Item C30
BOARD OF COUNTY COl'vIl'vllSSIONERS
AGENDA ITEl\'1 SUMMARY
Meeting Date: December 21.2005
Bulk Item: YES X NO
Division: Community Services
Department: Social Services-Transportation
c""'"
AGENDA ITEM WORDING: Approval of an agreement between the Monroe County
Community Transportation Coordinator, Guidance Clinic of the Middle Keys and Monroe
County Board of County Commissioners for contract period of 1l/l/2005-6/30!2006 to
provide fee-for-service for Medicaid Non-Emergency Transportation as a Subcontracted
Transportation Provider.
~
ITEM BACKGROUND: This agreement, funded by the State of Florida Commissioner for
the Transportation Disadvantaged, will allow Monroe County Transportation to be paid
for providing contracted transportation services to Monroe County's Medicaid popu.lation.
PREVIOUS RELEVANT ROCC ACTION: None
CONTRACT/AGREEMENT CHANGES: N/A
STAFF RECOMMENDATION: Approval of cont.ract
TOTAL COST:
$0
BUDGETED:
Yes_
No
COST TO COUNTY: $0
SOURCE OF FUNDS:
REVENUE PRODUCiNG:
No
~o.s
AMOUNT PER MTH $5k-$7k YEAR $47.000
APPROVE~V:~~",
f \
Yes _ OMB/Purchasing . YES Risk Management YES
\
'c~ i
Prepared By: '~.o~.~+^<~"c .J
Print Name: Jerry 'tlik
/
Director, Transportation Program ~~_~,./~~j
-f"'~7~~~~.---- ~~,~~.;;<~,~""'~'~
DEPARTMENT DIRECTOR APPROVAL: /' ~~' (~+ O/~r-",..,.,
Print Name: LOUIS LA TORRE
.;//! ".
DIVISION DIRECTOR APPROVAL: X-:/~:LC::( i9(~:t/l){/~<u.
Print Name: SHEILA BARKER
DOCUMENTATION: Included
YES
To Follow
Not
DISPOSITION:
Agenda Item #
Fri&v. !)ecl,ml:wr 02. 2U05
MONROE COUNTY BOARD OF COUNTY COMMISSIONERS
CONTRACT SUMMARY
Contract with: CTC Contract # ~
Effective Date: 11/1/2005
Expiration Date: 6/3012006
-
Contract Purpose/Description:
This agreement, funded by the State of Florida Commission for the Transportation
Disadvantaged,. will allow Monroe rOllntv TransDortation to be p'!id for _servic~~..Q(Qyided 10
Monroe County':Ylm;uICa,id po . .;7 segment. -~-
.l ~- /7
'; f ,/' !'
'^~ )' ^T' f J -~
'-'" ;' L__.f ~
~.'""~4M'.C 0/
Contract Manager: ;.ferry Esk1w 4425 Transportation/Stop #1
p -~-
(Name) (Ext.) (Department/Stop #)
for BOCC meeting on 12121/2005 Agenda Deadline: 12/06/2005
CONTRACT COSTS
Total DoHar Value of Contract: $ 0
Budgeted? YesU No 0 Account Codes:
Grant: $ 0
~~~~~~
County Match: $ 0
Current Year Portion: $ 0
.N/ A- _~_~ - ~ - _~~- -----
- - - -
~- ~.~~ ~~~ -~~ ~~
- - - -
~--~~~~~
- - - -
-~~~~~
ADDITIONAL COSTS
Estimated Ongoing Costs: $L-Iyr For:
(Not included in dollar value above) (eg. maintenance, utilities, janitorial, salaries, etc.)
CONTRACT REVIEW
County Attorney
Date Out
Date In
~/7 - Reviewer f
;?;&{E.L~{q_ L5;[/L/l2iJ/,--.-
Division Director
Risk Management.
~ "' (\~
O,M.B./Purchastng
Comments:
OMB Fonn Revised 2127/() 1 MCP #2
STATE OF FLORIDA COMMISSION FOR THE TRANSPORTATION DISADVANTAGED
MEDICAID NON.EMERGENCY TRANSPORTATION (NET) PROGRAM
SUBCONTRACTED TRANSPORTATION PROVIDER AGREEMENT
BY THIS AGREEMENT, made and entered into this 1 st day of November, 2005, by and between
the Monroe County Community Transportation Coordinator, Guidance Clinic of the Middle Keys,
hereinafter called "CTC" and Monroe County 80ard of County Commission hereinafter called "Provider".
1. SERVICES AND PERFORMANCE
A. In connection with the delivery of Medicaid Non-Emergency Transportation Services, the
CTC does hereby retain the Subcontracted Transportation Provider to furnish certain
services, information, and items as described in Exhibits A and 8 and Attachments,
attached hereto and made a part hereof.
8. 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 CTe hereinafter upon completion or
termination without restriction or limitation on their use and shall be made available, upon
request, to the eTe at any time during the performance and upon completion or
termination of this Agreement Upon delivery to the CTe of said document(s), the eTe
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 CTe shall have the right to
visit the site for inspection of the work and the products of the Provider at any time.
e. The Provider agrees to provide reports in a format acceptable to the CTe and at intervals
established by the CTC. The CTe 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 Provider with
representatives of the CTC, or of other agencies interested in the project on behalf of the
CTC. 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.
E. In the event the provider is not the community transportation coordinator, in accordance
with Chapter 427, Florida Statutes, in the designated service area covered by this
agreement, the provider must sign a coordination contract with the CTe in the designated
service area.
2. TERM
A. INITIAL TERM. This Agreement shall begin on November 1, 2005 and shall remain in full
force and effect through completion of ail services required on June 30, 2006.
8. RENEWALS: This Agreement may be renewed for a period that may not exceed one (1)
year or the term of the original Agreement, whichever period is longer. Renewals shall
be contingent upon satisfactory performance evaluations by the CTC and subject to the
availability of funds. Any renewal or extension shali be in writing and executed by both
eTO MEDICAID NON-EMERGENCY TRAN$PORTA TlON (NET) AGREEMENT
PAGE 1 OF 40
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 CTC, 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 shaH be subject to the same
terms and conditions set forth in this Agreement; provided the CTC may, in its discretion,
grant a proportional increase in the total dollar amount based on the method and rate
established herein, There shall be only one extension of this Agreement unless the
failure to meet the criteria set forth in this Agreement for completion of this Agreement is
due to events beyond the control of the 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 CTC. Payment shall be made only after receipt and
approval of goods and services.
