Agenda 06/28/2011 Item #16A 6
6/28/2011 Item 16.A.6.
EXECUTIVE SUMMARY
Recommendation to execute the Non Emergency Transportation Medicaid Contract for the State
201112012 fiscal year; authorize a budget amendment in the amount of $486,958 to recognize the
Medicaid grant funds; authorize a budget amendment in the amount of $137,270 in order to fund
the Paratransit Transportation Disadvantaged program through the remainder of fiscal year
2011; and, to direct staff to work with the Local Coordinating Board to evaluate funding and
service options for paratransit throngh fiscal year 2012.
OBJECTIVE: To execute the Non Emergency Transportation Medicaid Contract for the State
201112012 fiscal year; authorize a budget amendment in the amount of $486,958 to recognize the
Medieaid grant funds; authorize a budget amendment in the amount of $137,270 in order to fund the
Paratransit Transportation Disadvantaged program through the remainder of fiscal year 2011; and, to
direct staff to work with the Local Coordinating Board to evaluate funding and service options for
paratransit through fiscal year 20 12.
CONSIDERATION: Chapter 427, Florida Statutes requires that, within each Florida County, all tax
sponsored, human service transportation be coordinated by one entity, the Community Transportation
Coordinator (CTC). The Collier County Board of County Commissioners is the CTC for Collier County.
Collier Area Paratransit (CAP) functions as the CTC on behalf of the Collier County Board of County
Commissioners. As the CTC, CAP provides transpOliation services under three funding mechanisms:
Medicaid, Transportation Disadvantaged (TO) and Americans with Disabilities Act (ADA). These
funding sources do not fully fund paratransit services and are annually supported by local funds
provided through Genera] Fund (00]) to date. The three programs combined form the Coordinated
System which is operated hy Collier Area Paratransit. Each funding source has guidance and
requirements that must be followed.
· Medicaid services: The County has an existing contract with the Florida Commission for the
Transportation Disadvantaged (CTD) to provide non-emergency transpOliation to persons who
receive Medicaid benefits from the fed era] government. The program provides only medical
trips and it requires a co-pay of $1.00 as dictated by Statute. The Medicaid contract does not
allow trips denials.
· Transportation Disadvantaged services: The County has entered into a Grant Agreement with the
CTD to provide transportation to persons who reside in areas where fixed route service is not
available, do not have other means of transportation and have a limited income. The co-pay for
these services is based on income level and it ranges from $0 to $6. The Transportation
Disadvantaged program follows the trip priority guidelines established by the Local
Coordinating Board (LCB).
· ADA services: The County has entered into a Grant Master Agreement with the Federal Transit
Administration (FT A) that requires providing transportation to persons who have disabilities
(certified by a licensed medica] professional); are unable to utilize the fixed route system and,
live within % of a mile of the fixed route corridor. This service must be provided along all
existing fixed route corridors and requires a $2.00 co-pay. No trips can be denied under this
category.
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6/28/2011 Item 16.A.6.
The CTD currently receives Medicaid funds from the Agency for Health Care Administration (AHCA)
and manages the distribution of funds to the CTCs in Florida via a Non Emergency Transportation
(NET) Medicaid contract. Collier County entered into a three year NET Medicaid contract with the
CTD in 2008 to provide Medicaid transportation to qualified recipients. This contract expires on June
30,201]. Collier County has received an amendment to this existing agreement that will continue the
contract for a year and provide $486,958.00 for fiscal year 11/12 services.
As part of the monthly Collier Area Transit (CAT) and CAP ridership analysis, an increase in trips has
been noticed over the past few months for Paratransit. Other providers such as neighbor agencies in Lee
County and Sarasota County have been experiencing similar increases and in the case of Sarasota,
demand has more than doubled (see attached letter from Sarasota). Staff attributes the increase
experienced in Collier County to a number of factors including the declining economy, an increase in
the Medicaid eligible recipients, and increased gas prices.
Each year, a budgeted number of trips are approved for the paratransit system. With the trip demand
trend that we are currently experiencing, it has become evident that we will exceed our allotted 120,000
trips for this fiscal year. Staff does not recommend a fare increase or a reduction in service in Fisca]
Year 2011 until a full evaluation is conducted and the BCC ha,; had ample opportunity to review staff's
findings and receive public input. Due to the increase in trips it is necessary to find additional funding to
support the projected demand. In order to continue providing essential transportation services that
improves the quality of life and promotes independence, Collier County must process a budget
amendment in the amount of$137,270 to covertrips though the remainder FY 20] 1.
We believe that the increase in ridership demand may continue into FY 20] 2; therefore, an evaluation of
the program is warranted. It is staff's intent to conduct a full evaluation of the Paratransit program over
the next 90 days to evaluate the continuation of Medicaid trips; the CTC designation; potential co-pay
fare increase; and the TD trip priorities. This evaluation will also assess the impacts on the users and
whether the continued services of our local transportation vendors will be needed. We \ViII follow the
public involvement process including, holding a public meeting as required by the FT A; seeking LCB
guidance and concluding by bringing this item back to the BCC for a final decision. The outcome of this
evaluation with recommendations will be presented to the BCC in September, prior to the start of the
new fiscal year.
FISCAL IMPACT: A budget amendment is required to transfer $137,270 from Gas Tax Fund 313,
Project No. 60173 to Transportation Disadvantaged Fund 427, Project No. 31427 for the remainder of
Fiscal Year 20] 1. Another budget amendment is required to recognize the Medicaid grant funds in the
amount of $486,958 to the Transportation Disadvantaged Fund 427, Project No. 45074. No matching
funds are required.
LEGAL CONSIDERATIONS: This item has been reviewed and approved by the County Attorney's
Office, is legally sufficient for Board action and only requires a majority vote for approval-SRT.
GROWTH MANAGEMENT IMPACT: There is no Growth Management Impact associated with this
Executive Summary.
RECOMMENDATION: That the Board approves the execution of the amendment to the Non
Emergency Transportation Medicaid Contract for FY ] 1/12; authorizes a budget amendment in the
amount of $486,958 to recognize the Medicaid grant funds; authorizes a budget amendment in the
amount of$137,270 in order to fund the Paratransit Transportation Disadvantaged program through the
Packet Page -396-
6/28/2011 Item 16.A.6.
remainder of the FY 2011; authorize the chairman to sign the contact and applicable budget
amendments; and direct the County Manager or his designee to work with the public and the Local
Coordinating Board to evaluate funding and service options for paratransit through FY 20]2.
Prepared by: Glama Carter, Public Transit Manager
Attachments: ]) Medicaid Contract; 2) Sarasota Letterto the CTD; 3) Medicaid Recipient Eligible Trend Charts;
4) Budget Amendments
Packet Page -397-
6/28/2011 Item 16.A.6.
COLLIER COUNTY
Board of County Commissioners
Item Number:
16.A.6.
Item Summary: Recommendation to execute the Non Emergency Transportation
Medicaid Contract for the State FY 11/12; authorize a budget amendment in the amount of
$486,958 to recognize the Medicaid grant funds; authorize a budget amendment in the amount
of $137,270 in order to fund the Paratransit Transportation Disadvantaged program through
the remaining offiscal year 2011; and, to acknowledge that staff is working with the Local
Coordinating Board to evaluate funding and service options for paratransit through fiscal year
2012.
Meeting Date:
6/28/2011
Prepared By
Name: CarterGlama
Title: Manager - Public Transit,Alternative Transportation Modes
6/8/2011 2:49:48 PM
Submitted by
Title: Manager - Public Transit,Alternative Transportation Modes
Name: CarterGlama
6/8/2011 2:49:50 PM
Approved By
Name: SotoCaroline
Title: Management/Budget Analyst.Transportation Administr
Date: 6/8/2011 3:42:48 PM
Name: OberrathKaren
Date: 6/9/2011 8:05:08 AM
Name: FederNorman
Title: Administrator - Growth Management Div,Transp011ati
Date: 6/9/2011 1 :56:28 PM
Packet Page -398-
Name: BetancurNatali
Title: Executive Secretary,Transportation Engineering & Construction Management
Date: 6/13/201] 8:36:27 AM
Name: ArnoldMichelle
Title: Director - Alt Transportation Modes,Alternative Tr
Date: 6/13/2011 II :52:34 AM
Name: FoordMarlene
Title: Grant Development & Mgmt Coordinator, Grants
Date: 6/13/20114:42:12 PM
Name: TeachScott
Title: Deputy County Attorney,County Attorney
Date: 6/14/20118:58:18 AM
Name: MarcellaJeanne
Title: Executive Secretary, Transportation Planning
Date: 6/16/201] 1:49:07 PM
Name: BetancurNatali
Title: Executive Secretary, Transportation Engineering & Construction Management
Date: 6/20/2011 4:17:53 PM
Name: KlatzkowJeff
Title: County Attorney,
Date: 6/20/2011 4:50:20 PM
Name: StanleyTherese
Title: Managemcnt/Budget Analyst, Senior, Office of Management & Budget
Date: 6/2]/2011 9:39:30 AM
Name: KlatzkowJetf
Title: County Attorney,
Date: 6/21/20] I 9:48:53 AM
Name: IsacksonMark
Title: Director-Corp Financial and Mgmt Svs,CMO
Date: 6/21/2011 10:36:57 AM
Packet Page -399-
6/28/2011 Item 16.A.6.
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6/28/2011 Item 16.A.6.
Packet Page -400-
6/28/2011 Item 16.A.6.
2011 Average monthly Transportation
Disadvantaged (TO) Funded Trips by
Priority
Average TDTrips
Priority TD Trip Purpose Per Month
1 Medical 2,711
2 Employment 1,278
3 Nutritional 509
Group Recreation for
4 Disabled 213
Social for agency-
5 related activity 0
Group Recreation for
6 Elderly & Low Income 0
7 Personal 518
TOTAL 5,228
Packet Page -401-
ADA & TO $1.00 Co-Pay
Increase Effective 10/1/12**
ADA & Increase
Paratransit Trips Trip Co-pay
Actual Co-pay by $1.00'
ADA $2 $95,550
TO-$O $0
TO-$2 $92,898
TO - $3 $920
TO-$4 $590
TO-$6 $29,946
Totals $219,904
Revenue Increase $67,442
* This scenario assumes 100% collection of co-pay
** Co-pay rate increase cannot be implemented until FY 12 in
order to comply with FTA and FCTD required public involvement
and notification process.
Packet Page -402-
6/28/2011 Item 16.A.6.
6/28/2011 Item 16.A.6.
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Aprilll.2011
Bobby JerniEan, Executive Director
riorido Cornmissiof\ far the Transportation Disi.ldvantagQd
GOS Su\Vannee 5tr'0:'2t, f\/1S ~19
Tallahassee, r:L 32399.04S0
Dear rJlr. JerniEJn'
TIV1S Manilgement Group; lnc {"TMS") has [1rovlded Medicaid Non-Emergency TrJTlsportation seNices
to HI!2 citize;ls of Sarasota County since 2007 and it is with regret that we must submit <l notice of
witht!r3wa\ to tile riorida CorntTll::siol1 for tt)'~ Tr03!1Sportation Disadvantaged ("CTO") as the
SUbC'HltfJcted TranSpOi,ation provider C'STP"] In SiJrJsot" County, efiective July 15, 2ell.
iT/iS is CO!YHllttted to ol-fering trdllsportatlun 9~r'/ices that are or a quality ti<iturr,;' at an efficient cost.
HOwc..vcr, as W~ ~1",ve documented eClch morr:h in ~,he (:1 D's !I,~onthly Perforrnllnce f\I1(~asures P.eport,
and 'tHough verba: communic~tion, the rri;:; volume hllS mure thall doubled since Januarv 20, 20'::>9 and
this has caused TMS to 5u5t~in continuing fir-;anucll iC~5'2:'S for the past 14 months, TIV1S has utilized
public tr;:nsit pa~s'2s., volunteer mileage reimbursement. and mu\tl~loaded trip scenanos as cost
conninl11ent options to uperate witrdn Sarasota Ceunty's Medicaid funding allocation. Even with the
!;1creased utili:;:ation of e<lCh of these options, lhi.':' revenue per trip hiJ5 dropped from $17.84 in january
2010 to only $11.38 in Mllfch 2011. This is well tJeloVJ the averaro;!; cost per trip for both this service area
and around the st8te,
As yeIJ recall, Tlv15 notiilCd the CTO of this is~;ue in lV'\,HCh tOlD, ilnd it is never o~~r intent to depart from
a coun~V, but, unfDrtunately, ;'./iecJicaicJ cllgiLj.::,s ~~:llj tr'p vclume:-, I:Jve increased to such J level that we
cali 110 !o~lger sustain the 105',["5 I;' S<H,,~;otd ::c'llnty. TMS 'Nill work closely with the C~[i stoff, and the
seh'l ted vendor, \0 ensure 011 da:a and '~;fc.wnctic)') j.) exp~ditloLJSiy snall"d to C~IS\;re minimal
interru;Jtlon in service> for" S.JrJ$ota Coumy Iv1edicaid oenef::;arics.
At his time, TIVlS r'elT1ains commit:ed to ai', other STP properties in Florida and :-;incerel'i regrets that It
h~j':' become nt.'cesVlry to CftlSe our rClil!ionship with the eTO in Sarasota County. 1f any further
inbnnation is nel'Lh~d at this tirne, plEa5~ f0"': free to contact rne: at 727.871.GSOO, Thank you.
Si"\('.rplll
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/.,,/ David i'....-1cBc;nClld, Presi,jent
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13825 \COT lJov\<:>vclfd. Suite 6'13,CleM\Ni1ter, Florian 33"760 - www.trn~milnagl?mentgroup.com
Toll Free: fl66.790.8859 - ~ax: 727.252.09)3
Packet Page -403-
6/28/2011 Item 16.A.6.
Page 2
CC: JR Harding. EdD, CTD Chairman
Beth Kidder, Bureau Chief, Medicaid Services Agency for Health Care Administration
John Irvine, Area 4 Project Manager, CTD
Anthony C. Beckford, SCAT General Manager
Packet Page -404-
-mo
. ,-~,;,~ r C).",,'E~)" ,;~. 1~[
Transportation
Disadvantaged
Charlie Crist
Governor
JR Harding Ed.D.
Chairperson
Lawrence Forman
Vice ChairpersDn
Bobby Jernigan
Interim Executive Director
6/28/2011 Item 16.A.6.
February 10, 2009
Ms. Michelle Arnold
Collier County Board of County Commissioners
c/o Collier Area Transit
2885 Horseshoe Drive South
Naples, Florida 34104
Re: em Medicaid Non-Emergency Transportation (NET) Program
Executed Agreement (Collier County)
Dear Ms. Arnold:
Enclosed is your copy of the fully executed Medicaid NET Program
Agreement for the above referenced project. Thank you for your
continued support of Florida's coordinated transportation system.
Should you have any questions or concerns, please contact me at
(850) 410-5715.
Sincerely,
~,~\;>-S
jJl~~ '
Transportation Disadvantaged Specialist{
Regional Manager
Enclosure: Executed Agreement
cc: DOT Comptroller
Miriam Turner, em Medicaid Financial Officer
605 Suwannee Street, MS.49 ro Tallahassee, FL 32399.0450
Phone: (850) 410.5700 ro Toll Free: (800) 983.2435 ro Fax: (850) 410.5752
www.dolstate.fl.uslctd
Packet Page -405-
6/28/2011 Item 16.A.6.
STATE OF FLORIDA COMMISSION FOR THE TRANSPORTATION DISADVANTAGED
MEDICAID NON-EMERGENCY TRANSPORTATION (NET) PROGRAM
SUBCONTRACTED TRANSPORTATION PROVIDER (STP) AGREEMENT
Agreement No.:
F.E.I.D. No.:
Procurement No.:
Financial Project LD.:
DMS Catalog Class No.:
~\)~\ 5'"1
596-000-558-004
N/A
41604318201
471
BY THIS AGREEMENT, made and entered into this -l..-day of Januarv . 2009. by and
between the Commission for the Transportation Disadvantaged, hereinafter called
"Commission" and Collier County Board of County Commissioners. 3301 E. Tamiami Trail.
Naoles. FL 34112 . hereinafter called "STP "for Collier County(ies) of the State of Florida,
duly authorized to conduct business in the State of Florida, hereby agree as follows:
1. SERVICES AND PERFORMANCE
A. In connection with the delivery of Medicaid Non-Emergency Transportation
Services, the Commission does hereby retain the STP to furnish certain services,
information, and items as described in Exhibits A and B and Attachments,
attached hereto and made a part hereof.
B. Before making any additions or deletions to the work described in this
Agreement, and before undertaking any changes or revisions to such work, the
parties shall negotiate any necessary cost changes and shall enter into an
Amendment covering such work and compensation. Reference herein to this
Agreement shall include any amendment(s).
C. All plans, maps, computer files, and/or reports prepared or obtained under this
Agreement, as well as all data collected, together with summaries and charts
derived therefrom, shall become the property of the Commission without
restriction or limitation on their use and shall be made available upon request, to
the Commission at any time during the performance of such services and/or
upon completion or termination of this Agreement. Upon delivery to the
Commission of said document(s), the Commission shall become the custodian
thereof in accordance with Chapter 119, Florida Statutes. The STP shall not
copyright any material and products or patent any invention developed under
this Agreement. The Commission shall have the right to visit the site for
inspection of the work and the products of the STP at any time.
The Commission shall have the right to use, disclose, or duplicate all information
and data developed, derived, documented, or furnished by the STP resulting
2008/2009 Medicaid Non-Emergency Transportation
Subcontracted Transportation Provider Contract
Page 1 of 117
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6/28/2011 Item 16.A.6.
from this Contract. Nothing herein shall entitle the Commission to disclose to
third parties data or information that is otherwise protected from disclosure by
State or federal law.
D. The STP agrees to provide reports in a format acceptable to the Commission and
at intervals established by the Commission. The Commission shall be entitled at
all times to be advised, at its request, as to the status of work being done by the
STP and of the details thereof. Coordination shall be maintained by the STP with
representatives of the Commission, or of other agencies interested in the project
on behalf of the Commission. Either party to the Agreement may request and be
granted a conference.
E. All services shall be performed by the STP to the satisfaction of the Director who
shall decide all questions, difficulties, and disputes of any nature whatsoever that
may arise under or by reason of this Agreement, the prosecution and fulfillment
of the services hereunder and the character, quality, amount of value thereof;
and the decision upon all claims, questions, and disputes shall be final and
binding upon the parties hereto. Adjustments of compensation and contract
time because of any major changes in the work that may become necessary or
desirable as the work progresses shall be subject to mutual agreement of the
parties, and amendment(s) shall be entered into by the parties in accordance
herewith.
Reference herein to the Director shall mean the Executive Director of the
Commission for the Transportation Disadvantaged.
2. TERM
A. INmAL TERM. This Agreement shall begin on January 1, 2009 and shall remain
in full force and effect through completion of all services required on June 30,
2011.
B. RENEWALS: This Agreement may be renewed for a period that may not exceed
three (3) years or the term of the original Agreement, whichever period is
longer. Renewals shall be contingent upon satisfactory performance evaluations
by the Commission and subject to the availability of funds. Any renewal or
extension shall be in writing and executed by both parties, and shall be subject
to the same terms and conditions set forth in this Agreement.
C. EXTENSIONS. In the event that circumstances arise which make performance by
the STP impracticable or impossible within the time allowed or which prevent a
new Agreement from being executed, the Commission, in its discretion, may
grant an extension of this Agreement. Extension of this Agreement shall be in
writing for a period not to exceed six (6) months and shall be subject to the
same terms and conditions set forth in this Agreement; provided the Commission
may, in its discretion, grant a proportional increase in the total dollar amount
based on the method and rate established herein. There shall be only one
extension of this Agreement unless the failure to meet the criteria set forth in
this Agreement for completion of this Agreement is due to events beyond the
control of the STP.
2008/2009 Medicaid Non-Emergency Transportation
Subcontracted Transportation Provider Contract
Page 2 of 117
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6/28/2011 Item 16.A.6.
3. COMPENSATION AND PAYMENT
A. Payment shall not be made until funds from Agency for Health Care
Administration have been received and deposited by the Commission. Payment
shall be made only after receipt and approval of goods and services unless
advanced payments are authorized by the Chief Financial Officer of the State of
Florida under Section 215.422 (14), Florida Statutes.
B. This Agreement involves units of deliverables and they must be received and
accepted in writing by the Commission's Contract Manager prior to payments.
C. The Commission has eleven (11) working days to inspect and approve the
deliverables, unless otherwise specified herein. The Commission has 20 days to
deliver a request for payment (voucher) to the Department of Financial Services.
The 20 days are measured from the latter of the date the invoice is received or
the goods or services are received, inspected and approved.
D. If a payment is not available within 40 days, a separate interest penalty pursuant
to Section 215.422(3)(b), F.5., shall be due and payable, in addition to the
invoice amount, to the STP. Invoices which have to be returned to a STP
because of STP preparation errors shall result in a delay in the payment. The
invoice payment requirements do not start until payment for Agency for Health
Care Administration has been received by the Commission and until a properly
completed invoice is provided to the Commission.
E. The State of Florida, through the Department of Management Services, has
instituted MyFloridaMarketPlace, a statewide eProcurement system. All STPs
must be registered in the My Florida Market Place. Pursuant to Section
287.057(23), Florida Statutes, all payments shall be assessed a transaction fee of
one percent (1 %), which shall be paid to the State. Services provided under this
Contract are exempt pursuant to Rule 60A-1.032(h), Florida Administrative Code.
F. A Vendor Ombudsman has been established within the Department of Financial
Services. The duties of this individual include acting as an advocate for vendors
who may be experiencing problems in obtaining timely payment(s) from the
Commission. The Vendor Ombudsman may be contacted at (850) 410-9724 or
by calling the Consumer Hotline, 1-800-848-3792.
G. Records of costs incurred under terms of this Agreement shall be maintained and
made available upon request to the Commission at all times during the period of
this Agreement and for five (5) years after final payment for the work pursuant
to this Agreement is made. Copies of these documents and records shall be
furnished to the Commission upon request. Records of costs incurred shall
include the STP's general accounting records and the project records, together
with supporting documents and records, of the STP and all subcontractors
performing work, as provided in Exhibit A, Scope of Work and all other records of
the STP and subcontractors considered necessary by the Commission for a
proper audit of project costs.
H. The Commission, during any fiscal year, shall not expend money, incur any
liability, or enter into any contract which, by its terms, involves the expenditure
200812009 Medicaid Non-Emergency Transportation
Subcontracted Transportation Provider Contract
Page 3 of 117
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6/28/2011 Item 16.A.6.
of money in excess of the amounts budgeted as available for expenditure during
such fiscal year. Any contract, verbal or written, made in violation of this
subsection is null and void, and no money may be paid on such contract. The
Commission shall require a statement from the Comptroller of the Department of
Transportation that funds are available prior to entering into any such contract or
other binding commitment of funds. Nothing herein contained shall prevent the
making of contracts for periods exceeding one year, but any contract so made
shall be executory only for the value of the services to be rendered or agreed to
be paid for in succeeding fiscal years. Accordingly, the Commission's
performance and obligation to pay under this Agreement is contingent upon an
annual appropriation by the Legislature.
1. For the satisfactory performance of the services and the submittal of Encounter
Data as outlined in Exhibit A, Scope of Services, the STP shall be paid up to a
maximum amount of $ 1.266,051.00 . The maximum amount shall be made up
of the following limiting amounts:
$ 251.519.00 from State Fiscal Year 08/09
$ 507.266.00 from State Fiscal Year 09/10
$ 507.266.00 from State Fiscal Year 10/11
The STP shall not provide services that exceed the limiting amount(s) without an
approved amendment from the Commission. The total amount of this contract is
expected to be funded by multiple appropriations and the State of Florida's
performance and obligation to pay under this contract is contingent upon annual
appropriations by the Legislature. The STP shall submit invoices in a format
acceptable to the Commission. The STP will be paid, after the Commission has
received payment from Agency for Health Care Administration, in equal
payments per month, unless otherwise specified. The STP shall request payment
through submission of a properiy completed invoice to the Commission in
accordance with Exhibit B, Method of Compensation.
J. The STP must submit the final invoice for payment to the Commission no more
than forty-five (45) days after the Agreement ends or is terminated. If the STP
fails to do so, all right to payment is forfeited and the Commission will not honor
any requests submitted after the aforesaid time period. Any payment due under
the terms of this Agreement may be withheld until all reports due from the STP
and necessary adjustments thereto have been approved by the Commission
K. The State of Fiorida's (Commission's) performance and obligation to pay under
this Agreement is contingent upon an annual appropriation by the Legislature
and nothing herein shall be construed to violate the provisions of Section
339. 135(6)(a), Florida Statutes, which provides the Commission, during any
fiscal year, shall not expend money, incur any liability, or enter into any contract
which, by its terms, involves the expenditure of money in excess of the amounts
budgeted as available for expenditure during such fiscal year. Any contract,
verbal or written, made in violation is null and void and no money may be paid
on such contract.
2008/2009 Medicaid Non-Emergency Transportation
Subcontracted Transportation Provider Contract
Page 4 of 117
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6/28/2011 Item 16.A.6.
4. INDEMNITY. PAYMENT FOR CLAIMS AND INSURANCE
A. INDEMNITY: To the extent allowed by Florida Law, the STP shall indemnify and
hold harmless the Comm ission, its officers and employees from liabilities,
damages, losses and costs, including but not limited to, reasonable attorney's
fees, to the extent caused by negligence, recklessness, or intentional wrongful
misconduct of the STP and persons employed by or utilized by the STP in the
performance of this Agreement.
It is specifically agreed between the parties executing this Agreement that it is
not intended by any of the provisions of any part of the Agreement to create in
the public or any member thereof, a third party beneficiary hereunder, or to
authorize anyone not a party to this Agreement to maintain a suit for personal
injuries or property damage pursuant to the terms of this Agreement.
B. PAYMENT FOR CLAIMS: The STP guaranties the payment of all just claims for
materials, supplies, tools, or labor and other just claims against the STP or any
subcontractor, in connection with the Agreement. The Commission's final
acceptance and payment does not release the STP's responsibilities until all such
claims are paid or released.
C. LIABIUTY INSURANCE: The STP shall carry and keep in force during the period
of this Agreement a general liability insurance policy or policies with a company
or companies authorized to do business in Florida, affording public liability
insurance in accordance with Rule Chapter 41-2.006, Florida Administrative
Code. If the STP is a political subdivision of the State of Florida and is self-
insured in accordance with the terms and provisions of Section 768.28, Florida
Statutes regarding waiver of sovereign immunity in tort actions, the STP shall
provide to the Commission a Certificate of Self-Insurance upon execution of this
Agreement. Any lapse in coverage shall be reported in writing to the
Commission.
D. WORKERS' COMPENSATION. The STP shall carry and keep in force Workers'
Compensation Insurance as required for the State of Florida under the Worker's
Compensation Law during the term of this Agreement.
E. CERTIFICATION. With respect to any insurance policy required pursuant to this
Agreement, all such policies shall be issued by companies licensed to do business
in the State of Florida. The STP shall provide to the Commission certificates
showing the required coverage to be in effect and showing the Commission to be
an additional certificate holder. Such policies shall provide that the insurance is
not cancelable except upon thirty (30) days prior written notice to the
Commission.
5. COMPLIANCE WITH LAWS AND REGULATIONS
A. The STP agrees to comply with all applicable federal and State laws, rules and
regulations including but not limited to: Title 42 CFR Chapter IV, Subchapter C;
Title 45 CFR Part 74, General Grants Administration Requirements; Chapters 409
and 641, F.S.; Part I of Chapter 427, F.S., Rule 41-2, F.A.C., the Electronics
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Accessibility Act, all applicable standards, orders, or regulations issued pursuant
to the Clean Air Act of 1970 as amended (42 USC 1857, et seq.); Title VI of the
Civil Rights Act of 1964 (42 USC 2000d) In regard to persons served; Title IX of
the education amendments of 1972 (regarding education programs and
activities); 42 CFR 431, Subpart F; Section 409.907(3)(d), F.S., and Rule 59G-
8.100 (24)(b), F.A.C. in regard to the contractor safeguarding information about
Medicaid Beneficiaries; Title VII of the Civil Rights Act of 1964 (42 use 2000e) in
regard to employees or applicants for empioyment; Rule 59G-8.100, F.A.C.;
Section 504 of the Rehabilitation Act of 1973, as amended, 29 USC 794 (which
prohi bits discrimination on the basis of handicap in programs and activities
receiving or benefiting from federal financial assistance); the Age Discrimination
Act of 1975, as amended, 42 USC 6101 et. seq. (which prohibits discrimination
on the basis of age in programs or activities receiving or benefiting from federal
financial assistance); the Omnibus Budget Reconciliation Act of 1981, P.L. 97-35,
which prohibits discrimination on the basis of sex and religion in programs and
activities receiving or benefiting from federal financial assistance; Medicare -
Medicaid Fraud and Abuse Act of 1978; the federal Omnibus Budget
Reconciliation Acts; Americans with Disabilities Act (42 U5C 12101, et seq.); the
Newborns' and Mothers' Health Protection Act of 1996, the Balanced Budget Act
of 1997, and the Health Insurance Portability and Accountability Act of 1996.
The STP is subject to any changes in federal and state law, rules, or regulations.
B. The STP shall allow public access to all documents, papers, letters, or other
material subject to the provisions of Chapter 119, Florida Statutes, and made or
received by the STP in conjunction with this Agreement. Failure by the STP to
grant such public access shall be grounds for immediate unilateral cancellation of
this Agreement by the Comm ission.
C. The STP agrees that it shall make no statements, press releases or publicity
releases concerning this Agreement or its subject matter or otherwise disclose or
permit to be disclosed any of the data or other information obtained or furnished
in compliance with this Agreement, or any particulars thereof, during the period
of the Agreement, without first notifying the Commission's Contract Manager and
securing prior written consent. The STP also agrees that it shall not publish,
copyright, or patent any of the data developed under this Agreement, it being
understood that such data or information are works made for hire and the
property of the Commission.
