Okaloosa County BOCC — 2013 meeting #1139 (date undetermined) — MEDICAID ORIGINAL 2009 — reading text

Beneficiary was unable to meet the scheduled pick-up time due to said unforeseen arid unavoidable circumstances. C. Co-Payments 1. The STP may charge a co-payment from Medicaid Beneficiaries that is not greater than one dollar ($1.00) for each Trip or two dollars ($2.00) per each round Trip. The STP must explain the STP's co-payment plan as part of the STP's co-payment plan in the Medicaid Beneficiary Transportation Services Handbook. 2. The following categories of Medicaid Beneficiaries are not required to pay a co- payment: a. Medicaid Beneficiaries under twenty-one (21) years of age; b. Pregnant women when the Transportation Services relate to: 2008/2009 Medicaid Non-Emergency Transportation Subcontracted Transportation Provider Contract Page 32 of 117  (1) The pregnancy; (2) To any medical condition that may complicate the pregnancy; or (3) Conditions or complications of the pregnancy extending through the .end of the month in which the sixty (60) day period following termination of pregnancy ends. c. Institutional Care Program (ICP) Medicaid Beneficiaries who are required to spend all of their income for medical care costs (excepUor a minimal amount that is required for personal needs) as a condition of receiving services in an institution and who are inpatients in long-term care facilities, Hospitals, or other. medical institutions; d. Medicaid Beneficiaries when Transportation Services relate to family planning services; and, e. Medicaid Beneficiaries who are receiving hospice services. 3. A STP cannot deny Transportation Services to a Medicaid BenefiCiary based solely on the Medicaid Beneficiary's inability to pay a Medicaid co-payment. If the Medicaid Beneficiary is unable to pay for Transportation Services at the time the Transportation Provider renders Transportation Services, the STP may bill the Medicaid BenefiCiary for the unpaid charge. D. Cultural Competency 1. The STP shall comply with the Commission's written Cultural Competency Plan, in accordance with 42 CFR 438.206, to ensure Transportation Services are provided in aculturally competent manner to all Medicaid Beneficiaries, including those with limited English profiCiency. The Cultural Competency Plan explains that STPs and STP employees will provide effective Transportation Services to people of all cultures, races, ethnic backgrounds, and religions in a manner that recognizes, values, affirms, and respects the worth of the individual Medicaid Beneficiaries and protects and preserves the dignity of each Medicaid BenefiCiary. IV. COVERED SERVICES A. Covered Services 1. The STP shall ensure the provIsion of Transportation Services in sufficient amount, duration, and scope reasonably expected to achieve the purpose for which the Transportation Services are furnished and shall ensure the provision of the following Covered Services as defined and specified in this Agreement. The STP shall not arbitrarily deny or reduce the amount, duration, or scope of Transportation Services solely because of a Medicaid Beneficiary's diagnosis, type of illness, or condition. 2008/2009 Medicaid Non-EmergenD{ Transportation Subcontracted Transportation Provider Contract Page 33 of 117  2. The STP is responsible for ensuring that it incorporates all Transportation Provider, service, and product standards specified in the Agency's Non- Emergency Transportation Services Coverage & Limitations Handbooks and the Commission's handbooks into the STP's Transportation Provider Agreement by reference. 3. Medicaid Beneficiaries who have begun self-administered home oxygen before transport may continue administration during transport. However, a Medicaid Beneficiary cannot begin a new regimen of oxygen therapy during transport, nor may the attendant employed by the Transportation Provider administer oxygen. 4. Escort Services - An Attendant/Escort is an individual whose presence is required to assist a Medicaid Beneficiary during transport and at the pl<;lce of treatment. The Attendant/Escort leaves the vehicle at its destination and remains with the Medicaid Beneficiary. An Attendant/Escort must be of an age of legal majority recognized under Florida law. a. The STP must allow, without charge to the Escort or Medicaid Beneficiary, one (1) Attendant/Escort to accompany a Medicaid Beneficiary or group of Medicaid Beneficiaries who are blind, deaf, mentally disabled, or under twenty-one (21) years of age, when the Medicaid Beneficiaries are transported to receive Medicaid compensable services. b. Upon the request of a Prescribed Pediatric Extended Care (PPEC) Center, the STP shall pick up Escorts for children attending said PPEC at a mutually agreed upon location from the Medicaid Beneficiary before picking up the Medicaid Beneficiary who is traveling to the PPEC. The STP shall not drop off the Escort until after the STP has dropped off the PPEC Medicaid Beneficiary. 5. Special Covered Services - The STP must supply Transportation for Medicaid Beneficiaries when: a. The Agency for Health Care Administration has begun a closure or decertification of a Nursing Facility and Medicaid Beneficiaries require Transportation from one Nursing Facility to another or to an alternate living arrangement; or, b. A Medicaid Beneficiary has a change in level of care that results in the facility not being certified or equipped to provide medically required or specialized services and the Medicaid Beneficiary requires Transportation from one Nursing Facility to another Nursing Facility or to an alternative living arrangement. 6. The STP shall provide Transportation Services for the following Covered Services: a. The STP must provide Transportation Services to eligible Medicaid Beneficiaries for Medicaid compensable services by using the most 2008/2009 Medicaid Non-Emergency Transportation Subcontracted Transportation Provider Contract Page 34 of 117  appropriate mode of Transportation, including, but not limited to, the following types: (1) Multiload Vehicles - A multiload vehicle is a multiple passenger vehicle, typically used for Transportation Services. It is appropriate only for ambulatory or non-ambulatory persons who can enter and exit a vehicle with minimal to no assistance. Assistance means that additional equipment and time are required. Multiload vehicles may include buses, vans, sedans, and taxis. (2) Wheelchair Vehicle - A wheelchair vehicle is a motorized vehicle equipped specifically with certified wheelchair lifts, or other eqUipment designed to carry persons in wheelchairs and scooters, or with mobility impairments. The STP may use wheelchair vehicles for the provision of ambulatory transportation services to maximize capacity. (a) The STP must use wheelchair vehicles in the following NET situations: (i) Medicaid Beneficiaries who are continually confined to a wheelchair; (ii) Medicaid Beneficiaries with severe mobility handicaps that prevent them from using private or public transportation or taxis; (iii) Medicaid Beneficiaries who are semi-ambulatory or homebound, ... and can accomplish . limited ambulatory movement with the assistance of a special ambulatory aid (like a walker or cane); or, (iv) Medicaid Beneficiaries who use a mobility device. (b) In questionable cases, the STP may contact the office of the Medicaid Beneficiary's Health Care Professional to verify the Medicaid Beneficiary's need for transport by a wheelchair vehicle. (3) Stretcher Vehicle - A stretcher vehicle is an enclosed vehicle that accommodates a litter and is equipped with locking devices to secure the litter during transit. Stretcher service is required for Medicaid Beneficiaries who are non-ambulatory and need assistance to be transported to and from the vehicle and the Health Care Professional's facility in a reclining pOSition. 2008/2009 Medicaid Non~Emergency Transportation Subcontracted Transportation Provider Contract Page 35 of 117  (a) No flashing lights, sirens, or emergency equipment are required to be installed on a stretcher vehicle. (b) The STP can provide stretcher services only in non- emergency situations and are limited to use by: (i) Medicaid Beneficiaries who need to remain in a