Background

1. Florida Commission for the Transportation DisadvantagedCTD Medicaid Non-Emergency Transportation (NET) ProgramA New Era in Transportation Disadvantaged Services

2. Background • Medicaid approved and utilized providers, including CTCs who billed directly, to operate the Medicaid NET Program • To contain costs, AHCA solicits the CTD seeking improved coordination and efficiency • 2003 Legislature reduces funding for Medicaid transportation, AHCA attempts to implement this reduction by capping the amount of funds available and enters into an Agreement with the CTD to manage program • AHCA requests a delay in implementation

3. Overview of the Agreement The CTD will: 1. Manage the NET Program 2. Identify Subcontracted Transportation Providers (STP) 3. Ensure NET services statewide 4. Receive encounter data and billing information 5. Receive a lump sum payment each month from AHCA • CTD then pays STP a lump sum each month • STP then pays all their operators for NET services 6. Ensure compliance • STP will be the “Gatekeeper” of the local NET program • STP will be charged with ensuring all local operators are in compliance

4. Medicaid Non-Emergency Transportation (NET) • “… medically necessary transportation for any recipient and personal care escort or attendant, if required, who have no other means of transportation available to any Medicaid compensable service for the purpose of receiving treatment, medical evaluation or therapy.”

5. STP Responsibilities: • Serve as Gatekeeper for the service area • Verify beneficiary’s Medicaid eligibility • Verify the trip purpose is to receive a Medicaid compensable service • Utilize the most appropriate and cost-effective mode of transportation • Provide reports to CTD for billing

6. STP is NOT responsible for providing the following transportation: • For returns to Florida when the beneficiary has traveled outside the state and requires hospitalization and/or subsequent nursing facility care. • For therapeutic home visits • From one facility to another at the preference of the beneficiary • For the deceased • For family members to visit a beneficiary

7. continued • For medical training • For pharmacy for prescriptions • For the sole purpose of a medical recommendation or medical records • For socialization and/or therapeutic field visits to locations other than the facility where such services are normally received • For services that are available, free of charge, to the general public • For transportation already covered by a per diem rate.

8. continued • For the salaries, fees, or other compensation for a professional health care attendant (PCA) • For transportation service covered by a Home and Community-Based Service (HCBS) waiver or is included in the reimbursement for the waiver service

9. STP Minimum Standards • Respond to transportation inquiries and requests • Provide interpreter services during Call Intake in areas where 20% of the population is non-English speaking • Respond to beneficiary complaints • Train customer service representatives on the complaint process • Provide toll-free access for requests for transportation services

10. continued • Provide 24-hour toll-free access to services for urgent care on holidays, weekends and after business hours • Take reservations three (3) days in advance • Answer telephone calls (90%) within 3 minutes • Drop off beneficiaries no more than one (1) hour prior to local appointment time • Provide adequate notice to beneficiaries of delays, alternative schedules, or alternate pick-up arrangements

11. Eligibility Determination • STP must provide NET services to the following eligible beneficiaries who require transportation to Medicaid compensable services: • Low income families and children • Sixth Omnibus Budget Reconciliation Act (SOBRA) • Supplemental Security Income (SSI) related Medicaid • Institutional Care Program (ICP) • Title XX1 MediKids • Medically Needy • Presumptively Eligible Pregnant Women • Foster care

12. STP Eligibility Screening Activities • Receive inquiries • Receive NET Eligibility Forms • Review and document recipient eligibility • Verify trip is Medicaid compensable • Regularly verify beneficiary meets a needs test for NET services

13. Who is ineligible? • Medicaid HMO members • Individuals with vehicle ownership or access • Qualified Individuals Level 1 (QI1) and Level 2 (QI2) • Qualified Medicare Beneficiaries (QMB) and QMB Renal Dialysis (QMBR) • Special low income Medicare recipients (SLMB) • Legal aliens

14. Who else could be denied services? • Anyone who refuses to provide requested information to determine need for NET services • Anyone who is found to be ineligible • Anyone who exhibits uncooperative behavior or misuses or abuses NET services • Anyone who is not ready to board in 5 minutes • Anyone who fails to make a reservation 3 days in advance without good cause, unless they require urgent care!

15. What about Co-Payments? • The STP is authorized to charge the beneficiary a co-payment of $1.00 per trip, however • The STP can not deny service based on the beneficiary’s inability to pay the $1.00 co-payment

16. Mode of Transportation • NET services that are provided to beneficiaries for Medicaid compensable appointments must utilize the following modes as determined by the STP: • Paratransit Vehicles • Multiload Vehicles • Fixed Route Vehicles • Over-the-Road Buses • Stretcher Vehicles • Private or Volunteer Transportation • Commercial Air Carriers

17. STP Recordkeeping • Maintain eligibility data • Protect the confidentiality of the recipient’s records • Maintain back-up copies • Make documentation available for audit purposes • Maintain encounter data for each one-way trip

18. Driver Standards • Drug and Alcohol Testing, when applicable • System safety training • Valid driver’s license • DMV records check • Wear proper ID and identify themselves • NOTE: Private and Volunteer drivers are exempt from some of these standards

19. CTD Quality Assurance Monitoring • Annual monitoring to ensure all programmatic and regulatory requirements are being met • Monitoring to be completed by CTD and local planners • Encounter Data and Financial reports will be monitored • Complaints will be monitored • Vehicles shall be inspected before they are used to provide services • Inspections on 5% of the vehicles of each operator, or if a complaint has been filed on a vehicle

20. How STP stays within their budget • Thoroughly screen applicants (Gatekeeping) • Require fixed route usage, where applicable • Require closest provider, when appropriate • Use the most cost-effective provider • Verify through CTD or MEVS/FAXBACK that beneficiaries are Medicaid eligible • Document abusers of system • Reservations must be made 72 hours in advance • Cancellations must occur 24 hours in advance • Document and refer “No-Shows” for education

21. CTD Agreement with STP • Agreement effective November 1, 2004* • Agreement effective for 12 months • Agreements will be sent overnight mail • Agreements must be signed and received by the CTD on or before November 1st

22. STP will need to: • Return executed Agreement to CTD by November 1, 2004 • Train staff on new changes and requirements • Notify current NET beneficiaries of the new changes and requirements • AHCA will notify all operators who previously billed Medicaid directly of the new changes • Update software to include new encounter data • Update software to report directly to CTD

23. HIPAA Requirements • STP executes Certification of Compliance • STP assures beneficiary privacy • STP assures beneficiary records security • No electronic billing compliance required

24. Financial Elements • STP Process: • Submit encounter data to CTD • Submit invoices to CTD monthly* • Payment received via electronic fund transfer (EFT) • CTD Process: • Review encounter data for eligibility and accuracy • Review and process invoice • Payment to STP will be made monthly*

25. Auditing Component • Review of encounter data • Verification of trip eligibility • On-site auditing • Single Agency Audit required • Single Agency Audit verification