D. The STP shall comply with all federal, state, and local laws and ordinances
applicable to the work or payment for work thereof, and will not discriminate on
the grounds of race, color, religion, sex, national origin, age, or disability in the
performance of work under this Agreement.
E. If the STP is licensed by the Department of Business and Professional Regulation
to perform the services herein contracted, then Section 337.162, Florida
Statutes, applies as follows:
1) If the Commission has knowiedge or reason to believe that any person has
vioiated the provisions of the state professionallicens ing laws or rules, it shall
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submit a complaint regarding the violations to the Department of Business
and Professional Regulation. The complaint shall be confidential.
2) Any person who is employed by the Commission and who is licensed by the
Department of Business and Professional Regulation and who, through the
course of the person's employment, has knowledge to believe that any
person has violated the provisions of state prefessionallicensing laws or rules
shall submit a complaint regarding the violations to the Department of
Business and Professional Regulation. Failure to submit a complaint about
the violations may be grounds for disciplinary action pursuant to Chapter
455, Florida Statutes, and the state licensing law applicable to that license.
The complaint sha II be confidential.
3) Any complaints submitted to the Department of Business and Professional
Regulation are confidential and exempt frem Section 119.07(1), Florida
Statutes, pursuant to Chapter 455, Florida Statutes, and applicable state law.
F. A person or affiliate who has been placed on the convicted vendor list following a
conviction for a public entity crime may not submit a bid, preposal or reply on a
contract to provide any goods or services to a public entity, may not submit a
bid, proposal or reply on a contract with a public entity for the construction or
repair of a public building or public work, may not submit bids, proposals or
replies on leases of real property to a public entity, may not be awarded or
perform work as a contractor, supplier, subcontractor, or consultant under a
contract with any public entity, and may not transact business with any public
entity in excess of the threshold amount provided in Section 287.017, Florida
Statutes, for CATEGORY TWO for a period of 36 months from the date of being
placed on th e convicted Vendor list.
G. An entity or affiliate who has been placed on the discriminatory Vendor list may
not submit a bid, proposal or reply on a contract to previde any goods or
services to a public entity, may not submit a bid, proposal or reply on a contract
with a public entity for the construction or repair of a public building or public
work, may not submit bids, preposals or replies on leases of real property to a
public entity, may not be awarded or perform work as a contractor, supplier,
subcontractor, or consultant under a contract with a public entity, and may not
transact business with any public entity.
H. The Commission shall consider the employment by any STP of unauthorized
aliens a violation of Section 274A( e) of the Immigration and Nationality Act. If
the 5TP knowingly employs unauthorized aliens, such violation shall be cause for
unilateral cancellation of this Agreement.
r. Pursuant to Section 216.347, Florida Statutes, the STP may not expend any State
funds for the purpose of lobbying the Legislature, the judicial branch, or state
agency. This Contract contains federal funding, therefore, the STP shall, upon
Contract execution, complete the Certification regarding Lobbying Form,
Attachment 2.
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6. CONTRACT MANAGEMENT
A. The Commission shall be responsible for the management of this Contract. The
Commission shall make all statewide policy decision-making or Contract
interpretation. In addition, the Commission shall be responsible for the
interpretation of all federal and State laws, rules and regulations governing, or in
any way affecting, this Contract. The Commission shall conduct the
management of this Contract in good faith, with the best interest of the State
and the Medicaid Beneficiaries it serves being the prime consideration. The
Commission shall consult with the Agency for Health Care Administration to
provide final interpretation of general Medicaid policy. When interpretations are
required, the STP shall submit written requests to the Com mission.
B. The terms of this contract do not iimit or waive the ability, authority or obligation
of the Office of Inspector General, the Bureau of Medicaid Program Integrity, its
contractors, or other duly constituted government units (State or federal) to
audit or investigate ma tters related to, or arising out of this Contract.
C. The parties shall amend the Contract only as follows:
1) The parties cannot amend or alter the terms of this Contract without a
written amendment.
2) Only a person authorized by the Commission and a person authorized by the
STP may amend or alter the terms of this Contract.
D. Contract Variation. If any provision of the Contract (including items incorporated
by reference) is deciared or found to be illegal, unenforceable, or void, then both
the Commission and the STP shall be relieved of all obligations arising under
such provisions. If the remainder of the Contract is capable of performance, it
shall not be affected by such declaration or finding and shall be fully performed.
In addition, if the laws or regulations governing this Contract should be amended
or judicially interpreted so as to render the fulfillment of the Contract impossible
or econom ically infeasible, both the Comm ission and the STP shall be discharged
from further obligations created under the terms of the Contract. However, such
declaration or finding shall not affect any rights or obligations of either party to
the extent that such rights or obligations arise from acts performed or events
occurring prior to the effective date of such declaration or findi ng.
E. Representation of Entire Contract. This Contract with exhibits and numbered
attachments represents the entire agreement between the STP and the
Commission with respect to the subject matter in it and supersedes all other
contracts between the parties when the duly authorized representatives of the
Commission and the STP signed the Contract. Correspondence and memoranda
of understanding do not constitute part of this Contract. In the event of a
conflict of language between the Contract and the exhibits and attachments, the
provisions of the Contract shall govern. However, the Commission reserves the
right to clarify any contractuai reiationship in writing with the concurrence of the
STP and such clarification shall govern. Pending final determination of any
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dispute over a Commission decision, the STP shall proceed diligently with the
performance of the Contract
7. ASSIGNMENT AND TRANSFER
The STP shall maintain an adequate and competent staff so as to enable the STP to
timely perform under this Agreement and may associate with it such subcontractors, for
the purpose of its services hereunder, without additional cost to the Commission, other
than those costs within the limits and terms of this Agreement. The STP is fully
responsible for satisfactory completion of all subcontracted work. The STP shall provide
the Commission with a listing of any subcontractor it sublets, assigns or transfers work
to under this Agreement.
B. CONFUCT OF INTEREST
This Contract is subject to the provisions of Chapter 112, F.S. If applicable, the STP and
Its Subcontractors shall disclose the name of any officer, director, or agent who is an
employee of the State of Florida, or any of its agencies. Further, the STP shall disclose
the name of any State employee who owns, directly or indirectly, an interest of five
percent (5%) or more in the STP's firm or any of its branches. The STP covenants that
it presently has no interest and shall not acquire any interest, direct or indirect, which
would conflict in any manner or degree with the performance of the services hereunder.
The STP further covenants that it will not employ any such person known to have such
interests in the performance of the terms of this Contract. No official or employee of the
Commission and no other public official of the State of Florida or the federal government
who exercises any functions or responsibilities in the review or approval of the
undertaking or carrying out the Contract shall, prior to completion of this Contract,
voluntarily acquire any personal interest, direct or indirect, in this Contract or proposed
Contract.
9. TERMINATION AND DEFAULT PROCEDURES
A. This Agreement may be canceled by the Commission in whole or in part at any
time the interest of the Commission requires such termination. The Commission
reserves the right to terminate or cancel this Agreement in the event an
assignment is made for the benefit of creditors.
B. If the Commission determines that the performance of the STP is not
satisfactory, the Commission shall have the option of (a) immediately terminating
the Agreement, or (b) notifying the STP of the deficiency with a requirement that
the deficiency be corrected within a specified time, otherwise the Agreement will
be terminated at the end of such time, or (c) taking whatever action is deemed
appropriate by the Commission.
C. If the Commission requires termination of the Agreement for reasons other than
unsatisfactory performance of the STP, the Commission shall notify the STP of
such termination, with instructions as to the effective date of termination or
specify the stage of work at which the Agreement is tc be terminated.
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D. The STP shall submit a notice of withdrawal from the Transportation Provider
network at least ninety (90) calendar days prior to the effective date of such
withdrawal.
E. In the event funds to finance this Contract become unavailable, the Commission
may terminate the Contract upon no less than twenty-four (24) hours written
notice to the STP. Said notice shall be delivered by certified mail, return receipt
requested, or in person with proof of delivery. The Commission shall be the final
authority as to the availability of funds.
F. Termination for Breach. Unless the STP's breach is waived by the Commission
in writing, the Commission may, by written notice to the STP, terminate this
Contract upon no less than twenty-four (24) hours written notice. Said notice
shall be delivered by certified mail, return receipt requested, or in person with
proof of delivery. If applicable, the Com mission may employ the default
provisions in Chapter 6OA-I006(4), Florida Administrative Code.
Waiver of breach of any provisions of this Contract shall not be deemed to be a
waiver of any other breach and shall not be construed to be a modification of the
terms of this Contract. The provisions herein do not limit the Commission's right
to remedies at law or to damages.
In accordance with 1932(e)(4), Social Security Act, the Commission shall provide
the STP with an opportunity for a hearing prior to termination for breach. This
does notpreclude the Commission from terminating without breach.
G. Upon receipt of final notice of termination, on the date and to the extent
specified in the notice of termination, the STP shall:
1) Stop work under the Contract, but not before the termination date;
2) Assign to the State those subcontracts as directed by the Commission
including all rights, title, and interest of the STP for performance of those
Subcontracts;
3) In the event the Commission has terminated this Contract in one or more
Commission areas of the State, complete the performance of this
Contract in all other areas in which the Commission did not terminate the
Contract;
4) Take such action as may be necessary, or as the Commission may direct,
for the protection of property related to the Contract that is in the
possession of the STP and in which the Commission has been granted, or
may acquire, an interest; and
5) Not accept any payment after the Contract ends, unless the payment is
for services rendered before the Contract's termination effective date.
The Commission may withhold any payments due under the terms of this
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Contract until it receives all written and properly executed documents
from the STP as required by written instructions from the Commission.
11. DAMAGES FOR FAILURE TO MEET CONTRACT REOUIREMENTS
In addition to any remedies available through this Contract, in law or equity, the STP
shall reimburse the Commission and/or AHCA for any federal disallowances or sanctions
imposed on the STP as a result of the STP's failure to abide by the terms of this
Contract.
12. WAIVER
The parties shall not waive any covenant, condition, duty, obligation, or undertaking
contained in or made a part of this Contract except by written agreement of the parties,
and forbearance or indulgence in any other form or manner by either party in any
regard whatsoever shall not constitute a waiver of the covenant, condition, duty,
obligation, or undertaking to be kept, performed, or discharged by the party to which
thesame may apply. Until complete performance or satisfaction of all such covenants,
conditions, duties, obligations, or undertakings, the other party shall have the right to
invoke any remedy available under law or equity not withstanding any such forbearance
or ind ulgence.
13. INDEPENDENT PROVIDER
The parties expressly agree that the STP and any Subcontractors, and any agents,
officers, and/or employees of the STP or any Subcontractors, in the performance of this
Contract shall act in an independent capacity and not as officers and/or employees of
the Commission or the State of Florida. Furthermore, the parties expressly agree that
they shall not construe this Contract as having formed a partnership or joint venture
between the STP or any Subcontractor and the Commis sion and/or the State of Florida.
14 MISCELLANEOUS
A. ATTORNEY'S FEES. In the event of a dispute, each party to the Contract shall be
responsible for its own attorney's fees, except as otherwise provided by law.
B. COURT OF JURISDICTION OR VENUE For purposes of any legal action occurring
as a result of, or under, this Contract, between the Commission and the STP, the
place of proper venue shall be Leon County.
C. FORCE MAJEURE. The Commission shall not be liable for any excess cost to the
STP if the Commission's failure to perform the Contract arises out of causes
beyond the control and without the result of fault or negligence on the part of
the Commission. In all cases, the failure to perform must be beyond the control
without the fault or negligence of the Commission. The STP shall not be liable
for performance of the duties and responsibilities of the Contract when its ability
to perform is prevented by causes beyond its control. These acts must occur
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without the fault or negligence of the STP. These include destruction to the
facilities due to hurricanes, fires, war, riots, and other similar acts.
D. LEGAL ACTION NOTIFICATION. The 5TP shall give the Commission, by certified
mail, immediate written notification (no later than thirty (30) Calendar Days after
service of process) of any action or suit filed or of any claim made against the
STP by any Transportation Provider, or any other party which results in litigation
related to this Contract for disputes or damages exceeding the amount of
$50,000. In addition, the 5TP shall immediately advise the Commission of the
Insolvency of the 5TP and/or Transportation Provider or of the filing of a petition
in bankruptcy by or against a principal STP.
E. MISUSE OF SYMBOLS. EMBLEMS. OR NAMES IN REFERENCE TO MEDICAID.
Neither the STP nor any person may use, in connectio n with any item
constituting an advertisement, solicitation, circular, book, pamphlet or other
communication, or a broadcast, telecast, or other production, alone or with other
words, letters, symbols or emblems, the words "Medicaid," or "Agency for Health
Care Administration," unless the AHCA provides prior written approval. The STP
must obtain specific written authorization from the Commission in order to
reproduce, reprint, or distribute any AHCA form, appiication, or publication for a
fee. State and local governments are exempt from this prohibition. A disclaimer
that accompanies the inappropriate use of program or AHCA terms does not
provide a defense. Each piece of mail or information constitutes a Violation and
is subject to sanctions.
F. OFFER OF GRATUmES. By signing this Contract, the STP signifies that, if
applicable, no member of, or a delegate of, Congress, nor any elected or
appointed official or employee of the State of Florida, the General Accounting
Office, Department of Health and Human Services, CM5, or any other federal
agency has or shall benefit financially or materially from this procurement. The
Commission may terminate this Contract if it is determined that gratuities of any
kind were offered to, or received by, any officials or employees from the State,
its agents, or employees.
G. EMERGENCY MANAGEMENT PLAN. The STP shall submit its plans describing
procedures ensuring the continuation of appropriate services during an
emergency, including but not limited to localized acts of nature, accidents, and
technological and/or attack-related emergencies, both natural and manmade.
The STP shall provide a copy of its disaster plan for written approval no later
than thirty (30) days after the effective date of this Contract and on June 1 of
each year of this Contract, or at the request of the Commission.
H. CULTURAL COMPETENCY PLAN. The STP shall comply with the Cultural
Competency Plan as developed by the Commission.
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1. The STP and its employees, agents, representatives, or subcontractors are not
employees of the Commission and are not entitled to the benefits of State of
Florida employees. Except to the extent expressly authorized herein, STP and its
employees, agents, representatives, or subcontractors are not agents of the
Commission or the State for any purpose or authority such as to bind or
represent the interests thereof, and shall not represent that it is an agent or that
it is acting on the behalf of the Commission or the State. The Commission shall
not be bound by any unauthorized acts or conduct of the STP or its employees,
agents, representatives, or subcontractors. STP agrees to include this provision
in all its subcontracts under this Agreem ent. .
J. All words used herein in the singular form shall extend to and include the plural.
All words used in the plural form shall extend to and include the singular. All
words used in any gender shall extend to and include all genders.
K. This Agreement embodies the whole agreement of the parties. There are no
promises, terms, conditions, or obligations other than those contained herein,
and this Agreement shall supersede all previous communications,
representations, or agreements, either verbal or written, between the parties
hereto. The State of Florida terms and conditions, whether general or specific,
shall take precedence over and supersede any inconsistent or conflicting
provision in any attached terms and conditions of the STP.
L. It is understood and agreed by the parties hereto that if any part, term or
provision of this Agreement is by the courts held to be illegal or in conflict with
any law of the State of Florida, the validity of the remaining portions or
provisions shall not be affected, and the rights and obligations of the parties shall
be construed and enforced as if the Agreement did not contain the particular
part, term, or provision held to be invalid.
M. This Agreement shall be govemed by and construed in accordance with the laws
of the State of Florida.
N. If this Agreement is the result of a formal solicitation (Invitation to Bid, Request
for Proposal or Invitation to Negotiate), the Department of Management Services
forms PURlOOO and PUR1001, included in the solicitation, are incorporated
herein by reference and made a part of this Agreement.
O. Time is of the essence as to each and every obligation under this Ag reement.
P. The following Exhibits and Attachments are incorporated and made a part of this
Agreement:
Exhibit A
Exhibit B
Attachment 1
Attachment 2
Attachme nt 3
Attachment 4
Attachment 5
Scope of Services
Method of Compensation
Business Associate Agreement
Special Audit Requirements
Required Data Elements for Encounter Data
Quarterly Grievance System Sum mary Report
Trip Travel Expense Report
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Attachment 6
Attachment 7
Attachment 8
Business Disruption Notification Report
Critical Inciden t Report
Definitions and Acronyms
IN WITNESS WHEREOF, the parties have executed this Agreement by their duly authorjzed
officers on the day, month and year set forth above.
oard of County Comm issioners
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2008/2009 Medicaid Non-Emergency Transportation
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AGREEMENT NO.: BbN. 59
EXHIBIT A
SCOPE OF SERVICES
Medicaid Non-Emergency Transportation Services
I. GENERAL OVERVIEW
A. Purpose
This Agreement between the Commission for the Transportation Disadvantaged
(Commission) and the Subcontracted Transportation Provider (STP) is for the provision
of Medicaid Non-Emergency Transportation (NET) services.
B. General Responsibilities of the State of Florida (State) and the Commission:
1. The Commission will be responsible for setting policy relating to the Medicaid
NET program.
2. The Commission will administer the Agreement with the STP, monitor STP
performance, and provide oversight in all aspects of the STP's operations.
3. The State has sole authority for determining Medicaid eligibility.
4. Except for Medically Needy Medicaid Beneficiaries, eligibility for Transportation
Services provided by the Recipient is effective at 12:01 a.m. on the first (1st)
Calendar Day of the month.
5. The Commission will conduct periodic monitoring of the STP's operations for
compliance with the provisions of the Agreement and applicable federal, State,
and local laws and regulations.
6. The Commission has final authority in interpreting the terms and conditions of
the Agreement and analyzing all policies relating to the Agreement.
7. Unless otherwise specified in this Agreement, the Commission shall respond to all
STP requests for a response within ten (10) Business Days of receipt of said
request.
8. The Commission shall ensure that the 5TP is Cost Effective (see Section
409.912(44), F.5.). The Commission may not renew this Agreement if it is not
Cost Effective.
C. General Responsibilities of the STP
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1. The STP shall comply with all provisions of this Agreement and its amendments,
if any, and shall act in good faith in the performance of the Agreement's
provisions. The STP shall comply with all written policies and procedures
developed by the Commission to implement all provisions of this Agreement. The
STP agrees that failure to comply with any provision of this Agreement shall
result in the assessment of sanctions as identified in this agreement.
2. The STP shall comply with all requirements of Section 6032 (Employee Education
About False Claims Recovery) of the federal Deficit Reduction Act of 2005 if the
Recipient receives or earns five million dollars or more, annually, under the
Medicaid State plan.
3. The STP shall comply with all pertinent Commission rules in effect throughout
the duration of the Agreement.
4. The STP shall comply with all current Florida Medicaid Handbooks as noticed in
the Florida Administrative Weekly ("FAW"), or incorporated by reference in rules
relating to the provision of Transportation Services set forth in this agreement,
except where the provisions of the Agreement expressly alter the requirements
set forth in the Florida Medicaid Handbooks promulgated pursuant to the Florida
Administrative Code (FAC). In addition, the STP shall comply with the limitations
and exclusions in the Medicaid Handbooks, unless otherwise specified by this
Agreement. In no instance may the STP's limitations or exclusions imposed be
more stringent than those specified in the Medicaid Handbooks. The STP shall
furnish Transportation Services in an amount, duration, and scope that the STP
may reasonably expect to achieve the purpose for which the Transportation
Services are furnished. The STP shall not arbitrarily deny or reduce the amount,
duration, or scope of Transportation Services solely because of a Medicaid
Beneficiary's diagnosis, type of illness, or condition.
5. This Agreement, including all attachments and exhibits, represents the entire
agreement between the STP and the Commission and supersedes all other
contracts, agreements, or understandings between the parties when it is
executed by duly authorized signatures of the STP and the Commission.
Correspondence and memoranda of understanding do not constitute part of this
Agreement. In the event of a conflict of language between the Agreement and
the exhibits and attachments, the provisions of the Agreement shall govern.
6. The Commission reserves the right to clarify any terms and conditions in
question in regards to the Agreement between the Commission and the STP, in
its sole discretion, in writing; such clarification shall govern. Upon final
determination of any dispute over any Commission decision, the STP shall
proceed diligently with the performance of its duties as specified under the
Agreement and in accordance with the direction of the Agency's Division of
Medicaid.
7. The STP shall comply with the Commission's Quality Improvement Program (QIP)
to ensure enhancement of quality of Transportation Services and emphasize the
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goals of improving the quality of Transportation Services provided to Medicaid
Beneficiaries. The Commission may sanction the STP, if the STP, or one of its
Subcontractors or a Transportation Provider does not meet acceptable Quality
Improvement (QI) and Performance Measures (PMs), based on the Commission's
reports and other outcome measures.
8. The STP must meet all requirements for doing business in the State of Florida.
9. The Commission may require the STP to provide to the Commission, or its Agent,
information or data that is not specified under this Agreement. In such instances,
and at the direction of the Commission, the STP shall fully cooperate with such
requests and furnish all information in a timely manner, in the format in which
the Commission requested. The STP shall have at least thirty (30) Calendar Days
to fulfill such ad hoc requests.
10. The STP shall monitor utilization of Transportation Services by Medicaid
Beneficiaries through the Prior Authorization of claims for Covered Services and
the reports specified in this agreement.
11. The STP shall collect and submit Encounter Data for each Agreement Year in the
format set forth in the Reporting Requirements section of this agreement, or as
required by the Commission, and withi n the time frames specified by the
Commission. All Covered Services rendered to Medicaid Beneficiaries shall result
in the creation of an encounter record.
12. The STP shall not:
a. Use Fee-for-Service ambulance transport in lieu of Cost Effective and
appropriate Transportation Services;
b. limit Medicaid Beneficiaries to a specific number of medical Trips for any
specific time period; and/or,
c. Limit Medicaid Beneficiaries to specific licensed Health Care Professionals
or use similar limitations that restrict the distance required for a Medicaid
Beneficiary to receive Transportation Services, or limit the number of
Trips provided to Medicaid Beneficiaries.
13. Use of Funding for Lobbyi ng or Advocacy Purposes
a. The STP shall ensure that neither the STP nor any of its Subcontractors
or Transportation Providers use Medicaid funding to lobby, advocate, or
encourage other parties to lobby or advocate legislators or other political
leaders in violation of State and federal law. If the Commission
determines that the STP, a Subcontractor, or a Transportation Provider
has violated this requirement against lobbying or advocating, the
Commission may sanction the STP.
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b. The Recipient shall ensure that all Subcontractors and Transportation
Providers execute a Certificate Regarding Lobbying no less than thirty
(30) Calendar Days before the effective date of the Agreement and
maintain copies of said Certificates in the Recipient's files.
c. All of the lobbying and advocating requirements set forth in this
Agreement apply to staff, Subcontractors, Transportation Providers,
Recipient volunteers, employees, independent contractors, and all
persons acting for, or on behalf of, the Recipient. The requirements set
forth in this Section shall govern the development of all materials.
Additionally, the Recipient is vicariously liable for any Violations of its
Subcontractors, Transportation Providers, agents, employees, staff,
and/or independent contractors.
II. BENEFICIARY ELIGIBILITY
A. Eligibility
1. Eligible Populations
a. The STP shall provide Medicaid Transportation Services only to Medicaid
Beneficiaries who are included in the eligible population.
b. The categories of eligible Medicaid Beneficiaries authorized to receive
services from the Recipient include, but are not limited to, the following:
(1) Low Income Families and Children;
(2) Foster Care Children;
(3) Sixth Omnibus Budget Reconciliation Act (50BRA) Children and
pregnant women;
(4) Supplemental Security Income (551) Medicaid only Medicaid
Beneficiaries;
(5) 551 Medicare, Part B only Medicaid Beneficiaries;
(6) 551 Medicare, Parts A and B Medicaid Beneficiaries;
(7) Medicaid Beneficiaries who are residents in ALFs;
(8 The MED5 Aged/Disabled (AD) population;
(9) Individuals with Medicare coverage (e.g., dual eligible individuals)
who are not enrolled in a Medicare-funded Managed Care
Organization (MCO);
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(10) Institutional Care Program (ICP) Residents: Beneficiaries who are
eligible for transportation services for placement in a facility while
their eligibility determination is being processed (e.g., nursing
home residents, etc.);
(11) Presumptively Eligible Pregnant Women: This program allows staff
at County Health Departments, Regional Prenatal Intensive Care
Centers, and other qualified medical facilities to make a
presumptive determination of Medicaid eligibility for low-income
pregnant women. This presumptive determination allows a
woman to access prenatal care while Department of Children and
Families eligibility staff make a regular determination of eligibility.
Outpatient or office services related to the pregnancy are
reimbursed by this program; transportation services are availabie
to support these visits;
(12) Medicaid Beneficiaries who are receiving services through:
(a) A hospice program;
(b) A Prescribed Pediatric Extended Care (PPEC) center;
(c) The Aged/Disabled Adult Waiver;
(d) The Alzheimer's Disease Waiver;
(e) The Assisted Living for the Elderly Waiver;
(f) The Channeling Waiver;
(g) The Familial Dysautonomia Waiver;
(h) The Florida Senior Care Waiver;
(i) The Model Waiver;
U) The Nursing Home Diversion Waiver;
(k) The Project AIDS Care Waiver; or
(I) The Traumatic Brain Injury/Spinal Cord Injury (TBI/SCI)
Waiver.
(13) TItle XXI MediKids: A TItle XXI health insurance program that
provides certain children, who are not Medicaid eligible, with
Medicaid benefits; and
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(14) Medically Needy: A Medically Needy beneficiary is an individual
who would qualify for Medicaid but has income or resources that
exceed normal Medicaid guidelines. On a month-by-month basis,
the individual's medical expenses are subtracted from income; if
the remainder falls below Medicaid's income limits, the individual
may qualify for Medicaid through the end of the month.
2. Ineligible Populations
a. The following categories describe Medicaid Beneficiaries who are not
eligible to receive Transportation Services from the Recipient:
(1) Medicaid MCO enrollees - Medicaid Beneficiaries who are enrolled
with a Medicaid MCO that provides Transportation;
(2) Medicaid Beneficiaries who have their own means of
Transportation;
(3) Medicaid Beneficiaries who, at the time of application for
enrollment and/or at the time of enrollment, are domiciled or
residing in an instituti on, including:
(a) Statewide inpatient psychiatric program (SIPP) facilities;
(b) Intermediate care facility for persons with developmental
disabilities (IeF-DD);
(c) State Hospitals; or
(d) Correctional institutions.
(4) Qualified Medicare Beneficiaries ("QMBs"), Special Low Income
Medicare BenefiCiaries ("SLMBs"), Quaiified Medicare Beneficiaries
Renal Dialysis ("QMBRs"), or Qualified Individuals at Levell ("QI-
is");
(5) Medicaid Beneficiaries who reside in the following:
(a) Residential commitment programs/facilities operated
through the Department of Juvenile Justice (DJJ);
(b) Residential group care operated by the Family Safety &
Preservation Program of the Department of Children and
Families (DCF);
(c) Children's residential treatment facilities purchased
through the Substance Abuse & Mental Health District
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(SAMH) Offices of the DCF (also referred to as Purchased
Residential Treatment Services - PRTS);
(d) SAMH residential treatment facilities Licensed as Level I
and Level II facilities; and
(e) Residential Level I and Level II substance abuse treatment
programs. See Sections 6SD-30.007(2)(a) and (b), F.A.C.
(6) Legal aliens;
(7) Medicaid Beneficiaries who are also members of a Medicare-
funded Managed Care Organizations (MCOs);
(8) Medicaid Beneficiaries who are enrolled in the Family Planning
Waiver; and/or
(9) Medicaid Beneficiaries who are enrolled in the Program of AII-
inclusive Care for the Elderly (PACE).
b. The following waivers' services are not eligible for Transportation
Services :
(1) The Developmentally Disabled Waiver (1ier 1);
(2) The Deveiopmentally Disabled Waiver (1ier 2);
(3) The Developmentally Disabled Waiver (Tier 3);
(4) The Family and Supported Living Waiver (Tier 4); and
(5) The Adult Cystic Fibrosis Waiver.
B. Gate Keeping
1. Medicaid Compensable Trips
a. Neither the STP, any of its Subcontractors nor Transportation Providers
shall require written verification from the Medicaid Beneficiary as to the
need for an Urgent Trip or Medically Necessary Trip.
b. The STP, Subcontractors or Transportation Providers, in its efforts to
ensure proper Gate Keeping, may:
(1) Contact the Medicaid Beneficiary's providers/Licensed Health Care
Professional's office and ask if the medical care is Medicaid
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compensable. If the Trip is not Medicaid compensable, the SfP
shall deny the Trip request.
(2) Contact the Medicaid Beneficiary's providers/Licensed Health Care
Professional's office and ask if the Medicaid Beneficiary has an
appointment. If the Medicaid Beneficiary does not have an
appointment, the STP shall deny the Trip request.
(3) Contact the Medicaid Beneficiary's providers/Licensed Health Care
Professional's office and ask if the medical care is considered
Urgent Care as defined in this Agreement. If the STP is able to
confirm that the Trip is not considered Urgent Care, the SfP may
require that the Medicaid Beneficiary reschedule the requested
Medicaid compensable Trip.
c. The SfP can require that a Medicaid Beneficiary seek Medicaid
compensable services from a physician/Licensed Health Care Professional
doing business in the Medicaid Beneficiary's city/community of residence
unless:
(1) There is not a physician/Licensed Health Care Professional in the
Medicaid Beneficiary's city/community of residence that can or will
provide services to the Medicaid Beneficiary;
(2) The Medicaid Beneficiary has started a course of treatment for an
Acute Condition in one county of residence and subsequently
changes his county of residence to an adjacent county of
residence. Upon completion of a course of treatment for an Acute
Condition, the Recipient may require the Medicaid Beneficiary
utilize the services of a provider/Licensed Health Care Professional
located in the Medicaid Beneficiary's city/community of residence;
or
(3) The Medicaid Beneficiary's prOVider/licensed Health Care
Professional is located in an adjacent city/community and is at a
distance no further from the Medicaid Beneficiary's home than a
similar physician/Licensed Health Care Professional in the
Medicaid Beneficiary's city/community of residence.
d. The 5TP shall not limit the number of Medicaid compensable Trips that a
Medicaid Beneficiary receives.
e. In order to manage the coordination of Transportation Services, the SfPs
may request that a Medicaid Beneficiary reschedule a Medicaid
compensable Trip that is not an Urgent Trip, but in no event may the
SfPs and/or Transportation Providers delay the Medicaid Beneficiary's
appointment by more than fifteen (15) Business Days.
