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Agenda 12/16/2008 Item #16B 7 Agenda Item No. 16B7 December 16, 2008 Page 1 of 62 EXECUTIVE SUMMARY Recommendation to approve and execute Medicaid Contract Amendment Number 8 between Collier County and the Florida Commission for the Transportation Disadvantaged for a funding increase in the amount of $41,920.00 for the provision of transportation for qualified Medicaid recipients. OBJECTIVE: To acquire Board approval to execute Medicaid Contract Amendment Number 8 between Collier County and the Commission for the Transportation Disadvantaged to extend the expiration date of the agreement and increase the amount of reimbursable funding by $41,920.00 for the provision of transportation services for qualified Medicaid recipients. CONSIDERATION: Agreement #BDA80 between Collier County and the Florida Commission of the Transportation Disadvantaged was first made and signed on January I, 2005 and provided for funding to Collier County for the provision of transportation for qualified Medicaid recipients. There have been seven (7) previous amendments. The last amendment was brought to the Board of County Commissioners on September 23, 2008 to add funds and extend the expiration ofthe agreement through November 30, 2008. .'-'. The proposed Amendment Number 8 is being brought to the Board of County Commissioners to extend the Agreement from November 30, 2008 through December 31, 2008 and add $41,920.00 in additional funding for services. As the Community Transportation Coordinator for Collier County, the Board of County Commissioners is asked to sign Amendment Number 8 of Agreement #BDA80 with the Commission for the Transportation Disadvantaged for the provision of the Medicaid non-emergency transportation services in the amount of$41,920 for the month of December 2008. This will increase the FY 09 Medicaid Project revenue budget within Transportation Disadvantaged Fund (427) from $125,760 to $167,681. Any costs above the funding provided by the Commission for the Transportation Disadvantaged will be funded through General Fund (00 I) dollars which are transferred to Fund (427) in support of the Transportation Disadvantaged Program. Amendment #8 also includes an amended Exhibit B "Method of Compensation" which will replace the previously amended Exhibit B. Exhibit B breaks down the disbursement schedule of funds: $20,960.00 for the first and second payments in the month of December 2008 for a total of$41,920.00. _. FISCAL IMPACT: A budget amendment in the amount of $41,920 is required within Transportation Disadvantaged Fund (427) to recognize grant revenue and set up the proper expense appropriation in alignmcnt with this additional grant revenue. Should program operating expenses exceed the grant amount, program operations would be supported by the approved budgeted General Fund transfer to Transportation Disadvantaged Fund (427) which totals $1,776,600 for FY 09. This General Fund transfer is intended to subsidize all Transportation Disadvantaged operations. Agenda Item No. 1687 December 16, 2008 Page 2 of 62 LEGAL CONSIDERATIONS: This item has been reviewed and approved by the County Attorney's Office, is not quasi-judicial and requires no ex parte disclosure, requires only a majority vote for approval, and is otherwise legally sufficient for Board action.-SRT GROWTH MANAGEMENT IMPACT: Consistent with Objectives 10 and 12 of the Transportation Element of the Growth Management Plan. RECOMMENDATION: That the Board of County Commissioners approve the Contract #BDA80 Amendment #8 between Collier County and the Florida Commission for the Transportation Disadvantaged in the amount of $41,920.00, that the Chairman be authorized to sign the contract extension on behalf of the Board and that the Board approve any budget amendments necessary to recognize the funds received. Prepared by: Sue Faulkner, Principal Planner, Alternative Transportation Modes Attachments: (I) Contract #BDA80 Amendment #8; (2) Resolution; (3) Original Medicaid Agreement BDA80; (4) Letter from Florida Commission for the Transportation Disadvantaged - Item Number: Item Summary: Meeting Date: Page lof2 Agenda Item No. 1687 December 16, 2008 Page 3 of 62 COLLIER COUNTY BOARD OF COUNTY COMMISSIONERS 1687 Recommendation to approve and execute Medicaid Contract Amendment Number 8 between Collier County and the Florida Commission for the Transportation Disadvantaged for a funding increase in the amount of $41 ,920.00 for the provision of transportation for qualified Medicaid recipients. 12/16/2008 9:0000 AM Prepared By Sue Faulkner Transportation Services Principal Planner Alternative Transportation Modes Date 11/28/20082:41:06 PM Approved By Barbara LaPierre Transportation Services Management/Budget Analyst Traffic Operations Date 12/1/20082:56 PM Approved By Michelle Edwards Arnold Transportation Services Alternative Transportation Modes Director Date Alternative Transportation Modes 12/1/20087:51 PM Approved By Scott R. Teach County Attorney Assistant County Attorney County Attorney Office Date 12/2/200810:40 AM Approved By Norm E. Feder, AICP Transportation Services Transportation Division Administrator Date Transportation Services Admin. 12/2/200810:53 AM Approved By Brian Hancock Transportation Division Operations Support Manager Transportation Administration Date 12/3/20088:50 AM Approved By Therese Stanley Transportation Grants Coordinator Date Transportation Administration 12/3/20089:59 AM Approved By Pat Lehnhard Transportation Services Executive Secretary Date Transportation Services Admin 12/3/200810:22 AM Approved By OMB Coordinator Administrative Services Applications Analyst Information Technology Date 12/3/20084:00 PM Approved By Mark Isackson County Manager's Office Budget Analyst Office of Management & Budget Date 12/4/2008 11 :48 AM Approved By James V. Mudd County Manager Date file://C:\AgendaTest\Export\ I 18-December%20 I 6,%202008\1 6.%20CONSENT%20AGE... 12/1 0/2008 Page 2 of2 Agenda Item No. 1687 December 16, 2008 Page 4 of 62 Board of County Commissioners County Manager's Office 12/9/20086:19 PM file://C:\AgendaTest\Export\ 118-December%20 16,%202008\ 16.%20CONSENT%20AGE... 12/1 0/2008 Agenda Item No. 1687 December 16, 2008 Page 5 of 62 RESOLUTION NO. 2008- A RESOLUTION BY THE BOARD OF COUNTY COMMISSIONERS, COLLIER COUNTY, FLORIDA, APPROVING AND AUTHORIZING ITS CHAIRMAN TO EXECUTE A CONfRACT AMENDMENT BETWEEN COLLIER COUNTY AND THE FLORIDA COMMISSION FOR THE TRANSPORTATION DISADVANTAGED FOR ADDmONAL FUNDING IN THE AMOUNT OF $41,920,00 FOR TIlE PROVISION OF TRANSPORTATION FOR QUALIFIED MEDICAID RECIPIENTS. WHEREAS, at the December 16, 2008 meeting of the Board of County Commissioners, the Board approved as an agenda item Contract #BDA80 Amendment #8 between Collier County and the Florida Commission for the Transportation Disadvantaged for additional funding in the amount of $41,920.00 for the provision of transportation for qualified Medicaid recipients, and authorized the Board of County Commissioners, through its Chairman, to enter into that contract amendment with the Florida Commission for the Transportation Disadvantaged; and WHEREAS, the Florida Commission for the Transportation Disadvantaged requires the Board provide a resolution memorializing and confirming the Board's aforementioned affirmative vote to approve a contract amendment and authorization for the Chairman to execute same. NOW, THEREFORE, BE IT RESOLVED BY THE BOARD OF COUNTY COMMISSIONERS OF COLLIER COUNTY, FLORIDA, that: On December 16, 2008, the Board of County Commissioners approved by majority vote the aforementioned contract amendment and authorized its chairman, Tom Henning, to execute the contract amendment. This Resolution adopted after motion, second, and majority vote favoring same, this 16th day of December, 2008. DATED: ATTEST: DWIGHT E. BROCK. Clerk BOARD OF COUNTY COMMISSIONERS OF COLLIER COUNTY, FLORIDA By: TOM HENNING, Chairman r~f k7:::;W sufficiency: Scott R. Teach, Deputy County Attorney Agenda Item No. 1687 December 16, 2008 Page 6 of 62 STATE OF FLORIDA COMMISSION FOR THE TRANSPORTATION DISADVANTAGED MEDICAID NON-EMERGENCY TRANSPORTATION (NEl) PROGRAM SUBCONTRACTED TRANSPORTATION PROVIDER AGREEMENT AMENDMENT NO 8 AGREEMENT tI: FINANCIAL PROJECT 10#: F.E.I.D.# BDABO 41604318201 596-000-558-004 This agrwment, entllled inlo on Nowmber 30, 2008 by and between \he Stele of Florida, CommisalClfl for the Transpoltation Disadvanlaged, hereinelter called 'C~ssion' and CoMier County Board of County Commissioners, 2885 S Horseshoe Drive, Naples, FL 34104, hereinefler called .Subcontracted Transportation Provider" for Collier CoUnlylies). WIINESSETH: WHEREAS, the Commission and the Subcontracled Tra!lllpOl1alion Provider heretOfore on 11112005 entered into an Agreement, herein8ller called the Onginal Agreement; VlltiEREAS, the Commission desires to participale in all eligible ilems of dewlcpment for this projeclas outlined In \he 8Ilached "",ended Exhibft B. WHEREAS, this amendment is necessilaled by the amendment of the con~ between the Commission, and the Agency for Health Cllll! Administration for Medicaid Non-Emergency Transportation (NET) services. NOW, THEREFORE, THIS INDENTURE WfTl\IESSETH; thlll for and in consideration of the mutual benefIts to flow from oach to the other, the parties hereto agree that the above described Agreement Is to be amended .. follOWll: 1. Purpose of Ag_ment. The pUIJlO88 of \he agreement is not changed. 2. Accomplishment of the Agreement: The accompliShment of the agreement is not changed. 3. Expir'lltion of Agreement: Paragraph 2, IJ;BM of said agreement is amended to be o..,..,."Ler 31, 2008. 4. Amendment Amount: The agreement is increased by $4 1,920.00. 5. Total Project Cost The revised Total Project Cost is $2,062,276.00 6. exhibit B of said Agreement is replaced by Amended Exhibft B and is stl8ched hereto and made e pon hereof. EXCEPT as hereby modified, amended, or changed, 911 other terms of the Agl1lement dated 1/1/2005 and Amendments 1 through 7 shall remain in full !orca and effect. This amendment cannot be executed un'"". all previous amendmenlB to this Agreement have bes1 fully executed. Agenda Item No. 16B7 December 16, 2008 Page 7 of 62 In witness whereof, the parties hereto hlMl caused these presents to be executed, the day and year first above written. STAlE OF FLORIDA COMMISSION FOR THE TRANSPORTA"ON DISADVANTAGED Collier County Board of County Commissioners SIGNATURE SIGNATURE . Interim Executive Director TITLE ChAirmAn TinE Bobbv Jerniaan PRINTED NAME TOlD Henninsz: PRINTED NAME AT'I'IST DWliR'l' E. BIlOCI, llLIBK If: "~lriz72 Deputy CoUbty Alluney Agenda Item No. 1687 December 16, 2008 Page 8 of 62 AGREEMENT #:BDA80 AGREEMENT AMENDMENT DATE: November 30, 2008 ExHIBIT B AMENDMENT'S METHOD OF COMPENSATION For the satisfactory performance of the services III1d the submill81 of Encounter Data 88 oU1fined in Exhibit A, Scope of SeNices, the SUbcontllleted Transportation Provider payments shall be Iwo (2) of $20,960.00 semi-monthly. The Subcontr8CIed TIlInspolt8lion Provider lhall be paid up to e maximum amount of $2,062,276.00. The Subconlnlcled Tl1ln!Iportation Provider shatl 1WJbm~ invoices in a format acceptable to the Commission. The Subcontlllcted TIlInspoftatlon Provider will be paid aIler the Commission has received payment from the Agency for Health Care Administration. 1. ProIect C08t: The STP shllll request payment through submisllion of a properly completed invoice to the Commission Contract Menager or its designee, Once the Commission has signed the invoice for approval, the Commission shllA IUbmlt the approved invoice to the DOT Disbursement Operationl 0Ifi<:e for payment 10 the STP. ~ Collier Total Proiec:t Coat Revised: $2,020,356.00 $ 41,920.00 $2,062,276.00 Total Proiect Cost To Date: Amendment Amount 2, Disbursement Schedule of Funds MONTH December FY 08109 ~ 2008 1~ PMT $20,96000 FY 08109 MONTH December ~ 2008 2nd PMT $20,960.00 $41,92.0.00 Agenda Item No. 16B7 rce6. ber.1~ 008 .N~, f6:t' -.. '._' '.i;..' ,~ STATE OF FLORIDA COMMISSION FOR THE TRANSPORTATION DISADVANTAGED MEDICAID NON-EMERGENCY TRANSPORTATION (NET) PROGRAM SUBCONTRACTED TRANSPORTATION PROVIDER AGREEMENT Agreement No. Financial Project I. D.: F.E.I.D. No.: BDA80 41604318201 596-000-558-004 BY THIS AGREEMENT, made and entered into this 1st day of January, 2005, by and between the Commission for the Transportation Disadvantaged, hereinafter called "Commission" and Collier County Board of County Commissioners. 2685 South Horseshoe Drive Suite 211 Naoles FL 34104 hereinafter called "Subcontracted Transportation Provider" for Collier county(s) of the State of Florida. 1. SERVICES AND PERFORMANCE A. In connection with the delivery of Medicaid Non-Emergency Transportation Services, the Commission does hereby retain the Subcontracted Transportation Provider to furnish certain services, information, and items as described in Exhibits A and Band Attachments, attached hereto and made a part hereof. B. 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 upon completion or termination without restriction or limitation on their use and shall be made available, upon request, to the Commission at any time during the performance and 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 Subcontracted Transportation Provider 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 prod ucts of the Subcontracted Transportation Provider at any time. C. The Subcontracted Transportation Provider 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 Subcontracted Transportation Provider and of the details thereof. Coordination shall be maintained by the Subcontracted Transportation Provider 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. D. In the event of a dispute between the parties in connection with this Agreement, the parties agree to submit the disputed issue or issues to a mediator for non-binding mediation prior to filing a lawsuit. The parties shall agree on a mediator as agreed upon by both parties. The fee of the mediator shall be shared equally by the parties. To the extent allowed by law, the mediation process shall be confidential and the results of the mediation or any testimony or argument introduced at the mediation shall not be admissible as evidence in any subsequent proceeding concerning the disputed case. em MEDICAID NON-EMERGENCY TRANSPORTATION (NET) AGREEMENT PAGE 1 OF 53 Agenda Item No. 16B 7 ID6'~ ~fg~ E. In the event the subcontracted transportation provider is not the community transportation coordinator, in accordance with Chapter 427, Florida Statutes, in the designated service area covered by this agreement, the subcontracted transportation provider must sign a coordination contract with the community transportation coordinator in the designated service area. 2. TERM A. INITIAL TERM. This Agreement shall begin on January 1, 2005 and shall remain in full force and effect through completion of all services required on December 31,2005. 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 Subcontracted Transportation Provider 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 meetlhe criteria set forth in this Agreement for completion of this Agreement is due to events beyond the control of the Subcontracted Transportation Provider. 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. Bills for fees or other compensation for services or expenses shall be submitted in detail sufficient for a proper pre-audit and post-audit 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 five (5) 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 laller 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, pursuant to Section 215.422(3)(b), F.S., a separate interest penalty as established pursuant to Section 55.03, Florida Statutes, shall be due and payable, in addition to the invoice amount, to the Subcontracted Transportation Provider. Invoices which have to be returned to a Subcontracted Transportation Provider because of Subcontracted Transportation Provider 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. 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 eTD MEDICAID NON~EMERGENCY TRANSPORTATION (NET) AGREEMENT PAGE 2 OF 53 AIeijei~7~~ 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 1-800-848-3792. F. 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 Subcontracted Transportation Provider's general accounting records and the project records, together with supporting documents and records, of the Subcontracted Transportation Provider and all subcontractors performing work, as provided in Exhibit A, Scope of Work and all other records of the Subcontracted Transportation Provider and subcontractors considered necessary by the Commission for a proper audit of project costs. G. 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 wrillen, 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 pnor to entering into any such contract or other binding comm ilment 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 State of Florida's performance and obligation to pay under this Agreement is contingent upon an annual appropriation by the Legislature. 4. INDEMNITY, PAYMENT FOR CLAIMS AND INSURANCE A. INDEMNITY: To the extent allowed by Section 768.28, Florida Statutes, and without waiving any defense of sovereign immunity or increasing limits of liability as set out in that statute, the Subcontracted Transportation Provider shall indemnify and hold harmless the Commission, the Department of Transportation and the Agency for Health Care Administration, their officers and employees from iiabilities, damages, losses and costs, including but not limited to, reasonable attorney's fees, to the extent that such liabilities, damages, losses and costs are a result of the negligence, recklessness, or intentional wrongful misconduct of the Subcontracted Transportation Provider and persons employed by or utilized by the Subcontracted Transportation Provider in the performance of this Agreement. B. PAYMENT FOR CLAIMS: The Subcontracted Transportation Provider guaranties the payment of all just claims for materials, supplies, toois, or labor and other just claims against the Subcontracted Transportation Provider or any subcontractor, in connection with the Agreement. The Commission's final acceptance and payment does not release the Subcontracted Transportation Provider's responsibilities until all such claims are paid or released. C. LIABILITY INSURANCE: The Subcontracted Transportation Provider shall carry and keep in force during the period of this Agreement a general liability insurance policy or policies with a company or companies authonzed to do business in Florida, affording public liability insurance in accordance with Rule Chapter 41-2.006, Florida Administrative Code. If the Subcontracted Transportation Provider 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 CTO MEDICAID NON-EMERGENCvTRANSPORTATION (NET) AGREEMENT PAGE 3 OF 53 Agenda Item No. 16B7 Ie~~ 3~~~~ tort actions, the Subcontracted Transportation Provider shall provide to the Commission a Certificate of Self-Insurance upon execution of this Agreement. D. WORKERS' COMPENSATION. The Subcontracted Transportation Provider 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 Subcontracted Transportation Provider 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 A. The Subcontracted Transportation Provider 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 Subcontracted Transportation Provider in conjunction with this Agreement. Failure by the Subcontracted Transportation Provider to grant such public access shall be 9rounds for immediate unilateral cancellation of this Agreement by the Commission. B. The Subcontracted Transportation Provider 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. C. 