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

b. The Recipient shall ensure that all Subcontractors and Transportation Providers execute a Certificate Regarding Lobbying no less than thirty (30) Calendar Days before the effective date of the Agreement and maintain copies of said Certificates in the Recipient's files . . c. All of the lobbying and advocating requirements set forth in this Agreement apply to staff, Subcontractors, Transportation Providers, Recipient volunteers, employees, independent contractors, and all persons acting for, or on behalf of, the Recipient. The requirements set forth in this Section shall govern the development of all materials. Additionally, the Recipient is vicariously liable for any Violations of its Subcontractors, Transportation Providers, agents, employees, staff, and/or independent contractors. II. BENEFICIARY ELIGIBILITY A. Eligibility 1. Eligible Populations a. The STP shall provide Medicaid Transportation Services only to Medicaid Beneficiaries who are included in the eligible population. b. The categories of eligible Medicaid Beneficiaries authorized to receive services from the Recipient include, but are not limited to, the following: (1) Low Income Families and Children; (2) Foster Care Children; (3) Sixth Omnibus Budget Reconciliation Act (SaBRA) Children and pregnant women; (4) Supplemental Security Income (SSI) Medicaid only Medicaid Beneficiaries; (5) SSI Medicare, Part B only Medicaid Beneficiaries; (6) SSI Medicare, Parts A and B Medicaid Beneficiaries; (7) Medicaid Beneficiaries who are residents in ALFs; (8 The MEDS Aged/Disabled (AD) population; (9) Individuals with Medicare coverage (e.g., dual eligible individuals) who are not enrolled in a Medicare-funded Managed Care . Organization (MCO); 2008/2009 Medicaid Non-Emergency Transportation Subcontracted Transportation Provider Contract Page 18 of 117  (10) Institutional Care Program (ICP) Residents: Beneficiaries who are eligible for transportation services for placement in a facility while their eligibility determination is being processed (e.g., nursing home reSidents, etc.); (11) Presumptively Eligible Pregnant Women: This program allows staff at County Health Departments, Regional Prenatal Intensive Care Centers, and other qualified medical facilities to make a presumptive determination of Medicaid eligibility for low-income pregnant women. This presumptive determination allows a woman to access prenatal care while Department of Children and Families eligibility staff make a regular determination of eligibility. Outpatient or office services related to the pregnancy are reimbursed by this program; transportation services are available to support these visits; (12) Medicaid Beneficiaries who are receiving services through: (a) A hospice program; (b) A Prescribed Pediatric Extended Care (PPEC) center; (c) The Aged/Disabled Adult Waiver; (d) The Alzheimer's Disease Waiver; (e) The Assisted Living for the Elderly Waiver; (f) The Channeling Waiver; (g) The Familial Dysautonomia Waiver; (h) The Florida Senior Care Waiver; (i) The Model Waiver; (j) The Nursing Home Diversion Waiver; (k) The Project AIDS Care Waiver; or (I) The Traumatic Brain Injury/Spinal Cord Injury (TBI/SCI) Waiver. (13) Title XXI MediKids: A Title XXI health insurance program that provides certain children, who are not Medicaid eligible, with Medicaid benefits; and 2008/2009 Medicaid Non-Emergency Transportation Subcontracted Transportation Provider Contract Page 19 of 117  (14) Medically Needy: A Medically Needy beneficiary is an individual who would qualify for Medicaid but has income or resources that exceed normal Medicaid guidelines. On a month-by-month basis, the individual's medical expenses are subtracted from income; if the remainder falls below Medicaid's income limits, the individual may qualify for Medicaid through the end of the month. 2. Ineligible Populations a. The following categories describe Medicaid Beneficiaries who are not eligible to receive Transportation Services from the Recipient: (1) Medicaid MCO enrollees - Medicaid Beneficiaries who are enrolled with a Medicaid MCO that provides Transportation; (2) Medicaid Beneficiaries who have their own means of Transportation; (3) Medicaid Beneficiaries who, at the time of application for enrollment and/or at the time of enrollment, are domiciled or residing in an institution, including: (a) Statewide inpatient psychiatric program (SIPP) facilities; (b) Intermediate care facility for persons with developmental disabilities (ICF-DD); (e) State Hospitals; or (d) Correctional institutions .. (4) Qualified Medicare Beneficiaries C'QMBs"), Special Low Income Medicare Beneficiaries C'SLMBs"), Qualified Medicare Beneficiaries Renal Dialysis C'QMBRs"), or Qualified Individuals at Levell ("QI- ls"); (5) Medicaid Beneficiaries who reside in the following: (a) Residential commitment programs/facilities operated through the Department of Juvenile Justice (DJJ); (b) Residential group care operated by the Family Safety & Preservation Program of the Department of Children and Families (DCF); (c) Children's residential treatment facilities purchased through the Substance Abuse & Mental Health District 2008/2009 Medicaid Non-Emergency Transportation Subcontracted Transportation Provider Contract Page 20 of 117  (SAMH) Offices of the DCF (also referred to as Purchased Residential Treatment Services - PRTS); (d) SAMH residential treatment facilities Licensed as Level I and Level II facilities; and (e) Residential Level I and Level II substance abuse treatment programs. See Sections 65D-30.007(2)(a) and (b), F.A.C. (6) Legal aliens; (7) Medicaid Beneficiaries who are also members of a Medicare- funded Managed Care Organizations (MCOs); (8) Medicaid Beneficiaries who are enrolled in the Family Planning Waiver; and/or (9) Medicaid Beneficiaries who are enrolled in the Program of AII- inclusive Care for the Elderly (PACE). b. The following waivers' services are not eligible for Transportation Services: (1) The Developmentally Disabled Waiver (Tier 1); (2) The Developmentally Disabled Waiver (Tier 2); (3) The Developmentally Disabled Waiver (Tier 3); .--. (4) The Family and Supported Living Waiver (Tier 4); and (5) The Adult Cystic Fibrosis Waiver. B. Gate Keeping 1. Medicaid Compensable Trips a. Neither the STP, any of its Subcontractors nor Transportation Providers shall require written verification from the Medicaid Beneficiary as to the need for an Urgent Trip or Medically Necessary Trip. b. The STP, Subcontractors or Transportation Providers, in its efforts to ensure proper Gate Keeping, may: (1) Contact the Medicaid Beneficiary's provider's/Licensed Health Care Professional's office and ask if the medical care is Medicaid 2008/2009 Medicaid Non-Emergency Transportation Subcontracted Transportation Provider Contract Page 21 of 117  compensable. If the Trip is not Medicaid compensable, the STP shall deny the Trip request. (2) Contact the Medicaid Beneficiary's provider's/Licensed Health Care Professional's office and ask if the Medicaid Beneficiary has an appointment. If the Medicaid Beneficiary does not have an appointment, the STP