FEATURED
NEMTAC Expands National NEMT Accreditation Program
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Medicaid NEMT is Now the Law of the Land PAGE 16
ALSO
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A Letter from NEMTAC's Executive Director
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Effie Carlson Board Member
Melissa Jankowski Executive Director
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Julie Correll Board Secretary
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Chris Kelly Board Member
Board of Directors
Michael Shabkie NEMTAC Founder
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Improve Your Customer Service with RoutingBox
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Peter Hicks Board Vice President
My Super Power: Adaptability
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We are off to the races in 2021 and the year is already chock-full of excitement. We started off the year learning that the Medicaid NEMT benefit became a law. This exciting announcement positions the industry for rapid growth. As we know, the integration of medical transportation is an integral part of the Social Determinants of Health (SDoH). We have several articles detailing this exciting development. Another major milestone for the NEMT Industry, NEMTAC has successfully completed the accreditation pilot process and we are thrilled to announce that Call the Car located in Pasadena, California has received national accreditation. The NEMTAC review team was impressed by Call the Car’s operation and enthusiastically recommended them for accreditation. Learn more about the NEMTAC Accreditation Process on page 8. We are pleased to announce another wonderful addition to our board of directors. Bill George, CEO of WHC Worldwide, LLC dba zTrip. We had the opportunity to meet Bill at The Transportation Alliance conference in November, 2020 and were immediately impressed by his leadership, background and industry expertise. Bill will be an excellent addition to our board. Finally, planning is in full swing for the upcoming NEMTAC conference in September 2021, Scottsdale, Arizona. We look forward to the year ahead and more milestones within NEMTAC.
Eliot Kalter Board Treasurer
OIG Audit Uncovers Improper Medicaid Payments
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David Marhoffer, Board Member, not pictured 

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Medicaid NEMT is Now the Law of the Land
Bill George Board Member
Innovations in NEMT: Alternative Uses for Fleets
Changes in NEMT Passenger Experience Through COVID
NEMTAC Welcomes Bill George to Board of Directors
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New Standard Could Improve NEMT Services
Table of Contents
Veyo + Sunshine Partner to Serve Their Community
2021 Healthcare Industry Trends Impacting NEMT
NEMT Industry to be Studied by Government Office
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Do it Right, The First Time and Every Time
NEMTAC Advisory Board Members
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A Huge Win for NEMT: Medicaid NEMT Codified in Law
Conducting an End-of-Year Review for Small Businesses
Accreditation Michael Shabkie and Eric Lane, Co-Chairs Carlos Ayestas, Priority Transportation Services Dori Boyle, Idaho Department of Health & Welfare Frank Ciccarella, Synergize Consulting, LLC Mindy Ginsberg, FR Conversions Max Gorin, LifeLine Ambulance Melissa Jankowski, NEMTAC Eric Lane, Bankers Insurance Valerie Lefler, Feonix Mobility Rising Michael Pinske, AmeriCare Mobility Van Michael Shabkie, NEMTAC Jim Smith, JC Paratransit Solutions Roddrelle Sykes, 3rd Millennium Insurance William van der Linde, Old Dominion Transportation Group Scott West, NEMT Solutions, LLC Compliance and Regulatory Julie Correll and Dan Reid, Co-Chairs Maggie Adams, EMS Financial Services Michael Adelberg, Faegre Drinker Biddle & Reath LLP Julie Correll, NEMTAC Laura Fleet, SendaRide, Inc Crystal Ford, Orange County EMS Melissa Jankowski, NEMTAC Martha Kendall, Tennessee Carriers Shea Long, Modivcare Tammy, Mihm, State of Tennessee Mark Porterfield, Careavan Transports Dan Reid, Grove Transit Kevin Teasdale, Secure Medical Transportation Certification Peter Hicks and Jim Adkins, Co-Chairs Kelly Addy, Clear Choice Express, LLC Jim Adkins, SouthStar Emergency Medical Services Howard Berkowitz, H&S Personal Car Service & Consulting, Inc Zackary Clemons, Solutions Medical Transport Peter Hicks, NEMTAC Melissa Jankowski, NEMTAC Gordon McInnis, LogistiCare Courtney Muchugu, United Transportation Group Jennifer Place, MAS Ray Shanahan, CareerCert Cris Sierra, ComfortCare Transportation Resource and Conference Christopher Kelly and Travis Draney, Co-Chairs Stephanie Barton, TripSpark Medical Howard Berkowitz, H&S Personal Car Service & Consulting, Inc Mike Chatelain, Risk Services of Louisiana, a Leavitt Group Co Travis Draney, Nonpareil Care, LLC Melissa Jankowski, NEMTAC Christopher Kelly, NEMTAC Manuel Leon, Alivi Gabriel Lullo, BiTS Misti Mills, Two M Insight Group Stephen Newman, 360 Quality Care + Transport Svc Marcus Norton, Mobility Support Solutions Jason Stempin, VMI Technology Michael Shabkie, Chair Jonathon Anthon, Route Genie Kyle Archer, Passio Technologies Arthur Attal, Via Tony Bradshaw, Bradshaw Consulting Services (BCS) Dominic Buono, UZURV Holdings Inc Sufian Chowdhury, Kinetik Healthcare Solutions, Inc Imran Cronk, Ride Health Jack Hayes, BiTS Melissa Jankowski, NEMTAC Brendan McNiff, Roundtrip Anantha Rao, Wellryde Michael Shabkie, NEMTAC Ben Salter, SafeRide Health Joe Tovar, TripSpark Medical
Advisory Boards
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Non Emergency Medical Transportation Accreditation Commission (NEMTAC) Strengthens Board of Directors with Appointment of Bill George Non Emergency Medical Transportation Accreditation Commission (NEMTAC) welcomed Bill George onto its board of directors effective February 3rd, 2021. NEMTAC is a non-profit healthcare organization dedicated to accrediting NEMT companies, training their drivers, and introducing the first set of American National Standards Institute (ANSI) standards for the industry. Bill George is a 35-year transportation industry expert that has led and developed some of the largest passenger ground transportation services in the United States. In 2018, Bill founded and currently serves as the CEO of WHC Worldwide, LLC dba zTrip. The company operates in 18 different states and completed over 5 million NEMT trips last year. Their mission is to “use mobility to enhance the lives of their employees, customers and driver partners.†"This is an exciting time for our organization as we look forward to introducing several major industry initiatives this year. Bill’s expertise, leadership and entrepreneurial background are the perfect skill set for our organization,†said Michael Shabkie, founder of NEMTAC. Most notably, Bill was recently awarded the Rosa Parks Spirit Award by the Kansas City Area Transportation Authority.This award was in recognition of a new service developed to provide true on-demand paratransit services and improve the quality of life for people throughout the region. NEMTAC’s Executive Director, Melissa Jankowski added, “His impressive mindset aligns with NEMTAC’s vision for the future and his industry knowledge will be indispensable to us as we focus on enhancing medical transportation throughout the country.†About NEMTAC –The Non Emergency Medical Transportation Accreditation Commission (NEMTAC) was established as a non-profit organization to enhance and promote the quality of care in America's non-emergency medical transportation system. NEMTAC standards represent industry best practices designed to ensure consistently high-quality customer care, safe vehicle operations and ethical business practices. In addition to accreditation, NEMTAC provides advanced education and training certificate programs to individuals seeking a career in the medical transportation industry. For more information visit www.nemtac.org. 

In order for the assessment to be useful, it is important that the NEMT owners, supervisors and managers take an honest look and deep dive in their review of internal processes, procedures and documentation within the organization. Once an organization has reviewed the accreditation standards outlined in the Self-Assessment Tool and is able to demonstrate evidence to meet accreditation standards, they are ready to start the formal accreditation process. Application Process (Accreditations Queue) Since the introduction of NEMTAC Accreditation, there has been a lot of interest from NEMT providers eager to raise the standards in the NEMT industry. Due to high demand of organizations actively seeking NEMTAC accreditation, NEMTAC has created an accreditation queue to manage the process. Organizations who are confident they have all the necessary policies, procedures and documentation completed, outlined in the self-assessment tool, will send in their completed checklist to NEMTAC. The NEMTAC Accreditation checklist is within the NEMTAC Accreditation Standards Self-Assessment Tool. The following are important checklist instructions: The checklist should be submitted by the organization's authorized contact. Any further accreditation communication will be sent to this contact. The receipt of the completed checklist will place an organization in the accreditation queue. NEMTAC will contact the organization for formal review timing. NEMTAC will use the accreditation queue as it methodically rolls out the accreditation program nationwide. The roll out will occur on a first come-first serve basis to those organizations who have submitted the NEMTAC Accreditation checklist. We look forward to assisting organizations in the accreditation process as we work together to raise the bar on NEMT industry standards. NEMTAC Accreditation NEMTAC is pleased to announce that Call the Car, a Pasadena CA based NEMT provider, has obtained national accreditation for their California based operations. As an American National Standards Institute (ANSI) standards developer, NEMTAC designed the national accreditation program to promote the quality of care within the NEMT industry. Obtaining accreditation distinguishes Call the Car and signifies to its customers and stakeholders that they have exceeded the industry standards of excellence. Congratulations to the entire Call the Car team on their hard work and dedication needed in achieving this coveted designation.