B. This Agreement involves units of deliverables and they must be received and accepted in
writing by the CTC's Contract Manager prior to payments.
C. The CTC has five (5) working days to inspect and approve the deliverables, unless
otherwise specified herein. The CTC has 20 days to deliver a request for payment
(voucher) to the Commission. The 20 days are measured from the latter of the date the
invoice is received or the goods or services are received, inspected and approved.
D, Invoices which have to be returned to a Provider because of 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 CTC
and until a properly completed invoice is provided to the CTC.
E. Records of costs incurred under terms of this Agreement shall be maintained and made
available upon request to the CTC 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 CTC upon request
Records of costs incurred shall include the Provider's general accounting records and the
project records, together with supporting documents and records, of the Provider and all
subcontractors performing work, as provided in Exhibit A, Scope of Work and all other
records of the Provider and subcontractors considered necessary by the CTC for a
proper audit of project costs.
F. The CTC, 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 of this subsection is null and void, and no money may
be paid on such contract. 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 shall indemnify and hold harmless the Florida Commission for
CTO MEDICAID NON-EMERGENCY TRANSPORTATION (NET) AGREEMENT
PAGE 2 OF 40
Transportation Disadvantaged, hereinafter called "Commission", CTC, the Department of
Transportation and the Agency for Health Care Administration, their officers and
employees from liabilities, 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
Provider and persons employed by or utilized by the in the performance of this
Agreement.
8. LIABILITY INSURANCE: The 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 authorized to do business in Florida, affording public liability insurance in
accordance with Rule Chapter 41-2.006, Florida Administrative Code. If the 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 tort actions, the Provider shall provide to the CTC a Certificate of Self-
Insurance upon execution of this Agreement.
C. WORKERS' COMPENSATION. The 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.
D. 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 Provider shall provide to the CTC certificates showing the required
coverage to be in effect and showing the CTC as additional certificate holder. Such
policies shall provide that the insurance is not cancelable except upon thirty (30) days
prior written notice to the CTC.
5. COMPLIANCE WITH LAWS
A. The 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
Provider in conjunction with this Agreement. Failure by the Provider to grant such public
access shall be grounds for immediate unilateral cancellation of this Agreement by the
CTC.
B. The Provider shall comply with all federal, state, and local laws and ordinances
applicable to the work or payment for work thereof, and wifl 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 public entity,
and may not transact business with any public entity in excess of the threshold amount
provided in Section 287.017, Florida Statutes, for CATEGORY TWO for a period of 36
months from the date of being placed on 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 reaf property to a public entity,
may not be awarded or perform work as a contractor, supplier, subcontractor, or
CTD MEDICAID NON-EMERGENCY TRANSPORTATION (NET) AGREEMENT
PAGE 3 OF 40
consultant under a contract with any public entity, and may not transact business with
any public entity.
E. The eTe shall consider the employment by any Provider of unauthorized aliens a
violation of section 274A(e) of the Immigration and Nationality Act. If the Provider
knowingly employs unauthorized aliens, such violation shall be cause for unilateral
cancellation of this Agreement.
6. TERMINATION AND DEFAULT
A. Either party may cancel this agreement with thirty (30) calendar days written notice,
without cause. The CTC reserves the right to terminate or cancel this Agreement with
thirty (30) calendar days written nbtice in the event an assignment is made for the benefit
of creditors.
B. If the CTe determines that the performance of the Provider is not satisfactory, the eTC
shall have the option of (a) terminating the Agreement with at least thirty (30) calendar
days written notice, or (b) notifying the 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 time, as long as the time period is at least thirty (30)
calendar days.
e. If the CTe requires termination of the Agreement for reasons other than unsatisfactory
performance of the Provider, the eTC shalf notify the 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 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 CTC shall be turned over promptly by the Provider.
7. ASSIGNMENT AND TRANSFER
A. The Provider shall maintain an adequate and competent staff so as to enable the
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
CTC, other than those costs within the limits and terms of this Agreement. The Provider
is fully responsible for satisfactory completion of alf subcontracted work. The Provider,
however, shall not assign or transfer any work under this Agreement without the prior
written consent of the CTe.
R 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 Provider shall be paid up to a maximum
amount of $46,666. The Provider shalf submit monthly trip data in a format acceptable to
the GTC. The Provider will be paid, after the eTe has received payment from the
Commission in the amount of $3,00 per mile with a 5 mile minimum, $2.00 per mile for
preauthorized out-of-County trips and $3.00 flat rate per cHent per mulitfoad for Medicaid
eligible trips.
B. The Provider must submit the final invoice for payment to the CTC no more than ninety
(90) days after the Agreement ends or is terminated. If the Provider fails to do so, alf
CTO MEDICAID NON-EMERGENCY TRANSPORTATION (NET) AGREEMENT
PAGE 4 OF 40
right to payment is forfeited and the CTC will not honor any requests submitted after the
aforesaid time period. Any payment due under the terms of this Agreement may be
withheld until all reports due from the Provider and necessary adjustments thereto have
been approved by the CTC.
C. The CTC'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 CTC,
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 Provider and its employees, agents, representatives, or subcontractors are not
employees of the CTC or the State of Florida as a result of this Agreement The CTC
and the State shall not be bound by any unauthorized acts or conduct of the Provider or
its employees, agents, representatives, or subcontractors. The 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 conflict 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 held 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 Provider
hereby waives any and all privileges and rights it may have under Chapter 47 and
Section 337.19, Florida 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.
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
Exhibit A
Exhibit B
Attachment 1
Scope of Services
Method of Compensation
Certification Regarding Health Insurance Portability and Accountability
Act of 1996 (H1PPA) Compliance
Drug-Free Workplace Certification
Attachment 2
CTO MeDICAID NON-EMERGENCY TRANSPORTATION (NET) AGREEMENT
PAGE 5 OF 40
Attachment 3 Financial and Compliance Audit
Attachment 4 Glossary
IN WITNESS WHEREOF, the parties have executed this Agreement by their duly authorized officers on
the day, month and year set forth above.
Title
Date
Subcontracted Transportation Provider
Printed Name
CTO MEDICAID NON-EMERGENCY TRANSPORTATION (NET) AGREEMENT
PAGE 6 OF 40
AGREEMENT #:
EXHIBIT A
SCOPE OF SERVICES
A SERVICES TO BE PROVIDED
1. GENERAL
The Provider shall comply with all the provisions of this Agreement and its amendments, if any,
and shall act in good faith in the performance of the Agreement provisions.