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 on a contract to provide any goods or services to a public entity, may not submit a bid on a contract with a publiC entity for the construction or repair of a public building or publiC work, may not submit bids 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 pubiic 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 the convicted Vendor list. D. An entity or affiliate who has been placed on the discriminatory Vendor list may not submit a bid on a contract to provide any goods or services to a public entity, may not submit a bid on a contract with a public entity for the construction or repair of a public building or public work, may not submit bids 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. E. The Commission shall consider the employment by any Subcontracted Transportation Provider of unauthorized aliens a violation of section 274A(e) of the immigration and Nationality Act. If the Subcontracted Transportation Provider knowingly employs unauthorized aliens, such violation shall be cause for unilateral cancellation of this Agreement. 6. TERMINATION AND DEFAULT CTO MEDICAID NON-oEMERGENCY TRANSPORTATION (NET) AGREEMENT PAGE 4 OF 53 Agenda Item No. 16B7 rc~~er 16,2008 Oare,f62 A. Either party may cancel this agreement with thirty (30) calendar days written notice, without cause. The Commission reserves the right to terminate or cancel this Agreement with thirty (30) calendar days written notice in the event an assignment is made for the benefit of creditors. B. If the Commission determines that the performance of the Subcontracted Transportation Provider is not satisfactory, the Commission shall have the option of (a) terminating the Agreement with at least thirty (30) calendar days written notice, or (b) notifying the Subcontracted Transportation Provider 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 lime, as long as the time period is at least thirty (30) calendar days. C. If the Commission requires termination of the Agreement for reasons other than unsatisfactory performance of the Subcontracted Transportation Provider, the Commission shall notify the Subcontracted Transportation Provider of such termination with at least thirty (30) calendar days written notice, with instructions as to the effective date of termination or specify the stage of work at which the Agreement is to be terminated. D. If the Agreement is terminated before performance is completed, the Subcontracted Transportation Provider shall be paid only for that work satisfactorily performed for which costs can be substantiated. Such payment, however, may not exceed an amount which is the same percentage of the Agreement price as the amount of work satisfactorily completed is a percentage of the total work called for by this Agreement. All work in progress shall become the property of the Commission and shall be turned over promptly by the Subcontracted Transportation Provider. 7. ASSIGNMENT AND TRANSFER A. The Subcontracted Transportation Provider shall maintain an adequate and competent staff so as to enabie Subcontracted Transportation Provider 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 Subcontracted Transportation Provider is fully responsible for satisfactory completion of all subcontracted work. The Subcontracted Transportation Provider, however, shall not assign or transfer any work under this Agreement without the prior written consent of the Commission. 8. AGREEMENT AMOUNT AND PAYMENT A. For the satisfactory performance of the services and the submittal of Encounter Data as outlined in Exhibit A, Scope of Services, the Subcontracted Transportation Provider shall be paid up to a maximum amount of $ 514,259.00 . The Subcontracted Transportation Provider shall submit monthly invoices in a format acceptable to the Commission. The Subcontracted Transportation Provider will be paid, after the Commission has received payment from Agency for Health Care Administration, in equal payments per month, unless otherwise approved by the Commission's Executive Director. The Subcontracted Transportation Provider shall request payment through submission of a property completed invoice to the Commission's Executive Director, in accordance with Exhibit 8, Method of Compensation. B. The Subcontracted Transportation Provider must submit the final invoice for payment to the Commission no more than ninety (90) days after the Agreement ends or is terminated. If the Subcontracted Transportation Provider falls to do so, all right to payment is forfeited and the Commission will not honor any requests submitted after the em MeOICAID NON-EMERGENCY TRANSPORTATION (NET) AGREEMENT PAGE 5 OF 53 Agenda Item No. 16B7 December 16, 2008 1 t,9S362 aforesaid time period. Any payment due under the terms of this Agreement may be withheld until all reports due from the Subcontracted Transportation Provider and necessary adjustments thereto have been approved by the Commission. C. The State of Florida'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. 9. MISCELLANEOUS A. The Subcontracted Transportation Provider and its empioyees, agents, representatives, or subcontractors are not employees of the Commission or the State of Florida as a result of this Agreement. The Commission and the State shall not be bound by any unauthorized acts or conduct of the Subcontracted Transportation Provider or its employees, agents, representatives, or subcontractors. Subcontracted Transportation Provider agrees to include this provision in all its subcontracts under this Agreement. B. 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. C. 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. D. 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 confiict with any law, 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 heid to be invalid. E. This Agreement shall be governed by and construed in accordance with the laws of the State of Florida. F. In any legal action related to this Agreement, instituted by either party, the Subcontracted Transportation Provider hereby waives any and all privileges and rights It may have under Chapter 47 and Section 337.19, Fiorida Statutes, relating to venue, as it now exists or may hereafter be amended, and any and all such privileges and rights it may have under any other statute, rule, or case law relative to venue, including, but not limited to those grounded on convenience. Any such legal action may be brought in the appropriate Court in any county chosen by the Commission and in the event that any such iegal action is filed by Subcontracted Transportation Provider, Subcontracted Transportation Provider hereby consents to the transfer of venue to the county chosen by the Commission upon the Commission filing a motion requesting the same. G. Time is of the essence as to each and every obligation under this Agreement. H. The following Exhibits and Attachments are incorporated and made a part of this Agreement: em MEDICAID NON-EMERGENCY TRANSPORTATION (NET) AGREEMENT PAGE 6 OF 53 Agenda Item No. 16B7 Decl~~61f5 Exhibit A Exhibit B Attachment 1 Scope of Services Method of Compensation Certification Regarding Health Insurance Portability and Accountability Act of 1996 (HIPPA) Compliance Drug-Free Workplace Certification Financial and Compliance Audit Glossary Attachment 2 Attachment 3 Attachment 4 IN WITNESS WHEREOF, the parties have executed this Agreement by their duly authorized officers on the day, month and year set forth above. Florida Commission for the Transportation Disadvantaged ~ Name Name Title C .'Pc...e.l ,-i'iVl.. 'D.1f C'Av-- Tille sufficiency ttorney :'HI~J~ ATTEST? ..-.~c. DWIGttT E{, ROCK,q;E1~ . ,k- eputy Cle'rf<'. . ..') Atust ;;z to. t.hilrtllln' s sl9"ature ooly. CTD MEDICAID NON.EMERGENCY TRANSPORTATION (NET) AGREEMENT PAGE 7 OF 53 Agenda Item No. 16B7 1l5~B63g~ AGREEMENT#:~ EXHIBIT A SCOPE OF SERVICES A. SERVICES TO BE PROVIDED 1. GENERAL The Florida Commission for the Transportation Disadvantaged (Commission) enters into this Agreement with the Subcontracted Transportation Provider to give the Subcontracted Transportation Provider responsibility for the administration and provision of non-emergency transportation (NET) services to eligible Medicaid beneficiaries. The Subcontracted Transportation Provider shall comply with all the provisions of this Agreement and rts amendments, if any, and shall act in good faith in the performance of the Agreement provisions. The Subcontracted Transportation Provider agrees to comply with all applicable federal and state laws and regulations as spec~ied in the Applicable Laws and Regulations Section. The Subcontracted Transportation Provider must ensure that all transportation operators under agreement or contract abide by the provisions of this Agreement, and meet all state and local licensing and insurance requirements. The Agreement may be subject to changes in federal and state law, rules or regulations. The Subcontracted Transportation Provider agrees that failure to comply with the provisions of this Agreement may result in sanctions and/or termination of the Agreement in whole or in part. The Subcontracted Transportation Provider must offer, maintain, and satisfactorily deliver the following services: a. Recruitino and Neootiatino with Transoortation Ooerators. Establish a network of non- emergency transportation operators to deliver transportation and negotiate Individual transportation rates with each transportation provider. b. Pavment Administration. Provide payment to each transportation prOVider based on authorized services rendered, in accordance with section 215.422, Fiorida Statutes. c. Gatekeeoina. Determine beneficiary eligibility; assess beneficiary need for NET services; determine the most appropriate transportation method to meet the beneficiary's need, including any special transport requirements for beneficiaries who are medically fragile or who have physical or mental impairments; and provide education to beneficiaries on the use of NET services. d. Reservations and Trio Assionments. Assure that scheduling and dispatChing are consistent with the most appropriate mode of transport that meets the needs of the beneficiary. e. Qualilv Assurance. Provide assurance that transportation operators meet health and safety standards for vehicle maintenance, operation, and inspection: driver qualifications and training: beneficiary problem/compialnt resolution; and the delivery of courteous, safe, and timeiy transportation services. f. Encounter Data Collection. The Subcontracted Transportation Provider must maintain an extensive secure database capable of collecting and holding, for each transport, the data elements outlined in this Agreement. CTD MEDICAID NON~EMERGENCY TRANSPORTATION (NET) AGREEMENT PAGE 8 OF 53 Agenda Item No. 16B7 Del~e 1B~ g. Administrative OversiohtlReoortino. Responsibility for the management of overall day-to-day operations necessary for the delivery of NET services and the maintenance of appropriate records and systems of accountability to report to the Commission and respond to the terms of the Agreement. 2. MINIMUM STANDARDS At a minimum, the Subcontracted Transportation Provider must: a. Validate that all paid transportation services are properly authorized and actually rendered; b. Transmit to the Commission encounter data for all trips made by Medicaid beneficiaries in accordance with Commission specifications in the Reports Section; c. Adhere to the policy and procedure manual developed by the Commission to prohibit fraudulent activity by the Subcontracted Transportation Providers and Medicaid beneficiaries and fulfill the Commission's reporting requirements regarding such activity; d. Adhere to the policy and procedure manual that provides policy clarity and guidance for the Commission, Subcontracted Transportation Provider, transportation operators, Medicaid beneficiaries, and the general public specific to the details contained in this Agreement; e. Subject to the provisions of Section 768.28, F.S., indemnify the Commission against any causes of actions or claims of payment relating to this Agreement brought by a Subcontracted Transportation Provider, or Medicaid beneficiary; f. Utilize a uniform contracting, billing and accounting system established by the Commission to include subcontracts with transportation operators and monitor their compliance; and g. Establish service agreements with transportation operators, as necessary, and monitor their compliance with the Monitoring Plan Section, and all other applicable sections of this Agreement. 3. ADMINISTRATION AND MANAGEMENT The Subcontracted Transportation Provider shall be responsible for the administration and management of all aspects of this Agreement. Any delegation of activities does not relieve the Subcontracted Transportation Provider of this responsibility. This includes all subcontracts, employees, agents and anyone acting for or on behalf of the Subcontracted Transportation Provider. 4. DATA MANAGEMENT The Subcontracted Transportation Provider must maintain a management information system (extensive database) for storage of transportation utilization, encounter, complaint/grievance, and financial data. The Subcontracted Transportation Provider must possess the capability to derive detailed reports from such systems and be capable of retrieving data as requested by the Commission as specified the Reports Section. 5. STAFF REQUIREMENTS The Subcontracted Transportation ProVider must be prepared to implement all aspects of the work outlined in this Agreement within the stated time frames. Staffing leveis must be sufficient to complete all of the responsibilities presented in the Agreement. 6. BENEFICIARY ELIGIBILITY 6.1 Elioible Beneficiaries CTO MEDICAID NON-EMERGENCY TRANSPORTATION (NET) AGREEMENT PAGE 90F 53 Agenda Item No. 16B7 Decei~~ ~~ The categories of eligible beneficiaries authorized to utilize transportation services as specified by this Agreement include: a. Low Income Families and Children; b. Foster Care Children; c. Sixth Omnibus Budget Reconciliation Act (50BRA) Children and Pregnant Women; d. Supplemental Security Income (551) Related Medicaid Beneficiaries; e. 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.); f. Title XXI MediKids - A Title XXI health insurance program that provides certain children, who are not Medicaid eligible, with Medicaid benefits; g. 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; h. Presumptively Eligible Pregnant Women - This program allows staff at County Health Departments, Regional Perinatal 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 available to support these visits; and 6.2 Ineliaible Beneficiaries The following categories describe beneficiaries who are not eligible to receive state plan transportation services: a. HMO beneficiaries - Beneficiaries who are members of a Medicaid HMO that provides transportation; b. Beneficiaries who have their own means of transportation; c. QI1 and QI2 beneficiaries are not eligible for any Medicaid service except for Medicaid payment of their Medicare premiums, deductibles and coinsurance; d. HMO QMB and QMBR beneficiaries are not eligible for any Medicaid service except for Medicaid payment of their Medicare premiums, deduclibies and coinsurance; e. HMO 5LMB beneficiaries are not eligible for any Medicaid service except for Medicaid payment of their Part B Medicare premium; f. HMO Beneficiaries with legal alien status have access to emergency services only and are not eligible for non-emergency transportation services; g. Vehicle ownership or access; h. Qualified (Medicare) Individuals Level 1 (QI1) and Level 2 (012); i. Oualified Medicare BenefiCiaries (OMB) and Quaiified Medicare Beneficiaries Renal Dialysis (OMBR); J. Special Low Income Medicare Beneficiaries (SLMB); and em MEDICAID NON-EMERGENCY TRANSPORTATION (NET) A.GREEMENT PAGE 10 OF 53 Agenda Item No. 16B7 Decei~6 ~3 k. Legal Aliens 6.3 Beneficiarv Enrollment and Education Once the Department of Children and Families or the Social Security Administration has confinned that an individual is eligibie for Medicaid, the individual upon enrollment shall be issued a Medicaid identification number. The date on which the individual becomes eligible for Medicaid is the beginning date of eligibility for transportation services for individuals that meet the specifications outlined in Eligibie Beneficiaries Section. The beneficiary may arrange transportation services w~h the Subcontracted Transportation Provider upon enrollment. 6.4 Education Plan The Subcontracted Transportation Provider will assist in implementing the education and outreach plan for Medicaid beneficiaries, regarding NET services. Each provider will be required to provide current Medicaid beneficiaries with the following information within 30 days of execution of the service agreements: a. Contractor contact information by county b. Process to apply for Medicaid transportation c. Medicaid application d. Rights and responsibilities e. No show and cancel policy f. ComplainUgrievance policy g. Denial of service process The Subcontracted Transportation Provider will provide notification to transportation eligible beneficiaries and make oral interpretation services availabie to beneficiaries, free of charge, in areas where twenty (20) percent or more of the population is non-English speaking. The beneficiary is not to be charged for interpretation services. The Subcontracted Transportation Provider shall notify beneficiaries that oral interpretation is available for any language and written information is available in prevalent languages, and how to access those services. Written material must be available in alternative formats and in an appropriate manner that takes into consideration the special needs of those who, for example, are visually limited or have limited reading proficiency. All transportation eligible beneficiaries must be informed that information is avaiiable in alternative formats and how to access those formats. All correspondence developed by the Subcontracted Transportation Provider, intended for Medicaid beneficiaries only and sent via mass mail out, must be submitted to the Commission prior to mailing. 7. COVERED SERVICES In accordance with federal regulations (42 CFR 431.53), NET services are defined as medically necessary transportation for any recipient and personal care attendanUescort, if required, who have no other means of transportation available to any Medicaid com pensable service for the purpose of receiving treatment, medical evaiuation, or therapy. Non-emergency transportation services must be provided to eligible Medicaid recipients for Medicaid compensable medical appointments by utilization of the modes of transportation specified in the sections below. eTD MEDICAID NON.EMERGENCY TRANSPORTATION (NET) AGREEMENT PAGE 11 OF 53 Agenda Item No. 16B7 December 16, 2008 IP5aj2 7.1 Multiload Vehicles A multilDad vehicle is a multiple passenger vehicle, typically used fDr NET services. It is apprDpriate only for ambulatory or nDn-ambulatory 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. 