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

5. Errors a. If, after preparation and submission of reports and/or invoices, the STP discovers an error, including, but not limited to, errors resulting in incorrect payments, either by the STP or the Commission, the STP has thirty (30) Business Days from its discovery of the error, or thirty (30) Business Days after receipt of notice by the Commission to correct the error and resubmit accurate reports and/or invoices. Failure to respond within the thirty (30) Business Day period shall result in a loss of any money due to the STP for such errors and/or sanctions against the STP pursuant to Sanctions Section of this Contract. B. Member Payment Liability Protection 1. Pursuant to Section 1932 (b)(6), Social Security Act (as enacted by Section 4704 of the Balanced Budget Act of 1997), the STP shall not hold Medicaid Beneficiaries liable for the following: a. For debts of the STP, in the event of the STPs Insolvency; b. For payment of Covered Services provided by the STP if the STP has not received payment from the Commission for the Covered Services, and/or, c. For payments to a STP that furnished Covered Services under a contract, or other arrangement with the STP, that are in excess of the amount that normally would be paid by the Medicaid Beneficiary if the Covered Services had been received directly from the STP. 2008/2009 Medicaid Non-Emergency Transportation Subcontracted Transportation Provider Contract Page 85 of 117  C. Transition to Managed Care Organizations (MCOs) and Medicaid Reform 1. The STP understands that the State is operating a Medicaid managed care pilot program as stated in s, 409,91211, Florida Statute (Medicaid Reform), As a result, in all areas in which the State implements Medicaid Reform, the STP's Enrollment will transition from coverage under this Agreement to an authorized Medicaid Reform MCO in accordance with the AHCA's implementation schedule, 2, The STP understands that the State allows specified MCOs in Miami-Dade County to provide Transportation Services, Beneficiaries enrolled in these MCOs are not included in this Agreement. XII. SANCTIONS A, General Provisions 1. The STP shall comply with all reqUirements and performance standards set forth in this Contract, In the event the Commission identifies a Violation of this Contract, or other non-compliance with this Contract, the STP shall submit a Corrective Action Plan (CAP) within three (3) Calendar Days of the date of receiving notification of the Violation or non-compliance from the Commission or within the timeframe specified by the Commission, whichever is later, a, Within five (5) Business Days of receiving the CAP the Commission will either approve or disapprove the CAP, If disapproved, the Commission must cite the specific reasons in a written format for said disapproval, Upon written notice of disapproval, the STP shall resubmit, within five (5) Business Days, or a date speCified by the Commission whichever is later, a new CAP that addresses the concerns identified bythe Commissio ll , b, Upon approval of the CAP, whether the initial CAP or the revised CAP, the STP shall implement the CAP within the time frames specified by the Commission, The STP shall submit a report to the Commission detailing the implementation of the STP's CAP forty-five (45) Business Days following the date of the Commission's approval of the CAP, c, Except where specified below, the Commission shall impose a monetary sanction of $100 per day on the STP for each Calendar Day that the STP does not implement the approved CAP to the satisfaction of the Commission, 2, If the Commission determines, in its sole discretion, that a STP and/or Transportation Provider has violated the terms of this Contract, the Commission can sanction the STP, can terminate this Contract, or both, If the Agency for Health Care Administration determined, in its sole discretion, that a STP and/or 2008/2009 Medicaid Non·Emergency Transportation Subcontracted Transportation Provider Contract Page 86 of 117  Transportation Provider has violated the terms of this contract, AHCA can sanction the Commission and request the this contract be terminated or both. 3. Unless the Commission specifies the duration of a sanction, the sanction shall remain in effect until the Commission is satisfied that the STP has corrected the basis for imposing the sanction and it is not likely to recur. B. Specific Sanctions 1. The Commission may impose any of the following sanctions against the STP if the Commission, in its sole discretion, determines that the STP and/or a