The Provider agrees to comply with all applicable federal and state laws and regulations as
specified in the Applicable Laws and Regulations Section.
The CTC must ensure that aU 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 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 Provider must offer, maintain, and satisfactorily deliver the following services:
a. EliQibility. 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.
b. Reservations and Trip Assignments. Assure that scheduling and dispatching are consistent
with the most appropriate mode of transport that meets the needs of the beneficiary.
c. Quality Assurance. The Provider must provide assurance to the CTC that their agency meets
health and safety standards for vehicle maintenance, operation, and inspection; driver
qualifications and training; beneficiary problem/complaint resolution; and the delivery of
courteous, safe, and timely transportation services.
d. Encounter Data Collection. The Provider must maintain an extensive secure database
capable of collecting and holding, for each transport, the data elements outlined in this
Agreement.
e. Administrative Oversight/Reporting. Responsibility for the management of overall day-to-day
operations necessary for the delivery of NET services within the designated areas and
the maintenance of appropriate records and systems of accountability to report to the
CTC and respond to the terms of the Agreement.
2. MINIMUM STANDARDS
At a minimum, the Provider must:
a. Validate that all clients are Medicaid eligible and going to a Medicaid eligible service. Transmit
to the eTe encounter data for all trips made by Medicaid beneficiaries in accordance with
CTe specifications in the Reports Section;
eTO MEDICAID NON-EMERGENCY TRANSPORTATION (NET) AGREEMENT
PAGE 7 OF 40
b. Adhere to the policy and procedure manual developed by the CTC to prohibit fraudulent
activity by the Providers and Medicaid beneficiaries and fulfill the CTC's reporting
requirements regarding such activity;
c. Adhere to the policy and procedure manual that provides policy clarity and guidance for the
CTC, Provider, transportation operators, Medicaid beneficiaries, and the general public
specific to the details contained in this Agreement;
d. Subject to the provisions of Section 768.28, F.S., indemnify the CTC against any causes of
actions or claims of payment relating to this Agreement brought by a Provider, or
Medicaid beneficiary;
e. Utilize a uniform contracting, billing and accounting system established by the CTC
3. ADMINISTRATION AND MANAGEMENT
The Provider shall be responsible for the administration and management of all aspects of this
Agreement. Any delegation of activities does not relieve the Provider of this responsibility. This
includes all employees, agents and anyone acting for or on behalf of the Provider.
4. DATA MANAGEMENT
The Provider must maintain a management information system (extensive database) for storage
of transportation utilization, encounter, complainVgrievance, and financial data. The Provider
must possess the capability to derive detailed reports from such systems and be capable of
retrieving data as requested by the CTC as specified the Reports Section.
5. STAFF REQUIREMENTS
The Provider must be prepared to implement all aspects of the work outlined in this Agreement
within the stated time frames. Staffing levels must be sufficient to complete all of the
responsibilities presented in the Agreement.
6. BENEFICIARY ELIGIBILITY
6.1 EIiQible Beneficiaries
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 (SOBRA) Children and Pregnant Women;
d. Supplemental Security Income (SSI) Related Medicaid Beneficiaries;
e. Institutional Care Program (JCP) Residents - Beneficiaries who are eligible for
transportation services for placement in a facility while their eligibility
determination is being processed (Rg., 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 fairs below Medicaid's income limits, the
individual may qualify for Medicaid through the end of the month;
CTO MEDlCAIO NON-EMERGENCY TRANSPORTATION (NET) AGREEMENT
PAGE 8 OF 40
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 Ineligible 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. Qt1 and QI2 beneficiaries are not eligible for any Medicaid service except for
Medicaid payment of their Medicare premiums, deductibles and coinsurance;
d. HMO OMB and OMBR beneficiaries are not eligible for any Medicaid service except
for Medicaid payment of their Medicare premiums, deductibles and coinsurance;
e. HMO SLMB 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. Qualified Medicare Beneficiaries (OM B) and Qualified Medicare Beneficiaries Renal
Dialysis (OMBR);
j. Special Low Income Medicare Beneficiaries (SLMB); and
k. Legal Aliens
6.3 Beneficiary Enrollment and Education
Once the Department of Children and Families or the Social Security Administration has
confirmed that an individual is eligible for Medicaid, the individual upon enroUment 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 Eligible Beneficiaries Section. The
beneficiary may arrange transportation services with the Provider upon enrollment
6.4 Education Plan
All correspondence developed by the Provider, intended for Medicaid beneficiaries only
and sent via mass mail out, must be submitted to the eTe 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 attendant/escort, if required, who
eTO MEDICAID NON-EMERGENCY TRANSPORTATION (NET) AGREEMENT
PAGE 9 OF 40
have no other means of transportation available to any Medicaid compensable service for the
purpose of receiving treatment. medical evaluation, 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.
7.1 Multiload Vehicles
A multiload vehicle is a multiple passenger vehicle, typically used for NET services. It is
appropriate only for ambulatory or non-ambulatory persons who can enter and exit a
vehicle with minimal to no assistance. Assistance means that additional equipment and
time are required. Multi/oad vehicles may include buses, vans, sedans and taxis.
7.2 Wheelchair Vehicle
A wheelchair vehicle is a motorized vehicle equipped specifically with certified wheelchair
lifts or other equipment designed to carry persons in wheelchairs and scooters, or with
mobility impairments. Wheelchair vehicles may be used for the provision of ambulatory
transportation services to 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 to remain in a lying position;
b. Beneficiaries who are continually confined to a wheelchair;
c. Beneficiaries with severe mobility handicaps that prevent them from using private,
public or taxi transportation;
d. Beneficiaries who are semi~ambulatory or homebound, and can accomplish limited
ambulatory movement with the assistance of a special ambulatory aid (like a
walker or cane); or
e. Beneficiaries who use a mobility device.
In questionable cases, the need for transport by a wheelchair vehicle may require
verification or documentation by a medical professional.
7.3 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.
7.4 Special Covered Services
The CTC must authorize and coordinate transportation for Medicaid beneficiaries when:
ero MEDICAID NON-EMERGENCY TRANSPORTATION (NET) AGREEMENT
PAGE 100F40
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 living
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.