7.2 Wheelchair Vehicle A wheeichair vehicle is a motorized vehicle equipped specifically with certified wheelchair lifts Dr other equipment designed tD carry persons in wheelchairs and scooters, or with mDbility impairments. Wheelchair vehicles may be used for the provision af ambulatory transportatiDn services tD maximize capacity. Wheelchair services can only be used in non-emergency situations and are limited to use by: a. Beneficiaries who can sit upright and have no acute medical problems that require them tD remain in a lying pDsitiDn; b. Beneficiaries who are continually cDnfined to a wheelchair; c. Beneficiaries with severe mobility handicaps that prevent them from using private, public or taxi transportatiDn; d. Beneficiaries who are semi-ambulatDry or homebDund, and can accomplish limited ambulatDry movement with the assistance of a special ambulatory aid (like a walker or cane); or e. Beneficiaries whD use a mobillly device. In questionable cases, the need for transport by a wheelchair vehicle may require veriflcatiDn or dDcumentatiDn by a medical professional. 7.3 Stretcher Vehicie A stretcher vehicle is an enclosed vehicle that accommodates a liller and is equipped with IDcking devices tD secure the Iiller during transit. Stretcher service is required fDr beneficiaries who are nDn-ambulatDry and need assistance tD be transpDrted to and from the vehicle and the health care provider in a reclining position. No flashing lights, sirens, Dr emergency equipment are required. Stretcher services can only be provided in nDn- emergency situations and are limited tD use by: a. Beneficiaries who need to remain In a lying pDsition but do not require the administration of life SUPPDrt; b. Beneficiaries who have severe mobility disabilities that render them unable tD sit in an upright position for prDlonged periDds Df time; or c. Beneficiaries who have begun self-administered home oxygen prior tD transport may continue administratiDn during transpDrt. HDwever, nD new regimen Df oxygen therapy may be started during transpDrt, nor may the attendant employed by the transportation service administer oxygen. In questionable cases, the need fDr transpDrt by a stretcher vehicle may require verification or documentation by a medical professional. CTD MEDICAID NON-EMERGENCY TRANSPORTATION (NET) AGREEMENT PAGE 12 OF 53 Ag~ne~1~;~g3 7.4 Public Transoortation In some areas of Florida, public transportation may be a viable and cost-effective altemative to more traditional and expensive forms of non-emergency transportation available to the Subcontracted Transportation Provider. Public transportation is transportation available, through the payment of a rider fee, to the general public. Public transportation may be provided by transit companies, county or city governments or federally funded transportation authorities. This type of transportation may be used to provide a full trip or portion of a trip to or from a health care service. 7.5 Over-the-Road Bus An over-the-road bus is traditionally used to traverse long distances such as cross-county and cross-state travel. 7.6 Private and Volunteer Transoortation Private and volunteer travel is provided by individuals or agencies that receive no compensation or payment other than minimal reimbursement for mileage for the provision of these transportation services. The Subcontracted Transportation Provider may arrange transportation with the volunteer or organization directly, including scheduling appointments and notifying beneficiaries of arrangements. Additionally, the Subcontracted Transportation Provider shall be responsible for payment of the minimai mileage of the private or volunteer transportation. The Subcontracted Transportation Provider may develop private and volunteer services as part of its responsibility to provide NET services in accordance with the Agreement. Use of private and volunteer transportation does not alleviate the Subcontracted Transportation Provider's responsibility to assure the safety, comfort and appropriate mode of transportation consistent with the beneficiary's health care status. The Subcontracted Transportation Provider must ensure that all individual and agency vehicles used to provide private and volunteer transportation are properly licensed and insured. 7.7 Escort Services An escort is an individual whose presence is required to assist a beneficiary during transport and at the place of treatment. The escort leaves the vehicle at its destination and remains with the beneficiary. An escort must be of an age of legal majority recognized under Florida law. The Subcontracted Transportation Provider must allow, without charge to the escort or beneficiary, one (1) escort to accompany a beneficiary or group of beneficiaries who are blind, deaf, mentally disabled, or under twenty-one (21) years of age, when the beneficiaries are transported to receive Medicaid covered services. 7.8 Commercial Air Carrier Transoortation Commercial air carrier transportation may be provided where appropriate to provide the necessary transportation to eligible Medicaid beneficiaries. If a beneficiary Is in need of transportation outside of the state or must be transported a long distance due to the location of specialized medical services, the Subcontracted Transportation Provider shall work directly with the beneficiary and the Commission to determine that such services are not available in the beneficiary's locality and shall schedule the commercial air carrier transport and purchase such services as needed. Prior authorization is required by the Commission for commercial air carrier transportation. em MEDICAID NON-EMERGENCY TRANSPORTATION (NET) AGREEMENT PAGE 13 OF 53 Agenda Item No. 16B7 December 16, 2008 Ia62B:3 The Subcontracted Transportation Provider must provide documented proof to the Commission prior to transport that necessary medicai services cannot be obtained within the beneficiary's service area and that commercial air carrier transportation is the only viable option. The Subcontracted Transportation Provider has authority under this Agreement to deny a request to cover commercial air carrier transport but must submit a written explanation to the Commission of how the beneficiary will be transported and what formed the basis for the denial. The Subcontracted Transportation Provider must foilow the procedures in Denial of Service Section, and must notify the beneficiary of his right to appeal as set forth in the Beneficiary Appeals Notice Section. The Subcontracted Transportation Provider may purchase any and all commercial air carrier transports when it is deemed to be the appropriate level of transport for the beneficiary. The Subcontracted Transportation Provider must utilize the commercial air carrier transportation policy established by the Comm ission that directly defines the policies and procedures for eligibility, payment and selection of the commercial air carrier mode of transportation. 7.9 Special Covered Services The Subcontracted Transportation Provider must authorize and supply transportation for Medicaid beneficiaries when: a. The Agency for Health Care Administration has begun a closure or decertification of a nursing facility and transportation is needed for the Medicaid beneficiary to be transported from one nursing facility to another or to an alternate iiving arrangement; or b. The 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 transportation is needed from one nursing facility to another nursing facility. 7.10 Excluded Services The Subcontracted Transportation Provider is not required to ensure the provision of the following exciuded services: a. Stretcher Van OxvGen Administration. Stretcher van providers are not required to be equipped to provide and administer oxygen to a beneficiary during a transport. Oxygen provided and administered by the beneficiary is appropriate for NET if no other medical equipment or medical care is required en route. Stretcher van providers are aiso not required to be equipped to maintain a ventilator or care for a beneficiary who is ventilator-dependent during a transport. If a beneficiary has a ballery-operated ventilator and an individual who has been trained to provide ventilator care wiil travel with the beneficiary to a doctor's office or to other medically necessary health care services, the beneficiary is eligible for NET if no other medical equipment or care is required en route. In questionable cases, the need for transport by a stretcher vehicle may require verification or documentation by a medical professional. b. Ground Ambulance Transportation. NET services do not include ground ambulance transportation uniess the ground ambulance is under contract as a stretcher or wheelchair transportation proVider as specified in the Wheelchair Van Section, or eTO MEDICAID NON-EMERGENCY TRANSPORTATION (NET) AGREEMENT PAGE 14 OF 53 Agend~em~. 16B7 Dece b 160011 a e Df:;;l the Stretcher Van Section. Ground ambulance transportation Is also excluded If a local governmental ordinance mandates non-emergency stretcher transportation services be provided in a ground ambulance vehicle. c. Air Ambuiance Transportation. NET services do not include air ambulance transportation. d. Basic Life Support IBLSI and Advance Life Support IALSl Transportation. For the purpose of this Agreement, NET services do not include the arrangement, coordination or delivery of transportation services for beneficiaries who require the administration of any level of life support services (ALS or BLS) during transport. 7.11 Special Exclusions The Subcontracted Transportation Provider is not responsible for the coverage of: a. The cost of transporting a Medicaid beneficiary back to Fiorida when that beneficiary has traveled outside of Florida and requires hospitalization and/or subsequent nursing facility care, unless a Medicaid beneficiary has traveled for the purpose of receiving a Medicaid compensable service; b. Transportation for therapeutic home visits to or from a hospital, hospice, nursing home, ICFIDD, state or other private or public institution; c. Transportation of a 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 beneficiary or a member of the beneficiary's family; 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 that are available to the general public free of charge; k. Transportation that is aiready covered by a per diem rate and included in a corresponding cost report. Transportation services are included in an ICF/DD's per diem; I. Salaries, fees, or other compensation for professional health care attendants; or m. Transportation of a Medicaid beneficiary to a service covered by a Home and Community-Based Service (HCBS) waiver and transportation is provided and can be billed to the waiver or is included in the reimbursement for the waiver service. 8. Geooraphical Considerations CTD MEDICAID NON-EMERGENCY TRANSPORTATION (NET) AGREEMENT PAGE 15 OF 53 Ag~ned~e~~ ~~ The Subcontracted Transportation Provider is responsible for the provision of transportation services to eligible Medicaid beneficiaries to or from a stated point of origin or to or from specific Medicaid compensable services at the request of the beneficiary or person acting on behalf of the beneficiary. Transportation outside the area customarily used for health care services by the beneficiary's immediate community is to be provided only when sufficient medical resources are not available in the area or when a health care provider has referred the beneficiary to medically necessary health care services outside of the immediate community. The Subcontracted Transportation Provider is responsibie for out-of-state NET services to and from health care providers. The Subcontracted Transportation Provider must utilize the policies and procedures elaborating on how services by ground or air beyond sixty (60) miles of the Florida State border shall be coordinated and purchased. 8.1 Residence and Closest Medical Facilitv The Subcontracted Transportation Provider is not responsible for providing transportation when the health care provider is located outside a beneficiary's community/vicinity if other similar and appropriate health care providers that offer the same or similar services appropriate for the beneficiary's needs and who will accept the beneficiary as a patient are located closer to the beneficiary's residence. The Subcontracted Transportation Provider may request a written referral signed by the referring medical provider and attesting to the need for travel outside the beneficiary's region of residence. Beneficiaries who are denied NET services must be given a written notice of the reason for denial and appeal rights. See Beneficiary Appeals Notice Section. The referral form should be uniform throughout the state and will be subject to approval by the Commission. 9. Subcontracted Transportation Provider Minimum Performance Standards The following sections describe the minimum standards required of the Subcontracted Transportation Provider. 9.1 Beneficiary Access The Subcontracted Transportation Provider shall: a. Respond to transportation inquiries and requests made by beneficiaries residing in the service area as provided for in this section; b. Maintain a business location in the service area or assign a representative whose responsibility is the service area; c. Provide notification to beneficiaries and make oral interpretation services available to beneficiaries, free of charge, in areas where twenty (20) percent or more of the population is non-English speaking; d. Develop wrillen procedures for dealing with beneficiary complaints internally; see Beneficiary Appeals Notice Section e. Train customer service representatives in the area of dispute resolution; f. Establish and maintain an electronic mail (e-mail) identity; g. Maintain a toll-free teiephone access number for scheduling NET specified as follows: Monday through Friday, eight (8) hours a day except nine (9) state holidays: New Year's Day, Martin Luther King's Day, Memorial Day, Independence Day, Labor Day, Veterans' Day, Thanksgiving Day and the Friday following, and Christmas Day. ern MEDICAIO NON-EMERGENCY TRANSPORTATION (NET) AGREEMENT PAGE 16 OF 53 Agenda Item No. 16B7 December 16, 2008 fab2~fj h. Provide thirty (30) calendar days written notice of any other intended days of closure. i. Provide twenty-four (24) hour toll-free telephone access to information on how to access transportation on holidays, weekends, and after business hours for urgent care, hospital discharge, or Incidents beyond the control of the beneficiary or facility. In addition, access must be provided to a beneficiary who has a return pick-up after business hours if agreed to in advance by the Subcontracted Transportation Provider and the beneficiary. j. Provide eligible transportation when trip requests are submitted no less than seventy-two (72) hours in advance. k. Provide adequate staff and telephone lines to allow ninety (90%) percent of all incoming calls, Including TTY calls, to be answered within an average of three (3) minutes. A phone answering machine or electronic voice mail may be used when offered as an option to the beneficiary; however, beneficiaries shall be given the option of staying In queue or reaching a staff person. I. Ensure the average queue time for a hearing-impaired system such as Florida T ele- Reiay Services or TTY calls shall not exceed three (3) minutes. m. Train staff to operate a hearing-impaired system such as Florida Tele-Reiay Services or TTY equipment to ensure service levels similar to non-hearing impaired beneficiaries are met. 9,2 Elioibilitv Screenlno The Subcontracted Transportation Provider shall: a. Review and document benefiCiary eligibility to receive transportation services provided by the contract. b. Review that the individual is currently eligible for services by relying upon the eligibility information supplied by one of the following: 1. Presentation of a valid medical card (Medicaid Gold Card) when smart card systems are in place and set to read the Medicaid Gold Card and capable of obtaining beneficiary eligibility information; 2. Documentation from a Medicaid Eligibility Verification System (MEVS) Vendor; 3. Documentation by FAXBACK with the Medicaid fiscal agent, or 4. Documentation by other Commission approved sources. c. Regularly verify that the beneficiary Is eligible for transportation services. Screening shall ensure: 1. Verification from the requesting beneficiary that they have no other available means of transportation to medical services; 2. That the requested transportation Is not covered by other programs or funding; 3. That the requested transportation is to the nearest Medicaid provider of covered services unless otherwise exempt by Medicaid rules or policy (see Applicable Laws and Regulations Section); 4. That authorization for requested transportation shall only be granted for eligible Medicaid services required by the beneficiary, eTD MEDICAID NON-EMERGENCY TRANSPORTATION (NET) AGREEMENT PAGE 17 OF 53 AgI:da~em No. 16B7 ec bf}1~008 aa;:J'f 62 5. That private and volunteer transportation or gas vouchers are utilized where appropriate to ensure cost-effective transportation. When private or volunteer mileage reimbursement, or gas vouchers, are utilized, the Subcontracted Transportation Provider shall have on record: the driver's license, current vehicle registration and obtain documentation of, or proof of, insurance of the vehicle operator. When documentation of the above- listed information is accepted in lieu of copies of the documents, the Subcontracted Transportation Provider shall obtain copies of these documents as soon as practicable; and 6. That requested transportation is necessary to the destination and to return from services as authorized under the Agreement. 9.3 Transoortation Standards The Subcontracted Transportation Provider shall: a. Arrange for the most appropriate, lowest cost transportation services available to beneficiaries who reside in the service area specified by the Agreement; b. Comply with standards in accordance with Chapter 427, Florida Statutes and Ruies 41-2 and 14-90, Florida Administrative Code. 9.4 Aooropriate Level of Transportation The Subcontracted Transportation Provider shall refer emergency calls to 911, or an ambulance, as necessary. The Subcontracled Transportation Provider and/or its Subcontracted Transportation Providers shall maintain a local referral source wrth whom to discuss emergency situations. Appropriate levels of transportation consist of the following: a. Door-ta-door or curb-to-curb services are appropriate for persons whose physical or mental limitations render them unable to use fixed route transit or other methods of public transport. b. The Subcontracted Transportation Provider shall use the most cost effective (lowest cost appropriate) available transportation, based on the medical condition of the beneficiary. c. Subcontracted transportation providers shall use public transit where available. Utilization shall be in compliance with ADA requirements. A beneficiary may be asked to fill out an ADA certification form to verify the beneficiary's mobility limitations or may be required to undergo an assessment process. The Subcontracted Transportation Provider may also require documentation by the benefiCiary's physician. 