How to Start an NEMT Business in Texas: A Several Part “Bambi Knows Best” State-By-State Series Part 1: Research the Texas NEMT Market Before launching a new NEMT business in Texas, conducting thorough market research is a must do. This strategic step helps you avoid entering an oversaturated market and allows you to identify any potential gaps in existing NEMT services. For example, you may discover that while there are NEMT providers serving certain sectors like rehabilitation centers , there is an opportunity to expand services to include adult day care centers , hospitals and other healthcare facilities. This approach ensures you can meet the transportation needs of the diverse healthcare settings across the massive state of Texas.
1 | Identify existing NEMT providers in your area
Under this system, MCOs handle service coordination, provider network management, and reimbursement processes, ensuring that eligible Texans receive timely and appropriate transportation solutions. The Texas Health and Human Services Commission (HHSC) oversees regulations to uphold quality service and patient safety standards. For more detailed information on Medicaid managed care you can consult resources provided by the Texas Medicaid & Healthcare Partnership (TMHP) .
Modicare Verida MTM, Inc . : MTM, Inc. is a national provider of transportation and healthcare management services, including NEMT. They collaborate with MCOs in Texas to manage transportation logistics and ensure compliance with Medicaid regulations.Access2Care Uber Health Your favorite search engine. Of course, one can always perform their own search with the keywords, “NEMT providers in Texas” or get more granular with your search by typing in specific municipalities (i.e. “NEMT companies in Dallas”). 2 | Assess the demand for NEMT services Learn about the demand for your NEMT business in your local Texas area upon determining if you will serve multiple jurisdictions or operate within a specific radius. Research local hospitals, healthcare facilities, wellness centers and other relevant health-focused establishments. Get creative, and think outside the Bambi box:
Adult Day Care (ADC) Centers. As mentioned in our first Texas article, with over 12% of Texans aged 65 and older facing chronic conditions like diabetes, hypertension and heart disease, the state hosts numerous adult day care centers across urban and rural areas to support elderly and disabled individuals. For the most up to date numbers, consult local health department records, Texas Health and Human Services Commission (HHSC) data or industry reports on senior care facilities in Texas.Dialysis Clinics. We don’t have a data point on this point, but because of Texas’ vastness there are a plethora of these clinics peppered across the state. Some of the biggest clinics with a prevalent presence in the state are the following: Fresenius Medical Care , DaVita Kidney Care and U.S. Renal Care .Physical Therapy Centers. It's tricky to pinpoint the exact number of physical therapy centers in Texas due to varying reporting methods and the state's expansive healthcare landscape. For the most accurate data, we advise that you check the state health department records, professional associations like the American Physical Therapy Association (APTA) or industry reports on Texas healthcare facilities that might provide clearer insights.Hospitals. Texas has over 600 hospitals, varying in size and specialization, from small rural facilities to large urban medical centers. For precise details on the number and types of hospitals across the state, we recommend you refer to databases maintained by the Texas Department of Health and Human Services (DSHS) and the Texas Hospital Association (THA). Rehabilitation centers. We don’t have an up-to-date number here either, but many hospitals — and just look at the point above, there are over half a thousand! — have partnering rehab centers so it’s always best to contact them.Nursing homes and assisted living facilities. Texas is home to a substantial number of nursing homes, essential for long-term care, particularly given that over 12% of its population is aged 65 and above — the prime age for Medicaid services. For precise figures, consulting databases maintained by the Texas Health and Human Services Commission (HHSC) or industry reports on senior care facilities would provide accurate information.Outpatient care centers. Similar to rehab facilities, Texas boasts numerous outpatient care centers statewide. For more details on these estimates, consider consulting your local hospitals.3 | Decide on a target market Note that the population of Texas is estimated to be around 30.5 million people . If you didn’t realize how big Texas was, now you do! And now that you've thoroughly researched the NEMT market opportunities and gauged the demand across these millions of folks, it’s time to identify the most viable demographic to target — be that seniors, individuals with disabilities or a broader patient population. By focusing on a specific group, you can better tailor your services and marketing strategies.4 | Choose a specific NEMT service (or offer them all!) NEMT providers roll out services such as ambulatory, stretcher and wheelchair rides. Start with one that you’ve noticed is in demand to fill those gaps! It's the savvy way to begin and guarantees long-term success after all. Be sure to keep an eye on competitors; stand out with unique services or find a niche that's underserved. And, ultimately, kick off with a top-notch fleet tailored for your chosen service area, whether you're ferrying folks to adult day cares, physical therapy centers, what be it.5 | Understand the different Medicaid delivery models The NEMT model in Texas blends elements of a regional broker and in-house management. Under the Medicaid program's managed care delivery model, Managed Care Organizations (MCOs) are pivotal in managing healthcare services for Medicaid beneficiaries. This includes coordinating a spectrum of patient care such as medical services, behavioral health and, our favorite: NEMT. MCOs establish networks of healthcare providers statewide to ensure access to vital services like NEMT services, hospital care, physician visits and prescription drugs.The Texas Health and Human Services Commission (HHSC) oversees Medicaid, establishing policies, regulations and ensuring adherence to federal guidelines. Medicaid recipients in Texas access healthcare through MCOs, which strive to improve care coordination, expand service accessibility, and effectively manage costs. For more information on Texas Medicaid and its NEMT services, refer to the Texas Medicaid program or contact the relevant managed care organization.State-by-State Profiles for Examining the Effects of Non-Emergency MEdical Transportation Brokerages on Transportation Coordination :
NEMT Model is a blend of in-house management and regional broker The Operating Authority is a blend of 1902(a)(70) State Plan Amendment and Federal Section 1915 (b) Demonstration Waiver NEMT expense is classified as either a “Medical Expense” or “Administrative Expense” (Source: Kaiser Family Foundation) 16% live below poverty (US Census 2015 5-Year Estimates) 75% live in Urbanized Areas (US Census 2010) $260.7 Million is the estimated annual NEMT 2013 expense (Source 2014 National NEMT Survey) 9,290,567 is the 2013 estimated number of annual NEMT trips 6 | Getting Paid In Texas, NEMT providers receive their payment through a few different methods under the Medicaid program:
Fee-for-Service (FFS) : Providers submit claims directly to Medicaid for each service rendered. Reimbursement rates are determined by Medicaid and vary depending on the type of service provided and other factors.Managed Care Organizations (MCOs) : Texas Medicaid operates under managed care, where MCOs are contracted to manage healthcare services, including transportation. Providers contract with MCOs to deliver NEMT services and receive payment according to negotiated terms and rates set by the MCOs.Brokers : Some MCOs or third-party brokers may coordinate NEMT services on behalf of Medicaid beneficiaries. Providers contract with these brokers and are reimbursed based on agreed-upon terms.Of course, providers must adhere to Medicaid billing guidelines and procedures when submitting claims for reimbursement. For more detailed information and specific requirements, providers should refer to the Texas Medicaid program or the managed care organization they are affiliated with.Great job on making it through this content-rich first part! Next up, let's dive into Part 2, where we'll focus on crafting your business plan. Click here to continue , or feel free to explore other sections in the series through the table of contents .
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