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

Services; (5) All records must show whether the Medicaid Beneficiary has any specific needs that require special equipment or services (e.g., dementia, uses a walker, etc.); and, (6) All records must show whether the Medicaid BenefiCiary requires a medical Attendant/Escort or assistance in accessing medical services (e.g., door-to-door delivery, etc.). b. Confidentiality of Medicaid Beneficiary Eligibility Records (1) The STP shall ensure the confidentiality of Medicaid BenefiCiary eligibility records in accordance with 42 CFR, Part 431, Subpart F and the Privacy and Security prOVisions of the Health Insurance Portability and Accountability Act (HIPAA). F. Invoice Payment 1. An invoice is considered received when the Commission receives the invoice in its Offices. 2. The Commission has eleven (11) business days to inspect and approve goods and services:· If payment is not available within fortY (40) calendar days, measured from the latter of the date the invoice is received or the goods or services are received, inspected and approved, a separate interest penalty set by the Comptroller pursuant to Section 55.03, F. S., will be due and payable in addition to the invoice amount. To obtain the applicable interest rate, please contact the Commission's Fiscal Section at (850) 410-5700. Invoices returned to a STP due to preparation errors will result in a payment delay. Invoice payment requirements do not start until a properly completed invoice is provided to the Commission. A Vendor Ombudsman, whose duties include acting as an advocate for Vendors who may be experiencing problems in obtaining timely payment(s) from a State Agency, may be contacted at (850) 410-9724 or by calling the State Comptroller's Hotline, 1-800-848-3792. G. Encounter Data . 1. The STP shall collect and submit Encounter Data to the Commission. The STP shall have a comprehensive automated and integrated Encounter Data system 2008/2009 Medicaid Non-Emergency Transportation Subcontracted Transportation Provider Contract Page 71 of 117  that is capable of meeting the requirements as defined by the Commission. The required data elements are provided in Attachment 3. The attach chart is the Draft Batch File Layout for the new Medicaid system. There will be an additional one alpha character identifier for any record that contains a Social Security Number consisting of all 9's (the only acceptable entry other than a valid SSN), that's not shown in this File Layout. This field must be occupied with either an I for Infant or A for Alien (not case-sensitive) if the value is all 9's (999-99-9999). In the case of a valid SSN, this field will be left blank. The exact File Layout, including the location of this new data element, will be provided by the Commission as soon as it is finalized. 2. The STP is responsible for errors or noncompliance resulting from its own actions or the actions of an agent authorized to act on its behalf. The STP shall resolve any errors or noncompliance and resubmit the Encounter Data. a. The Commission shall monitor the STP's submissions and provide error reports for the STP to resolve and resubmit. 3. The STP shall implement review procedures to validate their own Encounter Data. 4. The STP will designate sufficient information technology and staffing resources to perform these functions as set forth in this Agreement. S. The STP shall have a unique Florida Medicaid provider identification number. 6. The STP must attend and/or participate in training provided by the Commission and/or AHCA regarding: a. . The Commission's Information System; . b. The critical requirements for Encounter Data submission; and, c. The submission and resubmission reqUirements. 7. All Encounter Data from submission and resubmission shall be: a. Complete (1) All Trips shall be entered for the reported period. (2) All required data fields shall be populated. b. Accurate (1) One hundred percent (100%) of all fields shall contain valid values. 2008/2009 Medicaid Non~Emergency Transportation Subcontracted Transportation Provider Contract Page 72 of 117  (2) The STP shall input the fully allocated Cost in the "trip cost" field based on the Commission rate methodology. c. Timely (1) The STP shall submit Encounter Data no later than thirty (30) Calendar Days after the end of the reporting month. (2) The STP shall submit all corrected Encounter Data within ninety (90) Calendar Days after the end of the reporting month 8. The STP shall cooperate with Commission staff and its authorized representatives regarding onsite visits to evaluate the STP's MEDS operations, which include providing access to Transportation Records and administrative records for review. The STP shall participate in Commission and/or AHCA sponsored workgroups directed at continuous improvements in Encounter Data quality and operations. 9. The Commission and AHCA will monitor and track the quality of the STP's Encounter Data submissions and provide feedback to the STP and/or Commission pursuant to the schedule set forth below. a. The Commission shall use seventy-five percent (75%) accuracy as the starting point or benchmark for determining quality of the Encounter Data submissions. b. For purposes of this section, quality means that the Encounter Data for the service rendered conforms to the terms and conditions of this Agreement. Recipient's Encounter Data via MEDS System - -Expected % Quality Level Processing Month MED5 % Minimum Quality Expected March, 2009 75% April, 2009 80% May, 2009 85% June, 2009 85% July, 2009 90% August, 2009 90% September, 2009 - End of Agreement 95% 10. If the STP's Encounter Data reporting is not acceptable, the Commission shall require the STP to submit a Corrective Action Plan (CAP). If the STP fails to provide a CAP, or to implement an approved CAP, within the time speCified by the Commission, the Commission shall sanction the STP, in accordance with the 2008/2009 Medicaid Non~Emergency Transportation Subcontracted Transportation Provider Contract Page 73 of 117  Contract. When considering whether to impose sanctions, the Commission may take into account the STP's cumulative performance on all MEDS activities. H. Fraud Prevention 1. The STP shall establish functions and activities governing program integrity in order to reduce the incidence of Fraud and Abuse and shall comply with all State and federal program integrity requirements. 2. The Recipient shall have internal controls and policies and procedures in place that are designed to prevent, detect, and report known or suspected Fraud and Abuse activities. 3 The Recipient shall cooperate fully in any investigation by the AHCA, MPI, MFCU, or any subsequent legal action that may result from such an investigation. 4. Ensure that the Recipient does not retaliate against any individual who reports Violations of the Recipient's Fraud and Abuse policies and procedures or suspected Fraud and Abuse. IX. INFORMATION MANAGEMENT AND SYSTEMS A. General Provisions 1. Systems Functions - The STP shall have Information Management processes and Information Systems that enable it to meet Commission, AHCA and federal reporting requirements and other Agreement requirements and that are in compliance with this Agreement and all applicable State and federal laws, rules and regulations, including HIPAA. . 2. Systems Capacity - The STP's Systems shall possess capacity sufficient to handle the workload projected for the begin date of operations and will be scalable and flexible so they can be adapted as needed, within negotiated timeframes, in response to changes in Agreement requirements, etc. 3. E-Mail System - The STP may provide a continuously available electronic mail communication link (E-mail system) with the Commission. This system shall be: a. Available from the workstations of the deSignated STP contacts; and, b. capable of attaching and sending documents created using software products other than STP's Systems, including the Commission's currently installed version of Microsoft Office and any subsequent upgrades as adopted. 4. Participation in Information Systems Work Groups/Committees - The STP shall meet as requested by the Commission, to coordinate activities and develop cohesive Systems strategies across STPs and agencies. 2008/2009 Medicaid Non~Emergenc.y Transportation Subcontracted Transportation Provider Contract Page 74 of 117  5. Connectivity to the Commission Network and Systems - The STP shall be responsible for establishing connectivity to the Commission's data communications network, and the relevant Information Systems attached to this network, in accordance with all applicable Commission policies, standards and guidelines. 6. Sanctions - The STP shall maintain all