NEMTAC is pleased to announce the expansion of its accreditation program for qualified NEMT companies. Over the past 6 months, the accreditation program was operated as a pilot process with selected NEMT providers. The pilot was designed to identify operational outcomes and internal metrics needed to expand the program nationally. It also identified areas for improvement and accreditation best practices. NEMTAC accreditation standards were developed by an incredibly talented group of industry experts who shared their knowledge and real-world experience in supporting, operating, or regulating NEMT operations. This diverse group of leaders came together and served on NEMTAC’s Compliance and Regulatory Advisory Board or Accreditation Advisory Board. “Expanding the NEMTAC accreditation program nationally is a tribute to our hard-working Advisory Board members who dedicated countless hours in an effort to enhance NEMT services,†said Melissa Jankowski, NEMTAC’s Executive Director. NEMTAC accreditation represents the highest level of accreditation that can be given to a NEMT organization and shows the organization’s substantial conformance to industry best practices. An organization receiving three-year accreditation has put itself through a rigorous peer review process. It has also demonstrated to a team of NEMTAC assessors its commitment to offering services that are measurable, accountable, and of the highest quality. It is noted that this comprehensive accreditation process often exceeds those established by state or local regulators and are designed to increase utilization, serve as a market differentiator, and decrease liability. “On behalf of our Board of Directors, I would like to thank all of those who were instrumental in getting us to this point and look forward to recognizing many outstanding NEMT operations in the future,†said Michael Shabkie, NEMTAC Founder. Want to Become NEMTAC Accredited? The first step to take in seeking national accreditation for your NEMT company, is visiting the Accreditation tab on the NEMTAC website. Once there, you will find helpful information about the accreditation process, the most helpful being the NEMTAC Accreditation Standards Self-Assessment Tool. This document is your road map to navigating the accreditation process for your organization. In the Self-Assessment tool, you will learn about the timing of the entire accreditation process from start to finish, all the areas the organization will be evaluated on and evidence to meet compliance examples.
By Max Gorin, Co-Founder, LifeLine Ambulance
Charles Darwin theorized that in the kingdom of lesser animals, “ It is not the strongest species that survive, nor the most intelligent, but the ones most responsive to change.†Now, I wasn’t a good student in high school, so I am not sure why Mr. Darwin’s words have always stuck with me. In fact, during the 2020 dumpster fire that it was, I have been constantly reminded of the power of Darwin’s thesis. It’s a shame that the “adapt or die†motto, so common in the business world, has lost its ability to move the hearts and minds of the masses. Adaptation has been a major key to my personal and business success. The Foundation It’s essential to briefly acknowledge the two decades of research by Carol S. Dweck, author of Mindset: The New Psychology of Success. (definitely worth the read) Dweck explains that there are two mindsets that most people exhibit; fixed or growth. People who believe they are born with a limited skillset, intelligence, or personal characteristics are in the fixed mindset. Conversely, people who possess a growth mindset thrive on challenges, view failure as an opportunity to learn and improve and have the ability to adapt to the changing social or professional landscape. Simply stated, how do your friends, family, and colleagues describe you: “creature of habit†and “bullheaded,†or “flexible†and “goes with the flow� The answers could be quite revealing. Interestingly, your mindset determines your adaptability; how you respond to change. Bruce Lee said, “Be like water, my friend,†when describing his idea of adapting to fighting styles, but it could also be applied to life and business. As our circumstances transform, so should we. Resisting the reality of change is the leading cause of frustration when we face hardships and pain. Accepting that everything changes is the foundation of adaptation. While change is always difficult, it often brings rewards in ways we can’t imagine. 911 September 11, 2001, changed everything for me. I was a bit of a roughneck, uninterested in school, and always in trouble. In fact, it was just enough trouble that to escape further descent, I joined the army (by my own accord). After three years, I was honorably discharged and then obtained a license in life and health insurance. I planned to combine insurance sales with financial advising. So as I pursued my Series 7, I was lining up interviews with various banks. That morning, a Tuesday, I showered, shaved, got suited and booted, and was ready to own my interview at Washington Mutual Bank. That morning as I drove down the 405 highway, which was eerily empty, I had no idea the towers had been hit by two planes. I finished my interview and shook the manager’s hand. Just as the first tower fell, so did my aspirations of being a financial advisor. Like everyone else, I was in shock for our country, unsure of my future, and deeply saddened by the loss of friends, family, and all who passed in New York that day.
 But I didn’t shut down in the shadow of disaster. My first thought was to figure out a way to help the community at large. My father and I spoke for several weeks about what was next. He had recently sold his profitable taxi service and was looking for new opportunities. We had many conversations about financially viable businesses that would have continuous growth while providing a much-needed service. By the middle of October, I pitched LifeLine Ambulance to him.
My Super Power ... continued
My father is a serious Russian man, usually. When I asked him to invest in two ambulances to initiate LifeLine, he laughingly asked, "Maxim, what do you know of ambulances and healthcare? †I told him about a friend in the South Bay that had seen unprecedented growth in his emergency care service. After explaining some crucial details and the training I would need for this project, my father stopped laughing, shook my hand, and made the initial investment. He seriously emphasized “investmentâ€! In 2002, I bought my first two ambulances and worked day and night to protect my father’s investment. I trained and became a certified EMT. I also was the marketing director, the dispatcher, part-time mechanic, public relations specialist, driver, salesman, and custodial engineer. There was no job too big or small, and I learned the details of every aspect of the urgent healthcare field. Today, after 20 years of service, LifeLine Ambulance has grown to 70+ ambulances and 350 employees, servicing LA and Orange County. Adaptable Benefits There are three significant benefits, within your reach, to unlocking the adaptability mindset. Each of them can be applied to the workplace or in your personal life. 1. Leading the Leaders who Lead The idea of ruling with an iron fist is the stuff of fantasies, like “Game of Thrones.†The best leaders are adaptable, earning the respect of their employees and peers alike because of their ability to understand people’s strengths and motivations. This could prove beneficial during unanticipated developments. Leaders must not only make split-second decisions and pivot quickly during transitions but must inspire their teams to do the same; otherwise, both employees and organizations could suffer unwanted consequences. In the early Spring of 2020, the COVID pandemic started, and LifeLine Ambulance, like many other emergency care providers, were short on PPE. Once again, I thought of my community first. I planned, developed, and manufactured safety products through a new venture called LifeLine Supply, specifically focused on hand sanitizer and sanitizer wipes. These products feature 75% alcohol, deemed safe for both skin and surfaces. We donated and delivered LifeLine Supply sanitizers to local police stations, schools, hospitals, and businesses while bartering with our competitors to keep everyone’s communities safe. 2. Most Valuable Employee/Friend/Spouse These days organizations and individuals must possess the ability to adapt. Uncertain (unprecedented) time poses a tremendous challenge for traditional business strategies because they assume a stable and predictable world. Similarly, these same employers want workers who can traverse the flow of change adeptly, don’t panic when things go wrong, and, most importantly, solve crucial problems. Obviously, this quality is invaluable as an EMT at LifeLine Ambulance, but it is a fact across industries and in our daily lives. Who doesn’t love someone who is up for every adventure and offers different perspectives on solving problems? No one. Practicing adaptability is the competitive edge to winning 2021 and beyond. 3. Learn and Live Happy Throughout our personal and professional lives, we will face many challenges. Most of them will be beyond our control. Therefore we should focus on the one thing we can change; ourselves. Instead of succumbing to overwhelming difficulties, we need to be active participants in choosing what happens next. By carefully assessing problems and adjusting our response, we can advance our personal or business growth, which leads to regaining control of a situation. Demonstrating this type of resiliency makes us happy. I have used these tactics throughout my personal life and professional career. From joining the army to changing career paths and guiding the LifeLine team through a national pandemic, I continuously take what I have learned from one challenge and apply it to the next. It’s not easy, but if it was, I might not have been ready for 2020. The Last Word Fostering a culture of adaptation has been a key to LifeLine’s success. As the backbone of LifeLine Ambulance, employees are encouraged to use creativity in accomplishing goals, allowing them to look at problems from a new perspective while discovering new solutions. Emotional intelligence, another trait connected to flexibility, is an essential quality for my leadership team. It allows them to interact with employees constructively to accomplish our goals. Additionally, in a dynamic environment like emergency healthcare, it is often necessary to shift or maintain focus, a critical skill that illustrates adaptability when priorities change quickly. These are some of the principal elements for building a workforce with the growth-mindset of being adaptable and flexible that will lead to your ultimate success. After 20 years of serving the greater Los Angeles and Orange County communities, adaptability has been my greatest strength. It has unmeasurable personal value and driven business growth. 