9.5 Service Area a. The Subcontracted Transportation Provider may provide service to residents of other service areas in response to requests of the Subcontracted Transportation Provider responsibie for those service areas, if an agreed upon rate is determined by both parties. b. Other service areas include: 1. Medical facilities or services available in other communities or contiguous areas not available in the beneficiary's service area but em MEDICAID NON~EMERGENCY TRANSPORTATION (NET) AGREEMENT PAGE 18 OF 53 Agenda Item No. 16B7 Dre1j:s~ routinely used by residents of the service area who need medical care not provided within their service area; and 2. Medical facilities or services outside the service area that are closer to the beneficiary's residence than the same type of services within their service area. c. The Subcontracted Transportation Provider may arrange destination and retum trips outside the Subcontracted Transportation Provider's contracted service area when required services are not available within the contracted service area, but are within the state or designated border areas. 9.6 Activitv Documentation The Subcontracted Transportation Provider and/or its Subcontracted Transportation Providers must retain, and make available for audit purposes, the following records for five (5) years aller termination of the Agreement or for the duration any audit that extends past five (5) years. The Subcontracted Transportation Provider shall: a. Maintain beneficiary eligibility data. Eligibility data shall be provided to the Subcontracted Transportation Provider and its Subcontracted Transportation Provider by MEVS or FAXBACK or other similar provider. The Subcontracted Transportation Provider shall use this data to confirm eligibility of persons requesting or receiving transportation services. b. Protect the confidentiality of the beneficiary's records. c. Keep vehicle iogs on file for every transport for five (5) years after the Agreement ends, in accordance with state law. d. Maintain encounter data for each one-way trip provided as speCified below: 1. Subcontracted transportation provider's unique identification number assigned by the Commission; 2. Date the service was provided in month, day, year format: MM/DDNYYY; 3. Beneficiary's last name, first name, and middie initial exactly as it appears on the gold, plastic Medicaid 10 Card or other proof of eligioility; 4. Beneficiary's 10-digit Medicaid ID Number. Do not provide the number on the Medicaid ID card. This is a card control number, not the beneficiary's Medicaid ID number; 5. Total miles of trip provided; 6. Total cost of trip provided; 7. Pickup address including the street name and number, apartment number, and city; 8. Time that the beneficiary was picked up. Use military (24-hour clock) time. For example: 3:35 p.m. = 1535; CTD MEDICAID NON~EMERGENCY TRANSPORTA.TION (NET) AGREEMENT PAGE 19 OF 53 Agenda Item No. 16B7 Del~8 ffj 9. Complete address of the provider destination including the street name and number, apartment number, and city; 10. Identify trips that were not provided due to beneficiary no-shows; 11 . Medical necessity of the trip; 12. Origin of transport code: physician's office (P), clinic (C), laboratory (L), hospital (H), nursing home (N), dialysis (D), or other diagnostic or therapeutic (0), or residence (R); 13. Destination of transport code: physician's office (P), clinic (C), laboratory (L), hospital (H), nursing home (N), dialysis (D), or other diagnostic or therapeutic (0), or residence (R); 14. Mode of transportation used: multiload vehicie (MV), public transportation (PT), private volunteer transport (VT), wheelchair (WC), Stretcher (ST), over-the-road bus (OB), or commercial air carrier (CA); and e. Enter encounter data requirements for each bus ticket or pass issued, in a format provided by the Commission. 9.7 Service Standards a. All Subcontracted Transportation Providers must comply with standards in accordance with Chapter 427; Florida Statutes and Rules 41-2 and 14-90, Florida Administrative Code. These standards include, but are not limited to, Drug and Alcohol Testing, Safety Standards, Driver Accountability and, Driver Conduct. b. All Subcontracted Transportation Providers must maintain vehicles and equipment in accordance with manufacturer's state and federal safety and mechanical operating and maintenance standards for any and all vehicles and models used for transportation of Medicaid beneficiaries under this Agreement. c. The Subcontracted Transportation Provider shall comply with all applicable slate and federal laws as provided in Section 30.29, Applicable Laws and Regulations, including, but not limited to, the Americans with Disabilities Act (ADA) and the Federal Transit Administration (FT A) regulations. d. 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 shall be removed from service immediately and shall be re-inspected before it is eligible to be used to provide transportation services for Medicaid beneficiaries under the Agreement. e. Vehicles may not carry more passengers than the vehicle was designed to carry. f. Alllifl-equipped vehicles must comply with ADA regulations. 9.8 Vehicle Insoeclions a. Annual CTO MEDICAID NON.EMERGENCY TRANSPORTATION (NET) AGREEMENT PAGE 20 OF 53 Agenda Item No. 16B7 1 D6Ti~ ~~~~ All vehicles shall be inspected before they are used to provide transportation services. Inspections shall be done annually to ensure that all regulatory and licensing requirements are met. Vehicles not passing these inspections shall be immediately removed from service for Medicaid beneficiaries. Each vehicle shall be reinspected before It is eligible to return to service for Medicaid beneficiaries under the Agreement. Documentation of inspections done by other agencies will suffice as long as the Subcontracted Transportation Provider and Commission have access to it, and the program standards are met or exceeded. b. All Commercial Vehicles Shall Meet or Exceed the Followino Reauirements: 1. The Subcontracted Transportation Provider shall ensure that commercial transportation operators use a two-way communication system linking all vehicles used in delivering the services under this Agreement with the transportation operator's major place of business (dispatcher); 2. The two-way communication system shall be used in such a manner as to facilitate communication and to minimize the time in which out-of- service vehicles can be replaced or repaired. Pagers are not an acceptable substitute. A vehicle with an inoperative two-way communication system shall be placed out-of-service until the system is repaired or replaced; 3. All vehicles shall be equipped with climate control systems adequate for the heating and cooling needs of both driver and passengers. Any vehicle with a non-functioning climate control system shall be placed out- of-service until repaired; 4. Vehicles shall have functioning, clean, and accessible seat belts, where applicable, for each passenger seat position and shall be stored off the floor when not in use; 5. All vehicles shall have an accurate speedometer and odometer; 6. All vehicles shall have functioning interior light(s) within the passenger compartment; 7. All vehicles shall have adequate sidewall padding and ceiling covering; 8. All vehicles shall have two exterior rear view mirrors, one on each side of the vehicle; g. All vehicles shall have one interior mirror for monitoring the passenger compartment; 10. The vehicles' interior and exterior shall be clean and have exteriors free of broken mirrors or windows, excessive grime, rust, chipped paint or major dents that detract from the overall appearance of the vehicle; and 11. The vehicle shall have passenger compartments that are clean, free from torn upholstery or floor covering, damaged or broken seats, protruding sharp edges and shall also be free of dirt, oil, grease or Iiller. 9.9 Subcontract Reouirements The Subcontracted Transportation Provider shall monitor all transportation providers, at least annually, to ensure that they comply with the provisions of the Agreement. The Subcontracted Transportation Provider shall attempt to utilize Minority and Women- owned Business Enterprises (MWBE's) for providing beneficiary transportation services. ern MEDICAID NOH-EMERGENCY TRANSPORTATION (NET) AGREEMENT PAGE 21 OF 53 Ag~nedl~iN~~ ;- , The Subcontracted Transportation Provider shall document MWBE utilization and all efforts in encouraging MWBE participation. Subcontracts shall include verification that each transportation provider maintains sufficient liability insurance to meet the requirements of Florida State law. See Section I.G of the Terms and Conditions of the Commission Standard Agreement for specifiCS on insurance coverage. The Subcontracted Transportation Provider shall have an incident Investigation procedure in writing, and shall follow that procedure to respond to and review all incidents. The Commission must be notified by the Subcontracted Transportation Provider within twenty four (24) hours or by the beginning of the next business day of an accident during the transportation of Medicaid beneficiaries. This is for all accidents involving personal injury and/or property damage where the damage exceeds one thousand dollars ($1.000.00). A written report of the accident shall be submitted to the Commission within five (5) business days of the occurrence. 9.10 Personnel Subcontracted Transportation Providers are independent contractors and are not employees or agents of Florida Medicaid or the Commission. An independent contractor performs services for Medicaid under contract of a skilled nature or unique kind and works with minimal or no supervision from Medicaid staff. The Subcontracted Transportation Provider must ensure that all transportation providers: a. Be responsible for the work performed by their employees and transportation providers as described in this Agreement and other referenced documents; b. Be solely responsible for payment to all empioyees' for wages, benefits, and all consideration or reimbursement to transportation operators; c. Comply with the requirements of employer liability, worker's compensation. unemployment insurance, social security, and any other state and local taxes applicable to the Subcontracted Transportation Provider, the Subcontracted Transportation Provider's employees and transportation operators; and d. Have personnel poiicies that conform to all local, state and federal laws. The Commission retains the right to review the Subcontracted Transportation Provider's personnel policies. 9.11 Additional Subcontracted Transportation Provider Requirements The following sections describe performance standards with which the Subcontracted Transportation Provider must comply. a. The Subcontracted Transportation Provider is responsible for transportation services, and shall recruit, if necessary, and negotiate subcontracts with transportation providers sufficient to meet the needs of Medicaid beneficiaries to include utilization of multiload vehicles, public transportation, wheelchair vehicles, stretcher vehicles, private volunteer transport, over-the-road bus service or where applicable commercial air carrier transport. b. The Subcontracted Transportation Provider must utilize a uniform contracting, billing and accounting system to contract for services and pay providers while keeping accurate and detailed records on transactions with such contracted providers. CTD MEDICAID NON-EMERGENCY TRANSPORTATION (NET) AGREEMENT PAGE 22 OF 53 Agenda Item No. 16B7 ieB~g6j~~ c. The Subcontracted Transportation Provider shall secure sufficient resources (numbers and types of vehicles and drivers) to provide NET services in accordance with the requirements of the Agreement. d. The Subcontracted Transportation Provider may set up subcontracts with qualified transportation providers, inciuding providers in bordering states (Georgia and Alabama), if necessary, as long as the services provided are equitable in quality and safety. The Subcontracted Transportation Provider must maintain unique Identifiers of each transportation provider. The unique identifiers will be given to the Subcontracted Transportation Provider by the Commission. e. in all cases, the Subcontracted Transportation Provider must ensure the use of the most appropriate service available to meet the beneficiary's transportation needs. f. Regardless of the method or combination of methods used to provide NET service, the Subcontracted Transportation Provider is responsible for management, supervision and monitoring of all transportation provided with funds received through the Agreement. g. The Subcontracted Transportation Provider is prohibited from establishing or maintaining subcontracts with transportation providers that have been determined to have committed fraud of a state or federai agency or those that have been terminated from the Medicaid program. h. The Subcontracted Transportation Provider must terminate a subcontract with a transportation provider when substandard performance is identified and when the transportation provider has failed to take satisfactory corrective action within a reasonable time. The Commission reserves the right to direct the Subcontracted Transportation Provider to terminate any subcontract with a transportation provider when the Commission or the Agency for Health Care Administration determines it to be in the best interest of the state. I. The Subcontracted Transportation Provider's selection policies and procedures, consistent with 42 CFR 438.12, must not discriminate against particular providers that serve high-risk populations or specialize in conditions that require costiy treatment. j. The Subcontracted Transportation Provider may not employ or contract with providers exciuded from participation in Federal health care programs under either Section 1128 or 1128A of the Social Security Act. 9.12 Gatekeeoer Policv a. The Subcontracted Transportation Provider shall comply with the following gatekeeper responsibilities: 1. Accept requests for transportation directly from beneficiaries, adult family members on behalf of minor beneficiaries, guardians responsible for beneficiaries, and licensed health care professionals on behalf of beneficiaries. 2. Assure that the beneficiary is a resident of a county in Florida and is currently Medicaid eligible. Beneficiary eligibility shall be obtained by contacting a MEVS Vendor or similar provider, or through FAXBACK with the Medicaid fiscal agent where a fax is sent through an automated system and a report is transmitted back containing beneficiary or provider requested eligibility information. 3. Attempt to determine if transportation resources exist within the home regularly and/or specifically for the trip requested, and may deny CTD MEDICAID NON-EMERGENCY TRANSPORTATION (NET) AGREEMENT PAGE 23 OF 53 Ag~nie;i ~~~ transportation if available through resources in the beneficiary's household. "Household" is defined to include all persons residing at a common address. 4. Determine if there is a reason why the beneficiary's own transportation cannot be utilized (such as the vehicle is broken, out of gas, etc.) and, if it cannot be utilized, may assist in transportation. 5. Attempt to determine whether any person who does not reside in the beneficiary's household can reasonably provide transportation. "Reasonably" is defined to mean both willing and able. The Subcontracted Transportation Provider shall not demand the use of transportation resources available through any party residing outside the beneficiary's household. 6. Require the use of public transportation, where available and appropriate, for beneficiaries who are able to understand common signs and directions. For additional information on requirements for public transportation see Service Standards Section. 7. Determine if the beneficiary is ambulatory, requires a mobility device, or requires a stretcher for transport. Beneficiaries who must use a mobility device for ambulation or must remain in a lying position shall be transported in vehicles appropriate to their level of need. 8. Allow for extenuating circumstances in applying the seventy-two (72) hour or less advance application requirement for transportation. Such extenuating circumstances shall include, but not be limited to, such situations as the requirement for post-<Jperative or fOllow-up appointments in less than seventy-two (72) hours; urgent care requirements as claimed by the beneficiary, adult family members on behalf of a minor, elderly or disabied beneficiaries, guardians responsible for beneficiaries, and licensed health care professionals on behalf of beneficiaries who are residents of a nursing facility or other residential care facility, or who are otherwise unable to communicate for themselves; hospital and emergency room discharges; and transportation to appointments made to replace missed appointments that were not caused by the beneficiary's negligence. 9. Provide transportation only to a Medicaid compensable service. 10. Refuse to reimburse the cost of transportation provided for a beneficiary by any relative or member of the same household, exclusive of foster parents. 11. 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 Subcontracted Transportation Provider cannot deny service 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, such vehicle must be excluded from considerations of other available transportation. 12. Consider Information presented by or on behalf of a beneficiary relative to the need for NET services upon each such request for transportation, notwithstanding prevIous NET denials. em MEDICAID NON~EMERGENCY TRANSPORTATION (NET) AGREEMENT PAGE 24 OF 53 Agenda Item No. 16B7 Dece1~t3 113 13. Require that a beneficiary and associated escort be picked up from, and returned to, a common address. b. The Subcontracted Transportation Provider are not responsible for providing transportation when a sim i1ar and appropriate health care providers of a similar type that offer the same or similar services appropriate for the beneficiary's needs and who will accept the beneficiary as a patient are located cioser to the beneficiary's residence. c. The Subcontracted Transportation Provider and/or its Subcontracted Transportation Providers shall not arbitrarily deny services, but may require as a condition for approval of NET services, a written referral signed by a licensed health care provider attesting to the medical necessity for out-of-area service. 