
Annual Profit: (Current Profit + $150 billion) - Cost of NEMT services
The formulation above demonstrates increased profitability for insurance providers. These allocated funds benefit the insurance providers directly, not hospitals or other healthcare institutions. Therefore, it is unjust to maintain a system where organizations that receive no benefit are burdened with the costs, especially after COVID-19 inflation and the New Government Healthcare System budget cuts. Hospitals in the system are calling out for help. Are we hearing them?
The provision of health check-up incentives constitutes a corporate investment. Research indicates that individuals who undergo two health check-ups annually are less likely to experience illness, resulting in healthier policyholders. From an economic standpoint, healthier insurers result in reduced payouts; conversely, lower payouts are more profitable.
NEMT mirrors the strategic value of health check-up vouchers, despite their confirmed importance by Medicaid. The TCN document issued by Medicaid (Attached in Appendix A) serves as a legal foundation, aligning with this petition, and demonstrates that many insurance providers have overlooked NEMT's potential as a return on investment. However, this method offers a practical means to decrease company payouts. Missed medical appointments can result in unpredictable and potentially terminal medical bills. Therefore, investing in this useful method is imperative.
The current ambiguity surrounding medical transportation classifications, coupled with the miscategorization of services, has obscured the clear vision of otherwise astute providers. Various terms, including "Emergency Ambulance," are used to describe services with the singular objective of patient transport for life-saving purposes, while simultaneously diminishing insurance providers' ability to deny coverage. This constitutes a legitimate investment strategy to reduce payouts and enhance profitability. The healthcare system must refine its definition of medical transportation and restrict it to two distinct categories. (The correction is provided in the next section.)
Both Emergency-Ambulance and NEMT serve as legally sanctioned investment methods for insurance companies to mitigate increases in medical expenditures. Insurers must acknowledge that reduced payouts directly correlate with increased profitability within this industry. We advocate for a fact-based approach to guide the healthcare system towards a just and equitable direction—failure to address systemic flaws results in millions of unfairly processed transactions, impacting innocent parties. We invite victims who have silently borne these penalties, as well as hospitals and healthcare providers, to share their perspectives in the comments. America awaits your input. Seeking approval from the MEDCAC committee for our petition is a complex and time-intensive undertaking that requires substantial financial support to succeed. We are actively fundraising to advance this critical initiative.
Our goal is to persuade MEDCAC to include Non-Emergency Medical Transportation (NEMT) in the National Coverage Determination (NCD), benefiting all stakeholders:
- Hospitals and healthcare providers will be relieved of the financial burden of associated transportation fees.
- Insurance Providers: Will see a return on investment through increased profitability after providing upfront NEMT coverage.
- Patients (Current and Future): Will gain access to medical transportation for appointments, preventing increased medical bills and improving health outcomes. Improved patient health, in turn, enhances profitability within the healthcare insurance framework.
- NEMT Service Providers: Your service will be recognized by US healthcare law as the market shifts towards the most optimal and reliable service at an economical cost, positioning your company as a leader in the sector.
THE EXECUTIVE SUMMARY
Upon reviewing the Petition, it becomes evident that all stakeholders within the healthcare system bear some responsibility for the systemic flaws originating from the highest levels of authority down to the operational front lines. However, once a viable solution is identified to rectify these shortcomings, it becomes imperative to embrace it. Without such a solution, self-reproach would persist indefinitely. Given the availability of a Win-Win-Win Solution, there is no justifiable reason to abstain from its implementation.
#WHY THE RELUCTANCE PERSISTS
CMS: Upfront Cost Aversion: Even with strong ROI projections, the initial, visible cost of adding a universal NEMT benefit to Original Medicare is a substantial political hurdle. It would require significant new appropriations or a reallocation of existing funds.
“Siloed" Budgeting: Healthcare spending is often budgeted in silos. The "savings" from NEMT (e.g., fewer hospitalizations) might accrue to one part of the budget. At the same time, the "cost" of NEMT would appear in another way, making the overall ROI harder to track and politically justify.
The Argument
The Petitioner: Incorporating Non-Emergency Medical Transportation (NEMT) into the National Coverage Determination (NCD) is considered a sound Return on Investment (ROI). For every dollar advanced by Insurance Providers for NEMT annually, all insurance companies will realize an increase in investment funds and higher profitability by year-end. All theoretical frameworks and real-world applications, extensively tested by Medicaid for decades, confirm that "NEMT is a practical method for Insurance Providers to increase profitability through ROI." According to the Uber Health Professional Report 6 million patients missed their medical Appointments and that led to cost after missed appointments from the disease didn’t taking care on time and other symptoms of those patients worsened, and it’s creasing cost amount $150 billions dollars, Comparing with the Medicaid reported the amount of NEMT fees in 2018 cost $2.9 billion dollars. Now Medicare already covers NEMT for enrollees in Part C if it covers every part A, B, and C. It's estimated 3 times from the NEMT fees that Medicaid spent for their clients in 2018, $2.9 billion dollars x 3 = $8.7 billion dollars estimates. CMS and The Committee must see the same as the petitioner. The amount that we are not moving costs us $150 billion dollars, the cost of moving is Medicaid NEMT fees $2.9 billion dollars + Medicare All parts A, B and C $8.7 billion dollars = $11.6 billion dollars total. This amount is far apart from the number we are losing if we do not move forward.