It's amazing to think of the role that innovation has played in moving the world forward in the face of a global pandemic. This new year has established some new trends and brought fresh hope for the healthcare industry. However, we have also seen risks arise as our industry evolves from mainly "transporting people" to delivery-based services. Along with this, a new administration hopes to enforce healthcare regulations that will heavily impact NEMT. With some uncertainties about the future of NEMT and the healthcare profession at large, we are pleased to be finding answers to top healthcare questions: 
Q: How are NEMT and healthcare providers pivoting to fill service gaps? A: The Non-Emergency Medical Transportation industry is branching out to fulfil service gaps brought on by the pandemic, while patient treatment has moved exponentially to technology-based Telemedicine. NEMT While the medical transportation industry has been just one of the many businesses significantly impacted by decreased utilization during the pandemic lockdowns, diversification of services has opened many new doors. According to Brian Spani, Brokerage Administrator, Bay Cities Brokerage/Metro West Ambulance. "Because of COVID, new health and safety opportunities have opened for our business. "One of the ways Spani and others have been able to pivot within their organizations has been to identify areas that were under-serviced because of the pandemic so that they could lend a helping hand. Some examples include facilitating prescription deliveries, picking up and dropping off patients for COVID testing at hospitals, providing discounted rides to residents of care homes and to those who are at higher risk. The shift to emerging opportunities for NEMT organizations was recently explored at the Designing Progressive NEMT Operations NEMTAC virtual conference powered by TripSpark Technologies. Perhaps the greatest realization about COVID and how it has impacted business is that, while some areas are suffering, new opportunities have opened. When business returns to normal (or close-to-normal), these organizations will have established additional services to add to their suite of offerings. Telemedicine On the treatment front, telemedicine has grown more in the last six months than it has over the past decade! Its viability for specialty practices, hospitals and senior care also lend to telemedicine's staying power post COVID-19. Just look at the numbers. US Consumer adoption of Telehealth has skyrocketed, from 11% in 2019, to 46% now, replacing a significant volume of healthcare visits. Providers have rapidly scaled offerings and are seeing 50 to 175 times the number of patients via telehealth than they did before.
By Kris Lyon, Senior Manager, Business Development-NEMT, TripSpark Technologies
2021 Healthcare Industry ... continued
Q: What are Potential Security Risks and Credentialing Concerns? A: The reality is that with increased strain on healthcare and technology playing such a large part now in-patient care, cybersecurity is vital. Also, a shortage of medical practitioners has led to questionable credentialing of medical staff. Cybersecurity Healthcare cybersecurity has become a major focus for the healthcare industry lately. IT professionals must continually stay on top of healthcare data security issues to protect patient information and confidentiality, as mandated by Health Insurance Portability and Accounting Act (HIPAA) laws. Electronic health records (EHRs), contain a host of sensitive information about patients’ medical histories, making hospital network security a primary IT concern. EHRs make it possible for physicians and other healthcare professionals, as well as insurance companies, to share essential information. While medical professionals have been able to communicate more seamlessly than ever before, to meet patients’ needs, the interconnected nature of modern healthcare creates IT security risks — namely that consolidating so much essential data in a field that nearly all people use, makes it a conspicuous mark for hackers and cybercriminals. To combat this, medical organizations must be vigilant in establishing safeguards against online threats, as well as with complying with the privacy and security rules outlined in HIPAA. 1

Credentialing Protecting patients and giving them the confidence that their chosen medical professional is qualified, is essential to healthcare organizations. Credentialing medical staff has many moving parts and requires absolute attention to detail. Patient harm, stiff penalties and loss of trust are just a few of the things at stake when credentialing is not thorough. Furthermore, the credentialing process if rigorous. Hospitals are obligated to do primary source verification on the credentials of their respective medical staff. Some examples of what must be verified at the primary source include: Education
Boards
Work history
All state licenses
DEA
NPDB
Claims verification
Hospital affiliations
Peer reference
Comprehensives background checks 2 Because of an already stretched healthcare system, with a shortage of medical professionals, there is great concern that credentialing protocols are not always being followed. If a medical professional fails to validate, verify, and confirm credentialing data elements at the primary source, it may result in negligent credentialing. As a result, credentialing management software is more important than ever. Q: Will we see a transition to a value-based healthcare system for NEMT? A: There is a high potential that NEMT will be brought into the value-based healthcare arena and the industry should be prepared. Under value-based healthcare, where providers are paid based on the number of services they deliver and patient health outcomes, the benefits are remarkable. Health officials have not kept secret their desire to link healthcare payments to value-based care, with the Centers of Medicare & Medicaid Services (CMS) saying last year that they want to have 100 percent of providers taking on some downside financial risk by 2025. 3 Value-based Healthcare During the first COVID-19 surge, many providers who transitioned to value-based care, have fared better than those who leaned entirely on fee-for-service models. For these providers, revenue remained consistent during lockdowns while elective procedures were delayed and canceled, further underscoring the value to providers. An accelerated shift from volume to value-based healthcare benefits everyone from patients to society at large.
2021 – A Year to Grow With the welcoming of a new US Administration, we're certain to see a renewed commitment to the Affordable Care Act (ACA) and expanding Medicaid to low-income Americans.4 There will also be an investment in transportation infrastructure to incorporate the needs of people with disabilities, maintain deliveries of medical and food supplies during the pandemic, and support autonomous vehicles and on-demand services.5 In a time of many bad news stories, these positive trends are helping heal America and give the NEMT and healthcare industries something great to look forward to. 

As the last few days of the year wound down, President Trump signed the Consolidated Appropriations Act of 2021 into law. Included in this voluminous 5,000-page bill is a provision that codifies the NEMT benefit within the Medicaid statute. To say this provision is a game changer for the NEMT industry would be an understatement. Through the hard work of industry groups such as The Transportation Alliance (TTA) and Medical Transportation Access Coalition (MTAC), as well as strong bipartisan supporters in Congress--namely Rep. Buddy Carter (R-GA), Rep. Sanford Bishop (D-GA), Rep. Tony Cardenas (D-CA), Rep. Rosa DeLauro (D-CT), Rep. Tom Cole (R-OK), Rep. Nita Lowey (D-NY), and Rep. Kay Granger (R-TX)--the Medicaid transportation benefit has been preserved for generations to come. "The NEMT Medicaid benefit, which had been mandatory by regulation since 1966, was in danger of becoming optional under a Trump Administration regulation," Rep. Bishop said. "Thousands of Medicaid patients in Georgia and across the nation who relied upon NEMT to transport them to and from health services such as dialysis and COVID-19 testing would have been placed at risk if the benefit had been eliminated.†"By codifying NEMT under the Medicaid statute, we can rest assured that the benefit will remain protected now and into the future. I want to thank all those who helped, especially The Transportation Alliance, for their support in our fight to protect this vital need for so many Americans." We were able to take a deep dive into the language of the bill and would like to highlight some of its most significant areas: 1. Medicaid NEMT Benefit - The Medicaid NEMT benefit is now statutory law. It is effective January 1, 2021 and "ensures necessary transportation for individuals enrolled under such package or coverage to and from providers; and provides a description of the methods that will be used to ensure such transportation." 2. Government Accountability Office (GAO) Study - The new law requires the GAO to complete a comprehensive study of Medicaid NEMT over the next 24 months. This study will cover all 50 states with a focus on detailing previous fraud, waste, and abuse findings and to identify actions and safeguards NEMT brokers and states currently have in place. The study will also seek to identify future NEMT trends in what will become a guidance document for the entire NEMT industry. 3. NEMT Stakeholder Meetings - The new law requires the Centers for Medicare & Medicaid Services (CMS) to conduct a series of stakeholder meetings no later than June 2022. The purpose of the stakeholder meetings is to obtain input on best practices on program integrity and address other challenges of providing NEMT services to the Medicaid program. There will be a specific focus on NEMT services provided to Native Americans and individuals with disabilities. Stakeholders identified include State Medicaid programs, NEMT brokers, Transportation Network Companies (TNCs), Medicaid patient advocate organizations, and any others as identified by the Secretary. CMS is required to publish the results of the stakeholder meetings along with the guidance documents no later than December 2022. 4. NEMT Provider and Driver Requirements - Effective immediately, the new law requires NEMT providers, TNC companies, and individual NEMT drivers to:
 a. Ensure drivers are not excluded from participating in any federal healthcare program by the Office of Inspector General (OIG)
 b. Possess a valid state driver's license
 c. Have a process in place to address state drug violations
 d. Identify a process to disclose to the State Medicaid program the driving history of each driver along with any traffic violations. States may request a grace period if they are unable to enact laws that comply with these requirements in their next legislative cycles.
5. Analysis of T-MSIS Data - By December 2021, CMS is required to submit a report to Congress analyzing the data from the Transformed Medicaid Statistical Information System (T-MSIS). The report will include both an analysis of the data and recommendations related to NEMT services. 6. Consultation Relating to NEMT - If a state utilizes a NEMT broker, they may consult with relevant stakeholders including organizations who represent patients, medical providers, Medicaid Managed Care Organizations, NEMT brokers, and transportation providers, including public transit organizations. Setting a New Standard for the NEMT Industry As John F. Kennedy so eloquently said, "Change is the law of life, and those who only look to the past or present are certain to miss the future." This new law is the single most important development for the NEMT industry since the creation of the Medicaid program under the Social Security Amendments of 1965 and the seminal 1974 federal court case Smith v. Vowell, which held that, while the choice of means by which to carry out the obligation was a matter of state discretion, the assurance of non-emergency transportation represented a mandatory duty. The opportunity for improvement is immense, with appropriate input from all industry stakeholders. We are living in the age of disruption. Now more than ever it requires an individual, company, or industry to be agile, with the ability to adapt. NEMTAC is working day and night to advance the best interests of all participants in the NEMT industry. Over the coming months, we will keep everyone informed about the implementation of the statutory requirements and highlight the opportunities that emerge from the enactment of this groundbreaking law.
