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

Subcontracted Transportation Provider Contract Page 63 of 117 Srievanc:e Ninety (90) Calendar Yes Ninety (90) Fourteen (14) Thirty (30) Medicaid Fair Days From the Date of Calendar Days Calendar Days Calendar Days Hearing the Action That from the Date of Precipitated the Resolution of the Grtevance VIII. ADMINISTRATION AND MANAGEMENT A. General Provisions 1. The STP's governing body shall set forth POlicy and has overall responsibility for the organization of the STP. The STP shall be responsible for the administration and management of all aspects of this Agreement, including all Subcontracts, employees, agents, and services performed by anyone acting for or on behalf of the STP. The STP shall have a centralized executive administration, which shall serve as the contact point for the Commission, except as otherwise specified in this Agreement. 2. The STP shall be responsible for the administration and management of all aspects of this Agreement, such as, but not limited to the delivery of Transportation Services. If the STP Subcontracts any of its administrative and management duties under ttiis Agreement, the Commission shall hold the STP responsible for ensuring that the Subcontractor(s) maintain the same standards as the STP in administering and managing all aspects of the Subcontract. If the Subcontractor fails to maintain the same administration and management standards as the STP, the Commission shall sanction the STP in accordance with this Contract. 3. The STP shall not provide incentives to its Subcontractors to deny, limit, or discontinue Transportation Services to any Medicaid Beneficiary inappropriately. B. Staffing 1. The STP shall maintain an adequate and competent staff so as to enable the STP to timely perform under this Agreement C. Subcontract Requirements 1. The STP shall comply with all Commission procedures for Subcontracts review and approval submission. a. All Subcontracts must comply with 42 CFR 438.230. b. The STP and/or Transportation Providers shall be eligible for participation in the Medicaid program. If Medicaid involuntarily terminated a STP or Transportation Provider from the Florida Medicaid program, other than for 2008/2009 Medicaid Non-Emergency Transportation Subcontracted Transportation Provider Contract Page 64 of 117  purposes of inactivity, that STP or Transportation Provider is not an eligible Medicaid provider. c. The STP and/or Transportation Providers shall not employ or contract with individuals on the State or federal exclusions list available from the Department of Management Services' List of Excluded Vendors and the federal List of Excluded Individuals and Entities. d. No Subcontract that the STP enters into with respect to performance under this Agreement shall in any way relieve the STP of any responsibility for the provision of Transportation Services and other duties set forth in this Agreement. The STP shall assure that Transportation Providers perform all services and tasks related to the Subcontract in accordance with the terms of this Agreement. e. The STP shall include its Grievance System in its Subcontracts to ensure uniformity of its Grievance System statewide. 2. All Subcontracts and amendments executed by the STP must be in writing and signed by the Recipient and the Subcontractor. All model and executed Subcontracts and amendments entered into as a result of this Agreement shall meet the following requirements: a. Prohibit the Subcontractor from seeking payment from the Medicaid Beneficiary for any Covered Services provided to the Medicaid Beneficiary within the terms of the Agreement. b. Require the Subcontractor to look solely to the STP for compensation for services rendered, with the exception of co-payments, pursuant to the State Medicaid Plan and the Non-Emergency Transportation Services Coverage & Limitations Handbook (Handbook):·· c. The Subcontract shall not contain an incentive plan that, in any way, acts as an inducement to reduce or limit Transportation Services to a Medicaid Beneficiary inappropriately. d. Specify that any contracts, agreements, or Subcontracts entered into by the Subcontractor for the purposes of carrying out any aspect of this Agreement must include assurances that the individuals who are signing the contract, agreement or Subcontract are so authorized and that it includes all the requirements of this Agreement. e. Require the Subcontractor to cooperate with the STP's Grievance and Appeal policies and procedures and provide for monitoring and oversight, including monitoring of Transportation Services rendered to Medicaid Beneficiaries, by the STP and for the Subcontractor to provide proof annually, or at the request of the STP, the CommisSion, or its agent, that 2008/2009 Medicaid Non~Emergency Transportation Subcontracted Transportation Provider Contract Page 65 of 117  all drivers and vehicles are Licensed and meet all federal, State, and local laws and regulations. f. Not prohibit a Subcontractor from advocating on behalf of a Medicaid Beneficiary in any Grievance System or UM process, or individual authorization process to obtain necessary Transportation Services. g. Prohibit discrimination with respect to participation, reimbursement, or indemnification of any Subcontractor who is acting within the scope of his or her license or Certification under applicable State law, solely on the basis of such license or Certification. The STP should not construe this provision as a willing provider law, as it does not prohibit the STP from limiting provider participation to the extent necessary to meet the needs of the Medicaid Beneficiaries. This provision does not interfere with measures established by the STP designed to maintain quality and control costs. h. Prohibit discrimination against Subcontractors serving Medicaid Beneficiaries in high-risk populations or Subcontractors that specialize in conditions requiring costly transport. i. Require the Subcontractor to maintain an adequate record system for recording services, charges, dates and all other commonly accepted information elements for services rendered to the Recipient. j. Require that the Subcontractor maintain records related to this Agreement for a period not less than five (5) years from the close of the Agreement, and retained further if the records are under review or audit until the review or audit is complete. k. . Specify thatthe United States Department ·of Health & Human Services (DHHS) and the Agency or its Agents shall have the right to inspect, evaluate, and audit any records pertinent to the Agreement, including, but not limited to, the following: (1) Pertinent books; (2) Financial records; and, (3) Documents, papers, and records of any Transportation Provider involving financial transactions. I. Specify Covered Services and populations that the Subcontractor will serve under the Subcontract. m. Require that Subcontractors comply with the Recipient's Cultural Competency Plan. 2008/2009 Medicaid Non-Emergency Transportation Subcontracted Transportation Provider Contract Page 66 of 117  n. Require that any materials related to this Agreement that the Subcontractor distributes are submitted to the Commission for written approval before use. o. Provide for submission of all reports and information required by the Recipient. p. Require Subcontractors to submit notice of withdrawal from the Recipient's Transportation Provider network at least ninety (90) Calendar Days prior to the effective date of such withdrawal. q. Require all Subcontractors to notify the Recipient in the event of a lapse in general liability or other applicable insurance. r. Require safeguarding of information about Medicaid Beneficiaries according to 42 CFR, Part 438.224. s. Require compliance with HIPAA privacy and security provisions. t. Require an exculpatory clause, which survives termination of the Subcontract, including breach of Subcontract due to Insolvency, that assures that the Subcontractor's creditors cannot hold either Medicaid Beneficiaries or the AHCA or the Commission liable for any debts of the Subcontractors.