10. Fraud Prevention Policies and Procedures The Subcontracted Transportation Provider shall utilize the written policies and procedures developed by the Commission for fraud prevention that contain the following: a. A comprehensive employee-training program to investigate potential fraud; b. A review of Subcontracted Transportation Providers that demonstrate a pattern or practice of encounter or service reports that did not occur; c. A review of Subcontracted Transportation Providers that demonstrate a pattern or practice of overstated reports or up-coded ievels of service; d. A review of Subcontracted Transportation Providers that altered, falsified, or destroyed records prior to the five-year records retention benchmark. e. A review of Subcontracted Transportation Providers that make false statements about credentials; f. A review of Subcontracted Transportation Providers that misrepresent medical information to justify referrals; g. A review of Subcontracted Transportation Providers that fail to provide transportation for covered Medicaid beneficiaries to medically necessary services; and h. A review of Subcontracted Transportation Providers that charge Medicaid beneficiaries for covered services. Any determination by the Subcontracted Transportation Provider that any aspect of NET service delivery, by any provider, that might have short- or long-term detrimental consequences to the health of a Medicaid beneficiary shall be reported in writing to the Commission immediateiy upon detecting a problem or potential problem. The Subcontracted Transportation Provider must aiso immediately report all instances of suspected provider/beneficiary fraud to the Commission immediately upon identification. Upon detection of a potentially or suspected fraudulent action by a provider, the Subcontracted Transportation Provider shall file a report with the Commission. At a minimum, the report shall contain the name of the provider, the provider contact information, the prOVider lax identification number, and a description of the suspected fraudulent act. ThiS report must be sent in narrative fashion to the Commission. B. MANNER OF SERVICE(S) PROVISION: 1. Services to be orovided bv the Commission: CTO MEDICAID NON-EMERGENCY TRANSPORTATION (NET) AGREEMENT PAGE 25 OF 53 Agenda Item No. 16B7 December 16, 2008 !a8383 The Commission shall provide to the Subcontracted Transportation Provider the following services: a. access to Medicaid eligibiiity data, if available from the Agency. b. policy and Agreement ciarification as requested by the Subcontracted Transportation Provider. c. a timely review of all materials submitted to the Commission by the Subcontracted Transportation Provider as required. d. training in the appropriate use of Commission systems as needed. e. non-emergency transportation (NET) policy training pertinent to the performance of the Agreement. f. technical assistance, as needed, on transportation related inquiries. g. a poiicy and procedures manual, an education and outreach plan, and a monitoring plan. h. instructions and ongoing training on specific programs and covered services. i. monitor the Subcontracted Transportation Provider's compliance with the terms and conditions of the Agreement. 2. Services to be orovided bv the Subcontracted Transoortation Provider 2.1 Monitorino Plan The Subcontracted Transportation Provider will be monitored on an annual basis unless otherwise specified by the Commission. The monitoring pian must be based on Subcontracted Transportation Provider Minimum Standards Section, and must contain, at a minimum, the following monitoring elements: a. Beneficiarv Access 1. Provider name: 2. Provider's unique identification (ID) number: 3. Provider service area (counties): 4. Where available average dally phone calls abandoned, listed by: . incoming, . From queue, and . Average time in queue. 5. Percentage of calls answered within three (3) minutes: 6. Average call length; 7. Average daily phone calls received. 8. Eligibility Screening . Total applicants reviewed for transportation eligibility; . Total applicants denied for transportation eligibility, by reason code: and . Other data designated by the Commission. cro MEDICAID NON~EMERGENCY TRANSPORTATION (NET) AGREEMENT PAGE 26 OF 53 Agenda Item No. 16B7 December 16, 2008 1"011:3 9. Transportation Services . The number of trips provided by mode; . The average distance in miles per trip; . The average cost per trip using the average distance in miles per trip; . The number of unduplicated Medicaid beneficiaries using transportation; . Number of complaints and percentage of complaints compared to the total number of trips; and . The number of vehicle inspections completed with results. 10. Beneficiary Education 11. Staffing Issues 12. Other Monitoring as Specified by the Commission 2.2 Reoorts a. Encounter Data. The Subcontracted Transportation Provider will prepare reports on encounter data as well as complaints filed and corrective action taken. Some may be summary reports for wide distribution. Others may be detailed reports for Commission and other technical audiences. Users may be the general public, legislators, legislative staff, policy makers, media, and budget analysts. The Subcontracted Transportation Provider may be required to provide Immediate response to ad hoc data requests of Commission staff. b. Proiect Reoorts. The Subcontracted Transportation Provider shall utilize project reports established by the Commission. The Subcontracted Transportation Provider shall utilize reporting formats that will be developed by the Commission. When reporting requirements are not established in the Agreement, the Commission shall provide the Subcontracted Transportation Provider with instructions and submission timetables. The Commission reserves the right to modify reporting formats and submission timetables as a result of changing priorities or management direction. c. Annual Reoorts. The Subcontracted Transportation Provider must submit to the Commission, by September 15'" of each year, an annual operating report that summarizes all services provided for during the Agreement period. The annual operating report will be provided to the Commission via the electronic reporting mechanism available through the Commission's web page. d. Ad Hoc ReoortinQ. The Subcontracted Transportation Provider must provide reports to the Commission in response to requests for data on a periodic basis. Data should be provided to the Commission within one (1) business day, or longer, if agreed to by both the Commission and the Agency for Health Care Administration. e. Other Reoorts. The Subcontracted Transportation Provider may be required to provide additional information in the annual, and monthly reports when specified by the Commission. 2.3 Automation Requirements eTD MEDICAID NON-EMERGENCY TRANSPORTATION (NET) AGREEMENT PAGE 27 OF 53 Agenda Item No. 1687 Del~~ 1ff; The Subcontracted Transportation Provider must have the capacity (hardware, software and personnel) sufficient to generate all data and reports needed for this project. The Subcontracted Transportation Provider shall also have the necessary information technology needed to fully manage and report on the project described in this Agreement. 2.4 Svstems Compliance The following standards and criteria define systems compliance: a. Software and applications will not abnormally end or provide invalid or incorrect results as a result of date data, especially between centuries. b. In all new applications and where possible in legacy applications, date elements in interfaces and data storage should specify century to eliminate date ambiguity. The standard format for data storage and calculations should follow the international standard date notation, which includes a four-digit year. Applications that use or require month and date representation should conform to the following format: VYYYMMDD where YYYY = full representation of the year, MM = month (between 01 and 12) and DD = day of the month (between 01 and 31). User interfaces (I.e., screens, reports, etc.) should accurately show four digit years. Where this is impossible (I.e., date elements represented wtthout century), the correct century must be unambiguous for all manipulations and/or calculations involving that element. 2.5 Determination of Service Process a. The Subcontracted Transportation Provider shall structure the deterrrination of need for service process to meet the following basic requirements: 1. The beneficiary's eligibility has been verified; 2. The beneficiary has declared that he or she is a current resident of the subcontract provider/provider's service area; 3. The beneficiary's Medicaid ID number and address have been recorded for reporting purposes; 4. The beneficiary has declared that he or she needs non-emergency transportation; 5. The beneficiary has been determined to have a valid service need; 6. The beneficiary intake information has been obtained: 7. The trip is determined to be within the service locality, or that the needed medical service is not available in the iocality; and 8. The transportation mode is the most cost-effective possible. b. The Subcontracted Transportation Provider shall advise the benefiCiary that: 1. The beneficiary, under penalty of law, shall provide accurate and complete information to determine need for NET services; 2. When requested, the beneficiary must provide, as a condition for receiving service and being determined eligible for the service, information related to the need for services; CTD MEDICAID NON~EMERGENCY TRANSPORTATION (NET) AGREEMENT PAGE 28 OF 53 Ag61~7J~ J~ 3. It is the beneficiary's responsibility to call and cancel an appointment at least twenty-four (24) hours in advance; and 4. Only transportation to or from a health care service provider for a Medicaid covered service is allowable. c. Beneficiary Intake Inforrration The Subcontracted Transportation Provider must collect intake information at initial time of contact for a request made by the beneficiary, The following information will be collected by all Subcontracted Transportation Providers for each beneficiary. The Subcontracted Transportation Provider shall regularly verify information is accurate. The Subcontracted Transportation Provider shall develop mandatory beneficiary intake information for NET services, that provides the following information: 1. Deterrrination of Eligibility: Name and address; Beneficiary's date of birth in month, day, year format (MM/DDIYYVY); County of origin; Medicaid number; and Telephone number, if available. 2. Availabiltty of Suitable Mode or Transportation to Other Communtty Locations: Availability of friend or relative with vehicle; and Ownership of a vehicle or previous transportation arrangements. 3. Availability of Federally Funded or Public Transportation: Distance from public transportation route; Any limitations that would prevent the use of public transportation; Alternative funding to pay for transportation; and Previous use. 4. Special Needs: Mode of transportation needed; Services needed; and Need for an escort or attendants. 5 Results of Interview: Transportation approved or denied; Mode of transportation if approved; Date or dates of service; and . Reason eligibility was denied. d. Validity of Inforrration Except for the information contained on the Medicaid eligibility certification, the Subcontracted Transportation Provider shall accept the inforrration provided verbally by the beneficiary, or person speaking on behalf of the beneficiary, as valid when determining or predetermining the need for NET services unless the Subcontracted Transportation Provider has cause to doubt the validity of information provided. CTD MEDICAID NON-EMERGENCY TRANSPORTATION (NET) AGREEMENT PAGE 29 OF 53 Agenda Item No. 16B7 December 16, 2008 !t3 3ff:3 If the Subcontracted Transportation Provider has cause to doubt the validity of the information provided by or on behalf of the beneficiary, in accordance with approved gatekeeping policy, the Subcontracted Transportation Provider may require documentation of that information as a condition of providing transportation. 2.6 ADPlication for Services The beneficiary must contact the Subcontracted Transportation Provider with jurisdiction over the beneficiary's area of residence to request NET services prior to close of office business hours, three (3) workdays or more prior to a non-urgent, scheduled appointment. The three (3) workdays or more advance scheduling includes the day of the call but not the day of the appointment. Advance scheduling will be mandatory for all NET services except urgent care and follOW-Up appointments when the timeframe does not allow advance scheduling. The Subcontracted Transportation Provider shall be responsible to provide same-day transportation services when the beneficiary has no other available means of transportation and requests services for urgent care. Valid requests for urgent care transport shall be acknowledged for scheduling within three (3) hours of the time the request is made. Urgent care, for the purpose of this Agreement, is defined as an unscheduled episodic situation, in which there is no immediate threat to life or limb, but the beneficiary must be seen on the day of the request and treatment cannot be delayed until the next day. A hospttal discharge shall be considered as urgent care. The Subcontracted Transportation Provider may verify with the direct provider of service that the need for urgent care exists. The Subcontracted Transportation Provider must obtain from the beneficiary, or an individual acting on behalf of the beneficiary, sufficient information to allow a decision regarding the beneficiary's need for NET services. This determination must take into consideration the beneficiary's ability to provide for his or her transportation outside of the NET program, pursuant to the gatekeeper policy established by the Commission as well as the beneficiary's needed level of transportation in the Appropriate Level of Transportation Section. 2.7 Levels of Transoortation When determining the most appropriate mode of transportation for a beneficiary, a basic consideration must be the beneficiary's current level of mobility and functional independence. Modes other than public transportation must be used when the beneficiary: . Is able to travel independently but, due to a permanent or temporary debilitating physical or mental condition, cannot use the mass transit system; or . Is traveling to and from a location that is inaccessible by mass transit (accessibiltty is not within 3/4 mile of scheduled route). The Subcontracted Transportation Provider or its Subcontracted Transportation Provider shall determine the most appropriate mode of transportation needed by the beneficiary. This determination may be based on information provided by the beneficiary or, if a functional assessment process is in place, the results of a functional assessment process. 2.8 Criteria for Wheelchair or NET Stretcher Services CTDMEDICAIO NON-EMERGENCY TRANSPORTATION (NET) AGREEMENT PAGE 30 OF 53 Agenda Item No. 16B7 Dec8mber 16, 2008 186113 Services other than multiload vehicle or public transportation may be required when one of the following condttions is present: a. The beneficiary has a disabling physical condition which requires the use of a wheelchair, walker, cane, crutches or brace and is unable to use a multiload vehicie, commercial taxi or public transportation; b. An ambulatory beneficiary requires radiation therapy, Chemotherapy or dialysis treatment, which results in a disabling physical condition after treatment, causing the beneficiary to be unabie to access transportation without physical assistance; c. The beneficiary is unable to ambulate without personal assistance of the driver in entering or exiting the beneficiary's residence and medical facility; or the beneficiary has a severe, debilitating weakness or has a physical or mental disability as a result of illness or health care treatment and requires personal assistance. The Subcontracted Transportation Provider is not precluded from using more intensive modes of transportation if such use is determined to be appropriate. Wheelchair and stretcher van services are considered intensive transportation modes due to a higher level of transportation provided to accommodate the beneficiary's need based on the beneficiary's specific limitation. One of the above limiting conditions must exist before transportation modes other than multiload vehicle or public transportation are considered; however, the existence of a limiting condition does not necessarily mean that a more intensive mode of transportation is required. While the above conditions may demonstrate the possible need for wheelchair or stretcher services, the functional ability and independence of the Medicaid beneficiary should also be considered in determining the mode of transportation required. The key to the use of more intensive modes of NET services is that such services be adequate to meet the health needs of the individual. 2.9 Nursina Home and Mental Health Facility NET Services The Subcontracted Transportation Provider must allow nursing homes and mental health facilities to arrange and schedule transportation for beneficiaries residing in their facility directiy without a formalized contract with the Subcontracted Transportation Provider for the facility's place of business. At a minimum, nursing home and mental health facilities shall be allowed to: . Provide transportation to a residence through vehicles owned and operated by the nursing home or mental health facility after determining that the most appropriate mode of transportation can be provided by such vehicles in-house; and . Contact the subcontracted transportation provider to arrange for transportation services on behalf of the beneficiary residing in the facility if the nursing home or mental health facility is unable to provide the most appropriate mode of transportation. 2.10 Denial of Service Process The Subcontracted Transportation Provider may deny a trip or immediately discontinue a trip for any beneficiary who: a. Refuses to cooperate in determining the status of Medicaid eligibility: b. Refuses to provide the documentation requested to determine need for NET services; em MEDICAID NON.EMERGENCY TRANSPORTATION (NET) AGREEMENT PAGE 31 OF 53 A1d;e~~6B7 e b 1, 008 of62 c. Is found to be ineligible for NET services on the basis that the information provided cannot be otherwise confirmed; d. Exhibits uncooperative behavior or misuses/abuses NET services (the Subcontracted Transportation Provider must retain documentation of the incident); e. Is not ready to board NET transport five (5) minutes after the vehicle has arrived; or f. Fails to request a reservation three (3) workdays or more in advance of appointment without good cause. For purposes of this section, "good cause' is created by factors such as, but not limited to, any of the following: 1 . Urgent care; 2. Post-surgical and/or medical follow-up care specified by a health care provider to occur in fewer than three workdays; 3. Imminent availability of an appointment with a specialist when the next available appointment would require a delay of two weeks or more; or 4. The result of administrative or technical delay caused by the Subcontracted Transportation Provider and required that an appointment be rescheduled. 2.11 Beneficiarv Aooeals Notice When the Subcontracted Transportation Provider denies eligibiltty of transportation services to a beneficiary, the beneficiary must be informed of his/her right to appeal by sending, by mail, an initial decision letter outlining the reason the Subcontracted Transportation Provider is denying transportation services. This letter shall be mailed to the beneficiary no later than seven (7) calendar days following such decision to deny. The Subcontracted Transportation Provider must utilize a formal benefiCiary appeais process whereby a beneficiary may bring his/her complaint for resolution prior to the beneficiary beginning the formal Medicaid grievance procedures. Beneficiary transportation cannot be limited or suspended during the review period while the appeal is being reviewed. Beneficiaries must be allowed to schedule and receive transportation services throughout the appeal process. 