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

State of Florida. N. If this Agreement is the result of a formal solicitation (Invitation to Bid, Request for Proposal or Invitation to Negotiate), the Department of Management Services Forms PUR1000 and PUR1001, included in the solicitation, are incorporated herein by reference and made a part of this Agreement. O. Time is of the essence as to each and every obligation under this Agreement. P. The following Exhibits and Attachments are incorporated and made a part of this Agreement: Exhibit A Scope of Services 2008/2009 Medicaid Non-Emergency Transportation Subcontracted Transportation Provider Contract Page 13 of 117  Exhibit B Method of Compensation Attachment 1 Business Associate Agreement Attachment 2 Special Audit Requirements Attachment 3 Required Data Elements for Encounter Data Attachment 4 Quarterly Grievance System Summary Report Attachment 5 Trip Travel Expense Report Attachment 6 Business Disruption Notification Report Attachment 7 Critical Incident Report Attachment 8 Definitions and Acronyms IN WITNESS WHEREOF, the parties have executed this Agreement by their duly authorized officers on the day, month and year set forth above. Okaloosa COunty Board of County Florida COmmissio o~e Transportation Commissioners Disadv./ Authorized Signature William J. Roberts III Print/Type Print/Ty> Chairman /I!nltn 111 t5~ CUkl'Ve., J) vf Cr'D)/'" Title Title 2008/2009 Medicaid Non-Emergency Transportation Subcontracted Transportation Provider ConlTact Page 14 of 117  CD'I" AGREEMENT NO.: r:> I I\i I U EXHIBIT A SCOPE OF SERVICES Medicaid Non-Emergency Transportation Services I. GENERAL OVERVIEW A. Purpose This Agreement between the Commission for the Transportation Disadvantaged (Commission) and the Subcontracted Transportation Provider (STP) is for the provision of Medicaid Non-Emergency Transportation (NET) services. B. General Responsibilities of the State of Florida (State) and the Commission: 1. The Commission will be responsible for setting policy relating to the Medicaid NET program. 2. The Commission will administer the Agreement with the STP, monitor STP performance, and provide oversight in all aspects of the STP's operations. 3. The State has sole authority for determining Medicaid eligibility. 4. Except for Medically Needy Medicaid Beneficiaries, eligibility for Transportation Services provided by the Recipient is effective at 12:01 a.m. on the first (1st) Calendar Day of the month. S. The Commission will conduct periodic moriitoring of the STP's operations for compliance with the provisions of the Agreement and applicable federal, State, and local laws and regulations. 6. The Commission has final authority in interpreting the terms and conditions of the Agreement and analyzing all policies relating to the Agreement. 7. Unless otherwise specified in this Agreement, the Commission shall respond to all STP requests for a response within ten (10) Business Days of receipt of said request. 8. The Commission shall ensure that the STP is Cost Effective (see Section 409.912(44), F.S.). The Commission may not renew this Agreement if it is not Cost Effective. C. General Responsibilities of the STP 2008/2009 Medicaid Non~Emergency Transportation Subcontracted Transportation Provider Contract Page 15 of 117  1. The STP shall comply with all provisions of this Agreement and its amendments, if any, and shall act in good faith in the performance of the Agreement's provisions. The STP shall comply with all written policies and procedures developed by the Commission to implement all provisions of this Agreement. The STP agrees that failure to comply with any provision of this Agreement shall result in the assessment of sanctions as identified in this agreement. 2. The STP shall comply with all requirements of Section 6032 (Employee Education About False Claims Recovery) of the federal Deficit Reduction Act of 2005 if the Recipient receives or earns five million dollars or more, annually, under the Medicaid State plan. 3. The STP shall comply with all pertinent Commission rules in effect throughout the duration of the Agreement. 