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f. The STP may limit out of county Trips to specific days of the week (e.g.,
Tampa on Mondays and Wednesdays; Orlando on Tuesdays and
Thursdays). The STP must provide out of county Trips on unscheduled
days if the provider with whom the Medicaid Beneficiary has an
appointment does not see patients on the Recipient's regularly scheduled
Trip day. The STP is responsible for notifying Medicaid Beneficiaries of an
established out of county service route so that Medicaid Benefidaries can
schedule appointments accordingly.
(1) The STP can request confirmation, but shall not require written
confirmation, from the provider or the Medicaid area office that
the out of county Medicaid compensable services are not available
in the Medicaid Benefidary's county of residence or that the
services are available only on a specific day that does not
correspond to the established schedule.
2 Out of State Transportation
a. If the Agency for Health Care Adm inistration authorizes an out of State
Medicaid compensable service, the STP shall not require additional
confirmation that the services are available in the State.
(1) For advance notice purposes, within one (1) Business Day of
receipt from the Agency for Health Care Administration, the
Commission shall notify the STP when a Medicaid Beneficiary
requests out of State Medicaid compensable services.
(3) The Commission shall forward the written approval from the
Agency for Health Care Administration to the STP authorizing out
of State Medicaid compensable services.
(4) At least quarterly, the Commission shall update the STP on the
status of Medicaid Benefidaries receiving Medicaid compensable
services out of State.
(5) The Commission will forward any notification from AHCA stating
that a Medicaid BenefiCiary is ready for transport back to the
State.
3. Neither the Agency for Health Care Administration, the Commission, nor the STP
shall limit the following types of Trips. The STP shall provide the following types
of Trips in addition to the STPs daily Trip allocation:
a. Urgent Trips
b. Trips to the following types of services:
(1) Dialysis;
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(2) Chemotherapy;
(3) Wound treatment;
(4) Behavioral Health Care;
(5) Prescribed Pediatric Extended Care centers (PPECs); or,
(6) Any other Trip not specifically set forth above, but that the
Agency for Health Care Administration determines, after
consultation with the Commission, is in the best interests of the
Medicaid Beneficiary population.
4. The STPs shall comply with the following gate keeper responsibilities:
a. Accept requests for Transportation Services directly from Medicaid
Beneficiaries, adult family members on behalf of minor Medicaid
Beneficiaries, guardians responsible for Medicaid Beneficiaries, and
proViders/licensed Health Care Professionals on behalf of Medicaid
Beneficiaries.
b. Assure that the Medicaid Beneficiary is a resident of Florida and is
currently Medicaid eligible. Medicaid eligibility shall be obtained by
contacting a MEVS vendor or similar provider, induding the STPs
eligibility verification program, through FAXBACK with the Medicaid Fiscal
Agent where a fax is sent through an automated system and a report is
transmitted back containing Beneficiary eligibility information.
c. Determine if transportation resources exist within the Medicaid
Beneficiary's Household regularly and/or specifically for the Trip
requested, and may deny a Trip request if the Medicaid Beneficiary has
appropriate transportation resources in his/her Household.
d. Determine if there is a reason why the Medicaid Beneficiary cannot utilize
his/her own transportation (such as the vehicle is broken, out of gas,
etc.). If the Beneficiary is unable to utilize his/her transportation, the STP
may assist the Medicaid Beneficiary in utilizing his/her own means of
transport (fix vehicle, supply gas, etc.).
e. Determine whether any person who does not reside in the Medicaid
Beneficiary's household can reasonably provide transportation.
"Reasonably" is defined to mean both willing and able. The STP shall not
demand the use of transportation resources available through any party
residing outside the Medicaid Beneficiary's household.
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f. Require the use of public transportation, where available and appropriate,
for Medicaid Beneficiaries who are able to understand common signs and
directions.
g. Determine if the Medicaid Beneficiary is ambulatory, requires a mobility
device, or requires a stretcher for transport. The STP shall transport
Medicaid Beneficiaries who must use a mobility device for ambulation or
must remain in a lying position in vehicles appropriate to their level of
need.
h. Provide Transportation Services only to a Medicaid compensable service.
i. Refuse to reimburse the cost of transportation provided for a Medicaid
Beneficiary by any relative or member of the same household, exclusive
of foster parents.
j. Some nursing facilities, group homes, and personal care homes have one
or more vehicles, which are intended to facilitate the general
administration of the facility and not necessarily to provide for resident
transportation. The STP cannot deny Transportation Services based on
the mere existence of a vehicle. The availability of a vehicle for resident
transportation must be determined on a case by case basis. If the vehicle
is not available for resident transportation at the time required, as
represented by the nursing facility manager or director of nursing, as
applicable, the Recipient/Subcontractor shall exclude such vehicle as an
alternate form of available transportation.
k. Consider information presented by or on behalf of a Medicaid Beneficiary
relative to the need for Transportation Services upon each such request
for transportation, notwithstanding previous denials of service.
I. Except as otherwise specified below, require that a Medicaid Beneficiary
and associated Attendant/Escort be picked up from, and returned to, a
common address.
m. Ensure that Medicaid is the payor of last resort and that the Medicaid
Beneficiary does not have access to any other form of transportation
service to a Medicaid compensable service.
S. If the STP requires an application process to determine eligibility for
Transportation Services, the STP shall provide Transportation Services to all
Medicaid Beneficiaries requiring Urgent Trips pending the STP's final eligibility
determination.
C. Trip Limiting Procedure
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1. Nothing in the Trip Limiting Procedure detailed below supersedes the
Commission's or AHCA's prohibition against limiting specific types of Trips as set
forth in the Gate Keeping section above.
2. The STP may limit the total number of daily Medicaid Trips available so long as
the STP completes the following Trip limitation procedure:
a. The STP shall provide all detailed background information explaining why
the STP feels it must initiate Trip limits to the Recipient no less than sixty
(60) Calendar Days before the STP plans to initiate Trips limits. The
background information shall include the following:
(1) An explanation as to why the STP needs to initiate Trip limits and
what it plans to do to resolve the issues that require the STP to
request Trip limits as quickly as possible;
(2) The STP's process for establishing a daily budget;
(3) The STP's current Gate Keeping strategies/programs and how the
STP intends to revise its Gate Keeping strategies/programs to
ensure a swift retum to normal provision of Transportation
Services;
(4) The STP's Costs and an explanation of its financial situation;
(5) A copy of the notification the STP proposes to mail to all affected
Medicaid Beneficiaries at least thirty (30) Calendar Days before it
plans to initiate its Trip limits. The STP's letter should state that
trips for dialysis, chemotherapy, etc. are exempt from the
upcoming Trip limits.
(6) The STP's current daily budget allocation and the STP's projected
daily budget allocation during the period the STP proposes to limit
Trips; and
(7) A specific date upon which the STP expects to be able to provide
Transportation Services without Trip limits, not to exceed ninety
(90) Calendar Days.
b. Upon receipt of the Trip Limiting request from the STP, the Commission
shall review the information and, within ten (10) Business Days, either:
(1) Forward documentation with analysis as to why the request is
necessary and reasonable to AHCA for approval. Send written
notification to the STP that request has been submitted to the
AHCA for approval;
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(2) Deny the STP's request and send written notification to the STP;
or
(3) FOlWard documentation with analysis for partial approval of
request to AHCA for approval and notify the STP in writing of such
action. (STP may request a trip limit of 30 trips but the
Commission recommends a Trip limit of forty (40) Trips per day
for AHCA's approval).
c. If the STP's Trip limit request submission is incomplete or does not
adequately explain the reasons it feels that it must initiate Trip limits, the
Commission shall deny the STP's request and send a copy of the denial to
the Agency for Health Care Administration.
d. Upon receipt of the documents from the Commission, the Agency shall
have ten (10) business days to review the information and either:
(1) Approve the STP's request and send written notification to the
Commission;
(2) Disapprove the STP's request in full and send written notification
of the Agency's disapproval to the Commission, or
(3) Approve the STP's request in part and send written notification to
the Commission with specific instructions as to which partes) the
Agency approves.
(a) Example - The STP requests a Trip limit of thirty (30)
Medicaid compensable Trips per day, but the Agency for
Health Care Administration approves a Trip limit of forty
(40) Trips per day.
e. The STP shall aCknowledge the Commission's{Agency's final
determination within five (5) Business Days. If the Agency grants only
partial approval, the STP must specify in its acknowledgement that it will
abide by the final approved Trip limit program.
f. If the STP wants to extend the Trip limit, the STP must supply the
Commiss ion and the Agency at least thirty (30) Calendar Days before the
first Trip limit period ends with an explanation as to why the initial Trip
limit period was insufficient to meet the goals set forth in the STP's
original proposal and how the STP plans to be able to resume normal
services at the end of the second ninety (90) day period. The Commission
and the Agency may approve an extension of up to ninety (90) days.
g. The Agency will not allow a STP to conduct more than two (2) Trip limit
periods during a three-hundred sixty-five (365) Calendar Day period. If a
STP is unable to provide the full spectrum of Transportation Services
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without limiting Trips after two (2) Trip limit periods in a 365 Calendar
Day period, the Commission shall terminate the STP and procure a new
STP.
III. MEDICAID BENEFICIARY SERVICES
A. Medicaid Beneficiary Services
1. General Provisions
a. The STP shall have written policies and procedures for the provision of
Transportation Services, as specified in this Agreem ent
b. The STP shall ensure that Medicaid Beneficiaries are aware of their rights
and responsibilities, how to obtain Transportation Services, what to do in
an Emergency or Urgent Care situation, how to file a Complaint,
Grievance, Appeal, or Medicaid Fair Hearing, how to report suspected
Fraud and Abuse, and all other requirements and Covered Services.
c. The STP shall have the capability to answer Medicaid Beneficiary inquiries
via written materials, telephone, electronic transmission, and face-to-face
communication.
d. The STP shall not charge the Commission, Agency for Health Care
Administration or Medicaid Beneficiaries for printing written materials.
e. The STP must make oral interpretation services available free of charge
to non-English speaking Medicaid Beneficiaries. This applies to all non-
English languages, not just those that the State identifies as prevalent.
The STP shall not charge the Comm ission, Agency for Health Care
Administration or the Medicaid Beneficiary for interpretation services. The
STP shall notify all Medicaid Beneficiaries that oral interpretation is
available for any language and written information is available in
prevalent languages, and how to access those services.
2. Medicaid Beneficiary Communications
a. Requirements for all Commun ications
(1) The Commission and the AHCA must approve, in writing, all
written, website and verbal comm unications developed by the STP
for distributionjtra nsmission to Medicaid Beneficiaries before
communication.
(2) The STP shall make all written communications available in
alternative formats and in a manner that takes into consideration
the Medicaid Beneficiary's special needs, inciuding those who are
visually impaired or have limited reading proficiency (e.g., Braille,
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large print format, etc.). The STP shall notify all Medicaid
Beneficiaries that information is available in alternative formats
and how to access those formats.
(3) The STP shall make all written communications available in
English, Spanish, and all other foreign languages in a county
spoken by five percent (5%) or more of the total county
population.
(4) The STP shall provide Medicaid Beneficiary information in
accordance with 42 CFR 438.10, which addresses information
requirements related to written and oral communications provided
to Medicaid Beneficiaries, including: languages, format,
Transportation Services, Service Area, and the Grievance System.
The STP shall notify Medicaid Beneficiaries on at least an annual
basis of their right to request and obtain information in
accordance with the above regulations.
(5) All written materials shall be at or near the fourth (4th) grade
reading comprehension level. Suggested reference materials to
determine whether the STP's written materials meet this
requirement are:
(a) Fry Readability Index;
(b) PROSE The Readability Analyst (software developed by
Education Activities, Inc.);
(c) Gunning FOG Index;
(d) McLaughlin SMOG Index;
(e) The Flesch-Kincaid Index (available in Microsoft Word); or
(f) Other software approved in writing by the Agency.
(6) The STP shall provide written notice to the Commission of any
changes to any correspondences, templates for mass mailings,
and/or written materials provided to Medicaid Beneficiaries. The
Commission shall review and shall submit all written materials to
the AHCA at least forty-five (45) Calendar Days before the
effective date of the change. The STP shall provide written notice
of changes to the Medicaid Beneficiary Transportation Handbook
and any policy changes to Medicaid Beneficiaries at least thirty
(30) Calendar Days before the effective date of the change, but
not before the Commission and the AHCA approves, in writing, the
STP's written notice.
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b. The STP shall mail any other mutually agreed upon notices at a date and
time agreed to by the Agency for Health Care Administration and the
Commission.
c. The 5TP shall not mail or give any written comm unications to Medicaid
Beneficiaries without first obtaining the Commission's written approval of
the communication.
d. The Commission shall sanction the STP, in accordance with the contract,
for any failure on the part of the STP and/or Transportation Providers to
obtain the Commiss ion's written approval before disseminating written
materials to Medicaid Beneficiaries.
3. Notice of Eligibility and Medicaid Beneficiary Transportation Services Handbook
a. Within seven (7) Calendar Days following the STP's determination of a
Medicaid Beneficiary's eligibility to receive Transportation Services, the
STP shall mail each Medicaid Beneficiary a copy of its Medicaid
Beneficiary Transportation Services Handbook.
b. The Medicaid Beneficiary Transportation Services Handbook shall include
the following information:
(1) A Table of Contents;
(2) The STP's toll-free Trip scheduling telephone number;
(3) Information to explain the different types of coverage available
and the time frames for requesting and receiving Transportation
Services;
(4) Directions on the use of Transportation Services offered by the
STP;
(5) The extent to which, and how, the STP provides non-business
hour, inpatient delivery/return, Urgent Care delivery/return, and
Emergency Room discharge Transportation Services;
(6) An explanation of the Grievance System, including the address,
telephone number, and office hours of the STP's Grievance staff
and the Commission's Ombudsman. The 5TP shall specify phone
numbers for a grievant to call to present a Complaint, Grievance,
or Appeal. Each phone number shall be toll-free within the
grievant's geographic area and provide reasonable access to the
STP and/or Commission without undue delays;
(7) Medicaid Beneficiary rights and responsibi lities;
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(8) Information on Emergency Transportation and how to access
those services;
(9) Information on oral interpretati on services for all languages and
alternative communication formats are available, free of charge,
and how to acces s these services;
(10) Information that the Medicaid Beneficiary's Transportation
Services can continue if the Medicaid Beneficiary files a Complaint,
Grievance, or Appeal of a denied authorization and that the
Medicaid Beneficiary may have to pay in case of an adverse
ruling;
(11) Co-payments for the Medicaid Beneficiary;
(12) Instructions explaining how Medicaid Beneficiaries may obtain
information from the Commission regarding the Quality
Improvement Plan and Performance Measure indicators, including
Medicaid Beneficiary information;
(13) Procedures for reporting Fraud, Abuse, and Overpayment;
(14) Information regarding HIPAA relative to the Medicaid Beneficiary's
personal health information; and,
(15) Information relating to the STP's Medicaid Beneficiary No Show
Policy.
c. The Medicaid Beneficiary Handbook must clearly specify all necessary
procedural steps for filing Complaints, Grievances, Appeals, and Medicaid
Fair Hearings, including:
(1) Medicaid Beneficiary rights to file Complaints, Grievances, and
Appeals and all requirements and time frames for filing
Complaints, Grievances, and Appeals.
(2) The Commission's and STP's Grievances and Appeals Coordinator's
address, toll-free telephone number and office hours.
(3) The availability of assistance to Medicaid Beneficiaries in filing
Grievances, Appeals, and Medicaid Fair Hearings.
(4) The rules that govern representation at the Medicaid Fair Hearing.
(5) A statement explaining the Medicaid BenefICiary's right to request
a continuation of Transportation Services during an Appeal and/or
Medicaid Fair Hearing and a statement that if the Medicaid Fair
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Hearing upholds the STP's Action, the STP may hold the Medicaid
Beneficiary liable for the cost of any continued Transportation
Services.
(6) A detailed explanation of the proper procedure for a Medicaid
Beneficiary to request a continuation of Transportation Services
during an Appeal and/or Medicaid Fair Hearing.
B. No Show Beneficiary Education
1. If a Medicaid Beneficiary fails to provide notice of a cancellation to the STP or a
Transportation Provider at least twenty-four (24) hours in advance of a
scheduled Trip, or the Medicaid Beneficiary is not available, or has decided
he/she does not require Transportation Services, then the STP shall classify the
Medicaid Beneficiary as a No Show. The STP shall provide the Commission a
monthly report listing it's No Show Medicaid Beneficiaries. The No Show Medicaid
Beneficiary report shall include the Medicaid Beneficiary's name, phone number,
date and time scheduled for transport, and Trip destination.
2. The STP shall contact the Medicaid Beneficiaries who are identified as No Shows
and counsel them on the proper usage of NET services and provide technical
assistance. The STP shall track the Medicaid Beneficiaries it counseled regarding
the No Show policy and keep a record of the technical assistance provided. The
STP shall take no action to "lock-in" a Medicaid Beneficiary without written
approval provided by the Agency for Health Care Administration's Project
Manager. The Commission shall maintain a copy of the AHCA written approval in
the STP's contract file.
3. If the No Show Medicaid Beneficiary provides acceptable, verifiable evidence to
the STP that the No Show was due to unforeseen and unavoidable
circumstances, the STP shall not count the missed Trip as a No Show, unless
such evidence does not prove the Medicaid Beneficiary was unable to meet the
scheduled pick-up ti me due to said unforeseen and unavoidable circumstances.
C. Co-Payments
1. The STP may charge a co-payment from Medicaid Beneficiaries that is not
greater than one dollar ($1.00) for each Trip or two dollars ($2.00) per each
round Trip. The STP must explain the STP's co-payment plan as part of the STP's
co-payment plan in the Medicaid Beneficiary Transportation Services Handbook.
2. The following categories of Medicaid Beneficiaries are not required to pay a co-
payment:
a. Medicaid Beneficiaries under twenty-one (21) years of age;
b. Pregnant women when the Transportation Services relate to:
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(t) The pregnancy;
(2) To any medical condition that may complicate the pregnan cy; or
(3) Conditions or complications of the pregnancy extending through
the end of the month in which the sixty (60) day period following
termination of pregnancy ends.
c. Institutional Care Program (ICP) Medicaid Beneficiaries who are required
to spend all of their income for medical care costs (except for a minimal
amount that is required for personal needs) as a condition of receiving
services in an institution and who are inpatients in long-term care
facilities, Hospitals, or other medical institutions;
d. Medicaid Beneficiaries when Transportation Services relate to family
planning services; and,
e. Medicaid Beneficiaries who are receiving hospice services.
3. A STP cannot deny Transportation Services to a Medicaid Beneficiary based
solely on the Medicaid Beneficiary's inability to pay a Medicaid co-payment. If the
Medicaid Beneficiary is unable to pay for Transportation Services at the time the
Transportation Provider renders Transportation Services, the SfP may bill the
Medicaid Beneficiary for the unpaid charge.
D. Cultural Competen cy
1. The STP shall comply with the Commission's written Cultural Competency Plan, in
accordance with 42 CFR 438.206, to ensure Transportation Services are provided
in a culturally competent manner to all Medicaid Beneficiaries, including those
with limited English proficiency. The Cultural Competency Plan explains that STPs
and STP employees will provide effective Transportation Services to people of all
cultures, races, ethnic backgrounds, and religions in a manner that recognizes,
values, affirms, and respects the worth of the individual Medicaid BenefICiaries
and protects and preserves the dignity of each Medicaid Beneficiary.
IV. COVERED SERVICES
A. Covered Services
1. The SfP shall ensure the prOVISion of Transportation Services in sufficient
amount, duration, and scope reasonably expected to achieve the purpose for
which the Transportation Services are furnished and shall ensure the provision of
the following Covered Services as defined and specified in this Agreement. The
STP shall not arbitrarily deny or reduce the amount, duration, or scope of
Transportation Services solely because of a Medicaid Beneficiary's diagnosis, type
of illness, or condition.
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2. The STP is responsible for ensuring that it incorporates all Transportation
Provider, service, and product standards specified in the Agency's Non-
Emergency Transportation Services Coverage & Limitations Handbooks and the
Commission's handbooks into the STP's Transportation Provider Agreement by
reference.
3. Medicaid Beneficiaries who have begun self-administered home oxygen before
transport may continue administration during transport. However, a Medicaid
Beneficiary cannot begin a new regimen of oxygen therapy during transport, nor
may the attendant employed by the Transportation Provider administer oxygen.
4. Escort Services - An Attendant/Escort is an individual whose presence is required
to assist a Medicaid Beneficiary during transport and at the place of treatment.
The Attenda nt/Escort leaves the vehicle at its destination and remains with the
Medicaid Beneficiary. An Attendant/Escort must be of an age of legal majority
recognized under Florida law.
a. The STP must allow, without cha rge to the Escort or Medicaid Beneficiary,
one (1) Attendant/Escort to accompany a Medicaid Beneficiary or group
of Medicaid Beneficiaries who are blind, deaf, mentally disabled, or under
twenty-one (21) years of age, when the Medicaid Beneficiaries are
transported to receive Medicaid compensable services.
b. Upon the request of a Prescribed Pediatric Extended Care (PPEC) Center,
the STP shall pick up Escorts for children attending said PPEC at a
mutua lIy agreed upon location from the Medicaid Beneficiary before
picking up the Medicaid Beneficiary who is traveling to the PPEC. The STP
shall not drop off the Escort until after the STP has dropped off the PPEC
Medicaid Beneficiary.
5. Special Covered Services - The STP must supply Transportation for Medicaid
Beneficiaries when:
a. The Agency for Health Care Administration has begun a closure or
decertification of a Nursing Facility and Medicaid Beneficiaries require
Transportation from one Nursing Facility to another or to an alternate
living arrangement; or,
b. A Medicaid Beneficiary has a change in level of care that results in the
facility not being certified or equipped to provide medically required or
specialized services and the Medicaid Beneficiary requires Transportation
from one Nursing Facility to another Nursing Facility or to an alternative
living arrangement.
6. The STP shall provide Transportation Services for the following Covered Services:
a. The STP must provide Transportation Services to eligible Medicaid
Beneficiaries for Medicaid compensable services by using the most
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appropriate mode of Transportation, including, but not limited to, the
following types:
(1) Multiload Vehicles - A multiload vehicle is a multiple passenger
vehicle, typically used for Transportation Services. It is
appropriate only for ambulatory or non-am bulatory persons who
can enter and exit a vehicle with minimal to no assistance.
Assistance means that additional equipment and time are
required. Multiload vehicles may include buses, vans, sedans, and
taxis.
(2) Wheelchair Vehicle - A wheelchair vehicle is a motorized vehicle
equipped specifically with certified wheelchair lifts, or other
equipment designed to carry persons in wheelchairs and scooters,
or with mobility impairments. The STP may use wheelchair
vehicles for the provision of ambulatory transportation services to
maximize capacity.
(a) The STP must use wheelchair vehicles in the following NET
situations:
(I) Medicaid Beneficiaries who are continually confined
to a wheelchair;
(ii) Medicaid Beneficiaries with severe mobility
handicaps that prevent them from using private or
public transportation or taxis;
(i1i) Medicaid Beneficiaries who are semi-ambulatory or
homebound, and can accomplish limited
ambulatory movement with the assistance of a
special ambUlatory aid (like a walker or cane); or,
(iv) Medicaid Beneficiaries who use a mobility device.
(b) In questionable cases, the STP may contact the office of
the Medicaid Beneficiary's Health Care Professional to
verify the Medicaid Beneficiary's need for transport by a
wheelchair vehicle.
(3) Stretcher Vehicle - A stretcher vehicle is an enclosed vehicle that
accommodates a litter and is equipped with locking devices to
secure the litter during transit. Stretcher service is required for
Medicaid Beneficiaries who are non-am bulatory and need
assistance to be transported to and from the vehicle and the
Health Care Professional's facility in a reclining positio n.
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(a) No flashing lights, sirens, or emergency equipment are
required to be installed on a stretcher vehicle.
(b) The STP can provide stretcher services only in non-
emergency situations and are limited to use by:
(i) Medicaid Beneficiaries who need to remain in a
lying position but do not require the administration
of life support; or,
(ii) Medicaid Beneficiaries who have severe mobility
disabilities that render them unable to sit in an
upright position for prolonged periods of time.
(c) In questionable cases, the STP may require a medical
professional's verification or documentation of a Medicaid
Beneficiary's need for tra nsport by a stretcher vehicle.
(4) Public Transportation (where available) - In some areas of
Florida, public transportation may be a viable and Cost Effective
alternative to more traditional and expensive forms of Non-
Emergency Transportation. For purposes of this Agreement, public
transportation is any fixed-route transportation service that is
available to the general public.
(a) Transit companies, county or city governments, or
federally funded transportation authorities may provide
public transportation.
(b) The STP may use public transportation to provide a full
Trip, or portion of a Trip, to or from a Medicaid
compensable service.
(c) The intent of this section is to maximize the use of fixed-
route services.
(5) Over-the-Road Bus (where available) - An over-the-road bus is
traditionally used to traverse iong distances such as cross-county
and cross-state travel.
(6) Private Volunteer Transportation (where available) - Private
volunteer transportation is provided by individuals or agencies
that receive no compensation or payment other than minimal
reimbursement for Mileage for the provision of private volunteer
transportation services.
(a) The 5TP shall ensure that Medicaid Beneficiaries receive
Transportation Services from a volunteer organization,
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including, if applicable, scheduling appointments, and
notifying Medicaid Beneficiaries of arrangements.
(b) The STP is responsible for all necessary payments
(excluding co-payments, if any) to the private volunteer
Transportation Provider.
(c) Use of volunteer transportation does not alleviate the
STP's responsibility to assure the safety, comfort, and
appropriate mode of Transportation consistent with the
Medicaid Beneficiary's health care status. The STP must
ensure that all volunteers and vehicles used to provide
private volunteer transportation are properly Licensed and
insured.
(7) Commercial Air Carrier Transportation - The STP may provide,
where necessary or appropriate, commercial air carrier
transportation to Medicaid Beneficiaries.
(a) For in state Commercial Air Carrier Transportation, the
Medicaid Beneficiary must provide documented proof to
the STP before commercial air carrier transport that
necessary medical services are not available within the
Medicaid Beneficiary's city/community of residence, or an
adjacent city/community, and that commercial air carrier
transportation is the only viable option.
7. The STP shall provide Transportation Services and all related travel expenses, in
accordance with 42 CFR 440.170, pertaining to related travel expenses (including
the cost of meals and lodging) and as described in the Florida Medicaid Non-
Emergency Transportation Services Coverage and Limitations Handbook. The
STP is responsible for coordinating all Transportation Services, lodging, and
related travel expenses, for out of state transportation and in state
transportation, including:
a. The cost of Transportation for the Medicaid Beneficiary by ambulance
acting as a stretcher vehicle, taxicab, common carrier, commercial air
carrier, or other appropriate means; and,
b. The cost of an Attendant/Escort to accompany the Medicaid Beneficiary, if
necessary, and the cost of the Attendant's/Escort's transportation, meals,
lodging, and, if the Attendant/Escort is not a member of the Medicaid
Beneficiary's family, cost of the Attendant's/Escort's services rendered
based on the prevailing Medicaid rate.
B. Excluded Services
1. The STP is not required to provide the following excl uded services:
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a. Stretcher Vehicle Oxygen Administration - Stretcher van Transportation Providers
are not required to be equipped to provide and administer oxygen to a Medicaid
Beneficiary during a transport. Oxygen provided and administered by the
Medicaid BenefiCiary is appropriate for Transportation Services if no other
medical equipment or medical care is required en route.
(1) Stretcher Vehicle Transportation Providers are not required to be
equipped to maintain a ventilator or care for a Medicaid Beneficiary who
is ventilator-dependent during a transport. If a Medicaid Beneficiary has a
battery-operated ventilator and a properly trained Escort will travel with
the Medicaid Beneficiary to provide ventilator care en route to or from a
doctor's office or some other Medically Necessary health care service, the
Medicaid Beneficiary is eligible for Transportation Services if no other
medical equipment or care is required en route.
b. Ground Ambulance Transportation - Transportation Services do not include
ground ambulance transportation unless the ground ambulance is under contract
as a stretcher or wheelchair Transportation Provider as specified in the
Wheelchair Vehicle Section, or the Stretcher Vehicle Section.
(1) The STP is excluded from providing ground ambulance transportation if a
local governmental ordinance mandates non-emergency stretcher
transportation services be provided in a ground ambulance vehicle.
c. Air Ambulance Transportation - Transportation Services do not include air
ambulance transportation.
d. Basic Life Support (BLS) and Advance Life Support (ALS) Transportation - For
the purpose of this Agreement, Transportation Services do not include the
arrangement, coordination, or delivery of Transportation Services for Medicaid
Beneficiaries who require the administration of any level of life support services
(ALS or BLS) during transport.