“NEMTAC is thrilled that after more than 50 years, Congress declared the Medicaid NEMT benefit both essential and mandatory by enacting H.R. 133 codifying the Medicaid NEMT benefit. The law also establishes program integrity and provider credentialing requirements –NEMTAC’s primary mission-- and provides much-needed enhancements to government oversight activities. The law will improve the quality of life for beneficiaries through safer, less costly, and more reliable access to crucial health and wellness care.†said Julie Correll, JC, CHC, Board Secretary, NEMTAC
Contributing Author: Julie A. Correll, JD, CHC, Board Secretary, NEMTAC
By Michael Shabkie, Founder, NEMTAC
Include anniversaries and other milestones. When creating your end-of-year review, include anniversaries and significant milestones related to your business, the leaders in your brand, and your employees. This review can include the following: Work anniversaries, i.e., celebrating the number of years an employee has been with your business Hitting a major number in sales. For example, getting your 1,000th customer, getting 1 million views on your YouTube channel or getting 100 plugin installations Other fun events in your organization like weddings, employees who became parents, etc. Of course, this last idea works when you have a small business and people are in touch with each other. It's helpful to have a dedicated HR personnel or administrator to keep track of such information. But reckoning milestones and events like these add a much-needed positive note to your business activities. It reminds everyone that you celebrate your employees and care about them. Create a year-end financial review. And of course, one of the most important elements you'll need to create is your financial review for the year. Even if you follow an accounting or financial year format that ends in March, doing an end of year review now is a good idea, since you'll start the first quarter of 2021 with a clear idea of what your business’s financial health is like. Create reports including your balance sheet, income statement and cash flow statement. These statements will contain all the information you need to do a basic review. You'll find areas that need improvement, expenses that need to be trimmed, and you'll have an idea of the kind of taxes you'll have to pay. Such information is critical for you to make the right decisions for your business. What to do with an end-of-year review Doing the hard work of creating a review is helpful. You get clarity and arm yourself with information that leads to business growth. But you can further leverage your year-end review by sharing it. Let us look at who you should share an annual review with and how to do that. Share your year-end review with your audience. Your end-of-year review contains a lot of information that is worth sharing with your audience. Of course, you do not have to share every single detail. Instead, focus on content related to your growth so that it builds confidence in your company. To create full transparency and to show your audience that you are listening, you can also include some of the challenges you faced during the year and how you intend to address them. Some of our brands have dedicated pages just to showcase the end-of-year review. These pages are available to the public and are made in an infographic style. Instead of long paragraphs of text, we used graphics, bullet points and simple visual elements to highlight our achievements for the year. Digital marketing studies show that users recall 65% of the visual content they have consumed even three days after viewing it. Presenting our review in a visual format makes it impactful and memorable to our audience. Featuring how many of our plugins have been installed, the positive reviews they have received and other details make customers feel comfortable that we're going to be around to help them grow their business. Inform your employees. It is also important to do an end-of-year review with your employees. And in this case, you can afford to discuss the challenges your business has faced in greater depth that you will not want to share with a wider audience. In our business, we conduct a quarterly town hall where we talk about the state of affairs in the business. Employees can ask questions about the company, and we look at both the highlights and difficulties of the year. An end-of-year review can help you connect with your team better and creates transparency. Your team will feel more confident about the business and will know how to perform better in the years to come. Use these tips to make better decisions that will help you grow your business, especially when we are all dealing with a global crisis. Howard F. Berkowitz is the Managing Partner for H & S Personal Car Service & Consulting, Inc. is a public transportation consulting firm specializing in improving operational management, comprehensive analysis, financial performance and quality of service. We bring over 30+ years of public and private transportation experience and a network of industry associates to each assignment. Contact Howard at (561) 719-5541 or consulting@handspcs.com Calendly Scheduler: https://calendly.com/hs-consulting/consultation
By Howard F. Berkowitz, Managing Partner, H&S Personal Car Service & Consulting, Inc.
The close of a year is a good time to take stock of how your business is doing. All over the world, people and businesses approach the new year with the intention to create change. There is a cultural belief that we can move forward and put the events of the past year to rest. And what a year it has been. As the name suggests, an end-of-year review is a summary of important events and changes that have taken place in your business. You can also note general updates and other information to do a check-up of your business. For small businesses, doing an end-of-year review is important to understand the impact of the pandemic on their businesses. The review will help you come to terms with what's happening, and this can give you a clearer picture of the challenges and opportunities you must deal with in the future. So, what are the different things you need to review? Here's a breakdown of important developments in your business to be aware of and how to leverage them. What to include in your yearly review Not sure what to add when doing an annual review of your company? Here are some of my suggestions for what kind of information to gather and analyze to help understand the path your business is on. List your business's accomplishments. A good place to start is by looking at the positive achievements of your business for the year. And when you do this, make sure that you go into detail. At our business, we include the following details when creating a list of achievements: Any increase in the number of customers How many more products or plugins we sold compared to the previous year The number of positive ratings and reviews we received online How many new followers we have on social media New employees who joined the company New features and updates added to our products Whether we won prizes or received recognition from external sources The sales that took place during Black Friday, Cyber Monday and other major holiday events These are just some details you can include when listing your business's accomplishments. It's important to do this, because it gives a clear picture of how your business has grown and what to expect in the future. It's also a great morale booster for people in your organization. Doing a review of your past accomplishments helps you recognize your strengths and the work done by your team. Tally the things that went wrong. There's no year that goes by without challenges, and these are often chances to grow your business. It's important to make a list of setbacks and changes that you consider negative in your business. Here are some things you can include as challenges faced during the year: Any increase in your customer churn rate Negative responses to a new product launch or to changes made in your current offerings Getting social media backlash because of an ad or some other type of communication If there's an increase in negative reviews and ratings for your products Creating a list like this will help you be better prepared for the next year. You can plan for these issues and figure out ways to avoid repeating any mistakes. For your employees, a review of things that did not work out can swerve as a cautionary tale and firmly embed dos and don'ts in your business culture. Review your company's charitable works. One of the important works that we include in our overall business review is the state of our charitable works or programs to do with corporate social responsibility. Updating yourself, your stakeholders, employees, and customers about these projects and how they've affected other people's lives is powerful. It creates meaning in the work that you do and builds a shared sense of responsibility in the organization. If you haven't been active in this area, a review can give the wake-up call you need to prioritize social responsibility. And if you're not involved in any such works, this can be the starting point for you to seriously involve yourself in giving back to the community.
As a result, Sunshine Wheels was ready to deploy a dependable, caring, safe and reliable fleet. To do that, they needed a powerful yet simple system to manage scheduling across all their clients as they scaled that maintained their standard of service and care. Veyo’s turnkey solution Veyo partnered with Sunshine Wheels to implement simple transportation scheduling and payment operations. When a healthcare facility decides to choose Sunshine Wheels as a preferred NEMT provider, Veyo sets them up with Rideview, a streamlined platform that allows healthcare facilities or nursing homes to book transportation through a simple-to-use web portal. Through RideView, client staff are able to not only book trips with ease, but also access real-time information for every trip, such as trip status, pickup and drop-off details, and contact information on one user-friendly interface. In addition to simplifying ride scheduling, Veyo made it easy for Sunshine Wheels to meet the constantly-growing demand for their services. Through Veyo’s transportation provider portal, designed to support trips for Medicaid recipients, Sunshine Wheels can manage incoming trip requests, driver schedules, and trip details. By lifting the burden of developing a ride booking platform and taking over time-consuming invoicing work, Veyo allows Sunshine Wheels to focus on what they do best – providing exceptional care. “The system has been seamless,†Fitzgerald said. “Sunshine Wheels can add 50 new clients with ease. Their system is set up well for vendors like us.†To Sunshine Wheels, the personal relationship they have developed with Veyo is just as important as the technical and operational work they’ve done together. From the outset, Sunshine Wheels has been able to look to Veyo as a supportive partner that is equally invested in their success. And that success has paid off - Sunshine Wheels was recently named one of Veyo’s Top Performing Providers in the state of Connecticut. In collaboration with Veyo, Sunshine Wheels has completed over 4,000 trips and expanded their service region to serve clients across the state. “What we envisioned a year and a half ago when we began our partnership with Veyo has really exceeded our expectations,†said Fitzgerald. “If we make just one part of the healthcare experience easier for people who already face so much, then all our work will be time incredibly well spent.â€
Re-imagining EMS & NEMT ... continued
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Born from over 30 years of experience in care, Sunshine Wheels is a non-emergency medical transportation (NEMT) service exclusively dedicated to providing reliable wheelchair and ambulatory transportation services to individuals with mobility challenges. Launched in 2019, Sunshine Wheels is a division of New Horizons Inc., a Connecticut-based and managed non-profit organization dedicated to enabling independent living. In addition to providing NEMT services through Sunshine Wheels, New Horizons Inc. delivers a continuum of care that encompasses housing and support services for people with physical disabilities, as well as rehabilitation and inpatient nursing home care. According to a 2006 report, approximately 3.6 million adults miss or delay non-emergency medical appointments due to transportation issues. For New Horizons, Inc., whose community consists primarily of seniors and individuals with disabilities, the issue was particularly stark. Although NEMT services were initially implemented to help bridge this gap, errors and missed rides were a far too common experience. In the past, New Horizons, Inc. residents, many of whom did not have the capacity to return home by themselves, found themselves stranded at their doctor’s office without a way home, sometimes even past closing hours. Other residents were never even able to get to their clinicians, forcing them to miss critical appointments such as dialysis or pre-surgical meetings. Carol Fitzgerald, CEO of New Horizons, Inc., recognized the need for a sustainable solution. “Our mission is to promote independent living,†said Fitzgerald. “Without timely, proper medical care, it’s difficult to do that. And New Horizons, Inc. is committed to becoming part of the solution to provide reliable accessible transportation.†A strong foundation Fortunately, New Horizons was well-versed in transporting their residents for recreational purposes and decided to expand their service into medical transportation. They created Sunshine Wheels as a social enterprise, putting its proceeds back towards New Horizons’ charitable mission. With years of experience in transporting residents with mobility challenges, the staff at Sunshine Wheels possessed not only a deep knowledge of wheelchair, equipment, and patient safety, but also a nuanced understanding of the balance between respecting individuals’ right to be independent while also being there to meet their needs -- difficult lines to navigate without the right experience and training.
