How to Start an NEMT Business in Vermont: A "Bambi Knows Best" State-By-State Series Part 1: Research the Vermont NEMT Market With its stunning landscapes and close-knit communities, Vermont offers a unique backdrop for your new NEMT venture. But before you hit Bambi’s forest ground running, it's critical to conduct thorough market research to set yourself up for success.
1 | Identify Existing NEMT Providers in Vermont
Understanding the landscape of existing NEMT services in Vermont will help you spot opportunities and avoid unnecessary competition. The Department of Vermont Health Access (DVHA) oversees and monitors the state’s NEMT programming, issuing policies and procedures that adapt to evolving circumstances and federal and state directives.
DVHA is also responsible for approving various trips and exceptions, including authorizations for trips extending beyond a 100-mile radius from a member’s home and for out-of-state travel. Other key players in Vermont’s NEMT scene include these providers:
Modivcare Green Mountain Transit (GMT) Uber Health Local Directories and Online Research : Search online or consult local directories for specific NEMT companies operating in cities like Burlington, Montpelier and Rutland.2 | Assess the Demand for NEMT Services
To gauge the demand for NEMT services, focus on Vermont's key healthcare facilities and communities. It’s good to also consult with Vermont Department of Health for the latest numbers:
Adult Day Care (ADC) Centers : ADCs in Vermont are crucial for supporting its aging population. For the latest statistics and information, consult the Vermont Department of Disabilities, Aging and Independent Living (DAIL) or local health departments overseeing these facilities.Dialysis Clinics : Major providers in Vermont include Fresenius Medical Care and University of VT Medical. We advise that you contact local directories or health authorities for more details.Physical Therapy Centers : Numerous healthcare centers offer physical therapy across Vermont. The Vermont Physical Therapy Association can provide the most up-to-date information on this front.Hospitals : Vermont has between 15-20 hospitals depending on where you’re researching. These include community hospitals, critical access hospitals and a Veterans Affairs medical center. Key facilities include the University of Vermont Medical Center in Burlington , which is the largest hospital in the state, and several other regional medical centers providing essential healthcare services across Vermont according to the American Hospital Association .Nursing Homes and Assisted Living : There are multiple facilities offering long-term care. For current data, check with the Vermont Department of Disabilities, Aging and Independent Living (DAIL).Outpatient Care Centers : Vital for Vermont’s healthcare network, these centers offer various services for those receiving outpatient support. Contact local healthcare providers and/or hospitals as they’re often partnering with these places.3 | Decide on a Target Market
After evaluating the demand, define your target demographic. Whether you focus on the elderly, individuals with disabilities or a broader patient base, tailoring your services to these needs will enhance your business’s effectiveness, appeal and get you a nice marketing spend ROI.
4 | Choose Specific NEMT Services
Identify high-demand services to offer in Vermont. Consider specializing in areas like senior transportation, medical appointments or specialized care facilities to meet local needs and differentiate your business.
5 | Understand Different Medicaid Delivery Models
In Vermont, NEMT is covered for individuals enrolled in Medicaid and the Dr. Dynasaur programs. Dr. Dynasaur provides low-cost or free health coverage for children, teenagers under 19 and pregnant women.
NEMT services are provided through a contract between the Department of Vermont Health Access (DVHA) and the Vermont Public Transportation Association (VPTA) , a regional network of public transportation providers. DVHA is responsible for overseeing and monitoring the NEMT program, including issuing policies that align with federal and state regulations. The DVHA also authorizes transportation for trips that exceed a 100-mile radius from a member’s home or require travel out of state.
As the administrator for Vermont's NEMT program, VPTA subcontracts with various public transportation providers to ensure statewide access for eligible members. VPTA's responsibilities include verifying eligibility, arranging the most cost-effective transportation to medical appointments, and processing claims. VPTA must comply with DVHA’s service approval, claims processing, and utilization review requirements.
Quick NEMT Vermont Facts :
NEMT Model : Statewide Broker ModelOperating Authority : Federal Section 1115 Demonstration WaiverNEMT Expense Classification : Medical ExpensePoverty Rate : Approximately 10% live below the poverty line (Source: U.S. Census 2015 5-Year Estimates)Urban Population : About 17% live in urbanized areas (Source: U.S. Census 2010)Estimated Annual NEMT Expense : Roughly $11 million (is the estimated annual NEMT 2013 expense).Estimated Number of Annual NEMT Trips : Around 390,000 (is the estimated annual NEMT 2013 expense).Public Transportation: 12% is estimated as NEMT 6 | Getting Paid
DVHA compensates VPTA on a per member, per week basis for managing the NEMT program. VPTA is responsible for reimbursing its subcontractors in accordance with all applicable tax and employment laws.
Further information on the payment methods for NEMT services in Vermont include:
Fee-for-Service (FFS) : Providers submit claims directly to Medicaid for reimbursement.Managed Care Organizations (MCOs) : Providers contract with MCOs, receiving payment based on contractual terms.Administrative Contractors : Some services are managed by contractors who handle payment processes.Be sure to adhere to Medicaid billing guidelines when submitting claims. For specific details, consult the Vermont Agency of Human Services or contracted MCOs.
Prepare to navigate Vermont’s NEMT landscape with precision and insight. Stay tuned for Part 2 , where we’ll guide you through crafting a business plan tailored to Vermont’s unique regulations and market dynamics. Stick with us, or Bambi leap ahead through the series' table of contents to pave your path to success!
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