C. Special Exclusions
1. The STP is not responsible for the coverage of:
a. The cost of transporting a Medicaid Beneficiary back to Florida when the
Medicaid Beneficiary voluntarily traveled outside of Florida and requires
hospitalization and/or subsequent Nursing Facility care, unless a Medicaid
Beneficiary received prior authorization to travel out of State for the
purpose of receiving a Medicaid compensable service;
b. Transportation for therapeutic home visits to or from a Hospital, hospice,
nursing home, ICF/DD, State, or other private or public institution;
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c. Transportation of a Medicaid Beneficiary from one Hospital to another,
one Nursing Facility to another, or from a Hospital to a Nursing Facility,
solely based on the preference of the Medicaid Beneficiary or a member
of the Medicaid Beneficiary's family, except as otherwise set forth in this
Agreement;
d. Transportation of deceased Medicaid Beneficiaries;
e. Transportation of family members to visit a hospitalized or
institutionalized Medicaid Beneficiary;
f. Transportation of a Medicaid Beneficiary to receive medical training;
g. Transportation of Medicaid Beneficiaries to a pharmacy for the purpose of
having a prescription filled;
h. Transportation of a Medicaid Beneficiary to a medical facility or
physician's office for the sole purpose of obtaining a medical
recommendation or to pick up Medical Records;
i. Transportation of a Medicaid Beneficiary for socialization and/or
therapeutic field visits to locations other than the facility where such
services are received;
j. Transportation Services available to the general public free of charge;
k. Transportation Services that are already covered by a per diem rate and
included in a corresponding cost report. Transportation Services are
included in an ICF/DD's per diem;
J. Unless otherwise provided by State or federal law, the Recipient shall not
pay salaries, fees, or other compensation for professional health care
Attendants/Escorts;
m. Transportation of a Medicaid Beneficiary to a service covered by a Home
and Community-Based Service (HCBS) waiver if transportation can be
billed to the waiver or is included in the reimbursement for the waiver
service; or
n. Transportation Services to or from a n Adult Day Care center.
V. TRANSPORTATION PROVIDER NETWORK
A. General Provisions
1. The Commission shall maintain a Subcontractor List for each county in which it
provides services. The STP shall also maintain a Subcontractor List. The list
shall include, at a minimum, the follOWing information for each Subcontractor:
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a. Name;
b. Mailing address (including street number, city, state, and zip code);
c. Main contact's name;
d. Main contact's telephone number;
e. Main customer service telephone number;
f. Main fax telephone number; and,
g. E-mail address.
2. The Commission shall notify AHCA within seven (7) Business Days of any
significant changes to the STP's Transportation Provider network in a county.
The Agreement defines a significant change as:
a. A loss of all Transportation Providers of a particular mode of
Transportation (e.g., stretcher transportation, etc.); or,
b. other adverse changes to the composition of the STP's Transportation
Provider network that impair or deny a Medicaid Beneficiary's access to
adequate and appropriate Transportation.
3. The Commission shall notify the AHCA within seven (7) Calendar Days if the
inclusion of a new category of Medicaid Beneficiaries eligible to receive
Transportation Services will negatively impact the Transportation Provider
network.
B. Subcontractors
1. Service Standards
a. The following standards are for all vehicles and drivers, excluding
volunteer-owned vehicles:
(1) Drug and Alcohol Testing - The STP and/or Transportation
Providers shall in compliance with the Federal Transit
Administration's (FTA) drug and alcohol regulations, and the
Federal Highway Administration's drug and alcohol regulations,
where applicable.
(2) The FTA determines mandatory transportation safety standards
based on the size and nature of the Transportation Provider. The
STP can obtain full details of the FTA's safety standards from the
Federal Transit Administration, Office of Safety and Security, 400
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7th Street, S.W., Washington D.C., 20590. While the Commission
strongly recommends using the FT A's guidelines, it is the STP's
responsibility to ensure that it and any transportation providers
are in compliance with all applicable federal, State, and local
regulations.
(3) Driver Accountabil ity - The STP shall ensure that all drivers have a
valid driver's license and are covered by the STP's, or
Transportation Provider's insurance plan, as required by law,
before starting to provide Transportation Services. The STP shall
ensure that all drivers meet the locally determined driver
background screening standard before providing Transportation
Services to Medicaid Beneficiaries. The STP must have ready
access to all documentation of the above listed requirements.
(a) If a particular driver is not properly licensed or insured, the
STP shall remove the driver from all routes transporting
Medicaid Beneficiaries.
(4) Driver Conduct - The STP shall ensure that drivers act in a
professional manner at all times and shall perform the minimum
levels of service as explained in all Subcontracts.
(a) If the Commission and/or STP receive Complaints and/or
Grievances regarding a particular driver, and it is
determined that the driver is not conducting
himself/herself in a manner consistent with the minimum
levels of service, and corrective action has not resulted in
improved performance, the 5TP shall remove the driver
from all routes transporting Medicaid Beneficiaries.
(5) The STP and/or transportation providers shall use child safety
restraints, if applicable, where the use of such devices would not
interfere with the safety of a child (e.g., a child is in a
wheelchair).
(6) Where applicable, shall follow the rules and regulations of the
Americans with Disabilities Act.
2. Standards for Commercial and Volunteer Drivers:
a. Drivers and/or attendants shall not engage in activities including, but not
limited to, the following:
(1) Make sexually explicit comments towards, solicit sexual favors
from, or engage in sexual activity with Medicaid beneficiaries;
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(2) Solicit or accept controlled substances, alcohol, or medications
from Medicaid beneficiaries;
(3) Solicit or accept money from Medicaid Beneficiaries other than
authorized co-payments;
(4) Use alcohol, narcotics, or controlled substances, or be under their
influence, while on duty. A driver/attendant may use prescription
medication so long as he/she can still perform his/her duties in a
safe manner and the STP hCls written documentation that the
drivers/attendant's medication will not impact his/her ability;
(5) Eat or consume any beverage while operating the vehicle or while
providing Transportation Services to Medicaid Beneficiaries;
(6) Smoke or use smokeless tobacco products in the vehicle;
(7) Wear any type of headphones while on duty; and/or,
(8) Be responsible for passengers personal items.
b. At a minimum, drivers/attendants shall:
(1) Wear, or have visible, easy to read identification that identifies the
driver/attendant as an employee of the STP or Transportation
Provider;
(2) Unless the vehicle has a mechanism by which it can open and
close the door from the inside of the vehicle, exit the vehicle to
open and close vehicle doors when passengers enter or exit the
vehicle;
(3) Properly identify and announce their presence at the entrance of
the buildings, or with attending faciiity staff, at the specified pick-
up location if a curbside pick-up is not appropriate;
(4) Assist Medicaid beneficiaries in seating, including the fastening of
the seat belt when necessitated by a Medicaid Beneficiary's
cond ition;
(5) Confirm, prior to allowing any vehicle to proceed, that wheelchairs
and wheelchair passengers are properly secured; and that, when
appropriate, passengers are properly secured in their seat belts;
(6) Provide an appropriate level of assistance to Medicaid
Beneficiaries when requested or as needed due to a Medicaid
Beneficiary's condition. Such assistance shall also apply to the
movement of wheelchairs and persons with iimited mobility as
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they enter or exit the vehicle using the wheelchair lift and shall
include the driver stowing any mobility aids and folding
wheelchairs; and,
(7) Be clean and maintain an appearance while transporting Medicaid
Beneficiaries.
3. Vehicle Requirements
a. Maintenance - The STP and/or transportation providers shall maintain
vehicles and equipment to meet the requirements of the Agreement.
(1) Vehicles and all components shall meet or exceed the
manufacturer, state, and federal safety and mechanical operating
and maintenance standards for any and all vehicles and models
used for transportation of Medicaid Beneficiaries under the terms
of the Contract.
(2) The STP and Transportation Providers shall comply with all
applicable state and federal laws including, but not limited to, the
Americans with Disabilities Act (ADA) and the Federal Transit
Administration (FTA) regulations.
(3) The STP and/or Transportation Providers shall immediately
remove from service any vehicle that does not meet or exceed the
Florida . Department of Highway Safety and Motor Vehicles
(DHSMV) licensing requirements, safety standards, ADA
regulations, or Agreement requirements and shall re-inspect such
vehicle before using it to provide Transportation Services to
Medicaid beneficiaries.
(4) The STP and/or Transportation Providers shall not allow vehicles
to transport more passengers than the vehicle was designed to
carry.
(5) All lift-eqUipped vehicles shall comply with ADA regulations.
4. Vehicle Inspections
a. The STP shall submit annual documentation certifying that all vehicles
meet the regulatory requirements. If it is determined during an
inspection, filed Complaint and/or Grievance, or other means, that a
vehicle does not meet the regulatory requirements, the STP or
Transportation Provider, as applicable, must immediately remove the
vehicle from service. The STP must proVide documentation to the
Commission ensuring that the manufacturer or a mechanic, certified by
the Nationa I Institute for Automotive Service Excellence (ASE), has
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corrected all deficiencies before the STP or Transportation Provider can
use the vehicle to transport Medicaid Beneficiaries.
b. All commercial vehicles shall meet or exceed the following requirements:
(1) All commercial Transportation Providers shall use a mo-way
communication system linking all vehicles used in delivering
Transpcrtation Services to Medicaid Beneficiaries with the
Transpcrtation Provider's major place of business (dispatcher).
(2) The Transpcrtation Provider shall use the mo-way communication
system in such a manner as to facilitate communication and to
minimize the time in which it can replace or repair out-of-service
vehicles.
(3) Pagers are not an acceptable substitute for a mo-way
communication system. Transpcrtation Providers shall
immediately remove from service any vehicle with an inoperative
mo-way communication system until it repairs or replaces the
mo-way communication sys tem.
(4) The STP shall ensure that:
(a) All vehicles are equipped with climate control systems
adequate for the heating and ventilation needs of both
driver and passengers. The STP shall remove from service
immediately any vehicle with a non-functioning climate
control system until it repairs or replaces the system;
(b) All vehicles have functioning, clean, and accessible seat
belts, where applicable, for each passenger seat pcsition
and that the seat belts are stored off the floor when not in
use;
(c) Each vehicle utilizes child safety seats, where applicable,
that meet all State and federal guidelines. Each STP must
show proof that it has trained its drivers in the proper
installation and use of child safety seats;
(d) All vehicles shall have functional door handles on all doors;
(e) All vehicles shall have an accurate speedometer and
odometer;
(f) All vehicles shall have functioning interior Iight(s) within
the passenger compartment;
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(g) All vehicles shall have adequate sidewall padding and
ceiling covering;
(h) All vehicles shall have two (2) exterior rear view mirrors,
one (1) on each side of the vehicle;
(i) All vehicles shall have at least one (1) interior mirror for
monitoring the passenger compartment;
(j) All vehicle interiors and exteriors are clean and free of
broken mirrors or windows, excessive grime, rust, chipped
paint, or major dents that detract from the overall
appearance of the vehicle;
(k) All vehicles have passenger compartments that are clean,
free from torn upholstery or floor coverings, damaged or
broken seats, or protruding sharp edges and shall also be
free of dirt, oil, grease, or litter.
C. Minimum Standards
1. Access for Persons with Disabilities -All transportation facilities open to the public
have access for persons with disabilities.
2. Health, Cleanliness, and Safety -All transportation facilities (or services) owned,
operator and/or provided by the STP and/or Transportation Providers shall
adequate space, supplies, proper sanitation, and smoke-free transportation
facilities with proper fire and safety procedures in operation.
D. Coverage Provisions
1. The STP shall provide Transportation Services twenty-four (24) hours per day,
seven (7) days per week, as set forth below. The coverage shall consist of an
answering machine, call fOlwarding, or 5TP call coverage. The STP shall obtain
the Commission's written approval for any other means used to ensure call
coverage before implementation.
Trip Schedulino Time Standards
Trip Type Reservation Period Acknowledgement Pick Up Period
Period
Routine Three (3) Business Days At Time of Call As Scheduled
Hospital/Facility Discharges At Time of Call Within One (1) Hour Within Three (3) Hours
From Time of Call From Time of Call*
Urgent Care At Time of Call Within One (1) Hour Within Three (3) Hours
From Time of Call From Time of Call*
Emergency Room/Facility Discharges At Time of Call Within One (1) Hour Within Three (3) Hours
From Time of Call From Time of Call*
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Will Call
At 1ime of Call
Within One (1) Hour N/A
From 1ime of Call
*Unless otherwise specified in this Contract.
2. Transportation Services shall be available on a timely basis, as follows:
a. Routine Trips
(t) Unless as otherwise set forth in this Contract, a Medicaid
Beneficiary must contact the STP before the close of business at
least three (3) Business Days before the Medicaid Beneficiary
needs to receive Transportation Services. The three (3) Business
Days inciudes the day the Medicaid Beneficiary calls the STPs, but
not the day of the Medicaid Beneficiary's medical appointment.
b. Hospital/Facility Discharges
(1) The STP must acknowiedge and schedule all Hospital/facility
discharge requests for Transportation Services within one (1) hour
of the time the Hospital/facility makes the request.
(2) The STP shall provide Hospital/facility discharge staff with contact
information, procedures, and other appropriate information to
access and schedule Transportation Services for all Medicaid
Beneficiaries.
(3) Transportation Services shall be provided to a Medicaid
Beneficiary within three (3) hours of when the Hospital/facility
makes the request. If the Hospital/facility is located in a county
other than the Medicaid Beneficiary's county of residence, the STP
may add additional time to the three (3) hour time limit at the
rate of thirty (30) minutes for every fifteen (15) Miles the STP
must travel outside of the Medicaid Beneficiary's county of
residence. The STP must work with the Hospital's/facility's
discharge coordinator to assure that the Medicaid BenefiCiary is
ready for transport at the scheduled time.
c. Urgent Care
(1) The STP shall provide Transportation Services to return a Medicaid
Beneficiary to his/her home after business hours.
(2) The STP must acknowledge and schedule all requests for Urgent
Care Transportation Services within one (1) hour of the time the
Medicaid Beneficiary, or his/her representative, makes the
request.
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(3) Transportation Services must be provided to a Medicaid
Beneficiary within three (3) hours of when the Medicaid
Beneficiary, or his/her representative, makes the request. If the
Hospital/facility is located in a county other than the Medicaid
Beneficiary's county of residence, the STP may add additional time
to the three (3) hour time limit at the rate of thirty (30) minutes
for every fifteen (15) Miles the STP must travel outside of the
Medicaid Beneficiary's county of residence.
d. Emergency Room/Facility Discha rges
(1) The STP shall provide Hospital emergency room or facility
discharge staff with contact information, procedures, and other
appropriate information to access and schedule Transportation
Services for all Medicaid Beneficiaries.
(2) The STP must acknowledge and schedule all requests for
Emergency Room/facility Transportation Services within one (1)
hour of the time the Medicaid Beneficia ry, or his/her
representative, makes the request.
(3) Transportation Services must be provided to a Medicaid
Beneficiary within three (3) hours of when the Medicaid
Beneficiary, or his/her representative, makes the request. If the
Hospital/facility is located in a county other than the Medicaid
Beneficiary's county of residence, the STP may add additional time
to the three (3) hour limit at the rate of thirty (30) minutes for
every fifteen (15) Miles the Recipient must travel outside of the
Medicaid Beneficiary's county of residence.
e. Will Call
(1) If a Medicaid Beneficiary must delay receipt of Transportation
Services as a result of a backlog of patients at the doctor's office
or due to some other reason beyond the Medicaid Beneficiary's
control, the Medicaid Beneficiary can contact the STP and request
Transportation Services to return to his/her residence.
(2) The STP must acknowledge and schedule all such requests within
one (1) hour of the time the Medicaid Beneficiary, or his/her
representative, makes the request.
3. Bariatric Transportation
a. The STP shall make provisions for Transportation Services to Medicaid
Beneficiaries whose weight exceeds the limits of the STP's equipment.
4. Nursing Home and Behavioral Health Facility Transportation Services
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a. The STP shall provide the appropriate level of Transportation Services to
Medicaid compensable services for Medicaid Beneficiaries who are
residents of nursing facilities, group homes, behavioral health facilities, or
assisted living facilities.
b. If the Medicaid Beneficiary's facility provides free Transportation Services
for its residents to receive medical services, the facility must provide the
same Transportation Services at no charge to Medicaid Beneficiaries who
reside at the facility. If the Medicaid Beneficiary's facility provides free
Transportation Services for its residents to receive medical services, the
STP is not required to supply Transportation Services to the Medicaid
Beneficiary.
c. The STP shall provide Medicaid Beneficiaries who are residents of nursing
facilities, group homes, behavioral health facilities, or assisted living
facilities Transportation Services that are appropriate to the needs and
condition of the Medicaid Beneficiary. The STP shall coordinate pick-up
and return times for Medicaid Beneficiaries, especially those who have
physical conditions or limitations that may be exacerbated by lengthy
waiting periods, as verified by the facility.
5. The STP shall have written procedures in place for the provision of transportation
services during inclement weather conditions and/or declared emergencies as
determined by State, federal, or local officials.
6. Service Area
a. Transportation Services shall be provided to all eligible Medicaid
Beneficiaries regardless of their county of residence. All STPs are required
to transport outside the Medicaid Beneficiary's county of residence or
adjacent counties when necessary to transport a Medicaid Beneficiary to
a covered Medical service and the required services are not available
within the STP's normal county of operations, but are within the State or
designated border areas.
E. Medicaid Beneficiaries Needing Transportation Following Exercise of Baker Act
1. Transportation Services shall not be provided to transport a Medicaid Beneficiary
from a Hospital/facility to a Behavioral Health Care facility if the Medicaid
Beneficiary is receiving services pursuant to the Baker Act.
2. Transportation Services shall be provided to a Medicaid Beneficiary that is
receiving services pursuant to the Baker Act if it is a transfer from a Behavioral
Health Facility to a Hospital, facility, or other destination (including the Medicaid
Beneficiary's residence) and it is confirmed by the Behavioral Health Facility that
the Medicaid Beneficiary does not pose a threat of harm to themselves or others
during transport.
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~. OUALnYIMPROVEMENT
A. Quality 1m provement
The Commission shall have a Quality Improvement Program to monitor and evaluate the
quality and appropriateness of Transportation Services rendered to Medicaid
Beneficiaries.
1. General Requirements
a. STP will attend annual "best practices" seminars to learn how best to
coordinate Transportation Services and meet the needs of this
Agreement.
b. The STP shall participate in Quality Improvement activities by the
Commission to enhance the Quality of Transportation Services provided
to Medicaid Beneficiaries.
B. Performance Measures
1. In order to develop appropriate benchmarks, the STP shall report the following
performance measures by the start date established in the chart below:
Start Date PM DescriptiDn Source MethDCIDlogy (Where
ADDlicable 1
Start Date of Agreement The number of Subcontractor Logs N/A
accidents per 100,000
miles, broken down by
ccunty.
Start Date of Agreement The number of Road Subcontractor Logs N/A
Calls per 10,000 miles,
broken down by
county.
Start Date of Agreement Average Medicaid Recipient N/A
Beneficiary call hoid Survey/Monitoring
times on a county by
county basis and as
measured throughout
the year and at
different times of the
dav.
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------_._._._-~'-.~--..,..~.
6/28/2011 Item 16.A.6.
Starts upon Commencement of The number of Encounter Data Found by Subtracting
Submission of Encounter Data Medicaid Beneficiaries "Reservation
delivered to Appointment lime" by
appointments later "Trip Destination Drop
than the scheduled Off TIme"
appointment time,
broken down by
county.
Starts upon Commencement of The number of Encounter Data Found by Gounting Each
Submission of Encounter Data Medicaid Benefidary "No Show" in the "Trip
No Shows, broken Indicator" Field
down by county.
01/01/2010 The average waiting Encounter Data Found by Subtracting
time for a scheduled "Trip Actual Pickup
pickup, broken down TIme" by "Reservation
bv countv. Pick UD TI me"
01/01/2010 The average travel Encounter Data Found by Subtracting
time that a Medicaid "Trip Actual Pickup
Beneficiary must Time" by "Trip
remain in a vehicle Destination Drop Off
from the point Df pick Time"
up to the destination,
broken down by
transportation mode
and county.
2. For the Performance Measures that must begin reporting via Encounter Data on
January 1, 2010, the Commission shall collect a sample of the data manually, as
described below, from those STPs that are not able to submit the information
electronically upon the date of commencement of Encounter Data submission.
a. Upon the start date of this Contract, the STP shall require all drivers to
record Performance Measure information on all driver manifests.
b. Upon the start date of this Contract, STPs shall monitor the driver
manifests on a monthly basis by examining a statistically significant
sample of driver manifests to determine the timeliness of reporting. The
STPs shall submit their on-time pickup and delivery report either directly
to the Commission using the Medicaid Encounter Data System (MED5
System).The STP shall submit the on time pickup and delivery reports
using the MEDS System by January 1, 2010.
c. Until the STP begins submitting Performance Measure information via the
MEDS System, STPs shall submit all Performance Measure information to
the Commission for review to be submitted to the AHCA.
(1) If it is determined that a STP is excessively late in picking up
and/or delivering Medicaid Beneficiaries to their destinations, the
Commission or the AHCA shall require the STP to initiate a
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Corrective Action Plan (CAP) to explain how the STP will pick up
and/or deliver Medicaid Beneficiaries in a timely manner.
(2) If the STP is unable to meet the requirements set forth in the
CAP to pick up or deliver Medicaid Beneficiaries on time, the
Commission shall require the STP to begin electronic submission
of Performance Measure information using the Encounter Data
System, within sixty (60) Calendar Days of the determination or
by January 1, 2010, whichever comes first.
(3) Those STPs that are able to submit the Performance Measure
information electronically upon the start date of this contract shall
not be required to submit sampling reports as described above.
VII. GRIEVANCE SYSTEM
A. Overview
1. Description
a. Complaint process - The Complaint process is the Commission's and the
STP's procedure for addressing Medicaid Beneficiary Complaints, which
are expressions of dissatisfaction about any matter other than an Action
that are resolved at the Point of Contact rather than through filing a
formal Grievance.
b. Grievance process - The Grievance process is the Commission's and the
STP's procedure for addressing Medicaid Beneficiary Grievances, which
are expressions of dissatisfaction about any matter other than an Action.
c. Appeal process - The Appeal process is the Commission's and the STP's
procedure for addressing Medicaid Beneficiary Appeals, which are
requests for review of an Action.
d. Medicaid Fair Hearing process - The Medicaid Fair Hearing process is the
administrative process which allows a Medicaid Beneficiary to request the
State to reconsider an adverse decision made by the Commission or the
SIP.
2. General Requirements
a. The Commission and the STP shall have a Grievance System in place that
includes a Complaint process, a Grievance process, an Appeal process,
and access to the Medicaid Fair Hearing system. The Grievance System
shall comply with the requirements set forth in Section 641.511, F.s., if
applicable and with all applicable federal and State laws and regulations,
including 42 CFR 431.200 and 42 CFR 438, Subpart F, "Grievance
System."
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b. The STP must develop and maintain written policies and procedures
relating to the Grievance System. Before implementation, the Commission
must give the STP written approval of the STP's Grievance System
policies and procedures.
c. The STP shall refer all Medicaid Beneficiaries who are dissatisfied with the
STP or its Actions to the STP's Grievance/Appeal Coordinator for
processing and documentation in accordance with this Contract and
established policies and procedures.
d. The STP shall provide reasonable assistance to Medicaid Beneficiaries in
completing forms and other procedural steps, including, but not limited
to, providi ng interpreter services and toll-free numbers with T1Y (TDD and
interpreter capability.
e. The STP shall acknowledge, in writing, the receipt of a Grievance or a
request for an Appeal, unless the Medicaid Beneficiary requests an
expedited resolution.
f. The STP shall not allow any of the decision makers on a Grievance or
Appeal were involved in any of the previous levels of review or decision-
making when deciding any of the following:
(1) An Appeal of a denial that is based on lack of Medical Necessity;
and,
(2) A Grievance regarding the denial of an expedited resolution of an
Appeal.
g. The Medicaid Beneficiary, and/or the Medicaid Beneficiary's
representative, shall be allowed an opportunity to examine the Medicaid
Beneficiary's case file before and during the Grievance or Appeal process,
including all Medical Records an d any other documents and records.
h. The Medicaid Beneficiary and/or the Medicaid Beneficiary's representative
or the representative of a deceased Medicaid Beneficiary's estate shall be
considered as parties to the Grievance/Appeal.
i. The STP shall maintain, monitor, and review a record/log of all
Complaints, Grievances, and Appeals in accordance with the terms of this
Contract and to fulfill the reporting requirements as set forth in this
Contract.
j. The STP shall work with the Commission's Grievance/Appeals Coordiator
to resolve all grievance related issues.
k. Notice of Action
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(1) The SIP shall notify the Medicaid Beneficiary, in writing, using
language at, or below the fourth (4th) grade reading level, of any
Action taken by the SIP to deny a Transportation Service request,
or limit Transportation Services in an amount, duration, or scope
that is less than requested.
(2) The SIP shall provide notice to the Medicaid Beneficiary as set
forth below (see 42 CFR 438.404(a) and (c) and 42 CFR
438.21O(b) and (c)):
(a) The Action the Recipient has taken or intends to take;
(b) The reasons for the Action, customized for the
circumstances of the Medicaid Beneficiary;
(c)
The Medicaid Beneficiary's or the
Professional's (with written permiSSion
Beneficiary) right to file an Appeal;
Health Care
of the Medicaid
(d) The procedures for filing an Appeal;
(e) The circumstances under which expedited resolution is
available and how to request it; and,
(f) The Medicaid Beneficiary's rights to request that
Transportation Services continue pending the resolution of
the Appeal, how to request the continuation of
Transportation Services, and the circumstances under
which the Medicaid Beneficiary may be required to pay the
costs of these services.
(3) The SIP must provide the notice of Action within the following
time frames:
(a) At least ten (10) Calendar Days before the date of the
Action or fifteen (15) Calendar Days if the notice is sent by
Surface Mail (five [5] Calendar Days if the Recipient
suspects Fraud on the part of the Medicaid Beneficiary).
See 42 CFR 431.211, 42 CFR 431.213 and 42 CFR
431.214.
(b) For denial of the Trip request, at the time of any Action
affecting the Trip request.
(c) For standard Service Authorization decisions that deny or
limit Transportation Services, as quickly as the Medicaid
Beneficiary's health condition requires, but no later than
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fourteen (14) Calendar Days following receipt of the
request for service (see 42 CFR 438.210(d)(1)).
(d) If the STP extends the time frame for notification, it must:
(i) Give the Medicaid Beneficiary written notice of the
reason for the extension and inform the Medicaid
Beneficiary of the right to file a Grievance if the
Medicaid Beneficiary disagrees with the Recipient's
decision to extend the time frame; and,
(ii) Carry out its determination as quickly as the
Medicaid Beneficiary's health condition requires,
but in no case later than the date upon which the
fourteen (14) Calendar Day extension period
expires (see 42 CFR 438.210(d)(1)).
(e) If the STP fails to reach a decision within the time frames
described above, the Medicaid Beneficiary can consider
such failure on the part of the STP a denial and, therefore,
an Action adverse to the Medicaid Beneficiary (See 42 CFR
438.210(d)).
(f) For expedited Service Authorization decisions, within three
(3) Business Days (with the possibility of a fourteen (14)
Calendar Day extension). See 42 CFR 438.210(d)(2).
B. The Complaint Process
1. A Medicaid Beneficiary may file a Complaint, or a representative of the Medicaid
Beneficiary, acting on behalf of the Medicaid Beneficiary and with the Medicaid
Beneficiary's written consent, may file a Complaint.
2. General Duties
a. The STP must:
(1) Resolve each Complaint within fi fteen (15) Business Days from the
day the STP received the initial Complaint, be it oral or in writing;
(a) The STP may extend the Complaint resolution time frame
by up to ten (10) Business Days if the Medicaid Beneficiary
requests an extension, or the Recipient/Subcontractor
documents that there is a need for additional information
and that the delay is in the Medicaid Beneficiary's best
interest.
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(b) If the STP requests the extension, the
Recipient/Subcontractor must give the Medicaid
Beneficiary written notice of the reason for the delay.
(2) Notify the Medicaid Beneficiary, in writing, within five (5) Business
Days of the resolution of the Complaint if the Medicaid Beneficiary
is not satisfied with the STP's resolution. The notice of disposition
shall include the results and date of the resolution of the
Complaint, and shall include:
(a) A notice of the right to request a Grievance or Appeal,
whichever is the most appropriate to the nature of the
objection; and,
(b) Information necessary to allow the Medicaid Beneficiary to
request a Medicaid Fair Hearing, if appropriate, including
the contact information necessary to pursue a Medicaid
Fair Hearing (see Medicaid Fair Hearing System Section).
(3) Provide the Commission with a report detailing the total number
of Complaints received, pursuant to Reporting Requirements of
this contract; and,
(4) The STP nor any Transportation Providers shall take any punitive
action against a physician or other Health Care Provider who files
a Complaint on behalf of a Medicaid Beneficiary, or supports a
Medicaid Beneficiary's Complaint.
b. Filing Requirements
(1) The Medicaid Beneficiary or a representative of the Medicaid
Beneficiary, acting on behalf of the Medicaid Beneficiary and with
the Medicaid Beneficiary's written consent must file a Complaint
within fifteen (15) Calendar Days after the date of occurrence that
initiated the Complaint.
(2) The Medicaid Beneficiary or his/her representative may file a
Complaint either orally or in writing. The Medicaid Beneficiary or
his/her representative may follow up an oral request with a
written request, however the timeframe for resolution begins the
date the STP receives the oral request.
C. The Grievance Process
1. A Medicaid Beneficiary may file a Grievance, or a representative of the Medicaid
Beneficiary, acting on behalf of the Medicaid Beneficiary and with the Medicaid
Beneficiary's written consent, may file a Grievance.
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2. General Duties
a. The STP must:
(1) Resolve each Grievance within ninety (90) Calendar Days from the
day the STP received the initial Grievance request, be it oral or in
writing;
(2) Notify the Medicaid Beneficiary, in writing, within thirty (30)
Calendar Days of the resolution of the Grievance. The notice of
disposition shall include the results and date of the resolution of
the Grievance, and for decisions not wholly in the Medicaid
Beneficiary's favor, the notice of disposition shall include:
(a) Notice of the right to request a Medicaid Fair Hearing, if
applicable; and,
(b) Information necessary to allow the Medicaid Beneficiary to
request a Medicaid Fair Hearing, including the contact
information necessary to pursue a Medicaid Fair Hearing
(see Medicaid Fair Hearing System Section, below);
(3) Provide the Commission with a copy of the written notice of
disposition upon request;
(4) The STP nor any Transportation Provider shall take any punitive
action against a physician or other health care provider who files a
Grievance on behalf of a Medicaid Beneficiary, or supports a
Medicaid Beneficiary's Grievance; and,
(5) Provide the Commission with a report detailing the total number
of Grievances received, pursuant to the Reporting Requirements
Section of this Contract.
b. The STP may extend the Grievance resolution time frame by up to
fourteen (14) Calendar Days if the Medicaid BenefiCiary requests an
extension, or the STP documents that there is a need for additional
information and that the delay is in the Medicaid Beneficiary's best
interest.