2.12 No-Show Beneficiarv Education If a beneficiary fails to provide a cancellation notice to the Subcontracted Transportation Provider at least 24-hours In advance of a scheduled trip, then the benefiCiary is classified as a "no-show". In addition, cancellations at the door will be considered a "no- show." The Subcontracted Transportation Provider shall provide the Commission a listing of the "no-show" beneficiaries. The no-show beneficiary listing shall include the beneficiary's name, phone number, date and time scheduled for transport, and trip destination. The submittal of the activity documentation In Section 9.6 will serve as the no-show listing. The Subcontracted Transportation Provider, the Commission, or the Agency may contact the beneficiaries and counsel them on proper usage of NET services and provide technical assistance. The Subcontracted Transportation Provider shall track the beneficiaries contacted as no-shows and counseied and keep a record of the technical assistance provided, The Subcontracted Transportation Provider may take action CTD MEDICAID NON-EMERGENCYIRANSPORTATlON (NET) AGREEMENT PAGE 32 OF 53 Age!7lit ! JB7 De r, 8 e 0 2 against beneficiaries (I.e. "lock-in") that have reoccurring no-shows and do not respond to counseling and technical assistance. Such action shall be approved by the Commission Contract Manager prior to implementation. If the no-show beneficiary provides acceptable, verifiable evidence to the Subcontracted Transportation Provider or the Commission that the no-show was due to unforeseen and unavoidable circumstances, the missed trip will not be counted as a no-show unless such evidence does not prove the beneficiary was unable to meet the scheduled pick-up time due to unforeseen and unavoidable circumstances. 2.13 Complaint Resolution The Subcontracted Transportation Provider must maintain a toll-free access for receiving beneficiary complaints. The Subcontracted Transportation Provider shall ensure that the beneficiary has followed the established complaint procedures. The Subcontracted Transportation Provider may utilize the Commission's ombudsman program to serve as a regulatory body for the voicing of complaints by beneficiaries. If the complaint is not resolved through the Ombudsman program, the beneficiary must be informed of his/her right to file a formal grievance with the Office of Administrative Appeals or other legal venues appropriate to the specific nature of the complaint. 2.14 Fair Hearino Reouirements The Medicaid fair hearing policy and process is detailed in Rule 65-2.042, FAC. The Subcontracted Transportation Provider's grievance system policy and appeal and grievance processes shall state that the beneficiary has the right to request a Medicaid fair hearing in addition to pursuing the Subcontracted Transportation Provider's grievance process. A provider acting on behalf of the beneficiary and with the beneficiary's wrillen consent may request a Medicaid fair hearing. Parties to the Medicaid fair hearing include the Subcontracted Transportation Provider, as well as the beneficiary and his or her representative or the representative of a deceased beneficiary's estate. a. Reouest Reouirements The beneficiary or provider may request a Medicaid fair hearing within 90 calendar days of the date of the notice of action. The beneficiary or provider may request a Medicaid fair hearing by contacting Department of Children and Families at the Office of Public Assistance Appeals Hearings, 1317 Winewood Boulevard, Building 1, Room 309, and Tallahassee, Florida 32399-0700. b. General Plan Duties The Subcontracted Transportation Provider must: 1. Continue the beneficiary's benefits while Medicaid fair hearing is pending if: a. The Medicaid fair hearing is filed timely, meaning on or before the later of the following: . Within 10 workdays of the date on the notice of action (add 5 workdays if the notice is sent via U.S. mail). . The intended effective date of the plan's proposed action. eTD MeDICAID NON-EMERGENCY TRANSPORTATION (NET) AGREEMENT PAGE 33 OF 53 Agenda Item No. 16B7 Decl~~6if3 b. The Medicaid fair hearing involves the termination, suspension, or reduction of a previously authorized course of treatment; c. The services were ordered by an authorized provider; d. The authorization period has not expired; and e. The beneficiary requests extension of benefits. 2. Ensure that punitive action is not taken against a provider who requests a Medicaid fair hearing on the beneficiary's behalf or supports a beneficiary's request for a Medicaid fair hearing. If the Subcontracted Transportation Provider continues or reinstates beneficiary benefits while the Medicaid fair hearing is pending, the benefits must be continued until one of following occurs: a. The beneficiary withdraws the request for a Medicaid fair hearing. b, 10 workdays pass from the date of the Subcontracted Transportation Provider's adverse decision and the beneficiary has not requested a Medicaid fair hearing with continuation of benefits until a Medicaid fair hearing decision is reached. (Add 5 workdays if the notice is sent via U.S. mail.) c. A Medicaid fair hearing decision adverse to the beneficiary is made. d. The authorization expires or authorized service limits are met. The Subcontracted Transportation Provider must authorize or provide the disputed services promptly, and as expeditiously as the beneficiary's health condition requires, if the services were not furnished while the Medicaid fair hearing was pending and the Medicaid fair hearing officer reverses a decision to deny, limit, or delay services. The Subcontracted Transportation Provider must pay for disputed services, in accordance with state policy and regulations, ~ the services were furnished while the Medicaid fair hearing was pending and the Medicaid fair hearing officer reverses a decision to deny, limit, or delay services. 2.15 Beneficiarv Co-oavment The Subcontracted Transportation Provider, at its discretion, may require a co-payment of beneficiaries that is not greater than $1.00 per each one-way trip or $2.00 per each round trip whichever is less. Any change in beneficiary co-payment amounts must receive Commission approval prior to implementation of such increase or decrease. The following categories of beneficiaries are not required to pay a co-payment: . Children under 21 years of age; Pregnant women when the services relate to the pregnancy or to any other medical condition that may complicate the pregnancy or conditions or complications of the pregnancy extending through the end of the month in which the 60-days period following termination of pregnancy ends; em MEDICAID NON~EMERGENCY TRANSPORTATION (NET) AGREEMENT PAGE 34 OF 53 Agenda Item No. 16B7 Dec-,g~l, 16,..?~ [\Jti'J . Institutional care program (ICP) beneficiaries who are required to spend all of their income for medical care costs (expect for a minimal amount that is required for personal needs) as a condttion of receiving services in an institution and who are inpatients in long-term care facilities, hospitals, or other medical institutions; . Beneficiaries who require emergency services after the sudden onset of a medical condition which if left untreated would place the beneficiary's health in serious jeopardy; . Beneficiaries when the services or supplies relate to family planning; . Beneficiaries who are receiving hospice services. A provider cannot deny service to a recipient based soleiy on the recipient's inability to pay a Medicaid co-payment. If the recipient is unable to pay at the time services are rendered, the provider may bill the recipient for the unpaid charge, 2.16 Subcontracted Transportation Provider Limitations The Subcontracted Transportation Provider is prohibited from: a. Using fee-for-service ambulance transport in lieu of cost-effective and appropriate non-emergency transportation; b. Limiting Medicaid beneficiaries to a specific number of medical trips for any specific time period if such limitation would effectively prevent the beneficiary from receiving necessary medical care; and c. Limiting Medicaid beneficiaries to specific providers within a geographical range, establish trip zones, or use similar limitations for the purpose of restricting the distance required to receive medical services if such limitation would effectively prevent the beneficiary from receiving necessary medical care. 3. Term of Acreement The Commission may provide an increase each year, beginning July 1, 2005, based on an increase in Medicaid eligibles. Such increases shall begin on July 1 for all subsequent years. The Commission reserves the right to determine whether an increase will be granted for each year and the level of increase to be provided. 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. Renewal of the Agreement shall be in writing and subject to the same terms and conditions set forth in the initial Agreement prior to Agreement termination. A renewal Agreement may not include any compensation for costs associated with the renewal. 4. BillinQ and Pavment Non-emergency transportation services are mandatory Medicaid services that may not be restricted due to inadequate funding. Through this Agreement, the Subcontracted Transportation Provider accepts responsibility to provide or coordinate delivery of all non- emergency transportation services within the existing funds of this Agreement. The Subcontracted Transportation Provider shall be paid upon satisfactory submission of receivables as designated in the Agreement. CTD MEDICAID NON-E.MERGENCY TRANSPORTATION (NET) AGREEMENT PAGE 35 OF 53 Ag~n1da ~eQ~rNi ;~ pt)e fj ~2 Section 215.422, Florida Statutes, provides that agencies have 5 working days to inspect and approve goods and services, unless bid specifications, contract or purchase order specifies otherwise. 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) 488- 5869. Invoices returned to a Subcontracted Transportation Provider 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 Subcontracted Transportation Provider Ombudsman, whose duties include acting as an advocate for Subcontracted Transportation Providers who may be experiencing problems in obtaining timely payment(s) from a State Commission, may be contacted at (850) 410-9724 or by calling the State Comptroller's Hotline, 1-800-848-3792. C. SPECIAL PROVISIONCS): 1. Termination Procedures The Subcontracted Transportation Provider agrees to the termination procedures in Section 6 of the Commission's standard Agreement. The party initiating the termination shall render written notice of termination to the other party by certified mail, return receipt requested, or in person wtth proof of delivery, or by facsimile ietter followed by certified mail, return receipt requested. The notice of termination shall specify the nature of termination, the extent to which performance of work under the Agreement is terminated, and the date on which such termination shall become effective. In accordance with 1932(e){4), Social Security Act, the CommiSSion shall provide the Subcontracted Transportation Provider with an opportunity for a hearing prior to termination for cause. After receipt by the Commission of final notice of termination, on the date and to the extent specified in the notice of termination, the Subcontracted Transportation Provider shall: a. Stop work under the Agreement, but not before the termination date. b. Pay all claims prior to and including the date of termination. c. Assign to the state those subcontracts as directed by the Commission's Contracting Officer including all the rights, title and interest of the Subcontracted Transportation Provider for performance of those subcontracts. d. Take such action as may be necessary, or as the Commission's contracting officer may direct, for the protection of properly related to the Agreement which is in the possession of the Subcontracted Transportation Provider and in which the Commission has been granted or may acquire an interest. e. Not accept any payment after the contract ends unless the payment is for the time period covered under the Agreement. 2. Sanction Process a. Performance Improvement Plan If the Commission determines that the Subcontracted Transportation Provider is out of compliance with the proviSions of the Agreement. the Commission may em MEDICAID NON-EMERGENCY TRANSPORTATION (NET) AGREEMENT PAGE 36 OF 53 Agenda Item No. 1687 le6~ 3~7~~ issue to the Subcontracted Transportation Provider, via certified mail, a request for a performance improvement plan (PIP). The Commission shall provide the Subcontracted Transportation Provider with a time certain that the corrections are to be made. The Subcontracted Transportation Provider must respond to the request within fifteen (15) calendar days by providing a PIP to the Commission. The Commission must approve the plan and submit the signed approval to the Subcontracted Transportation Provider prior to implementation of the PIP. The Commission may suggest changes or request a rewrite of the PIP and provide a specific deadline for the rewrite. If the Subcontracted Transportation Provider does not meet the standards established in the PIP by the time certain, the Subcontracted Transportation Provider will be in violation of the provisions of the Agreement and is subject to sanctions. b. Sanctions . Wtthholdino Pavments. Withholding of monthiy payments or a portion thereof to the Subcontracted Transportation Provider by the Commission; . Fines. Imposition of a fine determined by the Commission for violation of the Agreement with the Commission. Fines shall not exceed an amount that is more than five (5%) percent of the total monthly payment to the Subcontracted Transportation Provider; and . Mediation In the event of a dispute between the parties in connection with this Agreement, the parties agree to submit the disputed issue or issues to a mediator for non-binding mediation prior to filing a lawsuit. The parties shall agree on a mediator as agreed upon by both parties. The fee of the mediator shall be shared equally by the parties. To the extent allowed by law, the mediation process shall be confidential and the results of the mediation or any testimony or argument introduced at the mediation shall not be admissible as evidence in any subsequent proceeding concerning the disputed case. . Termination. Pursuant to section 6 of the Agreement. Unless the duration of a sanction is specified, a sanction shall remain in effect until the Commission is satisfied that the basis for imposing the sanction has been corrected. 3. Travel Expenses The Subcontracted Transportation Provider shall not bill the Commission for any travel expenses. 4. Subcontracts The Subcontracted Transportation Provider may subcontract work required by a contract resulting from this Agreement. The Commission may review any and all subcontracts at any time. The Commission may disapprove any subcontract at any time with sixty (60) calendar days notice. The Commission must provide each Subcontracted Transportation Provider with a unique identification number that will be used for data collection, data management, and reporting. 5. Assionment CTO MEDICAID NON~EMERGENCY TRANSPORTA.TION (NET) AGREEMENT PAGE 37 OF 53 Agenda Item No. 16B7 Deci~~6B73 The Subcontracted Transportation Provider shall not assign the Agreement, in whole or in part, without the express written approval of the Commission. 6. Waiver No covenant, condition, duty, obligation, or undertaking contained in or made a part of the Agreement may be waived except by the written agreement of the parties, and a 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 the same may apply. 7. Severabilitv of Provisions If any provision of the Agreement is declared or found to be illegal, unenforceable, or void, then both the Subcontracted Transportation Provider and the Commission shall be relieved of all obligations arising under such provision. If the remainder of the Agreement is capable of performance, it shall not be affected by such declaration or finding and shall be fully enforceable. However, the Commission shall reduce the amount of the Agreement accordingly, 8. insoection of Records and Work Performed The state and its authorized representatives shall, at all reasonable times, have the right to enter the Subcontracted Transportation Provider's premises, or other places where duties under the Agreement are performed. All inspections and evaiuations shall be performed in such a manner as shall not unduly delay work. Refusal by the Subcontracted Transportation Provider to allow access to all records, documents, papers, letters, other materials or on-site activities related to performance shall constitute a breach of the Agreement. The right of the state and its authorized representatives to perform Inspections shall continue for as long as a Subcontracted Transportation Provider is required to maintain records. The Subcontracted Transportation Provider will be responsible for all storage fees associated with records maintained under the Agreement. The Commission shall give the Subcontracted Transportation Provider advance notice of cancellation pursuant to this provision and shall pay the Subcontracted Transportation Provider only those amounts that are earned prior to the date of cancellation in accordance with the terms and conditions of the Agreement. Performance by the Commission of any of its obligations under this Agreement shall be subject to the Subcontracted Transportation Provider's compliance with this provision. 9. Accountinq The Subcontracted Transportation Provider shall maintain an accounting system and employ accounting procedures and practices that conform with generally accepted accounting principles and standards. All charges applicable to the contract shall be readily ascertainable from such records. The Subcontracted Transportation Provider is required to submit annual financial audits to the Commission within thirty (30) calendar days of receipt. 10. Confidentialitv of Beneficiarv Information All personally identifiable beneficiary information obtained by the Subcontracted Transportation Provider shall be treated as privileged and confidential information and shall be used only as authorized for purposes directly related to the administration of the Agreement. The Subcontracted Transportation Provider must have a process that specifies that beneficiary-specific information remains confidential, is used solely for the CTD MeDICAID NON-oEMERGENCY TRANSPORTATION (NET) AGREEMENT PAGE 38 OF 53 Agenda item No. 16B7 December 16, 2008 16li362 purposes of data analysis and other Subcontracted Transportation Provider responsibilities under the Agreemen~ and is exchanged only for the purpose of conducting a review or other duties outlined in a contract. Any beneficiary-specific information received by the Subcontracted Transportation Provider can be shared only wtth those agencies that have legal authority to receive such inforrration and cannot be otherwise transmitted for any purpose other than those for which the Subcontracted Transportation Provider is retained by the Commission. The Subcontracted Transportation Provider must have in place written confidentiality policies and procedures to ensure confidentiality and to comply with all federal and state laws (including the Health Insurance Portability and Accountability Act (HIPAA) governing confidentiality, including electronic treatment records, facsimile mail, and electronic mail). The Subcontracted Transportation Provider's contracts with others must explicitly state expectations about the confidentiality of information. If prOVider-specific data are released to the public, the Subcontracted Transportation Provider shall have policies and procedures for exercising due care in compiling and releasing such data that address statutory protections of quality assurance and confidentiality while assuring that open records requirements of Chapter 119, Florida Statutes, are met. Any reieases of information to the media, the public, or other entities require prior approval from the Commission. 