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

Systems and submit all reports as set forth in this Section and the Reporting Requirements Section of this Contract. If the STP fails to maintain its Systems or submit all reports as set forth, the Commission shall sanction the STP in accordance with this Contract. B. Data and Document Management Requirements 1. Adherence to Data and Document Reporting Requirements a. The STP's Systems shall conform to the standard transaction code sets specified in this agreement. b. The STP's Systems shall conform to HIPAA standards for data and document management that are currently under development within one hundred twenty (120) Calendar Days of the Agreement's effective date or, if earlier, the date stipulated by CMS or the AHCA. c. The STP shall comply with the Commission's and the AHCA's standard transaction code sets specific to the Commission and AHCA . 2. Information Retention - The STP shall maintain Information in its Systems in electronic form for three (3) years in live Systems and, for audit and reporting purposes, for five (5) years in live and/or archival Systems. 3. Information Ownership - The Commission maintains ownership over all Information, whether data, documents, or reports that contain or make references to said Information involving or arising out of this Agreement. a. If the STP is required to provide documentation pursuant to a public records request, the STP shall redact any and all personal health information, in compliance with HIPAA and all other applicable federal and state laws and regulations. b. If the STP wishes to publish a report, information, or commentary that includes data drawn from the Medicaid population, the Commission and/or the AHCA must first give written approval to the STP's interpretation of all data before the STP can publish said report, information, or commentary. (1) In order to expedite approval of any report, information, or commentary that uses data drawn from the Medicaid population, 2008}2009 Medicaid Non~Emergency Transportation Subcontracted Transportation Provider Contract Page 7S of 117  the STP must include with its written request for approval all documentation, statistics, tables, graphs, and details that give rise to the STP's interpretation and the basis upon which the Recipient uses the data to support its interpretation. C. System and Data Integration Requirements 1. Data and Report Validity and Completeness a. The STP shall institute processes to ensure that the data is valid and complete; including reports submitted to the Commission pursuant to the Reporting Requirements of this contract. At its discretion, the Commission will conduct general data validity and completeness audits using industry- accepted statistical sampling methods. The Commission shall audit specific data elements including, but not limited to: Medicaid Beneficiary ID, date of service, category and sub category (if applicable) of service, procedure codes, revenue codes, date of claim processing, and (if and when applicable) date of claim payment. The Commission shall also review and verify control totals. 2. Data Exchange in Support of the Commission's Program Integrity and Compliance Functions a. The STP's System(s) shall be capable of generating files in the prescribed formats for upload into Commission Systems used specifically for program integrity and compliance purposes. D. Systems Availability, Performance, and Problem Management Requirements 1. Availability of Critical Systems Functions a. The STP shall ensure that critical Systems functions available to Medicaid Beneficiaries and Transportation Providers, functions that if unavailable would have an immediate detrimental impact on Medicaid Beneficiaries and Transportation Providers, are available twenty-four (24) hours a day, seven (7) days a week, except during periods of scheduled System Unavailability agreed upon by the Commission and the STP. Unavailability caused by events outside of a STP's Span of Control is outside the scope of this requirement. The STP shall make the Commission aware of the nature and availability of these functions prior to extending access to these functions to Medicaid Beneficiaries and/or Transportation Providers. 2. Availability of Data Exchange Functions a. The STP shall ensure that the Systems and processes within its Span of Control associated with its data exchanges with the Commission and/or its Agent(s) are available and operational according to specifications and the data exchange schedule. 2008/2009 Medicaid Non-Emergency Transportation Subcontracted Transportation Provider Contract Page 76 of 117  3. Problem Notification a. Upon discovery of any problem within its Span of Control that may jeopardize, or is jeopardizing, the availability and performance of Systems functions and the availability of information in said Systems, including any problems impacting scheduled exchanges of data between the STP and the Commission and/or its Agent(s), the STP shall notify the Commission's Project Manager via phone, fax and/or electronic mail within fifteen (15) minutes of such discovery. In its notification, the STP shall explain in detail the impact to critical path processes such as transportation coordination and claims submission processes. b. The STP shall provide to appropriate Commission staff, or its Agent's staff, information on System Unavailability events, as well as status updates on problem resolution. At a minimum, the STP shall provide these updates on an hourly basis via electronic mail or telephone (if electronic mail is unavailable due to the System Unavailability). 4. Recovery from Unscheduled System Unavailability a. Unscheduled System Unavailability caused by the failure of Systems and telecommunications technologies within the STP's Span of Control must be resolved, and the restoration of services implemented, within forty- eight (48) hours of the official declaration of System Unavailability. 5. Exceptions to System Availability Requirement a. The STP shall not be responsible for the availability and performance of Systems and information technology (IT) infrastructure technologies outside of the STP's Span of Control.· E. System Testing and Change Management Requirements 1. Notification and Discussion of Potential System Changes a. The STP shall notify the Commission Project Manager of the following changes to Systems within its Span of Control within at least ninety (90) Calendar Days of the projected date of the change; if so directed by the Commission, the STP shall discuss the proposed change with applicable Commission staff: (1) software release updates of core transaction Systems: claims proceSSing, eligibility and Enrollment proceSSing, Service Authorization management, Transportation Provider enrollment and data management; (2) conversions of core transaction management Systems. 2. Response to Commission Reports of Systems Problems not Resulting in System Unavailability 2008/2009 Medicaid Non·Emergency Transportation Subcontracted Transportation Provider Contract Page 77 of 117  a. The STP shall respond to Commission reports of System problems not resulting in System Unavailability according to the following timeframes: (1) Within seven (7) Calendar Days of receipt, the STP shall respond in writing to notices of System problems. (2) Within twenty (20) Calendar Days, the STP shall make a correction to the System or will make a Requirements Analysis and Specifications document. (3) The STP will correct the deficiency by a date certain as determined by the Commission. 3. Testing a. The STP shall work with the Commission pertaining to any testing initiative as required by the Commission. b. The STP shall ensure adequate Information System integrity to capture Encounter Data and, at a minimum, take necessary action to safeguard against System interruptions resulting from network, operating hardware, software, or operational errors that compromise the integrity of transactions that are active in a live system or archived at the time of an outage or causing unscheduled System Unavailability. F. Reporting Requirements - Specific to Information Management and Systems Functions and Capabilities - and Technological Capabilities 1. Reporting Requirements a. If the STPis extending access to "critical systems functions" to providers and Medicaid Beneficiaries as described in the Availability of Critical Systems Functions section, above, it shall submit a monthly Systems Availability and Performance Report to the Commission as described in Reporting Requirements, otherwise this reporting