(1) If the STP requests the extension, the 5TP must give the Medicaid
Beneficiary written notice of the reason for the delay.
c. Filing Require ments
(1) The Medicaid Beneficiary or provider must file a Grievance within
one (1) year after the date of occurrence that initiated the
Grievance.
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(2) The Medicaid Beneficiary or provider may file a Grievance either
orally or in writing. The Medicaid Beneficiary may follow up an
oral request with a written request, however the timeframe for
resolution begi ns the date the STP receives the oral request.
D. The Appeal Process
1. A Medicaid Beneficiary may file an Appeal, or a representative of the Medicaid
Beneficiary, acting on behalf of the Medicaid Beneficiary and with the Medicaid
Beneficiary's written consent, may file an Appeal.
2. General Duties
a. The STP shall:
(1) Confirm in writing all oral inquiries seeking an Appeal, unless the
Medicaid Beneficiary or provider requests an expedited resolution;
(2) If the resolution is in favor of the Medicaid Beneficiary, provide
the services as quickly as the Medicaid Beneficiary's health
condition requires;
(3) Provide the Medicaid Beneficiary or provider with a reasonable
opportunity to present evidence and allegations of fact or iaw, in
person and/or in writing;
(4) Allow the Medicaid Beneficiary, and/or the Medicaid Beneficiary's
representative, an opportunity, before and during the Appeal
process, to examine the Medicaid Beneficiary's case file, including
all documents and records;
(5) Consider the Medicaid Beneficiary, the Medicaid Beneficiary's
representative or the representative of a deceased Medicaid
Beneficiary's estate as parties to the Appeal;
(6) Continue the Medicaid Beneficiary's Transportation Services if:
(a) The Medicaid Beneficiary files the Appeal in a timely
manner, meaning on or before the later of the following:
(i) Within ten (10) Business Days of the date on the
notice of Action (add fIVe [5] Business Days if the
notice is sent via Surface Mail); or,
(ii) The intended effective date of the STP's proposed
Action.
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(b) The Appeal involves the termination, suspension, or
reduction of a previously authorized Transportation
service;
(c) The Transportation was for a Medicaid compensable
service ordered;
(d) The authorization period has not expired; and/or,
(e) The Medicaid Beneficiary requests extension of
Transportation Services.
(7) Provide written notice of the resolution of the Appeal, including
the results and date of the resolution within two (2) Business
Days after the resolution. For decisions not wholly in the Medicaid
Beneficiary's favor, the notice of resolution shall include:
(a) Notice of the right to request a Medicaid Fair Hearing;
(b) Information about how to request a Medicaid Fair Hearing,
including the DCF address necessary for pursuing a
Medicaid Fair Hearing, as set forth in Medicaid Fair Hearing
System Section, below;
(c) Notice of the right to continue to receive Transportation
Services pending a Medicaid Fair Hearing;
(d) Information about how to request the continuation of
Transportation Services; and
(e) Notice that if the STP's Action is upheld in a Medicaid Fair
Hearing, the Medicaid Beneficiary may be liable for the
cost of any continued Transportation Services.
(8) Provide the Commission with a copy of the written notice of
disposition upon request;
(9) The STP nor any Transportation Providers shall take any punitive
action against a physician or other health care provider who files
an Appeal on behalf of a Medicaid Beneficiary or supports a
Medicaid Beneficiary's Appeal; and,
(10) Provide the Commission with a report detailing the total number
of Appeals received, pursuant to Reporting Requirements of this
Contract.
b. If the STP continues or reinstates the Medicaid Beneficiary's
Transportation Services while the Appeal is pending, the STP must
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continue providing the Transportation Services until one (1) of the
following occurs:
(1) The Medicaid Beneficiary withdraws the Appeal;
(2) Ten (10) Business Days pass from the date of the STP's notice of
resolution of the Appeal if the resolution is adverse to the
Medicaid BenefICiary and if the Medicaid BenefICiary has not
requested a Medicaid Fair Hearing with continuation of
Transportation Services until a Medicaid Fair Hearing decision is
reached;
(3) The Medicaid Fair Hearing panel's decision is adverse to the
Medicaid Beneficiary; or,
(4) The authorization to provide services expires, or the Medicaid
Beneficiary meets the authorized service limits.
c. If the final resolution of the Appeal is adverse to the Medicaid Beneficiary,
the STP may recover the costs of the services furnished from the
Medicaid Beneficiary while the Appeal was pending, to the extent that the
STP furnished the services solely because of the requirements of this
Section.
d. If the STP did not furnish services while the Appeal was pending and the
Appeal panel reverses the STP's decision to deny, limit or delay services,
the STP must authorize or provide the disputed services promptly and as
quickly as the Medicaid Beneficiary's health condition requires.
e. If the STP furnished services while the Appeal was pending and the
Appeal panel reverses the STP's decision to deny, limit or delay services,
the STP must pay for disputed services in accordance with State policy
and regulations.
3. Filing Requirements
a. The Medicaid Beneficiary or his/her representative must file an Appeal
within thirty (30) Calendar Days of receipt of the notice of the STP's
Action.
b. The Medicaid Beneficiary may file an Appeal either orally or in writing. If
the filing is oral, the Medicaid Beneficiary must also file a written, signed
Appeal within thirty (30) Calendar Days of the oral filing. The STP shall
notify the requesting party that it must file the written request within ten
(10) Business Days after receipt of the oral request. For oral filings, time
frames for resolution of the Appeal begin on the date the STP receives
the oral filing.
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c. The STP shall resolve each Appeal within State-established time frames
not to exceed forty-five (45) Calendar Days from the day the STP
received the initial Appeal request, whether oral or in writing.
d. If the resolution is in favor of the Medicaid Beneficiary, the STP shall
provide the services as quickly as the Medicaid Beneficiary's health
condition requires.
e. The STP may extend the resolution time frames by up to fourteen (14)
Calendar Days if the Medicaid Beneficiary requests an extension, or the
STP documents that there is a need for additional information and that
the delay is in the Medicaid Beneficiary's best interest.
(1) If the STP requests the extension, the STP must give the Medicaid
Beneficiary written notice of the reason for the delay.
(2) The STP must provide written notice of the extension to the
Medicaid Beneficiary within five (5) Business Days of determining
the need for an extension.
4. Expedited Process
a. The STP shall establish and maintain an expedited review process for
Appeals when the STP determines, the Medicaid Beneficiary requests or
the provider indicates (in making the request on the Medicaid
Beneficiary's behalf or supporting the Medicaid Beneficiary's request) that
taking the time for a standard resolution could seriously jeopardize the
Medicaid Beneficiary's life, health or ability to attain, maintain or regain
maximum function.
b. The Medicaid Beneficiary may file an expedited Appeal either orally or in
writing. No additional written follow-up on the part of the Medicaid
Beneficiary is required for an oral request for an expedited Appeal.
c. The 5TP must:
(1) Inform the Medicaid Beneficiary of the limited time available for
the Medicaid Beneficiary to present evidence and allegations of
fact or law, in person and in writing;
(2) Resolve each expedited Appeal and provide notice to the Medicaid
Beneficiary, as quickly as the Medicaid Beneficiary's health
condition requires, within State established time frames not to
exceed seventy-two (72) hours after the ReCipient/Subcontractor
receives the Appeal request, whether the Appeal was made orally
or in writing;
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(3) Provide written notice of the resolution in accordance with the
Appeal Process Section, of the expedited Appeal to the Medicaid
Beneficiary;
(4) Make reasonable efforts to provide oral notice of disposition to the
Medicaid Beneficiary immediately after the Appeal panel renders a
decision; and,
(5) The STP nor any Transportation Provider shall take any punitive
action against a physician or other health care provider who
requests an expedited resolution on the Medicaid Beneficiary's
behalf or supports a Medicaid Beneficiary's request for expedited
resolution of an Appeal.
a. If the STP denies a request for an expedited resolution of
an Appeal, the STP must:
(1) Transfer the Appeal to the standard time frame of
no longer than forty-five (45) Calendar Days from
the day the Recipient/Subcontractor received the
request for Appeal (with a possible fourteen [14]
day extensi on);
(2) Make all reasonable efforts to provide immediate
oral notification of the Recipient's/Subcontractor's
denial for expedited resolution of the Appeal;
(3) Provide written notice of the denial of the
expedited Appeal within two (2) Calendar Days;
and,
(4) Fulfill all requirements set forth in the Appeal
Process Section above.
E. Medicaid Fair Hearing System
1. As set forth in Rule 65-2.042, FAC, the Recipient's/5ubcontractor's Grievance
Procedure and Appeal and Grievance processes shall state that the Medicaid
Beneficiary has the right to request a Medicaid Fair Hearing, in addition to, and
at the same time as, pursuing resolution through the Recipient's/Subcontractor's
Grievance and Appeal processes.
a. A physician or other health care provider must have a Medicaid
Beneficiary's written consent before requesting a Medicaid Fair Hearing
on behalf of a Medicaid Beneficiary.
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b. The parties to a Medicaid Fair Hearing include the STP, as well as the
Medicaid Beneficiary, his/her representative or the representative of a
deceased Medicaid Beneficiary's estate.
2. Rling Requirements
a. The Medicaid Beneficiary may request a Medicaid Fair Hearing within
ninety (90) days of the date of the notice of the STP's resolution of the
Medicaid Beneficiary's Grievance/Appeal by contacting DCF at:
The Office of Appeal Hearings
1317 Winewood Boulevard, Building 5, Room 203
Tallahassee, Florida 32399-0700
3. General Duties
a. The STP must:
(1) Continue the Medicaid Beneficiary's Transportation Services while
the Medicaid Fair Hearing is pending if:
(a) The Medicaid Beneficiary filed for the Medicaid Fair
Hearing in a timely manner, meaning on or before the
later of the followi ng:
(i) Within ten (10) Business Days of the date on the
notice of Action (add five [5] Business Days if the
notice is sent via Surface Mail);
(i1) The intended effective date of the STP's proposed
Action.
(b) The Medicaid Fair Hearing involves the termination,
suspension, or reduction of a previously authorized course
of treatment;
(c) The authorization period has not expired; and/or,
(d) The Medicaid Beneficiary requests extension of
Transportation Services.
(2) The STP nor any Transportation Provider shall take any punitive
action against a physician, Transportation Provider, or other
health care provider who requests a Medicaid Fair Hearing on a
Medicaid Beneficiary's behalf or supports a Medicaid Beneficiary's
request for a Medicaid Fair Hearing.
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b. If the SIP continues or reinstates Medicaid Beneficiary Transportation
Services while the Medicaid Fair Hearing is pending, the SIP must
continue said Transportation Services until one (1) of the folloWing
occurs:
(1) The Medicaid Beneficiary withdraws the request for a Medicaid
Fair Hearing;
(2) Ten (10) Business Days pass from the date of the SIP's notice of
resolution of the Appeal if the resolution is adverse to the
Medicaid Beneficiary and the Medicaid BenefiCiary has not
requested a Medicaid Fair Hearing with continuation of
Transportation Services until a Medicaid Fair Hearing decision is
reached (add five [5] Business Days if the Recipient/Subcontractor
sends the notice of Action by Surface Mail);
(3) The Medicaid Fair Hearing officer renders a decision that is
adverse to the Medicaid Beneficiary; and/or,
(4) The Medicaid Beneficiary's authorization expires or the Medicaid
Beneficiary reaches his/her authorized service limits.
4. If the final resolution of the Medicaid Fair Hearing is adverse to the Medicaid
Beneficiary, the SIP may recover the costs of the services furnished while the
Medicaid Fair Hearing was pending, to the extent that the SIP furnished said
services solely because of the requirements of this Section.
5. If the SIP did not furnish services while the Medicaid Fair Hearing was pending,
and the Medicaid Fair Hearing resolution reverses the SIP's decision to deny,
limit or delay services, the SIP must authorize or provide the disputed services
as quickly as the Medicaid Beneficiary's health condition requires.
6. If the SIP did furnish services while the Medicaid Fair Hearing was pending, and
the Medicaid Fair Hearing resolution reverses the SIP's decision to deny, limit or
delay services, the SIP must pay for the disputed services in accordance with
State policy and regulations.
Type Time Frilme to File Provide Time Frilme Extension Time Frame to Next Step
Transportation to Resolve Time Frame Send (if any)
Services During Notification of
Review Resolution
Compiaint Ninety (90) Calendar Yes Fifteen (15) Ten (10) Five (5) File a
Days From the Date of Business Days Business Days Business Days Grievance
the Incident That From the Date
Precipitated the of the Complaint
Complaint
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Grievance Ninety (90) Calendar Yes Ninety (90) Fourteen (14) Thirty (30) Medicaid Fair
Days From the Date of Caiendar Days Calendar Days Calendar Days Hearing
the Action That from the Date of
Precipitated the Resolution
of the Grievance
VIII. ADMINISTRATION AND MANAGEMENT
A. General Provisions
1. The STP's governing body shall set forth poiicy and has overall responsibility for
the organization of the SIP. The STP shall be responsible for the administration
and management of all aspects of this Agreement, including all Subcontracts,
employees, agents, and services performed by anyone acting for or on behalf of
the STP. The STP shall have a centralized executive administration, which shall
serve as the contact point for the Commission, except as otherwise specified in
this Agreement.
2. The STP shall be responsible for the administration and management of all
aspects of this Agreement, such as, but not limited to the delivery of
Transportation Services. If the STP Subcontracts any of its administrative and
management duties under this Agreement, the Commission shall hold the STP
responsible for ensuring that the Subcontractor(s) maintain the same standards
as the STP in administering and managing all aspects of the Subcontract. If the
Subcontractor fails to maintain the same administration and management
standards as the STP, the Commission shall sanction the STP in accordance with
this Contract.
3. The STP shall not provide incentives to its Subcontractors to deny, limit, or
discontinue Transportation Services to any Medicaid Beneficiary inappropriately.
B. Staffing
1. The STP shall maintain an adequate and competent staff so as to enable the STP
to timely perform under this Ag reement
C. Subcontract Requirements
1. The STP shall comply with all Commission procedures for Subcontracts review
and approval submission.
a. All Subcontracts must comply with 42 CFR 438.230.
b. The SIP and/or Transportation Providers shall be eligible for participation
in the Medicaid program. If Medicaid involuntarily terminated a STP or
Transportation Provider from the Florida Medicaid program, other than for
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purposes of inactivity, that STP or Transportation Provider is not an
eligible Medicaid provider.
c. The STP and/or Transportation Providers shall not employ or contract
with individuals on the State or federal exclusions list available from the
Department of Management Services' List of Excluded Vendors and the
federal List of Excluded Individuals and Entities.
d. No Subcontract that the STP enters into with respect to performance
under this Agreement shall in any way relieve the STP of any
responsibility for the provision of Transportation Services and other duties
set forth in this Agreement. The STP shall assure that Transportation
Providers perform all services and tasks related to the Subcontract in
accordance with the terms of this Agreement.
e. The STP shall include its Grievance System in its Subcontracts to ensure
uniformity of its Gri evance System statewide.
2. All Subcontracts and amendments executed by the STP must be in writing and
signed by the Recipient and the Subcontractor. All model and executed
Subcontracts and amendments entered into as a result of this Agreement shall
meet the following requirements:
a. Prohibit the Subcontractor from seeking payment from the Medicaid
Beneficiary for any Covered Services provided to the Medicaid Beneficiary
within the terms of the Agreement.
b. Require the Subcontractor to look solely to the 5TP for compensation for
services rendered, with the exception of co-payments, pursuant to the
State Medicaid Plan and the Non-Emergency Transportation Services
Coverage & Limitations Handbook (Handbook).
c. The Subcontract shall not contain an incentive plan that, in any way, acts
as an inducement to reduce or Iim it Transportation Services to a Medicaid
Beneficiary inappropriately.
d. Specify that any contracts, agreements, or Subcontracts entered into by
the Subcontractor for the purposes of carrying out any aspect of this
Agreement must include assurances that the individuals who are signing
the contract, agreement or Subcontract are so authorized and that it
includes all the requirements of this Agreement.
e. Require the Subcontractor to cooperate with the STP's Grievance and
Appeal policies and procedures and provide for monitoring and oversight,
including monitoring of Transportation Services rendered to Medicaid
Beneficiaries, by the STP and for the Subcontractor to provide proof
annually, or at the request of the STP, the Commission, or its agent, that
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all drivers and vehicles are Ucensed and meet all federal, State, and local
laws and regulations.
f. Not prohibit a Subcontractor from advocating on behalf of a Medicaid
Beneficiary in any Grievance System or UM process, or individual
authorization process to obtain necessary Transportation Services.
g. Prohibit discrimination with respect to participation, reimbursement, or
indemnification of any Subcontractor who is acting within the scope of his
or her license or Certification under applicable State law, solely on the
basis of such license or Certification. The STP should not construe this
provision as a willing provider law, as it does not prohibit the STP from
limiting provider participation to the extent necessary to meet the needs
of the Medicaid Beneficiaries. This provision does not interfere with
measures established by the STP designed to maintain quality and control
costs.
h. Prohibit discrimination against Subcontractors serving Medicaid
Beneficiaries in high-risk populations or Subcontractors that specialize in
conditions requiring costly transport.
i. Require the Subcontractor to maintain an adequate record system for
recording services, charges, dates and all other commonly accepted
information elements for services rendered to the Recipient.
j. Require that the Subcontractor maintain records related to this
Agreement for a period not less than five (5) years from the close of the
Agreement, and retained further if the records are under review or audit
until the review or audit is complete.
k. Specify that the United States Department of Health & Human Services
(DHH5) and the Agency or its Agents shall have the right to inspect,
evaluate, and audit any records pertinent to the Agreement, including,
but not limited to, the following:
(1) Pertinent bocks;
(2) Financial records; and,
(3) Documents, papers, and records of any Transportation Provider
involving financial transactions.
I. Specify Covered Services and populations that the Subcontractor will
serve under the Subcontract.
m. Require that Subcontractors comply with the Recipient's Cultural
Competency Plan.
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n. Require that any materials related to this Agreement that the
Subcontractor distributes are submitted to the Commission for written
approval before use.
o. Provide for submission of all reports and information required by the
Recipient.
p. Require Subcontractors to submit notice of withdrawal from the
Recipient's Transportation Provider network at least ninety (90) Calendar
Days prior to the effective date of such withdrawa I.
q. Require all Subcontractors to notify the Recipient in the event of a lapse
in general liability or other applicable insurance.
r. Require safeguarding of information about Medicaid Beneficiaries
according to 42 CFR, Part 438.224.
s. Require compliance with HIPAA privacy and security provisions.
t. Require an exculpatory clause, which survives termination of the
Subcontract, including breach of Subcontract due to Insolvency, that
assures that the Subcontractor's creditors cannot hold either Medicaid
Beneficiaries or the AHCA or the Commission liable for any debts of the
Subcontractors.
u. Contain a clause indemnifying, defending, and holding the AHCA, the
Commission and the STP's Medicaid Beneficiaries harmless from and
against all claims, damages, causes of action, costs or expense, including
court costs and reasonable attorney fees, to the extent proximately
caused by any negligent act or other wrongful conduct arising from the
Subcontract:
(1) This clause must survive the termination of the Subcontract,
including breach due to Insolvency; and,
(2) The Commission and/or AHCA may waive this requirement for
itself, but not Medicaid Beneficiaries, for damages in excess of the
statutory ca p on damages for public entities if the Subcontractor is
a public health entity with statutory immunity (the AHCA must
approve all such waivers in writing).
v. Where applicable, require that all Subcontractors secure and maintain,
during the life of the Subcontract, worker's compensation insurance
(complying with the Florida's Worker's Compensation Law) for all of its
employees/independent contractors connected with the work under this
Agreement unless such employees/independent contractors are covered
by the protection afforded by the Recipient or Subcontractor.
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w. Make provisions for a waiver of those terms of the Subcontract, which, as
they pertain to Medicaid Beneficiaries, are in confiict with the
specifications of this Agreement.
x. Contain no provision that in any way prohibits or restricts the
Subcontractor from entering into a contract with any other Vendor.
y. Contain no provision requiring the Subcontractor to contract for more
than one (1) transportation agreement or otherwise be excluded.
z. Require Subcontractors to cooperate fully in any investigation by the
AHCA or the Attorney General's Medicaid Fraud Control Unit (MFCU), or
any subsequent legal action that may result from such an investigation.
aa. Provide that the Comm ission, AHCA and DHHS may evaluate, through
inspection or other means, the quality, appropriateness, and timeliness of
the Transportation Services performed.
bb. Provide the STP and the Commission with the ability to monitor the
Subcontractor to ensure that all Transportation Providers are properly
Licensed and inspected pursuant to State, county, and local statute and
regulations.
cc. Provide the Commission and STP with the ability to monitor and oversee
all Transportation Services provided by Subcontractors to Medicaid
Beneficiaries.
dd. Identification of conditions and method of payment:
(1) The STP agrees to make payment to all Subcontractors pursuant
to all State and federal laws, rules, and regulations, specifically,
Section 641.3155, F.5., 42 CFR 447.46, and 42 CFR 447.45(d)(2),
(d)(3), (d)(5), and (d)(6); and,
(2) Provide for prompt submission by the Subcontractor of all
information and encounter data needed to make payment.
ee. Specify that if the Subcontractor delegates or Subcontracts any functions
of the STP, that the Subcontract or delegation includes all requirements
of this Ag reement.
ff. Provide for revoking a previously Subcontracted delegation, or imposing
other sanctions, if the Subcontractor's performance is inadequate.
3. STP{Transportation Provider Termination
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a. The STP shall comply with all State and federal laws regarding
Transportation Provider termination. In its Transportation Provider
Agreements, the Recipient shall:
(1) In addition to any other right to terminate the STP Agreement,
and not withstandi ng any other provision of this Contract, the
Commission may request immediate termination of a STP
Agreement if, as determined by the Commission, a STP fails to
abide by the terms and conditions of the STP Agreement, or in the
sole discretion of the Commission, the STP fails to come into
compliance with the STP contract within fifteen (15) Calendar
Days after receipt of notice from the Commission specifying such
failure and requesting such STP abide by the terms and conditions
thereof; and,
(2) If the Commission terminates a STP pursuant to any provision of
the STP Contract, the STP shall use the applicable appeals
procedures outlined in the STP Contract. There is no additional or
separate right of appeal to the AHCA or the Commission as a
result of the Commission's act of terminating, or decision to
terminate any STP under this Contract.
(3) The Commission shall provide sixty (60) Calendar Days' advance
written notice to the STP before canceling, without cause, a STP
Contract .
D. Transportation Provider Services
1. Genera I Provisions
a. The STP shall provide sufficient information to all Transportation
Providers in order to operate in full compliance with this Contract and all
applicable federa I, State, and local laws and regulations.
b. The STP shall monitor each Transportation Provider to ensure that each
Transportation Provider complies with the requirements of this Contract
and all applicable federal, State, and local laws and regulations and shall
take or require corrective actions to ensure compliance with such
requirements.
c. The Transportation Provider Agreements shall incorporate all provisions
of the STPs agreement with the Commission (Subcontract), unless
otherwise set forth below.
2. Transportation Provider Handbooks
a. The Commission shall develop and issue a Transportation Provider
Handbook. All Transportation Provider Handbooks and bulletins shall be
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in compliance with State and federal laws. The Transportation Provider
Handbook shall serve as a source of information regarding Covered
Services, policies and procedures, statutes, regulations, telephone access,
and special requirements to ensure that all contract requirements are
met. At a minimum, the Transportation Provider Handbook shall include
the following information:
(1) Description of the Non-Emergency Transportation program;
(2) Covered Services;
(3) Information about the Grievance System, the timeframes and
requirements, the availability of assistance in filing, the toll-free
numbers and the Medicaid Beneficiary's right to request
continuation of Transportation Services while utilizing the
Grievance System;
(4) Routine, Hospital/facility discharges, Urgent Care, Emergency
room/facility discharges, and will call pol icies and procedures;
(5) The Cultural Competency Plan;
(6) Medicaid Beneficiary rights and responsibilities (see 42 CFR
438.100 for guidance as to a Medicaid Beneficiary's rights and
responsibilities); and,
(7) Other Transportation Provider responsibilities.
b. Bulletins shall be disseminated as needed to incorporate any changes or
updates to the Transportation Provider Handbook.
3. Education and Training
a. STPs shall attend and/or participate in training and educational
workshops when scheduled by the Commission.
E. Medicaid Beneficiary Eligibility Records Requirements
1. The STP shall maintain records, either electronically or by hard copy, for each
Medicaid Beneficiary in accordance with this Section.
a. The STP's Medicaid Beneficiary eligibility records must include all
Encounter Data elements as set forth in the Encounter Data Section. At a
minimum, the STP's Medicaid Beneficiary eligibility records must include
the following:
(1) Each record must be legible and maintained in detail;
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(2) All record entries must be dated;
(3) All records must reflect the primary language spoken by the
Medicaid Beneficiary and any translation needs of the Medicaid
Beneficiary;
(4)
All records must identify
communication assistance in
Services;
Medicaid Beneficiaries needing
the delivery of Transportation
(5) All records must show whether the Medicaid Beneficiary has any
specific needs that require special equipment or services (e.g.,
dementia, uses a walker, etc.); and,
(6) All records must show whether the Medicaid Beneficiary requires a
medical Attendant/Escort or assistance in accessing medical
services (e.g., door-to-door delivery, etc.).
b. Confidentiality of Medicaid Beneficiary Elig ibility Records
(1) The STP shall ensure the confidentiality of Medicaid Beneficiary
eligibility records in accordance with 42 CFR, Part 431, Subpart F
and the Privacy and Security provisions of the Health Insurance
Portability and Accountability Act (HIPAA).
F. Invoice Payment
1. An invoice is considered received when the Commission receives the invoice in its
Offices.
2. The Commission has eleven (11) business days to inspect and approve goods
and services. If payment is not available within forty (40) calendar days,
measured from the latter of the date the invoice is received or the goods or
services are received, inspected and approved, a separate interest penalty set by
the Comptroller pursuant to Section 55.03, F. S., will be due and payable in
addition to the invoice amount. To obtain the applicable interest rate, please
contact the Commission's Fiscal Section at (850) 410-5700. Invoices returned to
a STP due to preparation errors will result in a payment delay. Invoice payment
requirements do not start until a properly completed invoice is provided to the
Commission. A Vendor Ombudsman, whose duties include acting as an advocate
for Vendors who may be experiencing problems in obtaining timely payment(s)
from a State Agency, may be contacted at (850) 410-9724 or by calling the State
Comptroller's Hotline, 1-800-848-3792.
G. Encounter Data
1. The STP shall collect and submit Encounter Data to the Commission. The STP
shall have a comprehensive automated and integrated Encounter Data system
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that is capable of meeting the requirements as defined by the Comm ission. The
required data elements are provided in Attachment 3.
The attach chart is the Draft Batch File Layout for the new Medicaid system.
There will be an additional one alpha character identifier for any record that
contains a Social Security Number consisting of all 9's (the only acceptable entry
other than a valid SSN), that's not shown in this File Layout. This field must be
occupied with either an I for Infant or A for Alien (not case-sensitive) if the value
is all 9's (999-99-9999). In the case of a valid 5SN, this field will be left blank.
The exact File Layout, includ ing the location of this new data element, will be
provided by the Comm ission as soon as it is finalized.
2. The STP is responsible for errors or noncompliance resulting from its own actions
or the actions of an agent authorized to act on its behalf. The STP shall resolve
any errors or noncompliance and resubmit the Encounter Data.
a. The Commission shall monitor the STP's submissions and provide error
reports for the STP to resolve and resubmit.
3. The STP shall implement review procedures to validate their own Encounter
Data.
4. The STP will designate sufficient information technology and staffing resources
to perform these functions as set forth in this Agreement.
S. The STP shall have a unique Florida Medicaid provider identification number.
6. The STP must attend and/or participate in training provided by the Commission
and/or AHCA regarding:
a. The Commission's Information System;
b. The critical requirements for Encounter Data submission; and,
c. The submission and resubmission requirements.
7. All Encounter Data from submission and resubmission shall be:
a. Complete
(1) All Trips shall be entered for the reported period.
(2) All required data fields shall be populated.
b. Accurate
(1) One hundred percent (100%) of all fields shall contain valid
values.
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(2) The STP shall input the fully allocated Cost in the "trip cost" field
based on the Commission rate methodology.
c. Timely
(1) The SIP shall submit Encounter Data no later than thirty (30)
Calendar Days after the end of the reporting month.
(2) The SIP shall submit all corrected Encounter Data within ninety
(90) Calendar Days after the end of the reporting month
8. The STP shall cooperate with Commi ssion staff and its a uthorized representatives
regarding onsite visits to evaluate the STP's MEDS operations, which include
providing access to Transportation Records and administrative records for
review. The STP shall participate in Commission and/or AHCA sponsored
workgroups directed at continuous improvements in Encounter Data quality and
operations.
9. The Commission and AHCA will monitor and track the quality of the SIP's
Encounter Data submissions and provide feedback to the STP and/or Comm ission
pursua nt to the schedule set forth below.
a. The Commission shall use seventy-five percent (75%) accuracy as the
starting point or benchmark for determining quality of the Encounter Data
submissions.
b. For purposes of this section, quality means that the Encounter Data for
the service rendered conforms to the terms and conditions of this
Agreement.