As part of the Consolidated Appropriations Act of 2021, Non-emergent Medical Transport (NEMT) has been solidified as a Medicaid benefit (see Michael Shabkie’s article in this edition of NEMT Today). While this is great news for NEMT providers, this announcement does come with some increased scrutiny of the industry. The Act requires the Government Accountability Office (GAO) to conduct a study that address four key points. First, the study will look at all 50 states’ current safeguards that are intended to prevent fraud and abuse specifically related to NEMT benefits. Second, the study will look at transportation brokers’ safeguards to prevent improper payments to transportation providers. Medicaid Fraud Control Units (MFCUs) are tasked with preventing fraud in the NEMT industry, and the third point the GAO study will review and report on are recent investigations by these offices. Finally, the GAO report will identify trends and risk factors for the purpose of creating new safeguard and risk management strategies in the future. This will not be the first time that the NEMT industry has been under the microscope. In fact, the Act makes a reference to a Department of Health and Human Services’ Office of Inspector General (“HHS OIGâ€) report from 2009 titled “Fraud and Abuse Safeguards for State Medicaid Nonemergency Medical Transportation Services†(report # OEI-06-00320) and requires the GAO to “take this report into account†when conducting their study. In its report, the OIG looked at the first three of the key points that the GAO will study. Let’s take a look at that report and what it found more than a decade ago. First the report noted that most States had some safeguards in place, specifically screening providers against the OIG exclusion list and requiring disclosure of relevant prior criminal convictions. A lesser percentage of States required special licenses or certification for NEMT providers, and only about half of States conducted onsite visits or periodic re-enrollment of providers. The next safeguard that most States employed was a prior approval process; 46 States reported requiring some or all NEMT services to be approved prior to provision of the service to the beneficiary. Most States also conducted post-payment claims review, data monitoring and pre-payment edits to prevent improper payments. The report also looked at the use of transportation brokers and found that the safeguards related to them were primarily investigating complaints, broker reporting requirements, and review of the broker at the time of contract renewal. A limited number of States also conducted onsite broker reviews and transport verification. There was no mention of any safeguards specific to broker payment practices, therefore the GAO study may be looking at this issue from a new perspective. When discussing the activity of the MFCUs, the report found that during a span of two years from 2004 to 2006, approximately 500 NEMT fraud cases were opened nationwide. The issues being investigated were most often billing for services not rendered, upcoding (for example billing for an attendant when one was not present or necessary), and missing or forged supporting documentation (such as trip logs or transportation vouchers). Those investigations resulted in 43 convictions (21.5 per year) and 37 civil settlements (18.5 per year). 2019 data recently released by the MFCUs shows that NEMT providers were involved in 26 criminal convictions and 11 civil settlements or judgements in that year. This seems to show that the volume of investigations is not significantly different from 2004 to 2019. From that one could argue that fraud and abuse does not seem to be on the rise, and therefore current safeguards are still functioning. However, when you consider that the combined recovery (civil and criminal) from NEMT providers in 2019 was almost $4.2 Million, the problem of fraud and abuse in the NEMT industry is still concerning. Add to that the fact that the MFCUs report a $6.41 recovery for every $1 spent on an investigation and it is easy to conclude that MFCU investigations will remain an important weapon in the fraud-prevention arsenal.
By Christopher Kelly, Attorney, Page, Wolfberg & Wirth
The 2009 OIG report did not conclude with any recommendations to prevent fraud and abuse in the future, but it did close with this statement: “All State Medicaid agencies reported multiple NEMT fraud and abuse safeguards… Despite these measures, NEMT fraud and abuse has been and may continue to be a problem…â€. Whether the upcoming GAO study draws the same conclusion and what additional safeguards may result from it, we will not soon know since the GAO has several years to issue its findings. However, from the recent MFCU activity and recoveries noted above, I believe it is safe to predict that there will be an increase in safeguards, audits, and investigations of NEMT providers. With greater funding and security of the NEMT benefit comes more responsibility as an industry, and I think this responsibility should be welcomed. As NEMT strives to be seen as a key element in the health of those we serve, providers should embrace the study of the industry and support additional safeguards, seeing these as opportunities to show that the industry can rise to the occasion. Christopher Kelly is an attorney with Page, Wolfberg & Wirth LLC, who focuses on regulatory healthcare law and litigation defense as it relates to the EMS and ambulance industry. Chris has over 20 years representing medical transport services on a wide range of compliance issues. He can be reached at (717) 691-0100 or email to ckelly@pwwemslaw.com. For over 20 years, PWW has been the nation’s leading EMS industry law firm. PWW attorneys and consultants have decades of hands-on experience providing EMS, managing ambulance services and advising public, private and nonprofit clients across the U.S. PWW helps transport agencies with reimbursement, compliance, HR, privacy and business issues, and provides training on documentation, liability, leadership, reimbursement and more. Visit the firm’s website at www.pwwemslaw.com. This article is for general information only and is not intended nor should it be relied on as legal advice or a definitive statement of the law. You should consult an attorney for advice specific to your situation.
The ClientLink Booking Portal helps you increase business and build loyalty among your customers. This tool bridges the gap between the facilities with which you work and your dispatchers to provide a top-notch passenger care. Because your facilities will use this web portal to book trips directly without having to call, you can use the time savings as a differentiator to win transportation contracts with facilities. Not only will this help you earn more contracts, but it can help you to improve your relationships existing customers by simplifying the trip booking process. The Booking Portal is completely integrated with your existing RoutingBox platform, which allows your dispatchers see trips immediately and make sure drivers are dispatched quickly and efficiently. The Facility can then see the driver’s location and status in real time, so that they don’t have to call your dispatchers for an update. Passenger App: The Passenger App is ideal of for self-pay clients and individuals who live on their own, perhaps with a caregiver. The client or their caregiver will set up their client account and their trips on their own through the app. They will get notifications the day before their trip, 2 hours before, and updates from their driver leading up to the trip. These reminders go right to their phone and help to reduce and potentially eliminate canceled trips and no shows. If this client has a will call trip, after they’ve put in all the details, they just need to click “I’m ready†and their driver will be notified to come pick them up. With the Passenger App your riders can: Book self-funded or account-funded trips in advance or on demand directly through the app. Track driver location and ETA for accurate and efficient pickup regardless of who booked the trip. Tap a button to be picked up. View future trips. Receive notifications and reminders. Passengers will enjoy real-time scheduling and tracking. Putting these tools in your customers hands will decrease phone calls to your dispatchers. No more wondering where their ride is! The Passenger App will help you: Reduce No Shows and Cancellations: Passengers get trip alerts and reminders, eliminating any confusion or miscommunication. Alert your passengers in advance about their upcoming trip and update them as their driver is approaching. Decrease Inbound Calls: For will-call trips, passengers alert dispatchers with the tap of a button. No need to call for a pick-up which simplifies the process for your riders and dispatchers alike. Reduce Wait Times: Passengers see their vehicle approaching in real time! No need to call your dispatchers to check on their driver. Improve Rider Satisfaction: An easier process creates an effortless experience for your passengers. They feel more in control of their trips and will recognize your company as one who operates with transparency that they can trust. Overall, this will reduce your operating costs by streamlining your processes and creating more efficient operating procedures. Your passengers will have peace of mind, a sense of control, and most importantly an overwhelming trust for your company. Here at RoutingBox, our biggest goal for 2021 is to make things simpler for you. We want all our customers to provide the best possible customer care this year because caring for your riders and your community is of the utmost importance especially after the year we’ve all just endured. If you’re currently a RoutingBox customer and would like help getting set up with our ClientLink tools, please reach out to your Customer Success Manager. If you’re not yet a RoutingBox customer and you’re interested in becoming one, visit our website routingbox.com or send us an email to marketing@builtbybits.com
This past year has proven that the way we care for people matters more than anything else. Caring for each other and our community has always been a core value of ours here at RoutingBox, and we want to make sure every one of our customers is set up to make caring for their people and their communities a core value of theirs as well. RoutingBox is known for making companies more efficient and effective by reducing data errors and streamlining your operations. In addition to these primary functions, RoutingBox allows you to provide the best possible customer service as an NEMT or paratransit provider. Our customer service tool ClientLink includes the booking portal and the passenger app, which can help your company better serve your customers and by extension, better serve your community. ClientLink: RoutingBox has two ClientLink options, which can serve as a point of differentiation for your company both when bidding for facility contracts and for securing more self-pay clients. Both are white labeled, client facing scheduling options that will vastly improve the way you're able to care for your customers. Booking Portal: The End User of the Booking Portal is an employee of the facility with whom you’re working. The portal is ideal for hospitals and nursing homes, as it helps them to know where transportation for their patients is at any given moment. This saves time on the facilities part by reducing time they spend on the phone with your company to book trips for patients, which in turn, saves your staff the time of needing to answer the phones and manually enter each trip. When a facility employee enters a trip, it will show up in your RoutingBox immediately.
