Audit of the Office of Medicaid (MassHealth)—Review of Transportation Services Overview of Audited Entity

This section describes the makeup and responsibilities of the Office of Medicaid (MassHealth)—Review of Transportation Services.

Overview

Under Chapter 118E of the Massachusetts General Laws, the Executive Office of Health and Human Services, through the Division of Medical Assistance, administers the state’s Medicaid program, known as MassHealth. MassHealth annually provides access to healthcare services for approximately two million eligible children, families, people over 65, and people with disabilities, all of whom have low or moderate incomes. In fiscal year 2024, MassHealth program expenditures totaled $20.1 billion, of which approximately 39% was paid by the Commonwealth. Medicaid program expenditures represented approximately 33% of the Commonwealth’s total fiscal year annual budget. 

Nonemergency Transportation Services

MassHealth provides nonemergency transportation services for its members who require an office visit to receive a covered medical service. These services are managed by the Human Services Transportation Office under the Executive Office of Health and Human Services.

A MassHealth member who requires nonemergency transportation services must reach out to their primary care physician or provider to obtain a Provider Request for Transportation (PT-1) form.¹ This form authorizes the member to receive transportation from their home to the provider’s office and the return trip to their home. The member must obtain separate PT-1 forms for any additional providers that they may visit. Members may bring an additional person with them, designated as an escort, to assist with entering or exiting the vehicle, translation, or general support. These services are also available to some MassHealth members when they are discharged from the hospital or other inpatient/outpatient settings.

After the member is approved for nonemergency transportation services, they are assigned to a broker based on their location. During the audit period, there were two brokers facilitating these services: the Montachusett Regional Transit Authority (MART) and the Greater Attleboro Taunton Regional Transit Authority (GATRA). These brokers match the member with a contracted transportation company based on a number of factors, including the type of vehicle needed, pickup fees, and mileage rates. The brokers and the transportation companies conduct annual Criminal Offender Record Information checks to ensure that drivers qualify to provide the transportation service to the members, under MassHealth regulations.

During the audit period, MassHealth paid $283,336,169 for nonemergency transportation services. The amount paid by fiscal year is as follows:

	Fiscal Year 2021	Fiscal Year 2022	Fiscal Year 2023	Total
Amount Paid	$51,823,426	$98,117,009	$133,395,734	$283,336,169
Number of Claims	2,011,186	3,127,356	3,595,129	8,733,671

Ride Selection

MART and GATRA are responsible for assigning rides to contracted transportation companies based on each member’s needs and the total cost of the ride. Every three months, transportation companies submit their prices to MART and GATRA for the vehicle types they offer. Prices include the pickup fee and mileage rate for each vehicle type. Rates are made public after each quarter, once the bidding period is over, to allow companies to adjust their rates for the next quarter of new bids, which allows for more competitive prices. When a member has a standing medical order, the selected provider transports that member for three months, until new rates are set, because they go to the same location multiples times per week for multiple months at a time. Brokers consider additional factors when matching a member with a transportation company. Brokers consider the relationship between the member and the company, as well as the company’s history of customer satisfaction. Additionally, the transportation company with the lowest cost may not be able to accommodate a member’s schedule, in which case the broker moves to the next lowest-cost provider based on the same criteria. If a member files a complaint about the company, there are measures in place to ensure that the member is not matched with that company moving forward.

Brokers, MassHealth members, and transportation companies use a transportation software to facilitate all rides. In addition to standing orders, some members may need to request rides for medical appointments that are not recurring. In these cases, the member submits a request through the transportation software. Once it receives a request, the broker offers the ride to a transportation company based on the criteria above, and the company has the option to accept or decline the offer. When an offer is declined, the ride is offered to a different company. Transportation companies are responsible for maintaining documentation confirming that the ride took place, while the brokers are responsible for submitting monthly reports to the Human Services Transportation Office. Each of these reports includes a list of active transportation providers in their service area; the number of on-site inspections completed; the number of critical incidents; and the number of transportation requests processed, implemented, and not implemented.

1.    According to Section 407.402 of Title 130 of the Code of Massachusetts Regulations, a PT-1 form is “a form designated by and submitted to MassHealth, used to request brokered transportation for a member. The PT-1 form documents the medical necessity of the transportation requested and its authorization by appropriate personnel.”

Date published:	May 8, 2025