Recipient's Encounter Data via MEDS System - Expected Ufo Quality Level
Processing Month MEDS % Minimum Quality Expected
March, 2009 75%
April, 2009 80%
May, 2009 85%
June, 2009 85%
July, 2009 90%
August, 2009 90%
September, 2009 - End of Agreement 95%
10. If the STP's Encounter Data reporting is not acceptable, the Commission shall
require the STP to submit a Corrective Action Pian (CAP). If the STP fails to
provide a CAP, or to implement an approved CAP, within the time specified by
the Commission, the Commission shall sanction the STP, in accordance with the
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Contract. When considering whether to impose sanctions, the Commission may
take into account the STP's cumulative performance on all MEDS activities.
H. fraud Prevention
1. The STP shall establish functions and activities governing program integrity in
order to reduce the incidence of fraud and Abuse and shall comply with all State
and federal program integrity requirements.
2. The Recipient shall have internal controls and policies and procedures in place
that are designed to prevent, detect, and report known or suspected fraud and
Abuse activities.
3 The Recipient shall cooperate fully in any investigation by the AHCA, MPI, MFCU,
or any subsequent legal action that may result from such an investigation.
4. Ensure that the Recipient does not retaliate against any individual who reports
Violations of the Recipient's Fraud and Abuse policies and procedures or
suspected fraud and Abuse.
IX. INFORMATION MANAGEMENT AND SYSTEMS
A. General Provisions
1. Systems Functions - The STP shall have Information Management processes and
Information Systems that enable it to meet Commission, AHCA and federal
reporting requirements and other Agreement requirements and that are in
compliance with this Agreement and all applicable State and federal laws, rules
and regulations, including HIPAA.
2. Systems Capacity - The STP's Systems shall possess capacity sufficient to handle
the workload projected for the begin date of operations and will be scalable and
flexible so they can be adapted as needed, within negotiated timeframes, in
response to changes in Agreement requirements, etc.
3. E-Mail System - The STP may provide a continuously available electronic mail
communication link (E-mail system) with the Commission. This system shall be:
a. Available from the workstations of the designated STP contacts; and,
b. Capable of attaching and sending documents created using software
products other than STP's Systems, including the Commission's currently
installed version of Microsoft Office and any subsequent upgrades as
adopted.
4. Participation in Information Systems Work Groups/Committees - The STP shall
meet as requested by the Commission, to coordinate activities and develop
cohesive Systems strategies across STPs and agencies.
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5. Connectivity to the Commission Network and Systems - The STP shall be
responsible for establishing connectivity to the Commission's data
communications network, and the relevant Information Systems attached to this
network, in accordance with all applicable Commission policies, standards and
guidelines.
6. Sanctions - The STP shall maintain all Systems and submit all reports as set forth
in this Section and the Reporting Requirements Section of this Contract. If the
STP fails to maintain its Systems or submit all reports as set forth, the
Commission shall sanction the STP in accordance with this Contract.
B. Data and Document Management Requirements
1. Adherence to Data and Document Reporting Requirements
a. The STP's Systems shall conform to the standard transaction code sets
specified in this agree ment.
b. The STP's Systems shall conform to HIPAA standards for data and
document management that are currently under development within one
hundred twenty (120) Calendar Days of the Agreement's effective date
or, if earlier, the date stipulated by CMS or the AHCA.
c. The STP shall comply with the Commission's and the AHCA's standard
transaction code sets specific to the Commission and AHCA .
2. Information Retention - The STP shall maintain Information in its Systems in
electronic form for three (3) years in live Systems and, for audit and reporting
purposes, for five (5) years in live and/or archival Systems.
3. Information Ownership - The Commission maintains ownership over all
Information, whether data, documents, or reports that contain or make
references to said Information involving or arising out of this Agreement.
a. If the STP is required to provide documentation pursuant to a public
records request, the STP shall redact any and all personal health
information, in compliance with HIPAA and all other applicable federal
and state laws and regulations.
b. If the STP wishes to publish a report, information, or commentary that
includes data drawn from the Medicaid population, the Commission
and/or the AHCA must first give written approval to the STP's
interpretation of all data before the STP can publish said report,
information, or commentary.
(1) In order to expedite approval of any report, information, or
commentary that uses data drawn from the Medicaid population,
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the STP must include with its written request for approval all
documentation, statistics, tables, graphs, and details that give rise
to the STP's interpretation and the basis upon which the Recipient
uses the data to support its interpretation.
C. System and Data Integration Requirements
1. Data and Report Validity and Completeness
a. The STP shall institute processes to ensure that the data is valid and
complete; including reports submitted to the Commission pursuant to the
Reporting Requirements of this contract. At its discretion, the Commission
will conduct general data validity and completeness audits using industry-
accepted statistical sampling methods. The Commission shall audit
specific data elements includ ing, but not limited to: Medicaid Beneficiary
ID, date of service, category and sub category (if applicable) of service,
procedure codes, revenue codes, date of claim processing, and (if and
when applicable) date of claim payment. The Commission shall also
review and verify control totals.
2. Data Exchange in Support of the Commission's Program Integrity and
Compliance Functi ons
a. The STP's System(s) shall be capable of generating files in the prescribed
formats for upload into Commission Systems used specifically for program
integrity and com pliance purposes.
D. Systems Availability, Performance, and Problem Management Requirements
1. Availability of Critical Systems Functions
a. The STP shall ensure that critical Systems functions available to Medicaid
Beneficiaries and Transportation Providers, functions that if unavailable
would have an immediate detrimental impact on Medicaid Beneficiaries
and Transportation Providers, are available twenty-four (24) hours a day,
seven (7) days a week, except during periods of scheduled System
Unavailability agreed upon by the Commission and the STP. Unavailability
caused by events outside of a STP's Span of Control is outside the scope
of this requirement. The STP shall make the Commission aware of the
nature and availability of these functions prior to extending access to
these functions to Medicaid Beneficiaries and/or Transportation Providers.
2. Availability of Data Exchange Functio ns
a. The STP shall ensure that the Systems and processes within its Span of
Control associated with its data exchanges with the Commission and/or
its Agent(s) are available and operational according to specifications and
the data exchange schedule.
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3. Problem NotifICation
a. Upon discovery of any problem within its Span of Control that may
jeopardize, or is jeopardizing, the availability and performance of Systems
functions and the availability of information in said Systems, including any
problems impacting scheduled exchanges of data between the STP and
the Commission and/or its Agent(s), the STP shall notify the
Commission's Project Manager via phone, fax and/or electronic mail
within fifteen (15) minutes of such discovery. In its notification, the STP
shall explain in detail the impact to critical path processes such as
transportation coordination and claims submission processes.
b. The STP shall provide to appropriate Commission staff, or its Agent's
staff, information on System Unavailability events, as well as status
updates on problem resolution. At a minimum, the STP shall provide
these updates on an hourly basis via electronic mail or telephone (if
electronic mail is unavailable due to the Sys tem Unavailability).
4. Recovery from Unscheduled System Unavailability
a. Unscheduled System Unavailability caused by the failure of Systems and
telecommunications technologies within the STP's Span of Control must
be resolved, and the restoration of services implemented, within forty-
eight (48) hours of the official declaration of System Unavailability.
5. Exceptions to System Availabi Iity Requirem ent
a. The STP shall not be responsible for the availability and performance of
Systems and information technology (IT) infrastructure technologies
outside of the STP's Span of Control.
E. System Testing and Change Management Requirements
1. Notification and Discussion of Potential System Changes
a. The STP shall notify the Commission Project Manager of the following
changes to Systems within its Span of Control within at least ninety (90)
Calendar Days of the projected date of the change; if so directed by the
Commission, the STP shall discuss the proposed change with applicable
Commission staff: (1) software release updates of core transaction
Systems: claims processing, eligibility and Enrollment processing, Service
Authorization management, Transportation Provider enrollment and data
management; (2) conversions of core transaction management Systems.
2. Response to Commission Reports of Systems Problems not Resulting in System
Unavailability
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a. The STP shall respond to Commission reports of System problems not
resulting in System Unavailability according to the following timeframes:
(1) Within seven (7) Calendar Days of receipt, the STP shall respond
in writing to notices of System problems.
(2) Within twenty (20) Calendar Days, the STP shall make a
correction to the System or will make a Requirements Analysis
and Specifications document.
(3) The STP will correct the deficiency by a date certain as
determined by the Commission.
3. Testing
a. The STP shall work with the Commission pertaining to any testing
initiative as required by the Commis sion.
b. The STP shall ensure adequate Information System integrity to capture
Encounter Data and, at a minimum, take necessary action to safeguard
against System interruptions resulting from network, operating hardware,
software, or operational errors that compromise the integrity of
transactions that are active in a live system or archived at the time of an
outage or causing unscheduled System Unavailability.
F. Reporting Requirements - Specific to Information Management and Systems Functions
and Capabilities - and Technolog ical Capabilities
1. Reporting Requirements
a. If the STP is extending access to "critical systems functions" to providers
and Medicaid Beneficiaries as described in the Availability of Critical
Systems Functions section, above, it shall submit a monthly Systems
Availability and Performance Report to the Commission as described in
Reporting Requirements, otherwise this reporting requirement is not
applicable.
X. REPORTING REOUIREMENTS
A. General Reporting Requirements
1. The STP shall comply with all Reporting Requirements set forth by the
Commission in this Contract.
a. The STP is responsible for assuring the accuracy, completeness, and
timely submission of each report.
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b. The STP shall certify the reports, attesting, based on his/her best
knowledge, information, and belief, that all data submitted in conjunction
with the reports or all documents requested by the Commission are
accurate, truthful, and complete.
c. The Certification shall be submitted at the same time the data reports are
submitted. The Certification page shall include a Certification that the
data submitted has been validated and the quality verified in accordance
with this Contract.
(1)
Deadlines for report submission referred to in this Contract specify
the actual time of receipt at the Commission, not the date the SIP
postmarks or transmits the file. The Commission shall date stamp
a hard copy report or send an email reply to an emalled report.
(2)
The STP shall use the timeframes set forth in the table below for
submitting all reports.
d. Before November 1 of each year, the STP shall deliver to the Commission
a Certification that the SIP has fairly and accurately presented all
Performance Measure data for the previous Agreement Year.
e. If a reporting due date falls on a weekend or State Holiday, the Agency
must receive the report on the following Business Day.
f. The STP shall file all quarterly reports based on a calendar year quarter.
Calendar year quarters are defined as the months ending March 31st,
June 30th, September 30th, and December 31st.
2. The Comm ission shall furnish the STP with the appropriate reporting formats,
templates, instructions, submission timetables, and technical assistance, as
required.
3. The Commission reserves the right to modify the reporting requirements, with a
sixty (60) Calendar Day notice to allow the 5TP to complete implementation,
unless otherwise required by law.
4. The Commi ssion shall provide the SIP with written notification of any
modifications to the reporti ng requirements.
5. Unless otherwise specified, the STP shall record and submit all filings
electronically or mall a hard copy to the following address:
The Commission for the Transportation Disa dvantaged
605 Suwannee Street, MS-49
Tallahassee, Florida 32399
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6. Unless otherwise set forth below, or in a request for an ad hoc report, the STP
shall limit the scope of all reports to operations affecting Medicaid BenefICiaries
and shall not include in any report any outside, non-Medicaid or non-Medicaid
Beneficiary related information. The STP shall limit all reports and Performance
Measures to Transportation Services provided under this Agreement to Medicaid
Beneficiaries and shall not include other, non-Medicaid, services or operations
that the STP provides.
7. The STP shall grant the Commission, or its representatives, full access to all
financial and statistical reports, supporting documents, and any other documents
pertinent to this Contract and the Transportation Provider Agreement. The STP
and all Transportation Providers shall provide the documentation requested by
the Commission, or its representatives, in a manner that the Commission will
provide when notifying the STP of the on-site surveys and desk reviews
B. The STP shall notify the Commission's Project Manager within twenty-four (24)
hours of discovering a Violation of the protections provided by HIPAA.
Required Reports
Report # Description Format Frequency
Grievance . Covers all Complaints, HardCOPY or electronic Quarterly - Due 30 Calendar
Syste m Grievances, ,nd folTl'lat. Template D'Y' after the ernj of the
Summary Report Appeals related to provided Oy the reporting quarter. Contains
Medicaid's NET Commission. data fo, entire reporting
Services. Quarter.
Audited NfA Audited Financial Hardcopy ,nd Annually' within 160 Calendar
Financial Statement. electronic format. Days after end of the -,
Statement Year. Reporting is for each
calendar year.
Trip Travel 5 Trip Travel Expenses Hardcopv or electronic Monthly - Due t5 Calendar
Expense Report by Trip. format. Template Days after the month In which
provided by the the STP provided the Trip.
Commission.
satetY' NfA Copy of the Self- Hardcopy or electronic Annually ~ Due January 15 of
Compllitnce self- Certification Report format. e~h year. Reporting is for
Certification (Vehicle Inspections, each calendar year.
Report Ddver Safety, Drug and
Alcohol ,rnj Quality
monitoring)
Systems Outage 6 Notification of a Phone Email and/or Phone Immediately upon
Notification 0' System outage call, followed 0, , occurrence,
affecting NET Services. summary report:.
rem plate provided Oy
the Commission.
Suspected Fraud NfA Suspected Fraud Hard copy, electronic Immediately upon
Reporting Report, format, 0' telephone occurrence.
-
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calt,
Clitia" Incidents 7 Critical InCident Report. Hardcopy or electronic: Upon OttufTence - Initial
Report format. Template ..port due .0. (1) Business
provided by the Day after learning of the
Commission. DCF incident A written final report
template available from sh" be submitted t. the
DCF. Commission within 15 busmess
days .tte, the incident.
Detailed report to include
measures to prevent similar
occurrenc~ in the future.
Performance N/A Performance Measure Hardcopy or electronic Monthly - Due 10 Calendar
Nelsures information - See format. Days afte, the eod 01 the
Performance Measure reporting month.
Section fordetalls.
B. Reporting Requirement Documents
1. Grievance System
a. The Grievance System report shall, include information based on the
STP's helpline and contain information about the number of Complaints,
Grievances, and Appeals received by the STP, its Subcontractors, and its
Local Coordinating Board (LCB) concerning issues related to the provision
of Non-Emergency Transportation Services to Medicaid Beneficiaries only.
b. Refer to Attachment 4 for a template
2. Annual Fina ncial Audit
a. The STP shall conduct an annual financial audit in accordance with
federal and State law, including, but not limited to, OMB Circular A-133
and Section 215.97, F.5., Florida Single Source Audit Act. The goal of the
audit is to capture the STP's financial information in a format for use by
the Commission, its Agents, and federal and State auditors. The STP
shall submit the audit annually, along with a copy of the STP's
Certification by hardcopy or in electronic format to the Commission. The
STP shall limit the scope of the audit report it submits to the Commission
to Transportation Services provided to Medicaid Beneficiaries. If, at any
time, the Recipient is determined to be a Vendor for purposes of OMB
Circular A-133 and/or the Florida Single Source Act, the Recipient shall
still be required to submit an annual financial audit in accordance with the
provisions of OMB Circular A-133 and/or the Florida Single Source Act.
b. The Commission does not provide a template for this report. Refer to
Attachment 2 for details on Special Audit Requirements.
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3. Trip Travel Expense Report
a. The purpose of this report is to track the travel expenses incurred by the
STP for each Trip that incurs travel expenses, as set forth in the Covered
Services Section of this Contract.
b. Refer to Attachment 5 for a template.
4. Safety Compliance Self Certificatio n Report
a. Self Certification - Each STPfTransportation Provider shall submit an
annual safety and security Certification, in accordance with 14-90.10,
F.A.C., to the Commission, and shall submit to any and all Safety and
Security Inspections and Reviews in accordance with 14-90.12, F.A.C.
Each STPfTransportation Provider shall submit the total number of vehicle
inspections completed during the previous calendar year (January 1
through December 31) and the results of said inspections by January 15'h
of each year.
b. The Safety Compliance Self Certification Report shall include, at a
minimum, a certification that the STPfTransportation Provider has
instituted and are com plying with the following safety and monitori ng
procedures:
(1) Vehicle safety inspection;
(2) Drug and alcohol training and monitoring;
(3) Quarterly monitoring; and,
(4) Operator/driver training and monitoring.
c. The Commission does not provide a template for this report.
5. Systems Outage Notification Re port
a. The STP shall notify the Commission Project Manager by electronic
submission or by telephone of a System outage immediately upon
determination of a System outage.
b. The STP shall submit the Business Disruption Notification using the
template provided as a guideline. The Business Disruption Notification
shall provide the date and time the incident occurred, what event
triggered the outage, the plan of action to bring the System back online,
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the expected date and time of recovery of the full use of the System, and
the impact the System outage has on Medicaid Beneficiaries.
c. The STP must submit a Systems Outage Report, in electronic format and
hardcopy, to the Commission's Project Manager only if the STP's
Information System s experience unscheduled downtime.
d. Refer to Report #6 for template.
6. Suspected Fraud Reporting
a. Upon detection of a potential or suspected Fraudulent encounter or act
by a Medicaid Beneficiary, the STP shall fiie a report with the Commission. The
Commission will forward the report to the AHCA's Bureau of Medicaid Program
Integrity.
b. The report shall contain at a minimum:
(1) The name of the Medicaid Beneficiary;
(2) The Medicaid Beneficiary's Medicaid identification number; and
(3) A description of the suspected Fraudulent act.
c. The Commission does not provide a template for this report.
7. Critical Incident Reporting
a. The STP shall notify the Commission within one (1) Business Day that
there was a critical incident.
b. The critical incident reporting requirements set forth in this Section do not
replace the abuse, Neglect, and exploitation reporting system established
by the State.
c. The definitions of reportable critical incidents a re as follows:
(1) Death of a Medicaid Beneficiary that occurs while the Medicaid
Beneficiary is in a vehicle operated or contracted by the STP, due
to one (1) of the followi ng:
(i) Suicide;
(ii) Homicide;
(Hi) Abuse;
(iv) Neglect; or,
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(v) An accident or other incident.
(2) Medicaid Beneficiary Injury or Illness - A medical condition that
requires medical treatment by a Health Care Professional and
which is sustained, or allegedly is sustained, due to an accident,
act of Abuse, Neglect or other incident occurring while a Medicaid
Beneficiary is in a vehicle operated or contracted by the STP.
(3) Sexual Battery - An allegation of sexual battery, as determined by
medical evidence or law enforcement involvement, by:
(i) A Medicaid Beneficiary on another Medicaid Beneficiary;
(Ii) An employee of the STP, a Subcontractor, or a
Transportation Provider on a Medicaid Beneficiary; and/or,
(iil) A Medicaid Beneficiary on an employee of the STP, a
Subcontractor, or a Transportation Provider.
(4). In addition to supplying the Critical Incidents Report, the STP shall
also report critical incidents in the manner prescribed by, and
using the template provided by, the appropriate district's DCF
Alcohol, Drug Abuse Mental Health office, using the appropriate
DCF reporting forms and procedures.
(5) Refer to Report #7 for a template.
8. Minority Participation Report
1. The Commission encourages the STP to use Minority and Certified
Minority businesses as subcontractors when procuring commodities or
services to meet the requirement of the Agreement.
The Commission requires information regarding the STP's use of minority
owned businesses as subcontractors for transportation services under this
Agreement. This information will be used for assessment and evaluation
of the Commission's Minority Business Utilization Plan. During the term of
the Agreement, it will be necessary for the STP to maintain this
information monthly. A minority owned business is defined as any
business enterprise owned and operated by the following ethnic groups:
African American (Certified Minority Code H or Non-Certified Minority
Code N), Hispanic American (Certified Minority Code I or Non-Certified
Minority 0), Asian American (Certified Minority Code J or Non-Certified
Minority Code P), Native American (Certified Minority Code K or Non-
Certified Minority Code Q), or American Woman (Certified Minority Code
M or Non-Certified Minority Code R). The STP should retain this
information and make it available upon request by the Commission.
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XI METHOD OF PAYMENT
A. Fixed Price Fixed Fee Agreement
1. This is a fixed price (fixed fee) Agreement. The Commission shall pay the STP,
upon satisfactory completion of all terms and conditions specified in the
Agreement, a total amount included in Exhibit B.
2. The STP shall request payment through submission of a properly completed
invoice to the Commission. Invoices shall be submitted in a format provided by
the Commission.
3. The Commission's performance and obligation to pay under this Agreement is
contingent upon an annual appropriation by the Legislature.
4. Transportation Services are mandatory Medicaid services that shall not be
restricted due to inadequate funding. Through this Contract, the STP accepts the
responsibility to provide or coordinate delivery of all Transportation Services
within the existing funds of this Contract.
5. Errors
a. If, after preparation and submission of reports and/or invoices, the STP
discovers an error, includi ng, but not limited to, errors resulting in
incorrect payments, either by the STP or the Commission, the STP has
thirty (30) Business Days from its discovery of the error, or thirty (30)
Business Days after receipt of notice by the Comm ission to correct the
error and resubmit accurate reports and/or invoices. Failure to respond
within the thirty (30) Business Day period shall result in a loss of any
money due to the STP for such errors and/or sanctions against the STP
pursuant to Sanctions Section of this Contract.
B. Member Payment Liabil ity Protection
1. Pursuant to Section 1932 (b)(6), SOCial Security Act (as enacted by Section 4704
of the Balanced Budget Act of 1997), the STP shall not hold Medicaid
Beneficiaries liable for the following:
a. For debts of the STP, in the event of the STPs Insolvency;
b. For payment of Covered Services provided by the STP if the STP has not
received paym ent from the Comm ission for the Covered Services, and/or,
c. For payments to a STP that furnished Covered Services under a contract,
or other arrangement with the STP, that are in excess of the amount that
normally would be paid by the Medicaid Beneficiary if the Covered
Services had been received directly from the STP.
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C. Transition to Managed Care Organizations (MCOs) and Medicaid Reform
1. The STP understands that the State is operating a Medicaid managed care pilot
program as stated in s. 409.91211, Florida Statute (Medicaid Reform). As a
result, in all areas in which the State implements Medicaid Reform, the STP's
Enrollment will transition from coverage under this Agreement to an authorized
Medicaid Reform MCO in accordance with the AHCA's implementation schedule.
2. The STP understands that the State allows specified MCOs in Miami-Dade County
to provide Transportation Services. Beneficiaries enrolled in these MCOs are not
included in this Agreement.
XII. SANCTIONS
A. General Provisions
1. The STP shall comply with all requirements and performance standards set forth
in this Contract. In the event the Commission identifies a Violation of this
Contract, or other non-compliance with this Contract, the STP shall submit a
Corrective Action Plan (CAP) within three (3) Calendar Days of the date of
receiving notification of the Violation or non-compliance from the Commission or
within the timeframe specified by the Commission, whichever is later.
a. Within five (5) Business Days of receiving the CAP the Commission will
either approve or disapprove the CAP. If disapproved, the Commission
must cite the specific reasons in a written format for said disapproval.
Upon written notice of disapproval, the STP shall resubmit, within five (5)
Business Days, or a date specified by the Commission whichever is later,
a new CAP that addresses the concerns identified by the Commission.
b. Upon approval of the CAP, whether the initial CAP or the revised CAP, the
STP shall implement the CAP within the time frames specified by the
Commission. The STP shall submit a report to the Commission detailing
the implementation of the STP's CAP forty-five (45) Business Days
following the date of the Commission's approval of the CAP.
c. Except where specified below, the Commission shall impose a monetary
sanction of $100 per day on the STP for each Calendar Day that the STP
does not implement the approved CAP to the satisfaction of the
Commission.
2. If the Commission determines, in its sole discretion, that a STP and/or
Transportation Provider has violated the terms of this Contract, the Commission
can sanction the STP, can terminate this Contract, or both. If the Agency for
Health Care Administration determined, in its sole discretion, that a STP and/or
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Transportation Provider has violated the terms of this contract, AHCA can
sanction the Commission and request the this contract be terminated or both.
3. Unless the Comm ission specifies the duration of a sanction, the sanction shall
remain in effect until the Commission is satisfied that the STP has corrected the
basis for imposing the sanction and it is not likely to recur.
B. Spedfic Sanctio ns
1. The Commission may impose any of the following sanctions against the STP if
the Commission, in its sole discretion, determines that the STP and/or a
Transportation Provider has violated any provision of this Agreement, or any
applicable statutes:
a. Suspension or revocation of payments to the STP for Medicaid
Beneficiaries during the sanction period;
b. For any nonwillful Violation of the Agreement, the Commission shall
impose a fine, not to exceed $2,500 per Violation. In no event shall such
fine exceed an aggregate amount of $10,000 for all nonwillful Violations
arising out of the same action;
c. With respect to any knowing and willful Violation of the Agreement, the
Commission shall impose a fine upon the STP in an amount not to exceed
$20,000 for such Violation. In no event shall such fine exceed an
aggregate amount of $100,000 for all knowing and willful Violations
arising out of the same action;
d. If the STP fails to carry out substantive terms of the Agreement, the
Commission shall terminate the Agreement. After the Commission notifies
the STP that it intends to terminate the Agreement, the Commission shall
give the STP's Medicaid Beneficiaries written notice of the State's intent
to terminate the Agreement.
e. The Commission may impose intermediate sanctions, including, but not
limited to civil monetary penalties in the amounts specified in this
Agreement.
f. Suspension of payment for Medicaid Beneficiaries after the effective date
of the sanction and until the Commission is satisfied that the reason for
imposition of the sanction no longer exists and is not likely to recur;
and/or
g. Before imposing any intermediate sanctions, the Commission must give
the STP timely notice.
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AGREEMENT NO.: 150M 59
COUNTY NAME: Collier
EXHIBIT B
METHOD OF COMPENSATION
This Exhibit defines the limits of compensation to be made to the contractor for the services set
forth in Exhibit "A" and the method by which payments shall be made.
1. Proiect Comoensation:
For the satisfactory performance of services detailed in Exhibit "A", the STP shall be paid up to
a Maximum Amount of $ 1.266.051.00
The Maximum Amount shall be made up of the following limiting amounts:
$ 251.519.00 from Fiscal Year
08/09
$ 507.266.00 from Fiscal Year
09/10
$ 507.266.00 from Fiscal Year
10/11
The Vendor shall not provide services that exceed the limiting amount(s) without an approved
Amendment from the Commission. The total amount of this contract is expected to be funded
by multiple appropriations and the State of Florida's performance and obligation to pay under
this contract is contingent upon annual appropriation by the Legislature.
Currently, $251.519.00of the total amount has been approved and encumbered for this
contract. Therefore, it is agreed that the Vendor will not be obligated to perform services nor
incur costs which would result in exceeding the funding currently approved, nor will the
Commission be obligated to reimburse the STP for costs or make payments in excess of
currently established funding. The Commission will provide written authorization if and when
subsequent funding is approved and encumbered for this contract.
2. PROGRESS PAYMENTS AND DISBURSEMENT SCHEDULE OF FUNDS:
The Vendor shall submit monthly invoices (3 copies) in a format acceptable to the Commission.
FY 08/09
Janua ry
Februa ry
March
April
May
June
$41,920.00
$41,920.00
$41,920.00
$41,920.00
$41,920.00
$41,919.00
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ATTACHMENT 1
BUSINESS ASSOCIATE AGREEMENT
The parties to this Attachment agree that the following provIsionS constitute a business
associate agreement for purposes of complying with the requirements of the Health Insurance
Portability and Accountability Act of 1996 (HIPAA). This Attachment is applicable if the Recipient
is a business associate within the meaning of the Privacy and Security Regulations, 45 C.F.R.
160 and 164.
The Recipient certifies and agrees as to abide by the following:
1. Definitions. Unless specifically stated in this Attachment, the definition of the terms
contained herein shall have the same meaning and effect as defined in 45 C.F .R. 160
and 164.
La. Protected Health Information. For purposes of this Attachment, protected health
information shall have the same meaning and effect as defined in 45 C.F.R. 160
and 164, limited to the information created, received, maintained or transmitted
by the Recipient from, or on behalf of, the Agency.
Lb. Security Incident. For purposes of this Attachment, security incident shall mean
any event resulting in computer systems, networks, or data being viewed,
manipulated, damaged, destroyed or made inaccessible by an unauthorized
activity. See National Institute of Standards and Technology (NIST) Special
Publication 800-61, "Computer Security Incident Handling Guide," for more
information.
2. Use and Disclosure of Protected Health Information. The Recipient shall not use or
disclose protected health information other than as permitted by this Agreement or by
federal and state law. The Recipient will use appropriate safeguards to prevent the use
or disclosure of protected health information for any purpose not in conformity with this
Agreement and federal and state law. The Recipient will implement administrative,
physical, and technical safeguards that reasonably and appropriately protect the
confidentiality, integrity, and availability of electronic protected health information the
Recipient creates, receives, maintains, or transmits on behalf of the Agency.
3. Use and Disclosure of Information for Manaaement. Administration. and Leaal
Resoonsibilities. The Recipient is permitted to use and disclose protected health
information received from the Agency for the proper management and administration of
the Recipient or to carry out the legal responsibilities of the Recipient, in accordance
with 45 C.F.R. 164.504(e)(4). Such disclosure is only permissible where required by law,
or where the Recipient obtains reasonable assurances from the person to whom the
protected health information is disclosed that: (1) the protected health information will
be held confidentially, (2) the protected health information will be used or further
disclosed only as required by iaw or for the purposes for which it was disclosed to the
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person, and (3) the person notifies the Recipient of any instance of which it is aware in
which the confidentia Iity of the protected health information has been breached.
4. Disclosure to Third Parties. The Recipient will not divulge, disciose, or oommunicate
protected health information to any third party for any purpose not in conformity with
this Agreement without prior written approval from the Agency. The Recipient shall
ensure that any agent, including a subcontractor, to whom it provides protected health
information received from, or created or received by the Recipient on behalf of, the
Agency agrees to the same terms, conditions, and restrictions that apply to the
Recipient with respect to protected health information.
5. Access to Information. The Recipient shall make protected health information available
in accordance with federal and state law, inciuding providing a right of access to persons
who are the subjects of the protected health information in accordance with 45 C.F.R.
164.524.
6. Amendment and Incorooration of Amendments. The Recipient shall make protected
health information available for amendment and to incorporate any amendments to the
protected health information in accordance with 45 C.F.R. g 164.526.
