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

thirty (30) minutes for every fifteen (15) Miles the STP must travel outside of the Medicaid Beneficiary's county of residence. The STP must work with the Hospital's/facility's discharge coordinator to assure that the Medicaid Beneficiary is ready for transport at the scheduled time. c. Urgent Care (1) The STP shall provide Transportation Services to return a Medicaid Beneficiary to his/her home after business hours. (2) The STP must acknowledge and schedule all requests for Urgent Care Transportation Services within one (1) hour of the time the Medicaid Beneficiary, or his/her representative, makes the request. 2008/2009 Medicaid Non-Emergency Transportation Subcontracted Transportation Provider Contract Page 46 of 117  (3) Transportation Services must be provided to a Medicaid Beneficiary within three (3) hours of when the Medicaid Beneficiary, or his/her representative, makes the request. If the Hospital/facility is located in a county other than the Medicaid Beneficiary's county of residence, the STP may add additional time to the three (3) hour time limit at the rate of thirty (30) minutes for every fifteen (15) Miles the STP must travel outside of the Medicaid Beneficiary's county of residence. d. Emergency Room/Facility Discharges (1) The STP shall provide Hospital emergency room or facility discharge staff with contact information, procedures, and other appropriate information to access and schedule Transportation Services for all Medicaid Beneficiaries. (2) The STP must acknowledge and schedule all requests for Emergency Room/facility Transportation Services within one (1) hour of the time the Medicaid Beneficiary, or his/her representative, makes the request. . (3) Transportation Services must be provided to a Medicaid Beneficiary within three (3) hours of when the Medicaid Beneficiary, or his/her representative, makes the request. If the Hospital/facility is located in a county other than the Medicaid Beneficiary's county of residence, the STP may add additional time to the three (3) hour limit at the rate of thirty (30) minutes for every fifteen (15) Miles the Recipient must travel outside of the Medicaid Beneficiary's county of residence. e. Will Call (1) . If a Medicaid Beneficiary must delay receipt of Transportation Services as a result of a backlog of patients at the doctor's office or due to some other reason beyond the Medicaid Beneficiary's control, the Medicaid Beneficiary can contact the STP and req uest Transportation Services to return to his/her residence. (2) The STP must acknowledge and schedule all such requests within one (1) hour of the time the Medicaid Beneficiary, or his/her representative, makes the request. 3. Bariatrlc Transportation a. The STP shall make provisions for Transportation Services to Medicaid Beneficiaries whose weight exceeds the limits of the STP's equipment. 4. Nursing Home and Behavioral Health Facility Transportation Services 200B/2009 Medicaid Non-Emergency Transportation Subcontracted Transportation Provider Contract Page 47 of 117  a. The STP shall provide the appropriate level of Transportation Services to Medicaid compensable services for Medicaid Beneficiaries who are residents of nursing facilities, group homes, behavioral health facilities, or assisted living facilities. b. If the Medicaid Beneficiary's facility provides free Transportation Services for its residents to receive medical services, the facility must provide the same Transportation Services at no charge to Medicaid Beneficiaries who reside at the facility. If the Medicaid Beneficiary's facility provides free Transportation Services for its residents to receive medical services, the STP is not required to supply Transportation Services to the Medicaid Beneficiary. c. The STP shall provide Medicaid Beneficiaries who are residents of nursing facilities, group homes, behavioral health facilities, or assisted living facilities Transportation Services that are appropriate to the needs and condition of the Medicaid Beneficiary. The STP shall coordinate pick-up and return times for Medicaid Beneficiaries, especially those who have physical conditions or limitations that may be exacerbated by lengthy waiting periods, as verified by the facility. 5. The STP shall have written procedures in place for the provision of transportation services during inclement weather conditions and/or declared emergenCies as determined by State, federal, or local officials. 6. Service Area a. Transportation Services shall be provided to all eligible Medicaid - Beneficiaries regardless of their county of residence. All STPs are required to transport outside the Medicaid Beneficiary's county of residence or adjacent counties when necessary to transport a Medicaid Beneficiary to a covered Medical service and the required services are not available within the STP's normal county of operations, but are within the State or deSignated border areas. E. Medicaid Beneficiaries Needing Transportation Following Exercise of Baker Act 1. Transportation Services shall not be provided to transport a Medicaid Beneficiary from a Hospital/facility to a Behavioral Health Care facility if the Medicaid Beneficiary is receiving services pursuant to the Baker Act. 2. Transportation Services shall be provided to a Medicaid Beneficiary that is receiving services pursuant to the Baker Act if it is a transfer from a Behavioral Health Facility to a Hospital, facility, or other destination (including the Medicaid Beneficiary's residence) and it is confirmed by the Behavioral Health Facility that the Medicaid Beneficiary does not pose a threat of harm to themselves or others during transport. 2008/2009 Medicaid Non-Emergency Transportation Subcontracted Transportation Provider Contract Page 48 of 117  VI. OUALITY IMPROVEMENT A. Quality Improvement The Commission shan have a Quality Improvement Program to monitor and evaluate the quality and appropriateness of Transportation Services rendered to Medicaid Beneficiaries. 1. General Requirements a. STP will attend annual "best practices" seminars to learn how best to coordinate Transportation Services and meet the needs of this Agreement. b. The STP shall participate in Quality Improvement activities by the Commission to enhance the Quality of Transportation Services provided to Medicaid Beneficiaries. B. Performance Measures 1. In order to develop appropriate benchmarks, the STP shall report the following performance measures by the start date established in the chart below: Start Date PM Description Source Methodology (Where Applicable) Start Date of Agreement The number of Subcontractor Logs N/A accidents per 100,000 _.. .. .. _. ---. .._., .- . . ... ·miles,.broken down by . .. . ... . . . ._ .. ... county. Start Date of Agreement The number of Road Subcontractor Logs N/A Calls per 10,000 miles, broken down by county. Start Date of Agreement Average Medicaid Recipient N/A Beneficiary call hold Survey/Monitoring times on a county by county basis and as measured throughout the year and at different times of the day, 2008/2009 Medicaid Non-Emergency Transportation Subcontracted Transportation Provider Contract Page 49 of 117 Starts upon Commencement of The number of Encounter Data Found by Subtracting Submission of Encounter Data Medicaid Beneficiaries "Reservation delivered to Appointment Timell by appointments later "Trip Destination Drop than the scheduled Off Time" appointment time,