Transportation tomorrow will look very different than it does today, but already we can glimpse the changes ahead. We can easily pull up an app on our smartphones and see several travel options, schedule a ride-hail, or rent an electric scooter—and, often even pay for those trips. A key question for non-emergency medical transportation providers and brokers is whether you are positioning your business models for this integrated transportation future. In November 2019, the National Academies of Sciences, Engineering and Medicine Transportation Research Board published a new transactional data specification for demand-responsive transportation (TDS) that can be used to modernize non-emergency medical transportation and other demand-responsive services. The TDS allows these services to interoperate with one another and eventually with the new mobility platforms under development, essentially paving the way for NEMT and other DRT providers and their customers to benefit from next-generation data sharing solutions. How can the TDS improve NEMT services? Too often NEMT providers operate their services in silos. Brokers may use ride-scheduling and dispatch technology to communicate with individual providers within their networks but unless those providers use the same software or have invested in data translators to enable their scheduling software to communicate directly with the broker’s system, rides may still need to be scheduled by sending an e-mail or picking up the phone. This is not a solution for 2021. The TDS allows interoperability to occur in a more cost-effective manner. What is a data specification? A data specification is simply a precursor to a data standard. Specifications and standards describe a common format for data exchange. The TDS is an open data specification, meaning that its code is freely available to software developers. When all providers in a network agree to use the specification, their software systems can exchange trip data using a standardized Application Programming Interface (or API). If software applications and updates are made compatible with the TDS, then interoperability with all providers is maintained. The terminology may sound intimidating, but data standards are ubiquitous in modern life for the transmission of electronic information. Think of the share icon on a website that allows an individual to share an article on social media. The healthcare sector offers a parallel example. The 21st Century Cures Act (2016) empowered the federal Office of the National Coordinator for Health Information Technology (ONC) to define the parameters around which healthcare interoperability would occur, leading to the development of the Fast Healthcare Interoperability Resources (FHIR).
By Jana Lynott, Senior Policy Advisor, AARP Public Policy Institute
FHIR standards have reduced the cost of building innovative solutions in part because standards allow software developers to reuse many open-source solutions. As a result, we have seen software developers rapidly introduce new innovations to this sector in the past couple of years. The TDS could be used to foster innovation in the NEMT sector, and in turn, allow NEMT brokers and providers to deliver the high-quality and convenient transportation options their customers are clamoring for. NEMT brokers would have a cost-effective approach to build an electronic network of providers and those providers would confront lower market-entry costs as they need not purchase scheduling software more complex than required for their individual needs. The TDS code can be used to interoperate providers using software as sophisticated at Trapeze or RouteMatch or as simple as Google Sheets, the cloud-based equivalent of scheduling rides using an Excel spreadsheet. Conclusion Medicaid NEMT is the largest single source of funding for DRT in the United States. The TDS would allow service to be delivered more efficiently and with greater transparency. And integrating NEMT services onto a platform with other services in the community, would also offer customers more options to get around. Embracing a standardized approach to data-sharing could revolutionize NEMT. Where can one find more information about the TDS? To learn more, visit the AARP Public Policy Institute’s new publication entitled, Modernizing Demand-responsive Transportation for the Age of New Mobility. This page also offers a video series on FlexDanmark, a global model for coordinated demand-responsive service and most sophisticated implementation of a transactional data standard. www.aarp.org/Futureoftransportation Transit Cooperative Research Program Report 210: Development of Transactional Data Specifications for Demand-Responsive Transportation Jana Lynott, AICP, is a senior policy advisor on transportation and livable communities for the AARP Public Policy Institute. She recently published “Modernizing Demand-Responsive Transportation for the Age of New Mobility†and other works as part of a series on the Future of Transportation. Jana joined the Shared Use Mobility Center’s Board of Directors in January 2020. Jana is an active promoter of data standards as an effective means to deliver higher-quality, more equitable transportation solutions.
On January 21st, 2021 the Office of the Inspector General (OIG) released the results of their Massachusetts NEMT Medicaid audit. The title of the report, “Massachusetts Made at Least $14 Million in Improper Medicaid Payments for the Nonemergency Medical Transportation Program, detailed lapses in program integrity and reimbursement irregularities. As noted in the audit, MassHealth pays for nonemergency medical transportation (NEMT) services determined to be necessary for beneficiaries to obtain care. As a brief background, Massachusetts operates under a NEMT broker system that contracts with regional transit authorities (RTAs) who are responsible for administering the NEMT benefit in defined geographic areas. The brokers provide NEMT services through the Demand-Response Transportation Model and Program-Based Transportation Model. The brokers are under contract to arrange the transportation for eligible Medicaid beneficiaries and are responsible for recruiting, hiring, and screening transportation providers. The brokers reviewed serviced five of the nine transportation areas in the State of Massachusetts. There are 15 RTAs in Massachusetts that were created in 1974. These RTAs manage bus and van services in cities and rural areas with the help of private NEMT companies and other contractors to transport more than 31 million passengers each year. The management and oversight of the program is conducted by the Massachusetts Human Service Transportation Office (HST).
New Standard ... continued
Scope of the Audit The OIG audit reviewed $17.3 million of Medicaid payments to two high-volume brokers for eligible NEMT services for which a qualifying medical service was not billed for the same date the paid NEMT service was provided. As a sampling, 100 random claims from 896,792 NEMT trips completed between January 1, 2016, to December 31, 2017 were reviewed. The audit focused on the oversight of the brokerage program to determine whether: The beneficiary received a qualifying medical service on the date of transportation. There was adequate documentation supporting the NEMT service. The NEMT service was provided. Driver and vehicle qualifications complied with State regulations. It was noted in this audit that prior OIG audit reports have consistently identified NEMT services as vulnerable to fraud, waste, and abuse. The auditors wanted to ensure that Federal Medicaid reimbursement for NEMT service claims were in accordance with Federal and State requirements and that NEMT providers adequately documented driver qualifications and maintained vehicle records. OIG Findings The OIG found that the State agency did not claim Medicaid reimbursement for NEMT services in accordance with Federal and State requirements and did not ensure that NEMT companies adequately documented all driver qualifications and maintained all vehicle records. Out of the 100 NEMT trips reviewed, only 14 complied with Federal and State requirements. 86 of the NEMT trips were out of compliance and were unallowable for Medicaid reimbursement. 48 out of 86 NEMT trips, the beneficiary did not receive a qualifying medical service on the date of the NEMT service. 62 out of 86 NEMT trips, the NEMT broker could not provide sufficient documentation to support that the NEMT trips service were provided to the beneficiary. 2 out of 86 NEMT trips, transportation was not provided to beneficiaries but were submitted for Federal Medicaid reimbursement. Some sample items had more than one error. Additional OIG Findings In every trip reviewed, the brokers did not ensure transportation providers complied with the requirements in the Transportation Manual and in the contractual agreement between the brokers and the State agency. The NEMT providers did not have documentation to support that required driver qualification checks and vehicle inspections, registration, and maintenance policies or schedules had been completed or were valid at the time of service. The Impact of Insufficient Information and documentation regarding driver qualifications and vehicle records led the OIG to conclude “we cannot be assured that the beneficiaries were transported by qualified drivers and in safely maintained vehicles.†According to the OIG, the State agency made improper payments for NEMT services that contained the errors described above. They estimated that at least 758,847 Medicaid NEMT lines of service with payments totaling $14,142,730 did not comply with certain Federal and State requirements. OIG Audit Recommendations The OIG estimated that at least 758,847 Medicaid claims totaling $14,142,730 did not comply with certain Federal and State regulations. In addition, because there was insufficient information and documentation to assess compliance with driver qualifications and vehicle requirements, the OIG concluded “it cannot be assured that the beneficiaries were transported by qualified drivers and in safely maintained vehicles.†As a result, the OIG recommended the following: Refund $7,071,365 million back to the Federal Government Perform data matches to all claims billed on the day of an NEMT service to ensure only NEMT claims are paid when there is a corresponding qualifying medical service. Work with its brokers to ensure that documentation contains all necessary elements to support the NEMT service. Require brokers to verify that documentation contains all the necessary elements, in a legible manner, to support the NEMT service. Evaluate whether GPS or other monitoring of drivers would be an effective control to verify whether transportation had occurred or was to the destination listed on the PT-1. Implement controls that verify that the beneficiary was in the vehicle on the day of the billed NEMT service. Work with its brokers to implement controls that ensure drivers and vehicles used to provide NEMT services can be directly and clearly traced to the correct driver qualifications and vehicle records.