7. Accountina for Disciosures. The Recipient shall make protected health information
available as required to provide an accounting of disclosures in accordance with 45
C.F.R. g 164.528. The Recipient shall document all disclosures of protected health
information as needed for the Agency to respond to a request for an accounting of
disclosures in accordance with 45 C.F.R. g 164.528.
8. Access to Books and Records. The Recipient shall make its internal practices, books, and
records relating to the use and disclosure of protected health informatio n received from,
or created or received by the Recipient on behalf of the Agency, available to the
Secretary of the Department of Health and Human Services or the Secretary's designee
for purposes of determining compliance with the Department of Health and Human
Services Privacy Regulations.
9. Reoortina. The Recipient shall make a good faith effort to identify any use or disclosure
of protected health information not provided for in this Agreement. The Recipient will
report to the Agency, within ten (10) business days of discovery, any use or disciosure
of protected health information not provided for in this Agreement of which the
Recipient is aware. The Recipient will report to the Agency, within twenty-four (24)
hours of discovery, any security incident of which the Recipient is aware. A violation of
this paragraph shall be a material violation of this Agreement.
10. Termination. Upon the Agency's discovery of a material breach of this Attachment, the
Agency shall have the right to termi nate this Agreement.
10.a. Effect of Termination. At the termination of this Agreement, the Recipient shall
return all protected health information that the Recipient still maintains in any
form, inciuding any copies or hybrid or merged databases made by the
Recipient; or with prior written approval of the Agency, the protected health
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information may be destroyed by the Recipient after its use. If the protected
health information is destroyed pursuant to the Agency's prior written approval,
the Recipient must provide a written oonfirmation of such destruction to the
Agency. If return or destruction of the protected health information is
determined not feasible by the Agency, the Recipient agrees to protect the
protected health information and treat it as strictly confidential.
The Recipient has caused this Attachment to be signed and delivered by its duly authorized
representative, as of the date set forth below.
Recipient Name:
rR--., d..4
Sig nature .
~~/O -?7 '7
Date
Donna Fiala, Chairman
Name and TItle of Authorized Sig ner
AT:T. ~.i'.~t ~1"
p.'~~''''''.~.H 'T...g....B'~O...CK.CLERK
-, ...... -" ~
.. ',', -<~
". iJS.. ~<,:. .r'''.. ~
"., .... .":'l :..\.r', .
="~ . (Jlt-t~$t;js tQ Cht I,...
(.v:,':, '1~.t.".. 011,. I
~n(1..:jrk'Zl. l,
~ CoImty Attorne)'
2008/2009 Medicaid NonwEmergency Transportation
Subcontracted Transportation Provider Contract
Page 91 of 117
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6/28/2011 Item 16.A.6.
ATTACHMENT 2
SPECIAL AUDIT REQUIREMENTS
The administration of resources awarded by the Commission for the Transportation
Disadvantaged (which may be referred to as the "Agency" or "Grantor") to the recipient (which
may be referred to as the "Vendor", "Facility" or "Recipient") may be subject to audits and/or
monitoring by the Commission, as described in this Attachment.
MONITORING
1n addition to reviews of audits conducted in accordance with OMB Circuiar A-133 and Section
215.97, F.s., as revised (see "AUDITS" below), monitoring procedures may include, but not be
limited to, on-site visits by Commission staff, limited scope audits as defined by OM8 Circular A-
133, as revised, and/or other procedures. By entering into this Agreement, the Recipient agrees
to comply and cooperate with any monitoring procedures/processes deemed appropriate by the
Commission. In the event the Commission determines that a limited scope audit of the
Recipient is appropriate, the Recipient agrees to comply with any additional instructions
provided by the Commission staff to the Recipient regarding such audit. The Recipient further
agrees to comply and cooperate with any inspections, reviews, investigations, or audits deemed
necessary by the Chief Financial Officer (CFO) or Auditor General.
AUDITS
PART I: FEDERALLY FUNDED
Recipients of federal funds (i.e. state, local government, or non-profit organizations as defined
in OMB Circular A-1233, as revised) are to have audits done annually using the following
criteria:
1. In the event that the recipient expends $500,000 or more in Federal awards in its fiscal
year, the Recipient must have a single or program-speCific audit conducted in
accordance with the provisions of OMB Circular A-133, as revised. EXHIBIT 1 to this
agreement indicates Federal resources awarded through the Agency for Health Care
Administration by this Agreement. In determining the Federal awards expended in its
fiscal year, the Recipient shall consider all sources of Federal awards, including Federal
resources received from the Com mission. The determination of amounts of Federal
awards expended should be in accordance with the guidelines established by OMB
Circular A-133, as revised. An audit of the Recipient conducted by the Auditor General in
accordance with the provisions OMB Circular A-133, as revised, will meet the
requirements of this part.
2. In connection with the audit requirements addressed in Part I, paragraph 1, the
Recipient shall fulfill the requirements relative to auditee responsibilities as provided in
Subpart C of OMB Circular A-133, as revised.
2008/2009 Medicaid Non-Emergency Transportation
Subcontracted Transportation Provider Contract
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6/28/2011 Item 16.A.6.
3. If the Recipient expends less than $500,000 in Federal awards in its fiscal year, an audit
conducted in accordance with the provisions of OMB Circular A-133, as revised, is not
required. However, if the recipient elects to have an audit conducted in accordance with
the provisions of OMB Circular A-133, as revised, the cost of the audit must be paid from
non-Federal resources (i.e., the cost of such an audit must be paid from Recipient
resources obtained from other than Federal entities).
4. Federal awards are to be identified using the Catalog of Federal Domestic Assistance
(CFDA) title and number, award number and year, and name of the awarding federal
agency. The Recipient may access information regarding the Catalog of Federal
Domestic Assistance (CFDA) via the internet at htto://12.46.245.173Idda/cfda.html.
PART II: STATE FUNDED
Recipients of state funds (i.e. a nonstate entity as defined by Section 215.97(2XI), Florida
Statutes) are to have audits done annually using the following criteria
1. In the event that the Recipient expends a total amount of state financial assistance
equal to or in excess of $500,000 in any fiscal year of such Recipient, the Recipient must
have a State single or project-specific audit for such fiscal year in accordance with
Section 215.97, Florida Statutes; applicable rules of the Department of Financial
Services; and Chapters 10.550 (local governmental entities) or 10.650 (nonprofit and
for-profit organizations), Rules of the Auditor General. EXHIBIT 1 to this agreement
indicates state financial assistance awarded through the Commission by this Agreement.
In determining the state financial assistance expended in its fiscal year, the Recipient
shall consider all sources of state financial assistance, including state financial assistance
received from the Commission, other state agencies, and other nonstate entities. State
financial assistance does not include Federal direct or pass-through awards and
resources received by a nonstate entity for Federal program matching requirements.
2. In connection with the audit requirements addressed in Part II, paragraph 1, the
Recipient shall ensure that the audit complies with the requirements of Section
215.97(8), Florida Statutes. This includes submission of a financial reporting package as
defined by Section 215.97(2), Florida Statutes, and Chapters 10.550 (local governmental
entities) or 10.650 (nonprofit and for-profit organizations), Rules of the Auditor General.
3. If the Recipient expends less than $500,000 in state financial assistance in its fiscal year,
an audit conducted in accordance with the provisions of Section 215.97, Florida
Statutes, is not required. However, if the recipient eiects to have an audit conducted in
accordance with the provisions of Section 215.97, Florida Statutes, the cost of the audit
must be paid from the nonstate entity's resources (i.e., the cost of such an audit must
be paid from the recipient's resources obtained from other than State
4. State awards are to be identified using the Catalog of State Financial Assistance (CSFA)
title and number, award number and year, and name of the state agency awarding it.
For information regarding the Florida Catalog of State Financial Assistance (CSFA), a
Recipient should access the Florida Single Audit Act website located at
httos: Ilaoos. fldfs .com/fsaa/.
2008/2009 Medicaid Non~Emergency Transportation
Subcontracted Transportation Provider Contract
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_"~_"""_~_____'_'_'''''_''.''~u,~__ ... ,,___.~. ...__._,,_ _ oO~__''''''~'''_
6/28/2011 Item 16.A.6.
PART III: OTHER AUDIT REQUIREMENTS
The recipient shall follow up and take corrective action on audit findings. Preparation of a
summary schedule of prior year audit findings, including corrective action and current status of
the audit findings is required. Current year audit findings require corrective action and status of
findings.
Records related to unresolved audit findings, appeals, or litigation shall be retained until the
action is completed or the dispute is resolved. Access to project records and audit work papers
shall be given to the Commission, the Department of Financial Services, and the Auditor
General. This section does not limit the authority of the Commission to conduct or arrange for
the conduct of additional audits or evaluations of state financial assistance or limit the authority
of any other state official.
(NOTE: This part would be used to specify any additional audit requirements imposed by the
State awarding entity that are solely a matter of that State awarding entity's policy (I.e., the
audit is not required by Federal or State laws and is not in conflict with other Federal or State
audit requirements). Pursuant to Section 215.97(8), Florida Statutes, State agencies may
conduct or arrange for audits of state financiai assistance that are in addition to audits
conducted in accordance with Section 215.97, Florida Statutes. In such an event, the State
awarding agency must arrange for funding the full cost of such additional audits.)
PART IV: REPORT SUBMISSION
1. Copies of reporting packages for audits conducted in accordance with OMB Circular A-
133, as revised, and required by PART I of this agreement shall be submitted, when
required by Section .320 (d), OMB Circular A-133, as revised, by or on behalf of the
recipient directly to each of the following:
A. The Department at the following address:
Executive Director
Commission for the Transportation Disadvantaged
605 Suwannee Street, MS-49
Tallahassee, Fiorida 32399-0450
B The Federal Audit Clearinghouse designated in OMS Orcular A-133, as revised
(the number of copies required by Sections .320 (d)(l) and (2), OMB Circular A-
133, as revised, should be submitted to the Federal Audit Clearinghouse), at the
following address:
Federal Audit Cleari nghouse
Bureau of the Census
1201 East 10th Street
Jeffersonville, IN 47132
2008/2009 Medicaid Non-Emergency Transportation
Subcontracted Transportation Provider Contract
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6/28/2011 Item 16.A.6.
C. Other Federal agencies and pass-through entities in accordance with Sections
.320 (e) and (f), OMB Circular A-133, as revised.
2. In the event that a copy of the reporting package for an audit required by PART I of this
agreement and conducted in accordance with OMB Circular A-133, as revised, is not
required to be submitted to the Commission for the reasons pursuant to Section .320
(e)(2), OMB Circular A-133, as revised, the recipient shall submit the required written
notification pursuant to Section .320 (e)(2) and a copy of the recipient's audited
schedule of expenditures of Federal awards directlv to each of the following
Executive Director
Commission for the Transportation Disadvantaged
605 Suwann ee Street, MS-49
Tallahassee, Florida 32399-0450
In addition, pursuant to Section .320 (f), OMB Circular A-133, as revised, the
recipient shall submit a copy of the reporting package described in Section .320
(c), OMS Circular A-133, as revised, and any management letters issued by the
auditor, to the Commission at each of the following addresses:
Executive Director
Comm ission for the Transportation Disadvantaged
605 Suwannee Street, MS-49
Tallahassee, Florida 32399-0450
3. Copies of financial reporting packages required by PART II of this agreement shall be
submitted by or on behalf of the recipient directlv to each of the follOWing:
A. The Commission at the following address:
Executive Director
Commission for the Transportation Disadvantaged
605 Suwann ee Street, MS-49
Tallahassee, Florida 32399-0450
B. The Auditor General's Office at the following address:
Auditor General's Office
Room 401, Pepper Building
111 West Madison Street
Tallahassee, Florida 32399-1450
4. Copies of reports or the management letter required by PART III of this agreement shall
be submitted by or on behalf of the recipient directlv to:
A. The Commission at the following address:
Executive Director
2008/2009 MedIcaid Non-Emergency Transportation
Subcontracted Transportation Provider Contract
Page 9S of 117
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6/28/2011 Item 16.A.6.
Commission for the Transportation Disadvantaged
605 Suwannee Street, MS-49
Tallahassee, Florida 32399-0450
5 Any reports, management letter, or other information required to be submitted to the
Department pursuant to this Agreement shall be submitted timely in accordance with
OMB Circular A-133, Florida Statutes, and Chapters 10.550 (local governmental entities)
or 10.650 (nonprofrt: and for-profit organizations), Rules of the Auditor General, as
applicable.
6. Recipients, when submitting financial reporting packages to the Commission for audits
done in accordance with OMB Circular A-133 or Chapters 10.550 (local governmental
entities) or 10.650 (nonprofit and for-profrt: organizations), Rules of the Auditor General,
should indicate the date that the reporting package was delivered to the Recipient in
correspondence accompanying the reporting package.
PART V: RECORD RETENTION
The Recipient shall retain sufficient records demonstrating its compliance with the terms of this
Agreement for a period of five (5) years from the date the audit report is issued, and shall allow
the Commission, or its designee, CFO, or Auditor General access to such records upon request.
The Recipient shall ensure that audit working papers are made available to the Commission, or
its designee, CFO, or Auditor General upon request for a period of three (3) years from the date
the audit report is issued, unless extended in writi ng by the Commission.
20OS/2009 Medicaid Noo.Emergency Transportation
Subcontracted Transportation Provider Contract
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ATTACHMENT 2
EXHIBIT 1
FEDERAL and/or STATE resouroes awarded to the recipient pursuant to this agreement should
be listed below. If the resources awarded to the recipient represent more than one Federal or
State program, provide the same information for each program and the total resources
awarded. Compliance Requirements applicable to each Federal or State program should also be
listed below. If the resources awarded to the recipient represent more than one program, list
applicable compliance requirements for each program in the same manner as shown here:
. (e.g., What services or purposes the resources must be used for)
. (e.g., Eligibility requirements for recipients of the resources)
. (Etc...)
.
Federal Funds Awarded to the Recipient Pursuant to this Agreement Consist of the
Following:
Federal Federal Agency CFDA CFDA Title Funding
Program Number Amount
Number
Medicaid 1itle 19 93.778 Medical Assistance Pavments 5251 519.00
Medicaid 1itJe 21 93.767 Childrens' Health Insurance Prooram
Medicaid 1itle 18 19 CLIA 93.777 Survev and Certification
State Funds Awarded to the Recipient Pursuant to this Agreement Consist of the
Following Matching Funds for Federal Programs:
Federal Program Federal Agency CFDA CFDA Title Funding
Number Number Amount
Medicaid 1itJe 19 93.778 Medical Assistance Payments N/A
Medicaid 1itle 21 93.767 Childrens' Health Insurance prooram N/A
Medicaid 1itie 18 19 CUA 93.777 Survev and Certification N/A
N/A
State Funds Awarded to the Recipient Pursuant to this Agreement Consist of the
Following Funds Subject to Section 215.97, F.S.:
Federal Program Federal Agency CFDA CFDA Title Funding
Number Number Amount
2008/2009 Medicaid Non-Emergency Transportation
Subcontracted Transportation Provider Contract
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6/28/2011 Item 16.A.6.
ATTACHMENT 3
REQUIRED DATA ELEMENTS FOR ENCOUNTER DATA
Draft Batch File Layout
File name should be CTC_EIN_Batch_Number.txt (if CTC_EIN = 123456789 and the
Batch_Number for this file is 000987650 then file name would be
123456789_000987650.txt)
Maximum of 5000 claims per file (Record_Type = C)
Header Record (one per batch - first record in file)
Total
FieldName Fonnat Beain End Positions Descrintion Edits
RecordType X(01) 1 1 1 Header Record Must = H
Indicator
CTC_EIN 9(09) 2 10 9 CTC Federal Numeric
, Em"lover 10
Batch_Number 9(09) 11 19 9 Unique to for batch Numeric with leading
(batches with zeroes
duplicate IDs will be
reiected'
File_Type X(01) 20 20 1 If a File.Jype - T is T=testfile.P=
sent to the Production file. Any other
production machine value witt cause entire
the entire file will be file to be rejected.
rejected. If a
Fjle~Type = P is
sent to the test
machine then the
entire file will be
rejected.
Claim (trip) Records (maximum 5000 per batch)
Total
FieldName Format Beoin End Positions Descrintion Edits
RecordType X(OI) 1 1 1 Claim Record Must = C
Indicator
UniaueTriolO X115\ 2 16 15 Uniaue Trio 10 Generated bv CTC software
Trip_Void X(OI) 17 17 1 Place 'V' in Must:: V or blank
field to void
previously
submitted
claim record
(determined ~y
UnioueTriolD
CTC_EIN 9(09) 18 26 9 CTC Federal Numeric
Employer 10
CTC_MedicaidlO 9(10) 27 36 10 CTC Medicaid Numeric - passes check
10 dicit validation
2008/2009 Medicaid Non-Emergency Transportation
Subcontracted Transportation Provider Contract
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Bene_Lname X(15) 37 51 15 Beneficiary Length> 0
Last Name
Bene_Fname X(15) 52 66 15 Beneficiary Length> 0
First Name
Bene_MI X(01) 67 67 1 Beneficiary None
Middle Initial
Bene_MedicaidlD X(10) 68 77 10 Beneficiary Numeric passes check
MedicaidlD dinit validation
Bene_HomeAddr X(30) 78 107 30 Beneficiary Length> 0
Home Address
Bene_HomeCity X(20) 108 127 20 Beneficiary Length:> 0
Home Cin:
Bene _HomeCounty 9(02) 128 129 2 Beneficiary Validated against attached
Home Countv table
Bene_HomeState X(02) 130 131 2 Beneficiary Validated against 50 States
Home State
Bene_HomeZip 9(05) 132 136 S Beneficiary Numeric (5 digit zip only)
Home ZiD
Bene_DOB 9(08) 137 144 8 Beneficiary Numeric and valid date
Date of Birth CCYVMMDD
Bene_Gender X(01) 14S 145 1 Beneficiary M :;:; male. F :;:; female. U =
Gender Unknown
Bene_SSN 9(09) 146 154 9 Beneficiary Numeric
SSN
Reservation~Date 9(08) 15S 162 8 Date Numeric and valid date
reservation call CCYVMMDD
received
Reservation_Time 9(04) 163 166 4 Time Numeric and valid time -
reservation call HH~~ (24 hour - 1 :OOpm =
received 1300
Reservation_Pickup _Date 9(08) 167 174 8 Original Numeric and valid date-
Scheduled CCYVMMDD
PickuD Date
Reservation_Pickup_ Time 9(04) 175 178 4 Original Numeric and valid time -
Scheduled HH~~ (24 hour - 1 :OOpm =
Pickuo Time 1300
Reservation_ Appt_ Time 9(04) 179 182 4 Dr's or F aGility Numeric and valid time
Appointment HHMM (24 hour - 1 :OOpm =
Time 1300) for Trip_Indicator = "I".
Blank for Trip_Indicator = I'"
or"R"
Trip_Origin_Address X(30) 183 212 30 Trip origination Length> 0
address
Trip_Origin_City X(20) 213 232 20 Trip origination Length> 0
city
Trip_Origin_County 9(02) 233 234 2 Trip origination Validated against attached
countv - table
Trip_Origin_Code X(01) 235 235 1 Trip origination Validated against attached
code table
Trip_Trans_Mode X(02) 236 237 2 Trip Validated against attached
transportation tabie
mode
Trip_Indicator X(Ol) 238 238 1 Trip indicator Validated against attached
table
Trip_NoShow X(01) 239 239 1 No Show N if No Show otherwise
blank
Trip_Miles 9(04).9 240 245 6 Trip miles Insert decimal. 4 miles - 4.0.
Must be valid miles.
Maximum value is 9999.9.
Trip miles = 0.0 for
Trio Trans Mode;;: BP. All
2008/2009 Medicaid Non.Emergency Transportation
Subcontracted Transportation Provider Contract
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6/28/2011 Item 16.A.6.
other Trip_ Trans_Mode> o.
May delete leading zeros
above first zero (example -
can have 0.0 but not .0)
(example - 0001.0 can be
1.0)
Trip_Cost 9(03).99 246 251 6 Trip cost No $ but insert decimal.
$12.95 = 12.95. $1 = 1.00.
Must be valid amount
Maximum value is 999.99.
Must be > 0.00.
Trip_Pickup_Date 9(08) 252 2S9 8 Trip pickup Numeric and valid date -
date CCYVMMDD
Trip_Pickup_ Time 9(04) 260 263 4 Trip pickup Numeric and valid time
time HHMM (24 hour - 1 :oopm =
1300). Same as
Reservation PickuD Time
Trip_Desl_Address X(30) 264 293 30 Trip Length> 0
destination
address
Trip_Oest_City X(20) 294 313 20 Trip Length> 0
destination city
Trip_Oest_County 9(02) 314 315 2 Trip Validated against attached
destination table
countv
Trip_Dest_Code X(01) 316 316 1 Trip Validated against attached
destination table
code
T rip ~ Actual_Pickup _Time 9(04) 317 320 4 Trip actual Numeric and valid time
pickup time HHMM (24 hour - 1 :OOpm =
1300)
Trip_ActuaL Dropoff _Time 9(04) 321 324 4 Trip actual Numeric and valid time-
dropoff time HHMM (24 hour - 1 :OOpm =
1300)
Trip ~Escort~Requjred X(01) 325 325 1 Trip escort Yes - Y. No = N
required
Trip Medical Necessity X(25) 326 350 25 None
Trip_MediKids X(01) 351 351 1 MediKids Ves = V, No= N
Indicator
Footer Record (one per batch - Last record in filel
Total
FieldName Format Begin End Positions Descri ption Edits
RecordType .--- X(01) 1 Footer Record Must = F
1 1
Indicator
CTC_EIN 9(09) 2 10 9 CTC Federal Numeric
Emolover 10
Batch_Number 9(09) 11 19 9 Unique 10 for Numeric Must match
batch (batches Batch_Number in header
with duplicate IDs record
will be reiected)
T 0181_ Claims_Batch 9(04) 20 23 4 Total number of Entire file rejected if this
claims in this batch field does not equal
file number of NC" records
2008/2009 Medicaid Non-Emergency Transportation
Subcontracted Transportation Provider Contract
Page 100 of 117
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6/28/2011 Item 16.A.6.
Trio Orioln Code & Trio Desl Code Validation Table
c~.,.
. .
P Physician
C Clinic
L Laboratory
H Hospital
N Nursing Home
D Dialysis
0 Other Diagnosis or Therapeutic
R Residence
Trio Trans Mode Validalion Table
""!Ie "'f~~~'c?l1a~q~l~,~de:,,~;;'
MV Multi-Load Vehicle
PT Public Transportation
VT Private Volunteer Transport
WC Wheelchair
ST Stretcher
OB Over-the-road Bus
CA Commercial Air
BP Bus Pass
TX Taxi
TriD Indicator Validation Table
Code Indicator
I. '.
I Initial
T Transfer
2008/2009 Medicaid Non-Emergency Transportation
Subcontracted Transportation Provider Contract
Page 101 of 117
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6/28/2011 Item 16.A.6.
I R I Return
County Validation Table
.~ ' IlQ.,1: Caunlll', . Ul t ",ii:i:Counlv, 10' CO ." ,:, lOt Co'-. ..a"
Alachua 01 Duval 15 Holmes 29 Miami-Dade 43 Santa Rosa 57
Baker 02 Escambia 16 Indian 30 Monroe 44 Sarasota 58
River
Bav 03 Flaoler 17 Jackson 31 Nassau 45 Seminole 59
Bradford 04 Franklin 18 Jefferson 32 Okaloosa 46 Sumter 60
Brevard 05 Gadsden 19 Lafavette 33 Okeechobee 47 Suwannee 61
Broward 06 Gilchrist 20 Lake 34 Oranae 48 Tavlor 62
Calhoun 07 Glades 21 Lee 35 Osceola 49 Union 63
Charlotte 08 Gulf 22 Leon 36 Palm Beach 50 Volusia 64
Citrus 09 Hamilton 23 Lew 37 Pasco 51 Wakulla 65
Clav 10 Hardee 24 Liberty 38 Pine lias 52 Walton 66
Collier 11 Hendry 25 Madison 39 Polk 53 Washinoton 67
Columbia 12 Hernando 26 Manatee 40 Putnam 54
Desoto 13 Highlands 27 Marion 41 Sl Johns 55
Dixie 14 Hillsborough 28 Martin 42 Sl Lucie 56
2008/2009 Medicaid Non-Emergency Transportation
Subcontracted Transportation Provider Contract
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6/28/2011 Item 16.A.6.
ATTACHMENT 4
QUARTERLY GRIEVANCE SYSTEM SUMMARY REPORT
STP Name:
Dates of Quarter Reporting:
Report is due 30 Calendar Days after the end of the reporting quarter.
STP must report all data until closed.
200B/2009 Medicaid Non-Emergency Transportation
Subcontracted Transportation Provider Contract
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6/28/2011 Item 16.A.6.
ATIACHMENT 5
TRIP TRAVEL EXPENSE REPORT
STP Name:
Reporting Period:
cou'b.l
... . a ". ,
Medicaid Beneficiary
Travel
lodging
Meals
Other
Total Medicaid
Benefidarv
Attendant{s)/Escort(s)
Travel
lodging
Meals
Other
Total Attendant/Escort
1
Travel
lodaina
Meals
Other
Total Attendant/Escort
2 ;kJ~ ....,:'t:"+Mhm'!': "!i~
;r1'tal''! ~ '! I.';;,;.;~~~
cO '!:4; :::1>,
Due to the Commission 15 Calendar Days after the month in which the travel
occurred.
2008/2009 Medicaid Non-Emergency Transportation
Subcontracted Transportation Provider Contract
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ATTACHMENT 6
BUSINESS DISRUPTION NOTIFICATION REPORT
STP Name:
Reporting Period:
County:
System{s) Affected Description of Outage Population Affected
Computer System
Telephony System
The date and time the
incident occurred
What event triggered the
incident
The plan of action to bring
the System back online
The expected date and
time of recovery of full
use of the System
The impact the outage
had on Medicaid
Beneficiaries
2008/2009 Medicaid Non-Emergency Transportation
Subcontracted Transportation Provider Contract
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6/28/2011 Item 16.A.6.
ATIACHMENT 7
CRITICAL INCIDENT REPORT
STP Name:
Reporting Period:
County of Incident:
Time of Incident:
Location of Incident:
Critical Incident Type:
Details of Incident (Include Medicaid
Beneficiary's age, gender, diagnosis,
current medication, source of information,
all reported details about the event,
action taken by
Commiss ion/Subcontractor/ Transportation
Provider, and any other pertinent
information):
Follow Up Planned or Required
(Include information relating to any
Com miss ion/Subcontractor/ Transportation
Provider policy or procedure that applies
to the event):
Transportation Provider:
Report Submitted By:
--
Date of Submission:
2008/2009 Medicaid Non-Emergency Transportation
Subcontracted Transportation Provider Contract
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ATTACHMENT 8
DEFINITIONS AND ACRONYMS
A. Definition 5
The following terms as used in this Agreement shall be construed and/or interpreted as
follows, unless the Agreement otherwise expressly requires a different construction
and/or interpretation.
Abuse - Practices that are inconsistent with generally accepted business or
Transportation practices and that result in an unnecessary cost to the Medicaid program
or in reimbursement for goods or services that are not Medically Necessary or that fail to
meet professionally recognized standards for health care; or Medicaid Beneficiary
practices that result in unnecessary cost to the Medicaid program.
Action - (i) The denial or limited authorization of a requested service, including the
type or level of service, pursuant to 42 CFR 438.4oo(b). (ii) The reduction, suspension,
or termination of a previously authorized service. (iii) The denial, in whole or in part, of
payment for a service. (iv) The failure to provide services in a timely manner, as
defined by the State. (v) The failure of the Recipient to resolve a Complaint within
fifteen (15) Business Days, a Grievance within ninety (90) Calendar Days, and an Appeal
within forty-five (45) Calendar Days from the date the Recipient/Subcontractor receives
the Complaint, Grievance, or Appeal.
Acute Condition - An Acute Condition is a medical condition with a rapid onset of
symptoms and/or a temporary or limited duration (as opposed to a Chronic Condition)
and inciudes subacute conditions. Treatment for an Acute Condition is intended to last a
short duration and may include surgical treatment, rehabilitative treatment, and/or other
care.
Agency - State of Florida, Agency for Health Care Administration.
Agent - An entity that contracts with the State to perform administrative functions,
including but not limited to: Fiscal Agent activities, outreach and education, eligibility
activities; Systems and technical su pport.
Agreement - The Agreement between the Recipient and the Agency to provide
Medicaid Non-Emergency Transportation Services to Medicaid Beneficiaries, comprised
of the Agreement, and any addenda, appendices, attachments, or amendments thereto.
Agreement Period - The term of the Agreement from December 1, 2008 through
August 31, 2011.
Agreement Year - The period of time from September 1 through August 31 of each
calendar year. There are three (3) Agreement Years in this Agreement. The first (1st)
Agreement Year shall run from December 1,2008 through August 31, 2009. The second
2008{2009 Medicaid Non-Emergency Transportation
Subcontracted Transportation Provider Contract
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(2nd) Agreement Year shall run from September 1, 2009 through August 31, 2010. The
third (3rd) Agreement Year shall run from September 1, 2010 through August 31, 2011.
Appeal- A request for review of an Action, pursuant to 42 CFR 438.400(b).
Attendant/Escort - An Attendant/Escort is an individual whose presence is required to
assist a Medicaid Beneficiary during transport and at the place of treatment.
Baker Act - The Florida Mental Health Act, pursuant to ss. 394.451-394.4789, F.S.
Behavioral Health Care - Services listed in the Community Behavioral Health
Services Coverage & Limitations Handbook and the Targeted Case Management
Coverage & Limitations Handbook. Behavioral Health Care involves issues relating to
mental health and substance abuse.
Business Days - Traditional workdays, which are Monday, Tuesday, Wednesday,
Thursday, and Friday, excluding State Holidays.
Calendar Days - All seven (7) days of the week.
Certification - The process of determining that a facility, equipment or an individual
meets the requirements of federal or State law, or whether Medicaid payments are
appropriate or sha II be made in certain situations.