7.5 SpeCial Exclusions
The Provider is not responsible for the coverage of:
a. The cost of transporting a Medicaid beneficiary back to Florida 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, ICF/DD, 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;
r 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 already covered by a per diem rate and included in a
corresponding cost report. Transportation services are included in an lCF/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 bilred to the waiver or is included in the reimbursement for the waiver
service.
8. Geoaraphical Considerations
The 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.
8.1 Residence and Closest Medical Facilit~
CTO MEDICAiD NON-EMERGENCY TRANSPORTATION (NET) AGREEMENT
PAGE 11 OF 40
The 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.
9. Subcontracted Transportation Provider Minimum Performance Standards
The following sections describe the minimum standards required of the 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 written procedures for dealing with beneficiary complaints internally; see
Beneficiary Appeals Notice Section and Local Coordinating Boards policy.
e. Train customer service representatives within own agency
f. Establish and maintain an electronic mail (e-mail) identity;
g. Provide eligible transportation when trip requests are submitted no less than twenty-
four (24) hours in advance.
h. 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.
L Ensure the average queue time for a hearing-impaired system such as Florida Tele-
Relay Services or TTY calls shall not exceed three (3) minutes.
j. Train staff to operate a hearing-impaired system such as Florida Tele-Relay
Services or TTY equipment to ensure service levels similar to non-hearing
impaired beneficiaries are met.
9.2 Eliqibilitv Screening
The 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. Documentation from a Medicaid Eligibility Verification System (MEVS)
Vendor;
CTD MEDICAID NON-EMERGENCY TRANSPORTATION (NET) AGREEMENT
PAGE 12 OF 40
2. Documentation by FAXBACK with the Medicaid fiscal agent, or
3. Documentation by other CTC 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,
5. That requested transportation is necessary to the destination and to
return from services as authorized under the Agreement.
9.3 Transportation Standards
The Provider shall:
a. Provide transportation services available to beneficiaries who reside in the service
area specified by the Agreement in as cost efficient way as possible (Le. multi-
loading);
b. Comply with standards in accordance with Chapter 427, Florida Statutes and Rules
41-2 and 14-90, Florida Administrative Code.
9.4 Appropriate Level of Transportation
The Provider shall refer emergency calls to 911, or an ambulance, as necessary.
a. The Provider shall use the most cost effective (lowest cost appropriate) available
transportation, based on the medical condition of the beneficiary.
b. 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 Provider may also require
documentation by the beneficiary's physician.
9.5 Service Area
a. The Provider may provide service to residents of other service areas in response to
requests of the CTC responsible 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
routinely used by residents of the service area who need medical care
not provided within their service area; and
cro MEDICAID NON-EMERGENCY TRANSPORTATION (NET) AGREEMENT
PAGE 13 OF 40
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.
9.6 Activity Documentation
The Provider must retain, and make available for audit purposes, the following records for
five (5) years after termination of the Agreement or for the duration any audit that extends
past five (5) years.
The Provider shall:
a. Maintain beneficiary eligibility data. Eligibility data shall be provided to the Provider
and by MEVS or FAXBACK or other similar provider. The 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 logs on fife 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. Date the service was provided in month, day, year format
MM/DDIYYYY;
2. Beneficiary's last name, first name, and middle initial exactly as it
appears on the gold, plastic Medicaid ID Card or other proof of eligibility;
3. Beneficiary's 10-digit Medicaid 10 Number. Do not provide the number
on the Medicaid 10 card. This is a card control number, not the
beneficiary's Medicaid ID number;
4. Total miles of trip provided;
5. Total cost of trip provided;
6. Pickup address including the street name and number, apartment
number, and city;
7. Time that the beneficiary was picked up. Use military (24-hour clock)
time. For example: 3:35 p.m. =:: 1535;
8. Complete address of the provider destination including the street name
and number, apartment number, and city;
9. Identify trips that were not provided due to beneficiary no-shows;
10. Medical necessity of the trip;
11. 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);
CTO MEDICAID NON-EMERGENCY TRANSPORTATION (NED AGREEMENT
PAGE 14 OF 40
12. 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);
13, Mode of transportation used: multiload vehicle (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 CTC.
9,7 Service Standards
a. All 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 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 Provider shall comply with all applicable state 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 regulatlons, 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. All lift-equipped vehicles must comply with ADA regulations.
9.8 Vehicle Inspections
a. Annual
All vehicles shall be inspected daily 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 CTC has access to it, and the program standards are met or exceeded.
b. All Commercial Vehicles Shall Meet or Exceed the Followina Requirements:
1. The Provider shall ensure that commercial transportation operators use a
two-way communication system linking all vehicles used in delivering the
CTD MEDICAID NON-EMERGENCY TRANSPORTATION (NET) AGREEMENT
PAGE 15 OF 40
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 coofing 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;
9, 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 litter.
9.9 Subcontract Requirements
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 CTC Standard Agreement for specifics on
insurance coverage.
The Provider shall have an incident investigation procedure in writing, and shall follow
that procedure to respond to and review all incidents. The CTC 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 eTe within five (5) business days of the occurrence.
9.10 Personnel
Providers are independent contractors and are not employees or agents of Florida
Medicaid, the Commission or the eTC. 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 Provider must:
CTD MEDICAID NON-EMERGENCY TRANSPORTATION (NET) AGREEMENT
PAGE 16 OF 40
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 employees' 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 Provider; and
d. Have personnel policies that conform to all local, state and federal laws. The CTe
retains the right to review the Provider's personnel policies.
9.11 Additional Provider Requirements
The following sections describe performance standards with which the Provider must
comply.
a. The Provider is responsible for transportation services within their three (3)
catch men areas
b. In all cases, the Provider must ensure the use of the most appropriate service
available to meet the beneficiary's transportation needs.
c. The CTC 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
d. The 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 costly treatment.
9.12 Gatekeeper Policy
a. The 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.
3. 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.
4. 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 Provider
shall not demand the use of transportation resources available through
any party reSiding outside the beneficiary's household.
5. 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.
6. Determine if the beneficiary is ambulatory, requires a mobility device, or
requires a stretcher for transport.
cro MEOICAlO NON-EMERGENCY TRANSPORTATION (NET) AGREEMENT
PAGE 17 OF 40
7. Allow for extenuating circumstances in applying the twenty-four (24)
hours or less advance application requirement for transportation. Such
extenuating circumstances shall include, but not be limited to, such
situations as the requirement for post-operative or follow-up
appointments in less than twenty-four (24) hours; urgent care
requirements as claimed by the beneficiary, adult family members on
behalf of a minor, elderly or disabled 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.