Transportation Provider has violated any provision of this Agreement, or any applicable statutes: a. Suspension or revocation of payments to the STP for Medicaid' Beneficiaries during the sanction period; b. For any nonwillful Violation of the Agreement, the Commission shall impose a fine, not to exceed $2,500 per Violation. In no event shall such fine exceed an aggregate amount of $10,000 for all nonwillful Violations arising out of the same action; c. With respect to any knowing and willful Violation of the Agreement, the Commission shall impose a fine upon the STP in an amount not to exceed $20,000 for such Violation. In no event shall such fine exceed an aggregate amount of $100,000 for all knowing and willful Violations arising out of the same action; d. If the STP . fails to carry out substantive terms of the. Agreement, the Commission shall terminate the Agreement. After the Commission notifies the STP that it intends to terminate the Agreement, the Commission shall give the STP's Medicaid Beneficiaries written notice of the State's intent to terminate the Agreement. e. The Commission may impose intermediate sanctions, including, but not limited to civil monetary penalties in the amounts specified in this Agreement. f. Suspension of payment for Medicaid Beneficiaries after the effective date of the sanction and until the Commission is satisfied that the reason for imposition of the sanction no longer exists and is not likely to recur; and/or g. Before imposing any intermediate sanctions, the Commission must give the STP timely notice. 2008/2009 Medicaid Non~Emergency Transportation Subcontracted Transportation Provider Contract Page 87 of 117  AGREEMENT NO.: J?zI)j\lID COUNTY NAME: Okaloosa EXHIBIT B METHOD OF COMPENSATION This Exhibit defines the limits of compensation to be made to the contractor for the services set forth in Exhibit "Au and the method by which payments shall be made. 1. Project Compensation: For the satisfactory performance of services detailed in Exhibit "Au, the STP shall be paid up to a Maximum Amount of $ 496.460.00 The Maximum Amount shall be made up of the following limiting amounts: $ 98.628.00 from Fiscal Year 08/09 $ 198.916.00 from Fiscal Year _--'0""'9"-/1..,0'--_ __ $ 198.916.00 from Fiscal Year _ .....I"'O'-'/l....l~_ __ The Vendor shall not provide services that exceed the limiting amount(s) without an approved Amendment from the Commission. The total amount of this contract is expected to be funded by multiple appropriations and the State of Florida's performance and obligation to pay under this contract is contingent upon annual appropriation by the Legislature. Currently, $98.628.00 of the total amount has been approved and encumbered for this contract. Therefore, it is agreed that the Vendor will not be obligated to perform services· horinc:ur costs which would result in exceeding the funding currently approved, nor will the Commission be obligated to reimburse the STP for costs or make payments in excess of currently established funding. The Commission will provide written authorization if and when subsequent funding is approved and encumbered for this contract. 2. PROGRESS PAYMENTS AND DISBURSEMENT SCHEDULE OF FUNDS: The Vendor shall submit monthly invoices (3 copies) in a format acceptable to the Commission. FY 08/09 January $16,438.00 February $16,438.00 March $16,438.00 April $16,438.00 May $16,438.00 June $16,438.00 2008/2009 Medicaid Non~Emergency' Transportation Subcontracted Transportation Provider Contract Page SS of 117  ATIACHMENT 1 BUSINESS ASSOCIATE AGREEMENT The parties to this Attachment agree that the following provIsions constitute a business associate agreement for purposes of complying with the requirements of the Health Insurance Portability and Accountability Act of 1996 (HIPAA). This Attachment is applicable if the Recipient is a business associate within the meaning of the Privacy and Security Regulations, 45 CF.R. 160 and 164. The Recipient certifies and agrees as to abide by the following: 1. Definitions. Unless specifically stated in this Attachment, the definition of the terms contained herein shall have the same meaning and effect as defined in 45 CF.R. 160 and 164. 1.a. Protected Health Information. For purposes of this Attachment, protected health information shall have the same meaning and effect as defined in 45 CF.R. 160 and 164, limited to the information created, received, maintained or transmitted by the Recipient from, or on behalf of, the Agency. 1.b. Security Incident. For purposes of this Attachment, security incident shall mean any event resulting in computer