Children/Adolescents - Medicaid Beneficiaries under the age of twenty-one (21).
Chronic Condition - A Chronic Condition is a medical condition that is long lasting or
recurrent. Chronic Conditions require ongoing management for effective long term
treatment.
Complaint - An expression of dissatisfaction about any matter other than an Action.
Possible subjects for Complaint include, but are not limited to, the quality of
Transportation Services, the quality of services provided and aspects of interpersonal
relationships such as rudeness of a Transportation Provider or employee or failure to
respect the Medicaid Beneficiary's rights. A Complaint is resolved at the Point of Contact
rather than through filing a formal Grievance.
Contracting Officer - The Secretary of the Agency or his/her delegate.
Cost - Fully allocated expenses associated with providing Transportation Services to
Medicaid Beneficiaries. The Recipient may determine Cost by using the Recipient's
approved rate calculation model or a Recipient approved rate calculatio n model
consistently utilized by a Subcontractor.
Cost Effective - Economical in terms of the goods or services received for the
2008/2009 Medicaid Non-Emergency Transportation
Subcontracted Transportation Provider Contract
Page 108 of 117
Packet Page -513-
6/28/2011 Item 16.A.6.
Covered Services - Those services provided by the Recipient in accordance with this
Agreement, and as outlined in Section V, Covered Services, in this Agreement. Also
referred to as "Transportation Services."
Cultural Competency Plan - A required written plan that the Recipient must maintain
in accordance with 42 CFR 438.206. The Cultural Competency Plan describes how the
Recipient will ensure that it provides Transportation Services in a culturally competent
manner to all Medicaid Beneficiaries, including those with limited English proficiency.
Disclosing Entities - The Recipient and any Subcontractors that furnish services or
arrange for furnishing services under this Agreement.
Emergency Transportation - The provision of Emergency Transportation Services in
accordance with Section 409.908(13)(c)(4), F.S.
Encounter Data - Encounter Data includes records of Covered Services provided by
the Recipient to a Medicaid Beneficiary.
Expedited Appeal Process - The process by which the Appeal of an Action is
accelerated because the standard time-frame for resolution of the Appeal could seriously
jeopardize the Medicaid Beneficiary's life, health, or ability to obtain, maintain, or regain
maximum function.
External Quality Review (EQR) - The analysis and evaluation by an External Quality
Review Organization (EQRO) of aggregated information on Quality, timeliness, and
access to the health care services that are furnished to Medicaid Beneficiaries by the
Recipient.
External Quality Review Organization (EQRO) - An organization that meets the
competence and independence requirements set forth in federal regulations 42 CFR
438.354, and performs EQR, other related activities as set forth in federal regulations, or
both.
Family Planning Waiver (FPW) - The Family Planning Waiver extends eligibility for
family planning services for twenty-four (24) months to postpartum women capable of
bearing a child who have lost Medicaid eligibility.
Fee-for-Service (FFS) - A method of making payment by which the Agency sets
prices for defined medical or allied care, goods, or services.
Fiscal Agent - Any corporation, or other legal entity, that enters into a contract with
the Agency to receive, process, and adjudicate claims under the Medicaid program.
Fiscal Year - The State of Florida's Fiscal Year starts July 1 and ends on June 30. This
may be different than the Agreement Year.
Florida Medicaid Management Information System (FMMIS) - The information
system used to process Florida Medicaid claims and payments to Recipients, and to
2008/2009 Medicaid Non-Emergency Transportation
Subcontracted Transportation Provider Contract
Page 109 of 117
Packet Page -514-
6/28/2011 Item 16.A.6.
produce management information and reports relating to the Florida Medicaid program.
The State uses this system to maintain Medicaid eligibility data and provider enrollment
data.
Fraud - An intentional deception or misrepresentation made by a person with the
knowledge that the deception results in unauthorized benefit to herself or himself or
another person. The term includes any act that oonstitutes fraud under applicable
federal or state law.
Grievance - An expression of dissatisfaction about any matter other than an Action.
Possible subjects for Grievances include, but are not limited to, the quality of
Transportation Services provided and aspects of interpersonal relationships such as
rudeness of a Provider or employee or failure to respect the Medicaid BenefICiary's
rights.
Grievance Procedure - The procedure for addressing Medicaid Beneficiaries'
Grievances.
Grievance System - The system for reviewing and resolving Medicaid Beneficiary
Grievances and Appeals. Components must inciude a Complaint Procedure, a Grievance
Procedure, an Appeal process, and access to the Medicaid Fair Hearing system.
Health Care Professional - A physician or any of the following, including, but not
limited to: podiatrist, optometrist, chiropractor, psychologist, dentist, physician assistant,
physical or occupational therapist, therapist assistant, speech-language pathologist,
audiologist, Registered Nurse or practical Nurse (including nurse practitioner, clinical
nurse specialist, certified Registered Nurse anesthetist and certified nurse midwife), a
Licensed certified social worker, registered respiratory therapist and certified respiratory
therapy technician.
Hospital - A facility Licensed in accordance with the provisions of Chapter 395, Florida
Statutes or the applicable laws of the state in which the service is furnished.
Household - Includes all persons residing at a common address.
Information - (i) Structured Data: data that adhere to specific properties and
Validation criteria that are stored as fields in database records. Structured queries can
be created and run against structured data, where specific data can be used as criteria
for querying a larger data set; (ii) Document: information that does not meet the
definition of structured data; includes text, files, spreadsheets, eiectronic messages,
images of forms, and pictures.
Information System(s) - A combination of oomputing hardware and software that is
used in: (a) the capture, storage, manipulation, movement, control, display,
interchange, and/or transmission of information (I.e. structured data, which may include
digitized audio and video), and documents; and/or (b) the processing of such
information for the purposes of enabling and/or facilitating a business process or related
transaction.
2008/2009 Medicaid Non.Emergency Transportation
Subcontracted Transportation Provider Contract
Page 110 of 117
Packet Page -515-
6/28/2011 Item 16.A.6.
Insolvency - A financial condition that exists when an entity is unable to pay its debts
as they become due in the usual course of business, or when the liabilities of the entity
exceeds its assets.
Institutional Care Program (ICP) Residents - Medicaid Beneficiaries who are
eligible for placement in a facility while their eligibility determination is being processed
(e.g., nursing home residents, etc.).
Licensed - A facility, equipment, or individual that has formally met State, county, and
local requirements, and has been granted a license by a local, State, or federal
government entity.
List of Excluded Individuals and Entities (LEI E) - A database maintained by the
Department of Health & Human Services, Office of the Inspector General. The LEIE
provides information to the public, health care providers, patients and others relating to
parties excluded from participation In Medicare, Medicaid, and all other federal health
care programs. The LEIE includes the Department of Management Services' List of
Excluded Vendors.
Managed Care Organization (MCO) - An organization, either for-profit or not-for-
profit, in which an organization, such as an HMO, PSN, or EPO, acts as an intermediary
between the Medicaid Beneficiary seeking care and the physician.
Medicaid - The medical assistance program authorized by Title XIX of the Social
Security Act, 42 U.s.e. 91396 et seq., and regulations there under, as administered in
the State of Florida by the Agency under 409.901 et seq., F.S.
Medicaid Beneficiary - Any individual whom Department of Children and Families
(DCF) or the Social Security Administration determines is eligible, pursuant to federal
and State law, to receive medical or allied care, goods, or services for which the Agency
may make payments under the Medicaid program, and who is enrolled in the Medicaid
program.
Medicaid Eligibility Vendor System (MEVS) - An entity that provides Medicaid
eligibility status to Medicaid providers. A MEVS vendor does not necessarily provide the
Non-Emergency Transportation eligibility status of a Medicaid Beneficiary.
Medicaid Reform - The program resulting from Chapter 409.91211, F.S.
Medically Needy - A Medicaid Beneficiary who would qualify for Medicaid but has
income or resources that exceed normal Medicaid guidelines. On a month-by-month
basis, the State determines the individual's eligibility by subtracting the individual's
medical expenses from his/her income; if the remainder falls below Medicaid's income
limits, the individual may qualify for Medicaid throug h the end of the month.
Medically Necessary or Medical Necessity - Services that include medical or allied
care, goods, or services furnished or ordered to:
2008/2009 Medicaid Non-Emergency Transportation
Subcontracted Transportation Provider Contract
Page 111 of 117
Packet Page -516-
6/28/2011 Item 16.A.6.
1. Meet the following cond itions:
a. Be necessary to protect life, to prevent significant illness or significant
disability or to alleviate severe pain;
b. Be individualized, specific and consistent with symptoms or confirm diagnosis
of the illness or injury under treatment and not in excess of the patient's needs;
c. Be consistent with the generally accepted professional medical standards as
determined by the Medicaid program, and not be experimental or investigational;
d. Be reflective of the level of service that can be furnished safely and for which
no equally effective and more conservative or less costly treatment is available
statewide; and
e. Be furnished in a manner not primarily intended for the convenience of the
Medicaid Beneficiary, the Medicaid Beneficiary's caretaker or the provider.
2. Medically Necessary or Medical Necessity for those services furnished in a Hospital on
an inpatient basis cannot, consistent with the provisions of appropriate medical care, be
effectively furnished more economically in a Nursing Facility basis or in an inpatient
facility of a different type.
3. The fact that a Licensed Health Care Professionai has prescribed, recommended, or
approved medical or allied goods or services does not, in itself, make such care, goods,
or services Medically Necessary, a Medical Necessity, or a Covered Service.
Medicare - The medical assistance program authorized by Title XVIII of the Social
Security Act.
Mile/Mileage - Distance that Transportation Providers log for each Medicaid
Beneficiary. Mile/Mileage starts at the location that the Transportation Provider picks up
the Medicaid Beneficiary and ends at the location at which the Transportation Provider
delivers the Medicaid Beneficiary.
Neglect - A failure or omission to provide care, supervision, and/or services necessary
to maintain a Medicaid Beneficiary's physical and mental health, including but not limited
to, food, nutrition, supervision, medical services, and Transportation Services that are
essential for the well-being of the Medicaid Beneficiary. Neglect might be a single
incident or repeated conduct that results in, or could reasonably be expected to result
in, serious physical or psychological injury, or a substantial risk of death.
No Show - If a Medicaid Beneficiary fails to provide a cancellation notice to the
Recipient or a Transportation Provider at least twenty-four (24) hours in advance of a
scheduled Trip, or the Medicaid Beneficiary is not available or has decided he/she does
not require Transportation Services, then the Recipient shall claSSify the Medicaid
Beneficiary as a No Show.
Non-Covered Service - A service that does not qualify as one of the Recipient's
Covered Services.
2008/2009 Medicaid Non.Emergency Transportation
Subcontracted Transportation Provider Contract
Page 112 of 117
Packet Page -517-
6/28/2011 Item 16.A.6.
Non-Emergency Transportation Services Coverage & Limitations Handbook
(Handbook) - A document that provides information to a Transportation Provider
regarding Medicaid Beneficiary eligibility, claims submission and processing,
Transportation Provider participation, covered care, goods and services, limitations,
procedure codes and fees, and other matters related to participation in the Medicaid
program.
Nursing Facility - An institutional care facility that furnishes medical or allied inpatient
care and services to individuals needing such services. See Chapters 395 and 400, F.S.
Outpatient - A patient of an organized medical facility, or distinct part of that
facility (such as a Hospital), whom a facility expects to receive, and who does receive,
professional services for less than a twenty-four (24) hour period, regardless of the
hours of admission, whether or not a bed is used and/or whether or not the patient
remains in the facility past midnight.
Overpayment - Includes any amount that is not authorized to be paid by the
Medicaid program whether paid as a result of inaccurate or improper cost reporting,
improper claiming, unacceptable practices, Fraud, Abuse, or mistake.
Point of Contact - Ombudsman, customer service center, call center, or other
program that receives Complaints from Medicaid Beneficiaries.
Presumptively Eligible Pregnant Women - This program allows staff at County
Health Departments (CHDs), Regional Perinatal Intensive Care Centers (RPICCs), and
other qualified medical facilities to make a presumptive determination of Medicaid
eligibility for low-income pregnant women. This presumptive determination allows a
woman to access prenatal care while Department of Children and Families eligibility staff
make a regular determination of eligibility.
Prior Authorization - The act of authorizing specific services before they are
rendered.
Protocols - Written guidelines or documentation outlining steps the Recipient,
Subcontractors (if any), and Transportation Providers must follow when handling a
particular situation, resolving a problem, or implementing a plan to provide
Transportation Servi ces. Also referred to as "policies and procedures."
Quality - The degree to which a Recipient increases the likelihood of desired health
outcomes of its Medicaid Beneficiaries through its structural and operational
characteristics and through the provision of Transportation Services that are consistent
with current professional knowledge.
Quality Improvement (QI) - The process of monitoring and assuring that the
delivery of Transportation Services are available, accessible, timely, and proVided in
sufficient quantity, of acceptable Quality, within established standards of excellence, and
appropriate for meeting the needs of Medicaid Beneficiaries.
2008/2009 Medicaid Non-Emergency Transportation
Subcontracted Transportation PrOVider Contract
page 113 of 117
Packet Page -518-
6/28/2011 Item 16.A.6.
Quality Improvement Program (QIP) - The program designed to ensure the
delivery of Transportation Services is appropriate, timely, accessible, and available.
Recipient - The entity that has entered into an Agreement with the Agency to proVide
Non-Emergency Transportation coordination services to Medicaid Beneficiaries.
Road Calls - A call to repair or replace a vehicle while en route to pick up a Medicaid
Beneficiary and/or while transporting Medicaid Beneficiaries due to a mechanical or
other failure, not the result of an accident (e.g., air conditioning broke requiring a
replacement vehicle to co mplete the driver's route, replacing a flat tire, etc.)
Routine Trips - Medically Necessary Trips that are not urgent in nature (e.g., doctor's
appointment for an annual checkup).
Service Area - The designated geographical area within which the Recipient is
authorized by the Agreement to furnish Covered Services to Medicaid Beneficiaries.
Service Authorization - The Recipient's approval to render services. The process of
authorization must at least include a Medicaid Beneficiary's request for the provision of a
service.
Span of Control - Information Systems and telecommunications capabilities that the
Recipient itself operates or for which it is otherwise legally responsible according to the
terms and conditions of this Agreement. The Recipient's Span of Control also includes
Systems and telecommunications capabilities outsourced/Subcontracted by the
Reel pient.
State - State of Florida.
State Holiday - Includes the following days: New Year's Day, Martin Luther King's Day,
Memorial Day, Independence Day, Labor Day, Veterans' Day, Thanksgiving Day and the
Friday following, a nd Christmas Day.
Subcontract - An agreement entered into by the Recipient and a subcontractor for
provision of administrative services on its behalf.
Subcontractor - Any person or entity with which the Recipient has contracted or
delegated, by use of a Subcontract, some of its functions, services, or responsibilities for
providing Transportation Services under this Agreement.
Surface Mail - Mail delivery via land, sea, or air, rather than via electronic
transmission.
Surplus - Net worth, i.e., total assets minus total liabilities.
System Unavailability - As measured within the Recipient's Information Systems
Span of Control, when a system user does not get the complete, correct full-screen
2008/2009 Medicaid Non.Emergency Transportation
Subcontracted Transportation Provider Contract
Page 114 of 117
Packet Page -519-
6/28/2011 Item 16.A.6.
response to an input command within three (3) minutes after depressing the "Enter" or
other function key.
Systems - See Information Systems.
Temporary Assistance for Needy Families (TAN F) - Public financial assistance
provided to low-income families.
Transportation - An appropriate means of conveyance furnished to a Medicaid
BenefICiary to obtain Medicaid compensable services,
Transportation Provider - A person or entity that is eligible to provide Medicaid
Transportation Services and has a contractual agreement with the Recipient or
Subcontractor to provide Medicaid Transportation Services. A Transportation Provider
must be Licensed in accordance with the applicable
laws of the State in which it furnishes Transportation Services. A Subcontractor may act
as a Transportation Provider.
Transportation Provider Agreement - An agreement between the Recipient or
Subcontractor and a Transportation Provider as described above.
Transportation Record - Documents corresponding to Transportation Services
furnished by the Recipient. The records may be on paper, magnetic material, film, or
other media. In order to qualify as a basis for reimbursement, the records must be
dated, legible, and signed or otherwise attested to, as appropriate to the media.
Transportation Services - See "Covered Services."
Trip -Transport of a Medicaid Beneficiary one way, from pickup to destination for the
purpose of receiving Medicaid com pensable services.
Urgent Care - Services for conditions, which, though not life-threatening, could result
in serious injury or disability unless medical attention is received (e.g., high fever,
animal bites, fractures, severe pain, etc.) or substantially restrict a Medicaid Beneficiary's
activity (e.g., infectious illnesses, fiu, respiratory ailments, etc.), require Transportation
Services to medical services in which advance scheduling is not possible (e.g., sudden
illness, an accident, or follow up laboratory work or tests), or Hospital/facility inpatient
or outpatient discharges after normal business hours.
Urgent Trip - A Trip relating to:
(1) Urgent Care;
(2) Hospital/facility inpatient and outpatient discharges; and
(3) Emergency room discharges.
Validation - The review of information, data, and procedures to determine the extent
to which they are accurate, reliable, free from bias, and in accord with standards for
data collection and analysis.
2008/2009 Medicaid Non-Emergency Transportation
Subcontracted Transportation Provider Contract
Page 115 of 117
Packet Page -520-
6/28/2011 Item 16.A.6.
Violation - A determination by the Agency, in its sole discretion, that the Recipient, or
one of the Recipient's Subcontractors or Transportation Providers, failed to act as
specified in this Agreement or applicable statutes, rules, or regulations governing
Medicaid Vendors. The Agency shall consider each day that an ongoing Violation
continues, for the purposes of this Agreement, to be a separate Violation. In addition,
the Agency shall consider each instance of failing to furnish necessary and/or required
Transportation Services to Medicaid Beneficiaries, for purposes of this Agreement, to be
a separate Violation. As well, the Agency shall consider each day that the Recipient, or
one of the Recipient's Subcontractors or Transportation Providers, fails to furnish
necessary and/or required Transportation Services to Medicaid Beneficiaries, for
purposes of this Agreement, to be a separate Violation.
Will Call - A scheduled Trip that could not be fulfilled within the timeframes of this
Agreement leading to the Transportation Provider making an unscheduled Medicaid
compensable Trip. Example - a Medicaid Beneficiary notifies the Transportation Provider
that a doctor is running later than originally scheduled and asks to reschedule his or her
Trip to his or her destination. When the Medicaid Beneficiary notifies the Transportation
Provider that he or she is ready for pick up, the Transportation Provider puts in a Will
Call pick up order to its driver to pick up the Medicaid Beneficiary and take him or her to
his or her destination.
B. Acronyms
AHCA -Agency for Health Care Administration
ALF - Assisted Living Faci Iity
ALS - Advanced Life Support
BLS - Basic Life Support
CAP - Corrective Action Plan
CFR - Code of Federal Regulations
CTAA - Community Transportation Association of America
OCF - Department of Chi Idren & Fam ilies
OHHS - United States Department of Health & Human Services
OJJ - Department of Juvenile Justice
EDI - Electronic Data Interchange
EQR - External Quality Review
EQRO - External Quality Review Organization
FAC - Florida Administrative Code
FTE - Full Time Equivalent Position
HCBS - Home and Community Based Services Waiver
HIPAA - Health Insurance Portabiiity & Accountability Act
LCB - Local Coordinati ng Board
LEIE - List of Excluded Individuals & Entities
MCO - Managed Care Organization
MFCU - Medicaid Fraud Control Unit of the Florida Attorney General's Office
MPI - Bureau of Medicaid Program Integrity, a part of the Agency
NET - Non-Emergency Transportation services
ODBC - Open Database Connectivity
2008/2009 Medicaid Non-Emergency Transportation
Subcontracted Transportation Provider Contract
Page 116 of 117
Packet Page -521-
PM - Performance Measure
PRTS - Purchased Residential Treatment Services
QI - Quality Improvement
QIP - Quality Improvement Program
RHC - Rural Health Clinic
SAMH - Substance Abuse & Mental Health District
SFTP - Secure File Transfer Protocol
SOBRA - Sixth Omnibus Budget Reconciliation Act
SQL - Structured Query Language
551 - Supplemental Security Income
UM - Utilization Management
2008/2009 Medicaid Non-Emergency Transportation
Subcontracted Transportation Provider Contract
Page 117 of 117
Packet Page -522-
6/28/2011 Item 16.A~
-mo
HOlID.. COMMISSION fO~ M
Trall5DOl'tatlon
Disadvantaged
Charlie Crist
Governor
JR Harding Ed,D.
Chairperson
Lawrence Forman
Vice ChBirperson
Bobby Jernigan
Interim Execuliv. O/,oelor
June 30, 2009
Ms. MiChelle Arnold
Collier County Board of County Commissioners
c/o Collier Area Transit
2885 Horseshoe Drive South
Naples, Florida 34104
6/28/2011 Item 16.A.6.
Ri2Ci2/I/i2D
JUL fJ 62009
OiANSp
ArM OD~TATtON
"'Pr.
Re: CTD Medicaid Non-Emergency Transportation (NET) Program
Executed Agreement Amendment (Collier County)
Dear Ms. Arnold:
Enclosed is your copy of the fully executed Medicaid NET Program
Agreel1lent Amendment for the above referenced project. Thank you for
your cqntinued support of Florida's coordinated transportation system.
Should, you have any questions or concerns, please contact me at
(850) 410-5715.
Sincerely,
~
Transportation Disadvantaged Specialist!
Regional Manager
Enclosure: Executed Amendment
cc: DOT Comptroller
Elmer Melendez, em Medicaid Financial Officer
605 Suwannee Street, MS-49 ,., T.Il.ha...., FL 32399.0450
Phon.: (850) 410.5700,., Toll F,..: 1800) 983.2435'" Fax: (850) 410.5752
www.dot..tat..fl.u./ctd
Packet Page -523-
6/28/2011 Item 16.A.6.
STATE OF FLORIDA
COMMISSION FOR THE TRANSPORTATION DISADVANTAGED
MEDlt=AID NON-EMERGENCY TRANSPORTATION (NET) PROGRAM
SUBcoNTRACTED TRANSPORTATION PROVIDER AGREEMENT
AMENDMENT NO 1
AGREEMENT #: BDM59
FINANCIAL PROJECT ID#:! 41604318201
F.E.I.D. # ' 596-000-558-004
This amendment, ~ntered into on July 1, 2009 by and between the State of Florida, Commission for
the Transportation Disa~antaged, hereinafter called "Commission" and Collier Countv RnRrd of Countv
Comm~. 3301 E~ Tamiami Tf3il Names. Florida. 34112. hereinafter called "Subcontractecf
Transportation Provider" fOr Collier County(ies).
WITNESSETH:
WHEREAS, the parties hereto entered into an original Grant Agreement effective 1/1/2009; and
WHEREAS, the parities wish to modify Exhibit B of the Agreement for the mutual benefit of both
parties.
NOW, THEREFORE; the aforesaid Agreement is hereby modified in the following respects only:
1. Purpose of /lgreement: The purpose of the agreement is not changed.
2. Aocomplishlinent of the Agreement: The accomplishment of the agreement is not changed.
3. Expiration cr Agreement: The expiration date of the agreement is not changed.
,
4. Amendment Amount: This amendment outlines the method of compensation for Fiscal Years
2009/2010 and 2010/2011.
5. Total Projec!t Cost: The Total Project Cost is not changed.
6. Exhibit B, Method of Compensation, of said Agreement is replaced by Amendment Number 1
Exhibit B a~d is attached hereto and made a part hereof.
EXCEPT as hereby modifll!id, amended, or changed, all other terms of the Agreement dated 1/1/2009 shall
remain in full force and effect. This amendment cannot be executed unless all previous amendments to
this Agreement have beenifully executed.
Packet Page -524-
6/28/2011 Item 16.A.6.
AGREEMENT NO.: BDM59
COUNTY NAME: Callier
AMENDMENT NO.1
EXHIBIT B
METHOD OF COMPENSATION
This Exhibit defines the limits of compensation to be made to the contractor for the services set forth in
Exhibit" A" and the methOCll by which payments shall be made.
1. Proiect Comoensatlpn:
For the satisfactory perfoninance of services detailed in Exhibit "A", the Subcontracted Transportation
Provider shall be paid up to a Maximum Amount of $ 1.266.051.00
The remaining Project Amount shall be made up of the following limiting amounts:
,
$ 251.519.00 from Rscal 'fear ~
$ 507.266.00 from Rscal 'fear 09/10
$ 507.266.00 from Rscal 'fear lOLll
The total amount of this e>>ntrad: is expected to be funded by multiple appropriations and the State of
Florida's perforrnana! and pbligation to pay under this contract is contingent upon annual appropriation by
the Legislature.
2. PROGIlF"" PAYMENTS AND DISBURSEMENT SCHEDULE OF FUNDS:
The STP shall submit monthly invoices in a format acceptable to the Commission.
Packet Page -525-
6/28/2011 Item 16.A.6.
In witness whereof, the authorized representatives of the parties hereto have executed this AMENDMENT,
effectjve July 1, 2009.
STATE OF RORIDA
COMMISSION FOR THE TRANSPORTATION
DISADVANTAGED
SIGNA
TIlt.E
Bobbv Jernioan
PRINTED NAME
I,
.<:. .~',_'}~f;{; t,~
,
,
J?
Collier County Boartf of County Commissioners
~L d~~
SIGNATURE
Chairman.Board of COlln~v ~omm;R~ioners
TIlt.E
Dnnn~ FiJllla
PRINTED NAME
Packet Page -526-
-~JJ __tl............. -. lI'
Y fi)-.vL
De,aty County AttOl'lleJ
6/28/2011 Item 16.A.6.
STATE OF FLORIDA
COMMISSION FOR THE TRANSPORTATION DISADVANTAGED
MEDICAID NON-EMERGENCY TRANSPORTATION (NED PROGRAM
SUBCONTRACTED TRANSPORTATION PROVIDER AGREEMENT
AMENDMENT NO.: 2.
AGREEMENT #:
FINANCIAL PROJECT lO#:
F.E.I.D. #
BDM59
41604318201
596-000-558-004
THIS amendment, entered into on June 30, 2011 by and between the State of Florida, Commission
for the Transportation Disadvantaged, hereinafter called "Commission" and Collier COunty Board of County
COmmissioners. 3301 E. Tamiami Trail. Naoles. Florida 34112. hereinafter called "Subcontracted
Transportation Provider" for COllier County(ies).
WHEREAS, this amendment is necessitated by the amendment of the contract between the
Commission and the Agency for Health Care Administration for Medicaid Non-Emergency Transportation
(NED services.
WHEREAS, this amendment is for the mutual benefit of both parties; and
NOW, THEREFORE, the aforesaid Agreement is hereby amended in the following respects only:
1. Purpose of Agreement: The purpose of the agreement is not Changed.
2. Accomplishment of the Agreement: The accomplishment of the agreement is not changed.
3. Renewal of Agreement: The Term of this agreement is hereby renewed until June 30, 2012.
4. Compensation and Payment: This agreement is increased by $ 486.958.00. for a total
maximum amount of $ 1.753.009.00.
5. Exhibit A, Paragraph VII. Grievance System, Section 2.k. (1). is hereby amended to read as
follows:
The STl' shall notify the Medicaid Beneficiary, in writing, using language at or near the fourth
(4"') grade reading level, if any Action taken by the STP to deny a Transportation Service
request, or limit Transportation Services in an amount, duration, or scope that is less than
requested.
6. Exhibit A, Paragraph III. Medicaid BenefiCiary Services Section 2.a. (5), is hereby.amended
to read as follows: .
All written materials, pursuant to 42 CFR 441.56, shail use clear and nontechnical
language and shall sbive to be at or near the fourth (4"') grade reading
comprehension level.
7. Exhibit B, Method of Compensation, of said Agreement is replaced by Amendment
Number k Exhibit B and is attached hereto and made a part hereof.
Packet Page -527-
6/28/2011 Item 16.A.6.
EXCEPT as hereby modified, amended, or changed, all other terms of the Agreemerit dated 1/112009 and
amendrnents .L shall remain in full force and effect. This amendment cannot be executed unless all
previous amendments to this Agreement have been fully executed.
In witness whereof, the.authorized representatives of the parties hereto have executed this AMENDMENT,
effective June 30, 2011.
STATE 'OF FLORIDA
COMMISSION FOR THE TRANSPORTATION
DISADVANTAGED
Collier County Board of County Commissioners
SIGNATURE
SIGNATURE
Executive Director
TITLE
Bobbv Jerniaan
PRINTED NAME
TITLE
PRINTED NAME
ATTEST
DWIGHT E. BROCK, CLERK
BY:
_...r_......~
DI.atr eouaty AUoraey
Packet Page -528-
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6/28/2011 Item 16.A.6.
AGREEMENT NO.: BDM59
COUNty NAME: Collier
AMENDMENT NO.2
EXHIBIT B
METHOD OF COMPENSAnON
This Exhibit defines the limits of compensation to be made to the contractor for the services set forth in
Exhibit "A" and the method by which payments shall be made.
1. Proiect Comoensation:
For the satisfactory performance of services detailed in Exhibit "A", the Subcontracted Transportation
Provider shall be paid up to a Maximum Amount of $ 1.753.009.00.
The remaining Project Amount shall be made up of the following limiting amounts:
$ 486.958.00 from Fiscal Year 11/12
The total amount of this contract is expected to be funded by multiple appropriations and the State of
Fiorida's performance and obligation to pay under this contract is contingent upon annual appropriation by
the Legislature.
2. PROGRESS PAYMENTS AND DISBURSEMENT SCHEDULE OF FUNDS:
The STP shall submit.monthlyinvoices in a format acceptable to the Commission.
pa ment
$ 42,272.00
42 272.00
40 241.00
$ 40,241.00
40241.00
40241.00
$ 40;241.00
40'241.00
40241.00
$ 40,241.00
$ 40,241.00
$ 40,245:00
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