Give brokers the authority to deny unusual transportation requests when medical services cannot be verified (e.g., medical appointment after business hours). Provide the brokers with standard language they can send to confirm medical appointments. Final Thoughts Due to a complex regulatory environment and significant fraud, waste and abuse issues, medical transportation companies have been the focus of increased state and federal government enforcement activity. Over the next 24 months, the Government Accountability Office (GAO) has been mandated to complete a comprehensive study of Medicaid NEMT. This study will cover all 50 states with a focus on detailing previous fraud, waste and abuse findings and to identify actions and safeguards NEMT brokers and states currently have in place. The study will also seek to identify future NEMT trends in what will become a guiding document for the entire NEMT industry. There is a tremendous amount of research and OIG audits that show the need for federal and state initiatives to improve the program integrity of Medicaid NEMT services. As a NEMT provider, it is essential you take a comprehensive look into your internal billing processes and NEMT operations. It is also in the best interest of the company to collaborate with state Medicaid leaders, brokers, managed care plans and delivery systems to improve the integrity of the Medicaid NEMT program. RELATED OFFICE OF INSPECTOR GENERAL REPORTS 2015-2020 Indiana Paid $3.5 Million for Medicaid Nonemergency Medical Transport Claims That Did Not Comply With Federal and State Requirements 8/25/2020 Michigan Did Not Always Comply With Federal and State Requirements for Claims Submitted for the Nonemergency Medical Transportation Brokerage Program 6/14/2018 Minnesota Did Not Always Comply With Federal and State Requirements for Claims Submitted for the Nonemergency Medical Transportation Brokerage Program 9/15/2017 Oklahoma Did Not Adequately Oversee Its Medicaid Nonemergency Medical Transportation Program 8/4/2017 Nebraska Did Not Always Comply With Federal and State Requirements for Claims Submitted for the Nonemergency Transportation Program 3/1/2017 Louisiana Did Not Always Comply With Federal and State Requirements for Claims Submitted for the Nonemergency Medical Transportation Program 1/4/2017 North Carolina Improperly Claimed Federal Reimbursement for Some Medicaid Nonemergency Transportation Services 11/18/2016 New Jersey Did Not Adequately Oversee Its Medicaid Nonemergency Medical Transportation Brokerage Program 7/5/2016 California Claimed Medicaid Reimbursement for Certain Nonemergency Medical Transportation Services in Los Angeles County Billed as Exempt From Prior Authorization That Did Not Comply With Federal and State Requirements 3/30/2015 Massachusetts Made at Least $14 Million in Improper Medicaid Payments for the Nonemergency Medical Transportation Program (A-01-19-00004) California Claimed Medicaid Reimbursement for Some Nonemergency Medical Transportation Services That Did Not Comply With Federal and State Requirements 1/23/2015
OIG Audit Uncovers ... continued
By Frank Ciccarella, Owner, Synergize Consulting, LLC
Do It Right, The First Time and Every Time
By Nick Cambas, President, The Transportation Alliance
In our business, mistakes are costly. They result in poor service, can lead to accidents, injuries, and even fatalities. Mistakes can also lead to complaints, loss of business, legal issues, and the termination of employees. There are no positives from mistakes! Every company seeks to be the best that they can be, doing the most with the least. This means training and leading your employees to “Do it Right, The First Time, Every Time†in everything they do. During this challenging time, it is important to review your training programs so that the foundational training that is given is thorough, understandable, and is structured in such a manner that the new employee grows with each day of training and becomes more confident in their abilities. The goals of every operation should be to achieve the following goals: To Deliver Quality Service To Have no Complaints To be Accident Free To be Recognized as a Quality Provider To have the Lowest Cost To Retrain and Grow your Business To be Profitable But how do we do this? We need to rely on our front-line employees, our drivers. Everything that I have listed above is controlled by the behavior and actions of our drivers. It is important to understand how we control and improve the behavior and actions of our drivers. Setting the “NORMS†of how you train gives your training program a foundation to build upon. Foundational training begins with a quality training program that is comprehensive, systematic, and engaging, and led by a qualified instructor in both the classroom and behind the wheel training techniques. What is a NORM? There are many definitions of what a “NORM†is. I like to think of it as “a group of beliefs about how a person should behave and perform in a given contextâ€. “NORMS†are what everyone knows is expected of them. They are the best and safest way to perform each task, and that everyone performs and completes the task in the same correct, efficient manner all the time. Typically, a “NORM†will consist of a Policy, Procedure, and a Program. So, when you think about your training program, are your drivers taught about their job in a consistent, thorough, understandable, and structured manner? A good example of this is how a driver handles and secures a wheelchair. Do the drivers understand the Policy, the Procedure, and the Program of securing a wheelchair? If done incorrectly or mistakes are made, this can be a costly problem. Ensuring that your training program provides consistent, thorough, understandable, and structured instruction by a qualified trainer who can explain the “Norms†will ensure that your risk to your clients will be reduced or eliminated. “NORMS†are not just for drivers! Certainly, drivers are our most important tool that we have to keep our business and improve our business. “NORMS†can be applied to other areas of our operations such as our maintenance operations and office operations. Some examples of how “NORMS†can be applied to other areas areas: How often are your vehicles inspected? What are the mileage intervals? Do you have a policy, procedure, and program that addresses this issue? In your office, do you have a security protocol to address visitors entering your facility. What is the “NORMâ€, the policy, the procedure, and the program for allowing visitors? Having “NORMS†established in other areas helps us control costs, improve operations, and reduce expenses. Your Leaders! Having a foundational training program is part of how we control and improve the behavior of our drivers. By setting the “NORMSâ€, we set the expectations that our drivers are to follow. It is equally important that the leaders in your organization understand what the expectations are. Leaders must communicate, encourage, and enforce the “NORMSâ€. Do It Right, The First Time, Every Time, applies to management as well as other employees. In Conclusion By developing a plan to set the most efficient, safest, “NORMS†you can take the right actions to eliminate risk and improve the actions of your employees. Now is the time to examine your training. The question you should be asking is, are your current training “NORMS†consciously set, or did they happen by default? Are you in control?
The Transportation Alliance (TTA) and its non-emergency medical transportation (NEMT) coalition partners celebrated a major legislative win at the end of 2020 when Congress voted to codify this life-saving service as part of Medicaid. When President Trump signed the Consolidated Appropriations Act of 2021 into law at the end of the year, the law became official on January 1, 2021. This is a huge win for the industry and is something TTA and our coalition partners have been working on since 2018. The legislation not only makes the Medicaid NEMT benefit the law of the land, but it also includes other important provisions such as ordering a Government Accountability Office (GAO) study of Medicaid NEMT that will focus on previous fraud, waste and abuse findings, as well as identify future NEMT trends. In addition, the Centers for Medicare & Medicaid Services (CMS) will conduct a series of stakeholder meetings to identify best practices surrounding program integrity and identify challenges for NEMT services in the Medicaid program. TTA hopes to participate and provide meaningful guidance during these meetings. It will also set new requirements for NEMT drivers. Millions of Americans rely on Medicaid-funded NEMT for transportation to life-saving medical treatments such as chemotherapy and dialysis. It was well past time for Congress to recognize the importance of protecting Medicaid NEMT. Previously, any attempts to cut Medicaid NEMT through rulemaking would have negatively impacted the most vulnerable Americans’ ability to access important transportation services, not only for Medicaid beneficiaries, but more broadly for entire populations at risk. By passing legislation that codifies the NEMT provision under Medicaid, only an act of Congress can change the provision in the future, ensuring that millions of Americans can continue to utilize these vital services. Our trade association was founded of, by and for the taxi industry back in 1917. But today, our membership has dramatically evolved. It’s why roughly half of our members are today involved in NEMT. That diversification has been key to the survival of so many of our members’ businesses, including my own. Our involvement in NEMT is also why we invest in government relations. You can’t simply turn on a relationship in Washington. It takes time. And we’ve invested that time, with our legislative team representing TTA year round and our members flying every year (except last year, of course) to Washington, DC for our annual Legislative Fly-In. Over the course of two or three days every year we meet with lawmakers on Capitol Hill, making sure that our voice is heard. Starting in 2018, we knew we needed to make sure our elected officials understood what was at stake if Medicaid-funded NEMT disappeared. We rallied our members, met with lawmakers, made phone calls and wrote letters to Congress. In the process, we found some remarkable champions of these efforts. "The NEMT Medicaid benefit, which had been mandatory by regulation since 1966, was in danger of becoming optional under a Trump Administration regulation,†Rep. Sanford Bishop (D-GA) said after the passage of this landmark legislation. “Thousands of Medicaid patients in Georgia and across the nation who relied upon NEMT to transport them to and from health services such as dialysis and COVID-19 testing would have been placed at risk if the benefit had been eliminated. By codifying NEMT under the Medicaid statute, we can rest assured that the benefit will remain protected now and into the future. I want to thank all those who helped, especially The Transportation Alliance, for their support in our fight to protect this vital need for so many Americans.†We are thankful for the tireless efforts of Rep. Bishop and his bipartisan colleagues who supported this law, including Rep. Buddy Carter (R-GA), Rep. Tony Cardenas (D-CA), Rep. Rosa DeLauro (D-CT), Rep. Tom Cole (R-OK), Rep. Nita Lowey (D-NY), and Rep. Kay Granger (R-TX). These members have been working to support the protection of these vital services for two years. We are thankful to all our members from across the country who joined TTA’s leadership in Washington to voice their support of protecting NEMT. We are heartened to see that Washington was able to cross the aisle and work so effectively together to protect passengers who rely on this vital transportation and the companies that provide these services. Indeed, this is a huge win for the NEMT industry, and is an affirmation of just how vital NEMT is to millions of Americans. Thanks to this law, it will remain so well into the future.