8. Provide transportation only to a Medicaid compensable service,
9. Require that a beneficiary and associated escort be picked up from, and
returned to, a common address.
b. The Provider shall not arbitrarily deny services.
10. Fraud Prevention Policies and Procedures
The Provider shall utilize the written policies and procedures developed by the GTG for fraud
prevention that contain the following:
a. A comprehensive employee~training program to investigate potential fraud;
b. A review of Providers that Demonstrate a pattern or practice of encounter or service
reports that did not occur;
c, A review of Providers that demonstrate a pattern or practice of overstated reports or
up-coded levels of service;
d, A Providers that altered, falsified, or destroyed records prior to the five~year records
retention benchmark.
e. A review of Providers that make false statements about credentials;
f. A review of Providers that misrepresent medical information to justify referrals;
g. A review of Providers that fail to provide transportation for covered Medicaid
beneficiaries to medically necessary services; and
h. A review of Providers that charge Medicaid beneficiaries for covered services.
Any determination by the CTC 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 GTC immediately upon detecting a problem or potential
problem. The Provider must also immediately report all instances of suspected
provider/beneficiary fraud to the CTC immediately upon identification.
Upon detection of a potentially or suspected fraudulent action by a provider, the Provider shall file
a report with the CTC. At a minimum, the report shall contain the name of the provider, the
provider contact information, the provider tax identification number, and a description of the
suspected fraudulent act. This report must be sent in narrative fashion to the CTC.
B. MANNER OF SERVICE'S) PROVISION:
1. Services to be provided by the CTC:
CTD MEDICAID NON-EMERGENCY TRANSPORTATION (NET) AGREEMENT
PAGE 18 OF 40
The CTC shall provide to the Provider the following services:
a. policy and Agreement clarification as requested by the Provider.
b. non-emergency transportation (NET) policy training pertinent to the performance of the
Agreement.
c. technical assistance, as needed, on transportation related inquiries.
d. a policy and procedures manual, an education and outreach plan, and a monitoring plan
e. instructions and ongoing training on specific programs and covered services.
f. monitor the Provider's compliance with the terms and conditions of the Agreement.
2. Services to be provided bv the Subcontracted Transportation Provider
2.1 Monitorinq Plan
The Provider will be monitored on an annual basis unless otherwise specified by the
CTC. The monitoring plan must be based on Provider Minimum Standards Section, and
must contain, at a minimum, the following monitoring elements:
a. Beneficiary Access
1. Provider name;
2. Provider's unique identification (ID) number;
3. Provider service area (counties);
4. Where available average daily 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 CTC.
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;
CTD MEDICAID NON-EMERGENCY TRANSPORTATION (NET) AGREEMENT
PAGE 19 OF 40
· The number of unduplicated Medicaid beneficiaries using
transportatio n;
· Number of complaints and percentage of complaints compared to
the total number of trips; and
· The number of vehicle inspections completed with results.
10. Other Monitoring as Specified by the CTC
2.2 Reports
a. Encounter Data. The Provider will prepare reports on encounter data as well as
complaints filed and corrective action taken. The Provider may be required to
provide immediate response to ad hoc data requests of CTC staff.
b. Proiect Reports. The Provider shall utilize project reports established by the
eTC. The Provider shall utilize reporting formats that will be developed by the
CTC. When reporting requirements are not established in the Agreement, the
eTC shall provide the Provider with instructions and submission timetables, The
CTC reserves the right to modify reporting formats and submission timetables as
a result of changing priorities or management direction,
c. Annual Reports. The Provider must submit to the eTC, by August 15th 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 CTC
via the electronic reporting mechanism available through the Commission's web
page.
d. Ad Hoc Reporting. The Provider must provide reports to the CTC in response to
requests for data on a periodic basis. Data should be provided to the CTC within
one (1) business day, or longer, if agreed to by both the CTC and the Agency for
Health Care Administration.
e, Other Reports. The Provider may be required to provide additional information in
the annual, and monthly reports when specified by the CTe.
2.3 Automation Requirements
The Provider must have the capacity (hardware, software and personnel) sufficient to
generate all data and reports needed for this project. The Provider shall also have the
necessary information technology needed to implement the reports and project described
in this Agreement.
2.4 Systems 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 appHcations and where possible in legacy appiications, 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: YYYYMMOD where YYYY = full representation of the year,
MM :::: month (between 01 and 12) and DO = day of the month (between 01 and
CTO MEDICAID NON-EMERGENCY TRANSPORTATION (NET) AGREEMENT
PAGE 20 OF 40
31), User interfaces (Le., screens, reports, etc.) should accurately show four digit
years, Where this is impossible (Le., date elements represented without
century), the correct century must be unambiguous for all manipulations and/or
calculations involving that element.
2.5 Determination of Service Process
R The Provider shall structure the determination of need for service process to
meet the following basic requirements:
1. The beneficiary's eligibility has been verifjed;
2. The beneficiary has declared that he or she is a current resident of the
provider's service area;
3. The beneficiary's Medicaid ID number and address have been recorded
for reporting purposes;
4. The beneficiary has decfared 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 locality; and
8. The transportation mode is the most cost-effective possible.
b. The 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;
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 Information
The 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 Providers
for each beneficiary. The Provider shall regularly verify information is accurate. The
Provider shall develop mandatory beneficiary intake information for NET services,
that provides the foUowing information:
1. Determination of Eligibility:
Name and address;
Beneficiary's date of birth in month, day, year format
(MM/DD!YYYV);
· County of origin;
· Medicaid number; and
· Telephone number, if available,
ero MEDICAID NON-EMERGENCY TRANSPORTATION (NET) AGREEMENT
PAGE 21 OF 40
2. Availability of Suitable Mode or Transportation to Other Community
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 Information
Except for the information contained on the Medicaid eligibility certification, the Provider
shall accept the information 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 Provider has cause to doubt the validity of information provided.
2.6 Application for Services
The 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 hospital discharge
shall be considered as urgent care. The Provider may verify with the direct provider of
service that the need for urgent care exists.
The 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 CTe as wen as the beneficiary's needed level of
transportation in the Appropriate Level of Transportation Section.
2.7 Levels of Transportation
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
CTO MEDICAID NON-EMERGENCY TRANSPORTATION (NET) AGREEMENT
PAGE 22 OF 40
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 (accessibility is
not within 3/4 mile of scheduled route).