11. Force Maieure Neither party shall be liable for loss or damage suffered as a result of any delay or failure in performance under this Agreement or interruption of performance resulting directiy or indirectly from acts of nature, civil or milttary authority, acts of war, riots, civil disturbances, insurrections, accidents, fire, explosions, earthquakes, floods, water, wind, lightning, strikes, labor disputes, shortages of suitable parts, materials, labor or transportation to the extent such events are beyond the reasonable control of the party claiming excuse from liability resulting there from. 12. EEO Comoliance The Subcontracted Transportation Provider shall not discriminate in its employment practices with respect to race, color, religion, age, sex, marital status, political affiliation, national origin, or handicap except as provided by law. 13. Patents, Rovalties. Coovriohts. Rioht to Data and Soonsorshio Statement The Subcontracted Transportation Provider, without exception, shall indemnify and save harmless the Commission and its employees from liability of any nature or kind, including cost and expenses for or on account of any copyrighted, patented, or unattended invention, process, or article manufactured or supplied by the Subcontracted Transportation Provider. The Subcontracted Transportation Provider has no liability when such claim is solely and exclusively due to the combination, operation or use of any article supplied hereunder wtth equipment or data not supplied by the Subcontracted Transportation Provider or is based soleiy and exciusively upon the Commission's alteration of the article. The Commission shall provide prompt written notification of a claim of copyright or patent infringement and shall afford the Subcontracted Transportation Provider full opportunity to defend the action and control the defense. Further, if such a claim is made or is pending, the Subcontracted Transportation Provider may, at its option and expense procure for the Commission the right to continue the use of, replace or modify the article to render it non-infringing (if none of the alternatives is reasonably available, the Commission agrees to return the article on request to the Subcontracted Transportation Provider and receive reimbursement, if any, as may be determined by a court of competent jurisdiction). If the Subcontracted Transportation CTO MEDICAID NON-EMERGENCY TRANSPORTATION (NET) AGREEMENT PAGE 39 OF 53 Agenda Item No. 16B7 De1?e ,!; Provider uses any design, device, or materials covered by letter, patent, or copyright, it is mutually agreed and understood without exception that the proposed prices shall include all royalties or cost arising from the use of such design, device, or materials in any way involved in the work. Where activities supported by the Agreement resulting from this procurement produce original writing, sound recordings, pictorial reproductions, drawings or other graphic representation and works of any similar nature, the Commission has the right to use, duplicate and disclose such materials In whole or in part, in any manner, for any purpose whatsoever and to have others acting on behalf of the Commission to do so. If the materials so developed are subject to copyright, trademark, or patent, legal title and every right, interest, claim, or demand of any kind in and to any patent, trademark or copyright, or application for the same, shall vest in the state of Florida, Department of State for the exclusive use and benefrt of the state. Pursuant to section 286.021, Florida Statutes, no person, finn, corporation, Including parties to this Agreement shall be entitled to use the copyright, patent, or trademark w~hout the prior written consent of the Florida Department of State. The Commission shall have unlimited rights to use, disclose, or duplicate, for any purpose whatsoever, all information and data developed, derived, documented, or furnished by the Subcontracted Transportation Provider under any contract. 14. Aoolicable Laws and Reoulations The Subcontracted Transportation Provider agrees to comply with all applicable federal and state laws and regulations, Including but not limited to: Title 42 Code of Federal Regulations (CFR) Chapter IV, Subchapter C; Title 45 CFR, Part 74, General Grants Administration Requirements; Chapters 409, Florida Statutes; 59G- 4.330 Florida Administrative Code; all applicable standards, orders or reguiations issued pursuant to the Clean Air Act of 1970 as amended (42 USC 1857, et seq.); Chapter 427, Florida Statutes; 41-2, Florida Administrative Code; Title VI of the Civil Rights Act of 1964 (42 USC 2000d) in regard to persons served; 42 CFR 431, Subpart F; Section 504 of the Rehabilitation Act of 1973, as amended; 29 USC 794, which prohibits 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 reiigion in programs and activities receiving or benefiting from federal financial assistance; the Medicare-Medicaid Fraud and Abuse Act of 1978; other federal omnibus budget reconciliation acts; Americans with Disabilities Act (42 USC 12101, et. seq.); and the Balanced Budget Act of 1997. The Agreement may be subject to changes in federal and state law, rules or regulations. 15. State Ownership The Commission shall have unlimited rights to use, disclose, or duplicate, for any purpose whatsoever, all information and data developed, derived, documented, or furnished by the Subcontracted Transportation Provider as a result of the Agreement. 16. Svmbols. Emblems or Names in Reference to Medicaid No person or program may use, in connection 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, ietters, symbols or emblems the words "Medicaid," or "Agency for Health Care Administration," except as required by the Agreement. unless prior written approval is obtained from the CTD MEDICAID NON~EMERGENCY TRANSPORTATION (NET) AGREEMENT PAGE 40 OF 53 Agenda Item No. 16B7 Decl~~lff; Commission. State and local governments are exempt from this prohibition. A disclaimer that accompanies the inappropriate use of program or Commission terms does not provide a defense. Each piece of mail or inforrration constitutes a violation. 17. Audits/Monitorino Provisions The Commission may conduct, or have conducted, performance and/or compliance reviews, reviews of specific records or other data as determined by the Commission. The Commission may conduct a review of a sample of beneficiary and other Subcontracted Transportation Provider records to verify the quality of the Subcontracted Transportation Provider's services. Reasonable notice shall be provided for reviews conducted at the Subcontracted Transportation Provider's or place of business. Reviews may include, but shall not be limned to, reviews of procedures, computer systems, accounting records, and internal quality control reviews. The Subcontracted Transportation Provider shall work with any reviewing entity selected by the state. The Commission is permitted to monitor and review the transportation operations and services of the Subcontracted Transportation Provider, services that are under agreement with a provider, or subcontracted services to Medicaid beneficiaries. This monitoring and review by said entities includes on-site visits and other monitoring methods to assure that the Subcontracted Transportation Provider and the Subcontracted Transportation Provider's subcontracted providers are complying with the requirements of the contract. These representatives shall also have access to all financial and statistical reports, supporting documents, and any other documents pertinent to this Agreement. CTD MEDICAID NON-EMERGENCY TRANSPORTATION (NET) AGREEMENT PAGE 41 OF 53 Agenda ~~,,~ fPt,Bl DeceLD~~ AGREEMENT #: ~ EXHIBIT B METHOD OF COMPENSATION For the satisfactory performance of the services and the submittal of Encounter Data as outlined in Exhlbtt A, Scope of Services, the Subcontracted Transportation Provider shall be paid up to a maximum amount of $ 514.259.00 . The Subcontracted Transportation Provider shall submit monthly invoices (3 copies) in a format acceptable to the Commission. The Subcontracted Transportation Provider will be paid, after the Commission has received payment from ACHA, in equal payments of $ 42.855.00 per month, unless otherwise approved by the Commission's Executive Director. 1. Proiect Cost: The Subcontracted Transportation Provider shall request payment through submission of a properly completed invoice to the Commission Contract Manager or its designee. Once the Commission has signed the invoice for approval, the Commission shall submit the approved invoice to the DOT Disbursement Operations Office for payment to the Subcontracted Transportation Provider. Collier County $ 514,259.00 Total Amount not to Exceed $ 514.259.00 2. Disbursement Schedule of Funds Nov Dee Jan Feb Mar Apr May Jun Jul Aug Sept Oct FY 04/05 42,855 42,855 42,855 42,855 42,855 42,855 42,855 42,855 FY 05/06 42,855 42,855 42,855 42,855 ern MEDICAID NON-EMERGENCY TRANSPORTATION (NET) AGREEMENT PAGE 42 OF 53 Agenda Item No. 16B7 DI~6~B j~ AGREEMENT #f'll>4ls'0 ATTACHMENT 1 CERTIFICATION REGARDING COMPLIANCE WITH THE HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT OF 1996 (HIPPA) The undersigned Provider certifies and agrees as to abide by the following: 1. Protected Health Information. For purposes of this Certification, Protected Health Information shall have the same meaning as the terrr "protected health inforrration" in 45 C.F.R. S 164.501, Jim ited to the inforrration created or received by the Provider from or on behalf of the Agency. 2. Limits on Use and Disclosure of Protected Health Information. The Provider shall not use or disciose Protected Health Information other than as permitted by this Agreement or by federal and state law. The Provider 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 Provider will not divulge, disclose, or communicate Protected Health Information to any third party for any purpose not in conformity with this Agreement without prior written approval from the Agency. The Provider will report to the Agency, within ten (10) business days of discovery, any use or disclosure of Protected Health Inforrration not provided for in this Agreement of which the Provider is aware. A violation of this paragraph shall be a material violation of this Agreement. 3. Use and Disclosure of Information for Manaoement. Administration. and Leoal ResDonsibilities. The Provider is permitted to use and disclose Protected Health Information received from the Agency for the proper management and administration of the Provider or to carry out the legal responsibilities of the Provider, in accordance with 45 C.F.R. 164.504(e)(4). Such disclosure is only permissible where required by law, or where the Provider obtains reasonabie 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 law or for the purposes for which it was disclosed to the person, and (3) the person notifies the Provider of any instance of which it is aware in which the confidentiality of the Protected Health Information has been breached. 4. Disclosure to Aoents. The Provider agrees to enter into an agreement with any agent, including a subcontractor, to whom it provides Protected Health Information received from, or created or received by the Provider on behalf of, the Agency. Such agreement shall contain the same terms, conditions, and restrictions that apply to the Provider with respect to Protected Health Information. 5. Access to Information. The Provider shall make Protected Health Information available in accordance with federal and state law, including providing a right of access to persons who are the subjects of the Protected Health Information. 6. Amendment and Incorporation of Amendments. The Provider 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. S 164.526. 7. Accountino for Disclosures. The Provider shall make Protected Health Information available as required to provide an accounting of disclosures in accordance with 45 C.F.R. 9164.528. The Provider 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 \I 164.528. CTD MEDICAID NON-EMERGENCY TRANSPORTATION (NET) AGREEMENT PAGE 43 OF 53 --...---- Agenda Item No. 16B7 De1~; 1B~; 8. Access to Books and Records. The Provider shall make its internal practices, books, and records relating to the use and disclosure of Protected Health Information received from, or created or received by the Provider on behalf of, the Agency to the Secretary of the Department of Heaith and Human Services or the Secretary's designee for purposes of determining compliance with the Department of Health and Human Services Privacy Regulations. 9. Termination. At the termination of this Agreement, the Provider shall return all Protected Health Information that the Provider still maintains in any form, including any copies or hybrid or merged databases made by the Provider; or with prior written approval of the Agency, the Protected Health Information may be destroyed by the Provider after its use. If the Protected Health Information is destroyed pursuant to the Agency's prior written approval, the Provider must provide a written confirmation of such destruction to the Agency. If return or destruction of the Protected Health Information is determined not feasible by the Agency, the Provider agrees to protect the Protected Health Information and treat it as strictly confidential. CERTIFICATION The Provider has caused this Certification to be signed and delivered by its duly authorized representative, as of the date set forth below. Collier Countv Board of Countv Commissioners Subcontracted nsportation Provider ~4.~ Signature )//3o/~'I Date ' Name and Title of Auth rized Signer -:-y ATIEST;. . . .:" e' DWIGHTE. BROCK E~, "'~ egal sufficiency 'e'putyCierk . :'?>' .' do' \,. .,,' '.c. . '. Attest ...to C1Ii:!......S %.~,.;..~. slgl1atllre on'J~L"" . CTD MEDICAID NON-EMERGENCY TRANSPORTATION (NET) AGREEMENT PAGE 44 OF 53 Agenda Item No. 16B7 Dere1tf; AGREEMENT #:~'t0 ATTACHMENT 2 DRUG-FREE WORKPLACE CERTIFICATION In order to have a drug-free workplace program, a business shall: 1. Publish a statement notifying employees that the unlawful manufacture, distribution, dispensing, possession, or use of a controlled substance is prohibited in the workplace and specifying the actions that will be taken against employees for violations of such prohibition. 2. Inform employees about the dangers of drug abuse in the workplace, the business policy of maintaining a drug-free workplace, any available drug counseling, rehabilitation, and employee assistance programs, and the penalties that may be imposed upon employees for drug abuse violations. 3. Give each employee engaged in providing the commodities or contractual services that are under bid a copy of the statement specified in subsection 1). 4. In the statement specified in subsection 1), notify the employees that, as a condition of working on the commodities or contractual services that are under bid, the employee will abide by the terms of the statement and will notify the employer of any conviction of, or plea of guilty or no 10 contendere to, any violation of Chapter 893 or of any controlled substance law of the United States of any state, for a violation occurring in the workplace no later than five (5) days after such conviction. 5. Irnpose a sanction on, or require the satisfactory participation in a drug abuse assistance or rehabilitation program if such is available in the employee's community by any employee who is so convicted. 6. Make a good faith effort to continue to maintain a drug-free workplace through implementation of this section. As the person authorized to sign the statement, I certify that this firm complies fully with the above requiremeifl~ Authorized ~igilatufQ'.{ . ATTEST:,:" . .'.'>:'~, DWIGHT Eo BROCI~}CL~K: \': . ~te(~<I/%~.':L, Attest as to C+;~~~:.- s1gnature nn' v. d4-~ /l3olo'f Date . CTD MEDICAID NON-EMERGENCY TRANSPORTATION (NET) AGREEMENT PAGE 45 OF 53 Agenda Item No. 16B7 Decemb:11~O~ paJ; '~llJ ..3 AGREEMENT #: 60;w ATTACHMENT 3 FINANCIAL AND COMPLIANCE AUDIT The administration of resources awarded by the Commission for the Transportation Disadvantaged to the Subcontracted Transportation Provider may be subject to audits and/or monitoring by the Commission. 1. MONITORING In addition to reviews of audits conducted in accordance with OMS Circular 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 Agency staff, limited scope audits as defined by OMB Circular A-133, as revised, and/or other procedures. By entering into this agreement, the Subcontracted Transportation Provider 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 Subcontracted Transportation Provider is appropriate, the Subcontracted Transportation Provider agrees to comply with any additional instructions provided by the Commission to the Subcontracted Transportation Provider regarding such audit. The Subcontracted Transportation Provider further agrees to compiy and cooperate with any inspections, reViews, investigations, or audits deemed necessary by the Comptroller or Auditor General. 2. AUDITS PART I Federally Funded This attachment is applicable if the Subcontracted Transportation Provider is a State or local government or a non-profit organization as defined in OMS Circular A-133, as revised. In the event that the Subcontracted Transportation Provider expends $300,000 or more in Federal awards in its fiscal year, the Subcontracted Transportation Provider must have a single or program-specific audit conducted in accordance with the provisions of OMB Circular A-133, as revised. PART VI of this agreement indicates Federal resources awarded through the Commission. In determining the Federal awards expended in Its fiscal year, the Subcontracted Transportation Provider shall consider all sources of Federal awards, inciuding Federal resources received from the Commission. 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 Subcontracted Transportation Provider conducted by the Auditor General in accordance with the provisions of OMB Circular A-133, as revised, will meet the requirements of this part. 1, In connection with the audit requirements addressed in Part I, paragraph 1., the Subcontracted Transportation Provider shall fulfill the requirements relative to auditee responsibilities as provided in Subpart C of OMB Circular A-133, as revised. If the Subcontracted Transportation Provider expends less than $300,000 in Federal awards in its fiscal year, an audit conducted in accordance with the provisions of OMS Circular A-133, as revised, is not required. In the event that the Subcontracted Transportation Provider expends less than $300,000 in Federal awards in its fiscal year and 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 CTO MEDICAID NON-EMERGENCY TRANSPORTATION (NET) AGREEMENT PAGE 46 OF 53 Ag6~~~lYiY13 paid from non-Federal resources (i.e., the cost of such an audit must be paid from the Subcontracted Transportation Provider resources obtained from other than Federal entities). 