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Before KY HSTD Coordination. Fraud
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1. Rural & Human Services Transportation Coordination in Georgia Workshop
Human Services Transportation Coordination
Governor Steve Beshear, Commonwealth of Kentucky
Secretary Mike Hancock, Kentucky Transportation Cabinet
Presented by Executive Director Vickie S. Bourne
Office of Transportation Delivery
Kentucky Transportation Cabinet
Monday, August 23, 2010
2. Before KY HSTD Coordination Fraud & Abuse of Non-Emergency Medicaid Transportation
Billings for excessive mileage
Ineligible trips
No Recipient nor Provider Accountability
Escalating Costs
No Safety Standards
Resource Inefficiency
Administrative
Operational
Need for Greater Mobility
3. Goals of KY HSTD Accessibility
Timeliness
Safety
Provider/Recipient Accountability
Customer Satisfaction
Cost
4. Chain of Events Empower KY Business Case
Transportation Cabinet Designated Lead
Sponsor KY HSTD Legislation
KY State Representative Jimmie Lee
State Law KRS 281.870-879
Administrative Regulations 603-KAR 7:080
Joint hearings/statements of considerations
5. Chain of Events 1. Law 468 (Passed April 14, 1998)
All willing and Able Providers
1915(b) waiver - No Freedom of Choice
Law 488 (Passed April 6, 2000)
Gave Freedom of Choice to all 07’s and 08’s
-Covered Services Increase due to Waiver Programs
-SCL/ADC adjustments put in Broker Contracts
-Transportation to set Sub Rates
-Program Coordinator Setup
3. SB 168 - law on escorts March 2003
6. How the Dollars Flow 1996 – Began Framework for Coordination
1998 – First Broker
2004 – Statewide fully operational
Agreements
Annual Agreements between State Partners/Transportation Cabinet
Finance Cabinet
Annual Agreements with Transportation Broker
Transportation Broker
Agreement Subcontractor
7. Transportation Broker Concept State Finance Cabinet
RFP Awards Broker for each HSTD Geographical Region
State Dept of Medicaid
Contracts with Transportation Cabinet
Determines Eligibility-Funds NEMT
Sets a Capitation Payment Rate for each Regional Broker (based on Actuarial Study)
State Transportation Cabinet
Monitors/Implements Program
Collects reports from the Broker
8. Transportation Broker Concept State Transportation Cabinet
Sets Subcontractor Rates
Makes Capitation Payment to Broker
Conducts assessments/audits
Submits reports to Dept of Medicaid
Holds Monthly Broker Meetings
Testifies to KY Legislative Committees
Testifies in Legal Proceedings
Meets with other State agencies to make policy or recommend Program
changes
11. Transportation Broker Concept Subcontractor
Receives trip pre-authorization from Broker/submits trip data and invoices to Broker
Provides Transportation Service
Paid by Broker
Paid on a Fee for Service Scale
Subcontractor pay scale set by Transportation Cabinet (Ky Statute)
13. Inter-agency Decision Making Body
Coordinated Transportation Advisory Council (CTAC)
Authority by KY Statute
Open to Public
Voting members
Health and Families Cabinet
Workforce Development
Transportation
Meets Monthly
Oversees
Progress
Program Issues
Policy Chain of Events
14. Executive Quality Management Council (EQMC)
Meets Monthly
Between Cabinets
Draft Policy
Take issues to CTAC
Develop Quality Improvement Plan Chain of Events
16. Partners/Funding Source KY Transportation Cabinet
Public Transit/Bus System
KY Education Cabinet
Department of Workforce Investment
Office for the Blind
Office of Vocational Rehabilitation
KY Health & Family Services Cabinet
Non-Emergency Medicaid
KY Finance Cabinet
Tentative Partners Aging and Veterans Group
17. Transportation Medicaid Specialist
18. NEMT Factors Affecting Costs 72 Hour Notice
Freedom of Choice
State Program Coordinators/ Transportation Specialist
800 line/Complaints/Denials
Urgent Care
Waiver Programs - ADC / SCL
Bus Passes
Private Autos
20. Safety/Security Transit on board cameras
AVL/MDT
Software tracking systems
23.
24. UNITED WE RIDE!
Kentucky Transportation Cabinet
Office of Transportation Delivery
Contact: Vickie S. Bourne Executive Director or
Jeremy Thompson, Br Mgr
502-564-7433
http://transportation.ky.gov/transportationdelivery