2.8 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;
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 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 twenty~four (24) hours 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 Provider
and required that an appointment be rescheduled.
2.9 Beneficiary Appeals Notice
When the Provider denies eligibility of transportation sefvices to a beneficiary, the
beneficiary must be informed of his/her right to appeal by sending, by mail, an initial
decision lettef outlining the reason the 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 Provider must utilize a formal beneficiary appeals 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 white
the appeal is being reviewed. Beneficiaries must be allowed to schedule and receive
transportation services throughout the appeal process.
CTD MEDICAID NON-EMERGENCY TRANSPORTATION (NET) AGREEMENT
PAGE 23 OF 40
2.10 Complaint Resolution
The 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.
2.11 Fair Hearino Requirements
The Medicaid fair hearing policy and process is detailed in Rule 65-2.042, FAC. The
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 written 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. Request Requirements
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.
2.12 Beneficiary Co-payment
The 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 CTC 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;
· 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 condition 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.
CTO MEDICAID NON.EMERGENCY TRANSPORTATION (NET) AGREEMENT
PAGE 24 OF 40
A provider cannot deny service to a recipient based solely 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.
2.13 Provider limitations
The 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 Aareement
The CTe 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 eTe 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. Billina and Payment
Non-emergency transportation services are mandatory Medicaid services that may not be
restricted due to inadequate funding. Through this Agreement, the Provider accepts
responsibility to provide or coordinate delivery of all non-emergency transportation
services within the existing funds of this Agreement.
The Provider shall be paid upon satisfactory submission of receivables as designated in
the Agreement.
C. SPECIAL PROVISION(S};
1, Termination Procedures
The Provider agrees to the termination procedures in Section 6 of the CTC'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 with proof of delivery, or by
facsimile letter 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
CTO MEDICAID NON-EMERGENCY TRANSPORTATION (NET) AGREEMENT
PAGE 25 OF 40
become effective. In accordance with 1932(e)(4), Social Security Act, the GTG shall
provide the Provider with an opportunity for a hearing prior to termination for cause.
After receipt by the GTe of final notice of termination, on the date and to the extent
specified in the notice of termination, the Provider shall:
a. Stop work under the Agreement, but not before the termination date.
b. 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 GTC determines that the Provider is out of compliance with the provisions
of the Agreement, the GTC may issue to the Provider, via certified mail, a request
for a performance improvement plan (PIP). The GTC shall provide the Provider
with a time certain that the corrections are to be made. The Provider must
respond to the request within fifteen (15) calendar days by providing a PIP to the
CTC. The CTC must approve the plan and submit the signed approval to the
Provider prior to implementation of the PIP. The CTG may suggest changes or
request a rewrite of the PIP and provide a specific deadline for the rewrite. If the
Provider does not meet the standards established in the PIP by the time certain,
the Provider will be in violation of the provisions of the Agreement and is subject
to sanctions.
b. Sanctions
· Withholding Payments Withholding of monthly payments or a portion
thereof to the Provider by the GTC;
· Fines Imposition of a fine determined by the CTC for violation of the
Agreement with the CTC. Fines shall not exceed an amount that is more
than five (5%) percent of the total monthly payment to the 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 CTC is satisfied that the basis for imposing the sanction has been
corrected.
3. Travel Expenses
The Provider shall not bill the CTe for any travel expenses.
CTO MEDICAID NON-EMERGENCY TRANSPORTATION (NET) AGREEMENT
PAGE 26 OF 40
4. AssiQnment
The Provider shall not assign the Agreement, in whole or in part, without the express
written approval of the eTC.
5. 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.
6. Severability of Provisions
If any provision of the Agreement is declared or found to be illegal, unenforceable, or
void, then both the Provider and the CTe 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
CTe shall reduce the amount of the Agreement accordingly.
7. Inspection of Records and Work Performed
The CTC at all reasonable times, have the right to enter the Provider's premises, or other
places where duties under the Agreement are performed. All inspections and evaluations
shall be performed in such a manner as shall not unduly delay work. Refusal by the
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 eTe to perform inspections shall continue for as long as a Provider is
required to maintain records. The Provider will be responsible for all storage fees
associated with records maintained under the Agreement. The eTe shall give the
Provider advance notice of cancellation pursuant to this provision and shall pay the
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 eTC of
any of its obligations under this Agreement shall be subject to the Subcontracted
Provider's compliance with this provision.
8. Confidentiality of Beneficiary Information
All personally identifiable beneficiary infofmation obtained by the Providef shall be treated
as privileged and confidential information and shall be used only as authorized fOf
purposes directly related to the administration of the Agreement. The Provider must have
a process that specifies that beneficiary-specific information femains confidential, is used
solely for the purposes of data analysis and other Provider responsibilities under the
Agreement, 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 Provider can
be shared only with those agencies that have legal authority to receive such information
and cannot be otherwise transmitted for any purpose other than those for which the
Provider is retained by the CTC. The Provider must have in piace 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).
ero MEDICAID NON-EMERGENCY TRANSPORTATION (NET) AGREEMENT
PAGE 27 OF 40
9. Force Majeure
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 directly or
indirectly from acts of nature, civil or military 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.
10. EEO Compliance
The 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.
11. Patents, Royalties, CODyriqhts, Riqht to Data and Sponsorship Statement
The Provider, without exception, shall indemnify and save harmless the CTC 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 Provider. The Provider has no liability when such claim
is solely and exclusively due to the combination, operation or use of any article supplied
hereunder with equipment or data not supplied by the Provider or is based solely and
exclusively upon the CTC's alteration of the articte. The CTC shall provide prompt written
notification of a claim of copyright or patent infringement and shall afford the Provider full
opportunity to defend the action and control the defense. Further, if such a claim is made
or is pending, the Provider may, at its option and expense procure for the CTe the right
to continue the use of, replace or modify the articte to render it non-infringing (if none of
the alternatives is reasonably available, the CTC agrees to return the article on request to
the Provider and receive reimbursement, if any, as may be determined by a court of
competent jurisdiction). If the 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 eTC 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 eTC 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 benefit of the state. Pursuant to
section 286.021, Florida Statutes, no person, firm, corporation, including parties to this
Agreement shall be entitled to use the copyright, patent, or trademark without the prior
written consent of the Florida Department of State.