2. Information concerning this section can be found on the Federal Office of Management and Budget Web page at: http://www.whitehouse.gov/omblindex PART II: State Funded This part is applicable if the Subcontracted Transportation Provider is a non-state entity as defined by Section 215.97(2)(1), Florida Statutes. 1. In the event that the Subcontracted Transportation Provider a total amount of State Financial Assistance (i.e., State financial assistance provided to the recipient to carry out a State project) equal to or in excess of $300,000 in any fiscal year of such Subcontracted Transportation Provider, the Subcontracted Transportation Provider 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 Executive Office of the Governor and the Comptroller, and Chapters 10.550 (local governmental entities) or 10.650 (nonprofit and for- profit organizations), Rules of the Auditor General. PART VI of 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 Subcontracted Transportation Provider shall consider all sources of State Financial Assistance, including State Financial Assistance funds received from the Commission, other state agencies, and other non-state entities. State Financial Assistance does not include Federal direct or pass- -through awards and resources received by the non-state entity for Federal program matching requirements. 2. In connection with the audit requirements addressed in Part II, paragraph 1, the Subcontracted Transportation Provider shall ensure that the audit complies with the requirements of Section 215.97 (7), Florida Statutes. This includes submission of a financial reporting package as defined by Section 215.97(2)(d), Florida Statutes, and Chapters 10.550 (Iocai governmental entities) or 10.650 (nonprofit and for-profit organizations), Rules of the Auditor General. If the Subcontracted Transportation Provider expends less than $300,000 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. In the event that the Subcontracted Transportation Provider expends less than $300,000 in State Financial Assistance in its fiscal year and elects to have an audit conducted in accordance with the provisions of Section 215.97, Florida Statutes, the cost of the audtt must be paid from the non-state entity's resources (i.e., the cost of such an audit must be paid from the Subcontracted Transportation Provider's resources funds obtained from other than State entities). 3. Information concerning this section can be found on the State of Florida Web page at: http://www.myfiorida.com/myfiorida/governmentlgovernori nitiatives/fsaa/ PART III: Other Audit Requirements 1. 45 CFR, Part 74.26(d) extends OMB requirements, as stated in Part I above, to for-profit organizations. PART IV: Report Submission Copies of reporting packages for audits conducted in accordance with OMB Circuiar A-133, as revised, and required by PART I of this agreement shall be submitted, when required by Section .320 (d), OMB eTD MEDICAID NO....EuERGENCy TRANSPORTATION (NET) AGREEMENT PAGE 47 OF 53 Ag6nediti~~ Circular A-133, as revised, by or on behalf of the Subcontracted Transportation Provider direcUv to each of the following: Commission for the Transportation Disadvantaged 605 Suwannee Street, MS-49 Tallahassee, FL 32399-0450 State of Florida Auditor General Room 574, Claude Pepper Building 111 West Madison Street Tallahassee, FL 32302-1450 Other Federal agencies and pass-through entities in accordance with Sections .320 (e) and (f), OMB Circular A-133, as revised. Pursuant to Section .320 (f), OMB Circular A-133, as revised, the Subcontracted Transportation Provider shall submit a copy of the financial reporting package described in Section .320 (c), OMB Circular A-133, as revised, and any management letters issued by the auditor, to the Commission at the Comrnission's Contract Manager. Copies of financial reporting packages required by PART II of this agreement shall be submitted by or on behaif of the Subcontracted Transportation Provider directlv to each of the following: Commission for the Transportation Disadvantaged 605 Suwannee Street, MS-49 Tallahassee, FL 32399-0450 State of Florida Auditor General Room 574, Claude Pepper Building 111 West Madison Street Tallahassee, FL 32302-1450 Copies of reports or management letters required by PART III of this agreement shall be submitted by or on behalf of the Subcontracted Transportation Provider directlv to: Commission for the Transportation Disadvantaged 605 Suwannee Street, MS-49 Tallahassee, FL 32399-0450 State of Florida Auditor General Room 574, Claude Pepper Building 111 West Madison Street Tallahassee, FL 32302-1450 C. The Federal Audit Clearinghouse designated in OMB Circular A-133, as revised (the number of copies required by Sections .320 (d)(1) and (2), OMB Circular A-133, as revised, should be submitted to the following address: Federal Audit Clearinghouse Bureau of the Census 1201 East 10" Street Jeffersonville, IN 47132 Any reports, management letters, or other information required to be submitted to the Commission 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 (nonprofit and for-profit organizations), Rules of the Auditor General, as applicable, Subcontracted Transportation Providers, when submitting financial reporting packages to the Commission for audits done in accordance with OMB Circular A-133, or/and Chapters 10.550 (local government entities) or 10.650 (nonprofit and for-profit) organizations, Rules of the Auditor General. should indicate the date that the reporting package was delivered from the auditor to the Subcontracted Transportation Provider in correspondence accompanYing the reporting package. This can be accomplished by providing the cover ietter from the reporting package received from the auditor or a cover letter indicating the date the audit reporting package was received by the Subcontracted Transportation Provider. PART V: Record Retention em MEDICAID NON~E.MERGENCY TRANSPORTATION (NET) AGREEMENT PAGE 48 OF 53 Agenda Item No. 16B7 December 16, 2008 Page 57 of 62 1683 The Subcontracted Transportation Provider shall retain sufficient records demonstrating its compliance wtth 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, Comptroller, or Auditor General access to such records upon request. The Subcontracted Transportation Provider shall ensure that audit working papers are made available to the Commission or tts designee, Comptroller, or Auditor General upon request for a period of five (5) years from the date the audit report is issued unless extended in writing by the Commission. NOTE: Section .400(d) of the OMS Circular A-133, as revised, and Section 215.97 (5)(a), Florida Statutes, require that the information about Federal Programs and State Projects included in Part VI of this attachment be provided to the Provider organization if the Provider is determined to be a recipient. If Part VI is not inciuded the Provider has not been determined to be a recipient as defined by the above referenced reverenced federal and state laws. ern MEDICAID NON-EMERGENCY TRANSPORTATION (NET) AGREEMENT PAGE 49 OF 53 Agenda Item No. 16B7 December 16, 2008 iei.) 113 AGREEMENT#:~ ATTACHMENT 3 GLOSSARY ADA (Americans with Disabilities Act) - Includes regulations for agencies and entities that provide services to persons wtth disabilities. Business Dav - The business office must be open at a minimum between the hours of 8:00 a.m. and 5:00 p.m., Monday through Friday. Climate Control Svstem - The heating or air condttioning system of the vehicle in question. CMS (Centers for Medicare and Medicaid Services) - The organizational unit of DHHS responsible for administering Title XIX of the Social Security Act, which is Medicaid. DHHS -- The United States Department of Health and Human Services. Deliverable - Each documentation, report, manual, and every other ttem that the Subcontracted Transportation Provider is required to produce under the terms and conditions of this Agreement. Deoendent -- An individual under the age of eighteen (18). A dependent may be a Medicaid recipient. Disoatchino - The act of designating a specific vehicle and driver to pick-up and deliver a Medicaid recipient. Elioible (Medicaid Eliaible) -- A person who is determined to be eligible for Medicaid services by the Social Security Administration, or Department of Children and Families. Emeroency Care - Care that is medically necessary as a result of a sudden onset of a medical condition manifesting itself by acute symptoms of such severity that the absence of immediate attention could reasonably be expected to result in serious dysfunction of any bodily part or death of the individual. Encounter Data - Data on transportation services provided to Medicaid recipients. Escort - An individual whose presence is required to assist a recipient during transport and while at the place of treatment. Escorts cannot be charged any cost for transportation when accompanying a recipient requiring assistance. EVS (Eliaibilitv Verification Svstem) - A systern for verifying recipient eligibility for Medicaid services, usually by direct, on-line computer hook-up. Fixed Route - Service in which the vehicle(s) repeatedly follows a consistent time schedule and stopping points over the same route, whereby such schedule, route or service is not at the user's request. Gatekeepina - The verification that a caller is actually an eligible Medicaid recipient, that Medicaid transportation is needed, and the appropriate type of transportation needed. Indeoendent Contractor -- See transportation provider, In State/Out-of-State Travel - In-state travel refers to all NET services the Subcontracted Transportation Provider is responsible to assure delivery within the boundaries of the State of Florida and within a line CTD MEDICAID NON-EMERGENCY TRANSPORTATION (NET) AGREEMENT PAGE 50 OF 53 Agenda Item No. 16B7 De Imber 16, 20.08 pee B 32 drawn outside the Florida border. Out-of-state travel refers to travel outside of the predetermined border limit. Intake and Screenino - See Gatekeeping. Medicaid ID Number - A unique identification number assigned to each Medicaid recipient for eligibility card issuance and claims submittal purposes. Medical Necessitv - Medicaid reimburses for transportation services if they do not duplicate another provider's services and are determined medically necessary by meeting all of the following criteria: Individualized, specific, consistent with symptoms or confirmed diagnosis of the illness or injury under treatment, and not in excess of the recipient's needs; not experimental or Investigational; reflective of the level of services that can be safely furnished, and for which no equally effective and more conservative or less costiy treatment is available statewide; and furnished in a manner not primarily intended for the convenience of the recipient, the recipient's caretaker, or the provider. The fact that a provider has prescribed, recommended, or approved medical or allied care, goods, or services does not, in itseif, make such care, goods or services medically necessary or a covered service. Medicare - The federal medical assistance program that is described in Title XVIII of the Social Security Act. It is not the same as Medicaid. Minibus - A multiple passenger van, and also includes buses, sedans, and taxI. Monitorina - The Commission shall monitor the Subcontracted Transportation Provider's performance of duties under this Agreement by a variety of methods. Satisfactory, quality performance is required. NET (Non-Emeraencv Transoortation) - In accordance with federal regulations (42 CFR 431.53), the Non-Emergency Transportation (NET) program offers transportation services for Medicaid recipients who need to secure necessary medical care and have no other means of transportation. NET Trio - A one-way transportation service from the recipient's place of origin to the place where a covered medical service will be provided to that recipient or the reverse or from one covered medicai service to another. NF - Nursing facility or nursing home. Non-Emeroencv Transportation Services -- These are non-emergency transportation services provided to Medicaid recipients by Subcontracted Transportation Providers and transportation operators that provide recipients with access to necessary medical services when the recipients have no other personal transportation available. Ooerational Procedures Manual - A manual developed by the Subcontracted Transportation Provider that presents the procedures for scheduiing, after-hours services, urgent care, driver customer service standards, record keeping requirements for drivers, etc. Public Transoortation - City, county or municipal subway, bus, rail, and other transportation services available in a number of locations in Florida. Recioient - An individual eligible for medical assistance in accordance with the State's Medicaid program who has been certified as such by the Social Security Administration and the Department of Children and Families. Recioient Aooeal - Recipients have the right to appeal when the Provider has denied or terminated or suspended NET services to them. CTD MEDICAID NO....E.MERGENCy TRANSPORTATION (NET) AGREEMENT PAGE 51 OF 53 _._^,.~._~"~. Agenda Item No. 16B7 December 16, 2008 IPE; a j2 Recipient Residencv -- The county or service area within which the Medicaid recipient is regularly domiciled. Reservation _ The verification of a trip for a recipient at a specific time and place for pick-up and delivery to a specific destination. Schedulino _ The process through which a Medicaid recipient contacts the Subcontracted Transportation Provider who assigns the trip to the most appropriate transportation provider. Normally, this must be done at least three (3) days before the NET service is required. Schedulino Dav/Hours - Any day or time when the Subcontracted Transportation Provider is expected, under the terms of this Agreement, to have personnel available for scheduling NET services. Designated hours during which scheduling of appointments can be done is a mandated function of the Subcontracted Transportation Provider. Service Aoreement - An Agreement between a CommiSSion and a subcontracted transportation provider for the delivery of transportation services. Social Security Administration (SSA) -- The federal agency that determines eligibility for SSI, including Medicaid benefits. State - State of Florida. State Medicaid Plan _ The comprehensive written commitment by a Medicaid agency, submitted under section 1903(a) of the Social Security Act, to administer or supervise the administration of a Medicaid program in accordance with federal and state requirements. Stretcher (Non-emeroencv) Van - An enclosed vehicle that accommodates a litter and is equipped with locking devices to secure the litter during transit. Recipients using this vehicle must be non-ambulatory and need the assistance in order to be transported to and from the vehicle and health care provider in a reclined position. No flashing lights, sirens or emergency equipment are required. Subcontractor _ A person, company or organization the Commission enters into a Contract with to provide the services delivered under this Agreement SSI (Suoplemental Securitv Income) - A type of cash assistance received by individuais determined eligible by the Social Security Administration. Medicaid benefits are included in the eligibility determination made by the Social Security Administration. TTY (Text Telephonv) - A specially designed telephone device equipped with a keyboard and small screen, which allows two-way conversation. This service may also be available in software to modem personal computer compatibility. Transoortation Ooerator -- Those entities that own and operate vehicies engaged in the direct delivery of transportation and provide services to recipients through the scheduling of the Subcontracted Transportation Provider. Transportation Service Aoreement -- An agreement between the Commission and a transportation provider for the delivery of transportation services. Uroent Care _ An unscheduled episodiC situation in which there is no threat to life or limb but the recipient must be seen on the day of the request under currently accepted standards of care. Treatment cannot be put off until the next day. Hospital discharge shall also be considered as urgent care. This requirement shall also apply to appointments established by medical care providers allowing insufficient time for routine three (3) day scheduling. Valid requests for urgent care transport shall be acknowledged for scheduiing within three (3) hours of the time the request is made. CTDMEDICAlD NON~EMERGENCY TRANSPORTATION (NET) AGREEMENT PAGE 52 OF 53 Agenda Item No. 16B7 Dei~~ a ~~ Vehicle Identification Number (VIN) - The unique number given to each vehicle produced by a manufacturer. Vehicle Loo - A log which is kept by the vehicle driver that reports information on all trips wtth that vehicle: names of driver and recipients, times, pick-up and delivery points, and odometer readings. Vendor - An entity that is responsible for recruiting and contracting with transportation providers; payment administration; quality assurance of services; and administrative oversight and reporting. Volunteer Transoortation - Transportation provided by individuals or agencies that receive no compensation or payment other than minimai reimbursement for miieage for the provision of these transportation services. Wheelchair Van - A van equipped wtth lifts and iocking devices to safely secure a wheeichair whiie the van is in motion. Work Dav - For purposes of establishing business hours and satisfying reporting requirements: a minimum of Monday through Friday between the hours of 8:00 a.m. and 5:00 p.m. with the exception of New Years Day, Memorial Day, July Fourth, Labor Day, Thanksgiving Day and the day after, and Christmas Day. eTD MEDICAID NON~EMERGENCY TRANSPORTATION (NET) AGREEMENT PAGE 53 OF 53 .-,.'------.,.-.- -mD f\C~ln^ COMW,'S~iON;m Tl"If Transportation Dis~~~I!!<ts:ed Charlie Crist Governor JR Harding Ed.D. Chairperson Lawrence Forman Vice Chairperson Lisa M. Bacot Executive Director Agenda Item No. 16B7 December 16, 2008 Page 62 of 62 November 20, 2008 Ms. Michelle Arnold Collier Area Transit 2705 South Horseshoe Drive, Suite 211 Naples, Florida 34104 Re: eTO Medicaid Non-Emergency Transportation (NET) Program Agreement Amendment (Collier County) Dear Ms. Arnold: Enclosed is the Medicaid NET Amendment to the Subcontracted Transportation Provider (STP) Agreement between the Commission for the Transportation Disadvantaged (aD) and your organization to provide services in the above referenced county through December 31,2008. Please print, execute and return to me two (2) copies of this amendment. Original signatures must be in blue ink. Do not date the amendments. I will return one (1) fully executed copy to you for your records, Should you have any questions or concerns, please contact me at (850) 410-5715. Sincerely, ~n() V), ()~) ~I\~?rl Joel Perez Transportation Disadvantaged Specialist/ Regional Manager Enclosures; Agreement Amendment 605 Suwannee Street, M5-49 IV Tallahassee, FL 32399-0450 Phone: (850) 41Q.5700 IV Toll Free: (800) 983.2435 IV Fax: {B50) 410.5752 www.dot.state.fl.us/ctd