The Argument
The Petitioner: To proactively address concerns regarding the definition of 'routine' NEMT and to prevent fraud, the proposed NEMT/LMT benefit is directly tied to verified medical appointments.
* Verification of Medical Necessity: NEMT/LMT coverage would be exclusively authorized for transportation from a beneficiary's verified home address to a confirmed, scheduled medical appointment at a hospital, clinic, or physician's office, and for the return trip to their home address on the same day.
* Preventing Patient Self-Scheduling: Beneficiaries would not self-schedule NEMT. Instead, all NEMT/LMT services must be coordinated and scheduled through a designated healthcare dispatcher, who verifies the existence and nature of the medical appointment directly with the healthcare provider. This crucial step prevents misinterpretation of 'routine' and ensures that NEMT/LMT is used solely for its intended purpose: ensuring access to care.
* Transparent Trip Logging: Each NEMT/LMT trip would correspond with the hospital or provider's billing on the same day, creating an essential audit trail and further limiting the scope to genuine, medically-related travel.
This rigorous, appointment-driven framework effectively defines 'routine' NEMT and inherently controls and screens trips to ensure their legitimacy, making fraud prevention an integral part of the process rather than a separate concern."
Key changes and why they're effective:
* Direct Link to Confirmed Appointments: This is the strongest point for defining "routine" and preventing fraud. It's objective and verifiable.
* Healthcare Dispatcher Role: Emphasizes that it's not patient-initiated, but professionally coordinated, which addresses the "patients lack requisite knowledge" point more professionally.
This directly refutes the committee's reluctance by demonstrating that fraud is not an ancillary consideration, but rather an inherent component of the system's design.
Furthermore, subsequent to the enactment of new legislation, the Petitioner has rectified this aspect within the system's correction of existing confusion. Through regulation, medical transportation must now be scheduled based on the patient's symptoms; the system does not permit patients to self-schedule medical transportation, as patients lack the requisite knowledge in this area, which could lead to a wasteful expenditure of funds within the system. NEMT is rigorously scheduled by a coordinated healthcare dispatcher. Medicare adopted insights regarding Non-Emergency Medical Transportation (NEMT) from Medicaid's experience. Reports from Medicaid programs in various states indicated instances of fraudulent transactions. An analysis of the 2018 report by The Office of Inspector General (OIG) revealed that certain states did not mandate brokers, drivers, or agencies to retain trip data. The Auditing Department will proactively eliminate and prevent such occurrences in real-time. The report from state agencies also identified a lack of comprehensive information. State agencies lacked the authority to approve or disregard receipts or trip data, as these documents are governed by IRS Regulation Topic #305 (Bookkeeping and Recordkeeping). Without proper documentation, drivers and brokers were unable to file their tax returns, suggesting that while front-line operators maintained records, the state agency reporting on these records did not submit them with processed refunds, potentially contributing to overbilling claims. This raises questions for Medicaid regarding the handling of claims lacking proper documentation. However, following Medicare's incorporation of Light Medical Transportation (LMT) into NCD, the implementation has been more secure than Medicaid's program. This enhanced security stems from Medicare's operation of the program under federal government regulations, minimizing local state involvement. Furthermore, document security will be improved through professional trip reporting and billing systems from Uber Health and Lyft Healthcare, or even a small business Provider their software now day all updated utilizing providers' professional dispatching software. The fraudulent transactions and overbilling claims occurred due to a misinterpretation of Medicaid's legal framework, which allowed transactions to proceed in violation of IRS Regulations Topic #305 (Bookkeeping and Recordkeeping) during the claiming process. It is important to reaffirm that while these fraudulent transactions and overbilling claims were likely not the fundamental cause of the program's issues, the lack of precise legal interpretation necessitates improvement.
#3. REASONS OF THE RELUCTANCE.
CMS: Political Will vs. Evidence: While the evidence is growing, it takes sustained political will and advocacy to translate that evidence into concrete legislative or regulatory change for a program as large and entrenched as Original Medicare. However, our Healthcare System leader showed decisiveness as a great leader to move half of the capacity of complexity, therefore we only needed the other half.