4. The STP shall comply with all current Florida Medicaid Handbooks as noticed in the Florida Administrative Weekly ("FAW"l, or incorporated by reference in rules relating to the provision of Transportation Services set forth in this agreement, except where the provisions of the Agreement expressly alter the requirements set forth in the Florida Medicaid Handbooks promulgated pursuant to the Florida Administrative Code (FAC). In addition, the STP shall comply with the limitations and exclusions in the Medicaid Handbooks, unless otherwise specified by this Agreement. In no instance may the STP's limitations or exclusions imposed be more stringent than those specified in the Medicaid Handbooks. The STP shall furnish Transportation Services in an amount, duration, and scope that the STP may reasonably expect to achieve the purpose for which the Transportation Services are furnished. The STP shall not arbitrarily deny or reduce the amount, duration, or scope of Transportation Services solely because of a Medicaid Beneficiary's diagnosis, type of illness, or condition. 5. This· Agreement; inc:ludingall .attachriielitsalicfexhibits,·repfeselits·· theehtire· agreement between the STP and the Commission and supersedes all other contracts, agreements, or understandings between the parties when it is executed by duly authorized signatures of the STP and the Commission. Correspondence and memoranda of understanding do not constitute part of this Agreement. In the event of a conflict of language between the Agreement and the exhibits and attachments, the provisions of the Agreement shall govern. 6. The Commission reserves the right to clarify any terms and conditions in question in regards to the Agreement between the Commission and the STP, in its sole discretion, in writing; such clarification shall govern. Upon final determination of any dispute over any Commission decision, the STP shall proceed diligently with the performance of its duties as specified under the Agreement and in accordance with the direction of the Agency's Division of Medicaid. 7. The STP shall comply with the Commission's Quality Improvement Program (QIP) to ensure enhancement of quality of Transportation Services and emphasize the 2008/2009 Medicaid Non-Emergency Transportation Subcontracted Transportation Provider Contract Page 16 of 117  goals of improving the quality of Transportation Services provided to Medicaid Beneficiaries. The Commission may sanction the STP, if the STP, or one of its Subcontractors or a Transportation Provider does not meet acceptable Quality Improvement (QI) and Performance Measures (PMs), based on the Commission's reports and other outcome measures. 8. The STP must meet all requirements for doing business in the State of Florida. 9. The Commission may require the STP to provide to the Commission, or its Agent, information or data that is not specified under this Agreement. In such instances, and at the direction of the Commission, the STP shall fully cooperate with such requests and furnish all information in a timely manner, in the format in which the Commission requested. The STP shall have at least thirty (30) Calendar Days to fulfill such ad hoc requests. 10. The STP shall monitor utilization of Transportation Services by Medicaid Beneficiaries through the Prior Authorization of claims for Covered Services and the reports specified in this agreement. 11. The STP shall collect and submit Encounter Data for each Agreement Year in the format set forth in the Reporting Requirements section of this agreement, or as required by the Commission, and within the time frames specified by the Commission. All Covered Services rendered to Medicaid Beneficiaries shall result in the creation of an encounter record. 12. The STP shall not: a. Use Fee-for-Service ambulance transport in lieu of Cost Effective and appropriate Transportation Servicesj b. Limit Medicaid Beneficiaries to a specific number of medical Trips for any specific time periodj· and/or, c. Limit Medicaid Beneficiaries to specific Licensed Health Care Professionals or use similar limitations that restrict the distance required for a Medicaid BenefiCiary to receive Transportation Services, or limit the number of Trips provided to Medicaid Beneficiaries. 13. Use of Funding for Lobbying or Advocacy Purposes a.· The STP shall ensure that neither the STP nor any of its Subcontractors or Transportation Providers use Medicaid funding to lobby, advocate, or encourage other parties to lobby or advocate legislators or other political leaders in violation of State and federal law. If the Commission determines that the STP, a Subcontractor, or a Transportation Provider has violated this requirement against lobbying or advocating, the Commission may sanction the STP. 2006/2009 Medicaid Non·Emergency Transportation Subcontracted Transportation Provider Contract Page 17 of 117