The eTC 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
12. Applicable Laws and ReQulations
The Provider agrees to comply with all applicable federal and state laws and regulations,
including but not limited to:
eTO MEDICAID NON-EMERGENCY TRANSPORTATION (NET) AGREEMENT
PAGE 28 OF 40
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 regulations 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 use 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 use 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, PL 97-35, which prohibits discrimination on the basis of sex and religion 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.
13. State Ownershig
The eTC shall have unlimited rights to use, disclose, or duplicate, for any purpose
whatsoever, all information and data developed, derived, documented, or furnished by
the Provider as a result of the Agreement
14. Symbols, 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, letters, 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 CTC. State
and local governments are exempt from this prohibition. A disclaimer that accompanies
the inappropriate use of program or CTC terms does not provide a defense. Each piece
of mail or information constitutes a violation.
15. Audits/MonitorinQ Provisions
The CTC may conduct, or have conducted, performance and/or compliance reviews,
reviews of specific records or other data as determined by the CTC. The eTC may
conduct a review of a sample of beneficiary and other Provider records to verify the
quality of the Provider's services. Reasonable notice shall be provided for reviews
conducted at the Provider's or place of business. Reviews may include, but shall not be
limited to, reviews of procedures, computer systems, accounting records, and internal
quality control reviews. The Provider shall work with any reviewing entity selected by the
state.
The CTe is permitted to monitor and review the transportation operations and services of
the 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 Provider is complying with the requirements of the contract.
These representatives shall also have access to art financial and statistical reports,
supporting documents, and any other documents pertinent to this Agreement.
CTD MEDICAID NON-EMERGENCY TRANSPORTATION (NET) AGREEMENT
PAGE 29 OF 40
AGREEMENT #:
EXHIBIT B
METHOD OF COMPENSATION
For the satisfactory performance of the services and the submittal of Encounter Data as outlined in
Exhibit A, Scope of Services, the Provider shall be paid up to a maximum amount of
$ 46,666.00 during the length of the contract. The Provider shall submit monthly invoices (3 copies) in a
format acceptable to the CTC. The Provider will be paid, after the CTC has received payment from the
Commission, in the amount of $3.00 per mile with a 5 mile minimum, $2.00 per mile for preauthorized out-
of-county trips and a $3.00 flat rate for multiloadjng. Submittal of Encounter Data will be conducted
weekly, and completed by the 3rd of the following month.
1 . Proiect Cost:
The Provider shall request payment through submission of a properly completed invoice to the
CTC's Transportation Director or its designee.
Monroe County Transportation:
$3.00 per mile/5 mile minimum
$2.00 per mile for preauthorized out-of-county trips
$3.00 flat rate per client per multi load
Total Amount not to Exceed
$ 46.666.00
CTO MEDICAID NON-EMERGENCY TRANSPORTATION (NET) AGREEMENT
PAGE 30 OF 40
AGREEMENT #:
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
shalf have the same meaning as the term "protected health information" in 45 C.FR S 164.501,
limited to the information 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 shalf not use or
disclose 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 Information not provided for in this
Agreement of which the Provider is aware. A violation of this paragraph shalf be a material
violation of this Agreement.
3. Use and Disclosure of Information for Management, Administration. and LeQal Responsibilities.
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 reasonable assurances
from the person to whom the Protected Health Information is disclosed that (1) the Protected
Health Information will be held confidentially, (2) the Protected Health Information will be used or
further disclosed only as required by 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 AQents. 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. ~ 164.526.
7. AccountinQ 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 9 164.528. 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 ~ 164.528.
CTO MEDICAID NON.EMERGENCY TRANSPORTATION (NET) AGREEMENT
PAGE 31 OF 40
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 Health
and Human Services or the Secretary's designee for purposes of determining compliance with
the Department of Health and Human Services Privacy Regulations.
9. Termination. At the termination of this Agreement, the Provider shall return aU 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.
Subcontracted Transportation Provider
Signature
Date
Name and Title of Authorized Signer
CTO MeDICAID NON.EMERGENCY TRANSPORTATION (NET) AGREEMENT
PAGE 32 OF 40
AGREEMENT #:
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. Impose 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
requirements.
Authorized Signature
Date
eTO MEDICAID NON-EMERGENCY TRANSPORTATION (NET) AGREEMENT
PAGE 33 OF 40
AGREEMENT #:
ATTACHMENT 3
FINANCIAL AND COMPLIANCE AUDIT
The Provider may be subject to audits and/or monitoring by the GTC.
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 OMS Circular A-133,
as revised, and/or other procedures, By entering into this agreement, the Provider agrees to
comply and cooperate with any monitoring procedures/processes deemed appropriate by the
CTC. In the event the CTC determines that a limited scope audit of the Provider is appropriate,
the Provider agrees to comply with any additional instructions provided by the CTC to the
Provider regarding such audit The Provider further agrees to comply 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 Provider is a State or local government or a non-profit
organization as defined in OMB Circular A-133, as revised,
PART VI of this agreement indicates Federal resources awarded through the CTC. In
determining the Federal awards expended in its fiscal year, the Provider shalf consider all
sources of Federal awards, including Federal resources received from the CTC. The
determination of amounts of Federal awards expended should be in accordance with the
guidelines established by OMS Circular A-133, as revised. An audit of the Provider conducted by
the Auditor General in accordance with the provisions of OMS 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 Provider shall
fulfill the requirements relative to auditee responsibilities as provided in Subpart C of
OMS Circular A-133, as revised.
If the 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 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 OMS Circular A-133, as
revised, the cost of the audit must be paid from non-Federal resources (Le., the cost of such an
audit must be paid from the 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/omb/index
PART II; State Funded
CTO MEDICAID NON-EMERGENCY TRANSPORTATION (NET) AGREEMENT
PAGE 34 OF 40
This part is applicable if the Provider is a non-state entity as defined by Section 215.97(2}(1),
Florida Statutes.
1. in the event that the 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 Provider, the 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 CTC by this agreement. In determining the
State Financial Assistance expended in its fiscal year, the Provider shall consider all
sources of State Financial Assistance, including State Financial Assistance funds
received from the CTC, 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 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 (local governmental entities)
or 10.650 (nonprofit and for-profit organizations), Rules of the Auditor General.
If the 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 Provider expends less than $300,000 in State Financial Assistance
in its fjscal year and elects to have an audit conducted in accordance with the provisions of
Section 215.97, Florida Statutes, the cost of the audit must be paid from the non-state entity's
resources (I.e., the cost of such an audit must be paid from the 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.myflorida.com/myflorida/government/governorinitiativesffsaa/
PART Ill: Other Audit Requirements
1. 45 CFR, Part 74.26(d) extends OMS requirements, as stated in Part I above, to for~profit
organ izations.
