How to Start an NEMT Business in Iowa: A Several Part “Bambi Knows Best” State-By-State Series Part 1: Research the Iowa NEMT Market
Before launching a new NEMT business in Iowa, thorough market research is essential. This step ensures you avoid an oversaturated market and identifies gaps in existing NEMT services. For example, you might find that while there are NEMT providers, they only serve adult day care centers, leaving an opportunity to expand services to rehabilitation centers, hospitals and other healthcare facilities.
1 | Identify existing NEMT providers in your area
Each MCO has its own network of providers, tailored to the regions they serve and the needs of their members. Providers must meet specific requirements and standards set by the MCOs.
This managed care model provides flexibility and choice for Medicaid beneficiaries, ensuring reliable transportation that meets healthcare needs across the state. Some of the most notable NEMT providers that work with these MCOs are as follows:
MTM, Inc. Hawkeye Area Community Action Program (HACAP) :AmeriHealth Caritas Iowa :UnitedHealthcare Community Plan of Iowa :Modivcare Compassionate Care Transportation Uber Health Your favorite search engine. Of course, one can always perform their own search with the keywords, “NEMT providers in Iowa” or get more granular with your search by putting in specific municipalities (i.e. “NEMT companies in Des Moines”). These providers and brokers collaborate with Iowa's managed care organizations to deliver NEMT services to Medicaid beneficiaries, ensuring access to essential healthcare appointments across the state.
2 | Assess the demand for NEMT services
Assess the demand for your NEMT business in your local Iowa area. Determine if you'll cross multiple jurisdictions or operate within a limited radius. Research local hospitals, health and wellness facilities and other relevant establishments such as:
Adult Day Care (ADC) Centers. There are many licensed adult day care centers in Iowa. These centers provide support services for the elderly and individuals with disabilities, offering safe and engaging places during the day while giving caregivers a much-needed respite. To get exact numbers it’s also advisable to reach out to the Iowa Department of Human Services and Iowa Department of Public Health .Dialysis Clinics. As of recently there are 43 dialysis facilities in Iowa. These facilities are spread across various cities and provide essential services to patients requiring regular dialysis treatments.Physical Therapy Centers. There are numerous physical therapy centers across Iowa, providing a range of rehabilitation services to patients. It’s tricky to find an exact number. One way to find this out would be by reaching out to the Iowa Department of Human Services Hospitals: Iowa has at least a total of 118 hospitals. These hospitals include various types such as general acute care hospitals, critical access hospitals, specialty hospitals and psychiatric hospitals. For the most accurate and current count, you may want to verify with the DHS or other authoritative sources. Some of the major hospital systems are UnityPoint Health , MercyOne and University of Iowa Health Care .Rehabilitation centers. We don’t have an up-to-date number here either, but many hospitals have partnering rehab centers so it’s always best to reach out to them.Nursing homes and assisted living facilities. There are approximately 440 nursing homes in Iowa. Outpatient care centers. Just like rehab facilities, there is a large amount of outpatient care centers throughout the state — talk to your local hospitals for more information on these estimates.3 | Decide on a target market After researching NEMT market opportunities and assessing demand, pinpoint the demographic that is most viable to target, such as seniors, individuals with disabilities, or a broader patient population. Focusing on a specific group will enable you to tailor your services and marketing strategies more effectively.Iowa State Data Center ).
4 | Choose a specific NEMT service (or offer them all!) NEMT providers offer ambulatory, stretcher, and wheelchair services. Starting with one service based on market needs and gaps is advisable, then expanding gradually. This approach ensures sustainability. Monitor competitors and either differentiate your services or find a niche that needs support. Begin with a well-equipped fleet tailored to your chosen service, whether for adult day cares or physical therapy centers.
5 | Understand the different Medicaid delivery models The Iowa Medicaid Enterprise (IME) , a division of the Iowa Department of Human Services (DHS), administers the Iowa Medicaid program. Effective April 1, 2016, most Iowa Medicaid members transitioned to the IA Health Link managed care program . Some members continue to receive services through Iowa Medicaid Fee-for-Service. IA Health Link is managed by three contracted MCOs, providing comprehensive health care services, including NEMT, to members.
NEMT services are available to members with full Medicaid benefits who require travel reimbursement or transportation to medical appointments. Eligible members receive NEMT services through different brokers, depending on their eligibility status and coverage provider (either Iowa Medicaid Fee-for-Service or an IA Health Link MCO). The appropriate broker verifies member and trip eligibility, and handles trip scheduling and claims.
The Iowa Health and Wellness Plan (IHAWP) is a Medicaid program developed in response to the Affordable Care Act. IHAWP benefits align with the state employees' commercial health insurance plan and do not include traditional Medicaid benefits. Notably, NEMT services are not covered for IHAWP members.
For further details on the Iowa Medicaid program and its NEMT services, please consult the Iowa Medicaid program or the relevant managed care organization.
Here are some fast AR facts according to report State-by-State Profiles for Examining the Effects of Non-Emergency MEdical Transportation Brokerages on Transportation Coordination :
NEMT Model is a Managed Care Organization The Operating Authority is Federal Section 1915 (b) Demonstration Waiver NEMT expense is classified as a “Medical Expense” (Source: Kaiser Family Foundation) 12% live below poverty (US Census 2015 5-Year Estimates) 42% live in Urbanized Areas (US Census 2010) $10.8 Million is the estimated annual NEMT 2013 expense (Source 2014 National NEMT Survey) 100,434 is the 2013 estimated number of annual NEMT trips 6 | Getting Paid
In Iowa, NEMT providers typically get paid through the following methods under the Medicaid program:
Fee-for-Service (FFS) : Providers submit claims directly to Medicaid for each service provided. Reimbursement rates are typically set by Medicaid and may vary based on the type of service and other factors.Managed Care Organizations (MCOs) : Iowa's Medicaid program is managed by MCOs, which may manage transportation services directly or subcontract them to specialized transportation providers. Providers contract with these MCOs and are reimbursed according to the terms of the contract.Brokers : In the brokerage model, a third-party broker or managed care organization coordinates transportation services for Medicaid beneficiaries. Providers contract with these brokers and are reimbursed according to the negotiated terms.Providers are typically paid based on the submission of claims for services rendered, and they must follow Medicaid billing guidelines and procedures. For specific details and requirements, providers should consult with the Iowa Medicaid program or the managed care organization they are contracted with.
Well done on navigating through this information-packed first part! Now, let's proceed to Part 2, where our focus will be on developing a business plan. Click here to continue , or you can skip ahead to other sections in the series by visiting the table of contents.
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