By Tamara Carlton, Director, Social Determinants of Health and Product Development, MTM
In 2020, non-emergency medical transportation (NEMT) providers experienced an unprecedented drop in trip volume. With elective procedures cancelled for several months in many areas, as well as the immense rise in telemedicine options, NEMT providers were left with only a fraction of their typical trip volume. Unfortunately, this resulted in many companies having to let staff go, and in some cases, shut down their operations for good. As one of the nation’s largest NEMT brokers, MTM remained committed to finding additional work for its network of transportation providers to help them make it through the COVID-19 pandemic. Thinking outside the box, MTM’s Logistics and Operations teams worked hand-in-hand to help their NEMT partners stay in business. Outside of taking passengers to medical appointments, there are many ways NEMT fleets can be used creatively—while also helping health plans address Social Determinants of Health (SDoH) through existing community transportation resources. SDoH are factors like food quality and availability, housing stability, education, socialization, and access to healthcare that influence a person’s health risks and outcomes. Collaborating with NEMT clients and providers, here are just a few of the ways MTM found additional work for providers while also improving the health outcomes of the communities it serves: In several areas, MTM identified dedicated providers who were willing to take COVID-positive passengers to medical care and presumed positive passengers to testing sites. These providers were given the proper PPE and cleaning supplies necessary to keep their drivers safe and their vehicles clean. In states like Texas and Nevada where residents struggled with food insecurity, MTM partnered with transit agencies to deliver meals to community members in need and create mobile hotspots in targeted neighborhoods using out-of-service vehicles. These deliveries were assigned to local transportation providers, resulting in a win-win for all parties—providers were able to keep their drivers working, and residents were able eat healthy, regular meals. In Minnesota, MTM worked closely with its client in the Twin Cities area to take transient populations to COVID testing facilities and isolation shelters, as well as a local university to transport COVID-positive students to isolation dorms. In the District of Columbia, MTM partnered with Ward 8 and three area transportation providers to help local seniors get to their polling place on Election Day, ensuring they had the opportunity to exercise their right to vote. In other areas, MTM collaborated with clients to delivers necessities like cribs and diapers to families in need.
Outside of helping NEMT providers find alternative work, MTM also partnered with them to ease as much financial burden as possible. The majority of its subcontracted providers are small businesses who income took a huge hit as a result of the pandemic. MTM waived liquidated damages during the pandemic, while continuing to emphasize the importance of getting all passengers to their appointments safely and on time. Additionally, to recognize the transportation partners who stepped up to the plate with dedication and unwavering dependability during the pandemic, MTM named more than 100 of its NEMT providers MTM Community Heroes. This designation recognizes the providers who risked their health to ensure COVID-positive and presumed positive passengers could access testing and healthcare. As a token of MTM’s appreciation, each of the Community Heroes received a certificate and vehicle magnet that they can proudly display while they are on the road. To NEMT providers around the nation, thank you for being a vital asset to brokers like MTM, health plans, managed care organizations, state and county governments, and passengers. Your dedication and willingness to risk your own health and safety during the pandemic hasn’t gone unnoticed. 
 About MTM MTM is the nation's most trusted and qualified partner for healthcare, transportation, and logistics solutions. Since 1995, MTM has managed NEMT for state and county governments, managed care organizations, health systems, and other programs involving transportation for the disabled, underserved, and elderly. Leveraging technology to streamline processes and improve the user experience for all stakeholders, MTM's wide spectrum of services help clients improve health outcomes, promote independence, reduce costs, and increase satisfaction. In 2009, MTM's leadership established MTM Transit, an affiliate that provides direct paratransit and fixed route transit services. Every year, MTM and MTM Transit collectively remove community barriers for twelve million people by providing more than 20 million trips in 32 states and the District of Columbia. MTM and MTM Transit are privately held, woman-owned business enterprises.
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Innovation in NEMT: Alternative Uses for Fleets
The Human Touch Matters Most We as humans crave interaction. We like being together. For the most vulnerable, life overall can be much more isolated and lonelier. The ride to the doctor’s appointment may be the big social outing of the week for some people. Now they’re stepping into a vehicle where they are separated by new barriers and can’t be next to others. So as drivers and operators of transport companies, what are we to do to improve the passenger experience? Just like our vehicles, we need to give our customer service an upgrade. We need to smile so big it shows through our masks. We need to become better listeners, especially because the masks can muffle soft voices and those difficult to understand even without a mask. We need to talk and communicate more effectively to break through the new physical barriers and create the caring and comfortable environment our passengers deserve. We need to have more patience as everyone continues to have challenges with this new “normal.†We need to be quick and proficient when securing wheelchairs and mobility devices. And as owners, we need to invest more time, effort and resources into training our people to be the best they can be to ensure all the above happens on every trip. The passenger experience starts and ends with their interactions with the drivers and people in operations. Yes - their sense of safety and good health will be enhanced by the changes made to the vehicles. But in the end, people make the difference. About Driverge Vehicle Innovations Driverge is the country’s leading builder of commercial accessible vans, shuttles, transporters, work vans and recreational vehicles. It is a Ford Qualified Vehicle Modifier (QVM), Mercedes-Benz MasterSolutions® Upfitter, and Ram Commercial Q-Pro supplier. With manufacturing facilities in Ohio, Kansas, South Carolina and California, Driverge provides vehicle conversions to numerous industries and government agencies including healthcare, fleet management, hospitality, wheelchair transport services, rideshare and other vocational markets. Driverge Vehicle Innovations and MobilityWorks together make up WMK, LLC which has been recognized on the Inc. 500|5000 list of Inc. Magazine’s fastest growing privately held companies for the past ten years.
PWW Client Connect™ is an opportunity for new and existing clients of Page, Wolfberg & Wirth to get PWW’s most popular services at a fixed monthly fee. Flat rate legal services for the medical transportation industry including: • Unlimited Phone and Email Consults • Three Agreement/Contract with PWW Attorneys and Consultants Reviews Per Year • Unlimited Legal Correspondence on • Annual Claims Snapshot General Business & Compliance Issues Review For more information, or to sign up, go to www.pwwemslaw.com/Client_Connect or email us at ClientConnect@pwwemslaw.com or call us at 1-877-EMS-Law1 Restrictions apply. In-depth legal issues such as litigation, disputes, and large research projects are not covered by PWW Client Connect™ and require additional fees. Detailed terms and conditions will be provided to participants.
By Jim Cermak, Product Training Manager, Driverge Vehicle Innovations
The COVID-19 pandemic caused the world to pivot, and that included all those in the NEMT industry. NEMT providers were deemed as “essential†businesses, and rightfully so. This meant providers could keep their wheels rolling but needed to operate in new ways. Safety brought on a whole new meaning in an industry that is focused on keeping its passengers safe during transit. Suddenly, a new world of masks, hand sanitizer, and keeping people distant was upon us. And now, a new President’s administration is firmly on the record with pandemic safety and vaccine deployment initiatives that will increase the impact on NEMT providers. Most passengers on public transit stopped riding altogether. Maybe they were working from home, or maybe they felt there was too much risk in riding. NEMT Providers Matter More Than Ever But for those served by the NEMT industry – people who need to get to important medical care, or those in wheelchairs or assistive devices who simply need a ride to get groceries, they couldn’t just stay home. The NEMT providers were their lifeline. Just because they had to leave the house didn’t mean they were not fearful. They wanted and deserved to feel safe all along the way. Spur of the Moment Adaptation Each transport company had to look for solutions, and those solutions when this all started either didn’t exist or weren’t readily available. We all had to get creative because vehicles weren’t set up for safely transporting during a pandemic. When driver turnover happened and/or driver training was needed, in-person options were greatly reduced. Online and virtual training options were also limited or insufficient. Fortunately, suppliers and options continued to evolve. New partitions and plexiglass shields became available to stop germs from spreading. Drivers and passengers alike wear face masks or face shields or both. Seat covers were used to put over seats to create social distancing. New virtual and video training options became available. Some vehicles are equipped with a flexible flooring system that allow for seats to be moved or removed. These vans are able to be converted to a new seating layout with 6’ distancing automatically built in. New vehicle options made the trip safer for all on board. But what did it do for the passenger experience?
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Ad Specifications: Furnish press ready pdf files All fonts must be embedded, and all images must be 200dpi minimum (300 dpi preferred) All advertisement will be invoiced and payment must be received prior to edition publication Prices and Specifications listed below: 

NEMT Today magazine is a quarterly publication with editions in the Winter, Spring, Summer and Fall. The publication is an 8.5" x 11" vertical interactive digital publication. We are interested in receiving articles that highlight educational topics related to Non-Emergency Medical Transportation (NEMT) business operations, industry trends, compliance & regulatory, technology and customer service. Submission Deadlines: Final copy for articles and advertisement is due on the following dates: Winter issue - January 15th Spring issue - March 15th Summer issue - June 15th Fall issue - October 15th Each issue will be published approximately one month after submission deadline. Article Specifications: Furnish articles in Word files format 1000 word maximum or less preferred All font will be Open Sans 9.6 pt. All articles must be submitted with author name and title All articles must be submitted with a title All articles must be submitted with a minimum of 1 photo relevant to the article Articles that heavily promote an organization will be considered sponsored content and the editor will contact you for approval and payment
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