PART IV: Report Submission
Copies of reporting packages for audits conducted in accordance with OMS Circular A-133, as revised,
and required by PART I of this agreement shall be submitted, when required by Section .320 (d), OMB
Circular A-133, as revised, by or on behalf of the Provider directly to:
Guidance Clinic of the Middle Keys
Community Transportation Coordinator
3000 41 sl Street, Ocean
Marathon, FL 33050
Other Federal agencies and pass-through entities in accordance with Sections .320 (e) and (f), OMS
Circular A~133, as revised.
Pursuant to Section .320 (f), OMB Circular A-133, as revised, the Provider shall submit a copy of the
financial reporting package described in Section .320 (c), OMS Circular A-133, as revised, and any
management letters issued by the auditor, to the CTC.
CTD MEDICAID NON-EMERGENCY TRANSPORTATION (NET) AGREEMENT
PAGE 35 OF 40
Copies of financial reporting packages required by PART II of this agreement shall be submitted by or on
behalf of the Provider directly to:
Guidance Clinic of the Middle Keys
Community Transportation Coordinator
3000 41 st Street, Ocean
Marathon, FL 33050
Copies of reports or management letters required by PART III of this agreement shall be submitted by or
on behalf of the Provider directlv to:
Guidance Clinic of the Middle Keys
Community Transportation Coordinator
3000 41 st Street, Ocean
Marathon, FL 33050
Any reports, management letters, or other information required to be submitted to the CTC pursuant to
this agreement shall be submitted timely in accordance with OMS 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.
Providers, when submitting financial reporting packages to the CTC for audits done in accordance with
OMS 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 Provider in correspondence accompanying the reporting package.
This can be accomplished by providing the cover lettef from the reporting package received from the
auditor or a cover letter indicating the date the audit reporting package was received by the Provider.
PART V: Record Retention
The Provider shall fetain sufficient records demonstrating its compliance with the terms of this agreement
for a period of five (5) years from the date the audit report is issued, and shall allow the CTC or its
designee access to such records upon request. The Provider shall ensure that audit working papers are
made available to the CTC or its designee upon request for a period of five (5) years from the date the
audit report is issued unless extended in writing by the GTC.
NOTE: Section AOO(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 included 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 36 OF 40
AGREEMENT #:
ATTACHMENT 3
GLOSSARY
ADA (Americans with Disabilities Act) -- Includes regulations for agencies and entities that provide
services to persons with disabilities.
Business Day -- 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 System -- The heating or air conditioning system of the vehicle in question.
CMS (Centers for Medicare and Medicaid Services) -- The organizational unit of DHHS responsible for
administering TiUe 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 item that the Subcontracted
Transportation Provider is required to produce under the terms and conditions of this Agreement.
Dependent -- An individual under the age of eighteen (18). A dependent may be a Medicaid recipient
Dispatching -- The act of designating a specific vehicle and driver to pick-up and deliver a Medicaid
recipient
Eligible (Medicaid Eligible) -. A person who is determined to be eligible for Medicaid services by the
Social Security Administration, or Department of Children and Families.
Emergencv 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 (EIiQibility Verification System) -- A system 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.
Gatekeeoinq -- The verification that a caller is actually an eligible Medicaid recipient, that Medicaid
transportation is needed, and the appropriate type of transportation needed.
Independent Contractor -- See transportation provider.
In State/Outcof..State Travel -- In-state travel refers to at! NET services the Subcontracted Transportation
Provider is responsible to assure delivery within the boundaries of the State of Florida and within a line
cro MEDICAID NON-EMERGENCvTRANSPORTATION (NET) AGREEMENT
PAGE 37 OF 40
drawn outside the Florida bordeL Out-of-state travel refers to travel outside of the predetermined border
limit.
Intake and Screeninq -- See Gatekeeping.
Medicaid 10 Number -- A unique identification number assigned to each Medicaid recipient for eligibility
card issuance and claims submittal purposes.
Medical Necessity -- 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 costly 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 itself, 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.
MonitorinQ - The CTC shaH monitor the Subcontracted Transportation Provider's performance of duties
under this Agreement by a variety of methods. Satisfactory, quality performance is required.
NET (Non-EmerQency Transportation) -- 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 Trip -- 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 medical
service to another.
NF -- Nursing facility or nursing home.
Non-Emergency 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.
Operational Procedures Manual -- A manual developed by the Subcontracted Transportation Provider
that presents the procedures for scheduling, after-hours services, urgent care, driver customer service
standards, record keeping requirements for drivers, etc.
Public Transportation -- City, county or municipal subway, bus, rail, and other transportation services
available in a number of locations in Florida.
Recipient -- 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.
ReCipient Appeal -- Recipients have the right to appeal when the Provider has denied or terminated or
suspended NET services to them.
CTO MEDICAID NON-EMERGENCY TRANSPORTATION (NET) AGREEMENT
PAGE 38 OF 40
ReCipient Residency -- 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,
SchedulinQ -- 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.
SchedulinQ Day/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 Agreement - An Agreement between a CTC 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-emerQency) 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 CTC enters into a Contract with to provide the
services delivered under this Agreement
SSI (Supplemental Security Income) -- A type of cash assistance received by individuals 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.
Transportation Operator -- Those entities that own and operate vehicles engaged in the direct delivery of
transportation and provide services to recipients through the scheduling of the Subcontracted
Transportation Provider.
Transportation Service Agreement -- An agreement between the CTe and a transportation provider for
the delivery of transportation services.
UrQent 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 scheduling within three (3) hours of the time the request is made.
eTO MEDICAID NON-EMERGENCY TRANSPORTATION (NET) AGREEMENT
PAGE 39 OF 40
Vehicle Identification Number (VIN) -- The unique number given to each vehicle produced by a
manufacturer.
Vehicle Loa -- A log which is kept by the vehicle driver that reports information on aU trips with 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 Transportation -- Transportation provided by individuals or agencies that receive no
compensation or payment other than minimal reimbursement for mileage for the provision of these
transportation services.
Wheelchair Van -- A van equipped with lifts and locking devices to safely secure a wheelchair while the
van is in motion.
Work Day -- 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.
CTD MEDICAID NON-EMERGENCY TRANSPORTATION (NET) AGREEMENT
PAGE 40 OF 40