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

shall deny the Trip request. (3) Contact the Medicaid Beneficiary's provider's/Licensed Health Care Professional's office and ask if the medical care is considered Urgent Care as defined in this Agreement. If the STP is able to confirm that the Trip is not considered Urgent Care, the STP may require that the Medicaid Beneficiary reschedule the requested Medicaid compensable Trip. c. The STP can require that a Medicaid Beneficiary seek Medicaid compensable services frorn a physician/Licensed Health Care Professional doing business in the Medicaid Beneficiary's city/community of residence unless: (1) There is not a physician/Licensed Health Care Professional in the Medicaid Beneficiary's city/community of residence that can or will provide services to the Medicaid Beneficiary; (2) The Medicaid Beneficiary has started a course of treatment for an Acute Condition in one county of residence and subsequently changes his county of residence to an adjacent county of residence. Upon completion of a course of treatment for an Acute Condition, the Recipient may require the Medicaid BenefiCiary utilize the services of a provider/licensed .Health Care ProfeSSional located in the Medicaid Beneficiary's city/community of residence; or (3) The Medicaid Beneficiary's provider/Licensed Health Care Professional is located in an adjacent city/community and is at a distance no further from the Medicaid Beneficiary's home than a similar physician/Licensed Health Care Professional in the Medicaid Beneficiary's city/community of residence. d. The STP shall not limit the number of Medicaid compensable Trips that a Medicaid Beneficiary receives. e. In order to manage the coordination of Transportation Services, the STPs may request that a Medicaid Beneficiary reschedule a Medica id compensable Trip that is not an Urgent Trip, but in no event may the STPs and/or Transportation Providers delay the Medicaid Beneficiary's appOintment by more than fifteen (15) Business Days. 2008/2009 Medicaid Non-Emergency Transportation Subcontracted Transportation Provider Contract Page 22 of 117  f. The STP may limit out of county Trips to specific days of the week (e.g., Tampa on Mondays and Wednesdays; Orlando on Tuesdays and Thursdays). The STP must provide out of county Trips on unscheduled days if the provider with whom the Medicaid Beneficiary has an appointment does not see patients on the Recipient's regularly scheduled Trip day. The STP is responsible for notifying Medicaid Beneficiaries of an established out of county service route so that Medicaid Beneficiaries can schedule appointments accordingly. (1) The STP can request confirmation, but shall'not require written confirmation, from the provider or the Medicaid area office that the out of county Medicaid compensable services are not available in the Medicaid Beneficiary's county of residence or that the services are available only on a specific day that does not correspond to the established schedule. 2 Out of State Transportation a. If the Agency for Health Care Administration authorizes an out of State Medicaid compensable service, the STP shall not require additional confirmation that the services are available in the State. (1)· For advance notice purposes, within one (1) Business Day of receipt from the Agency for Health Care Administration, the Commission shall notify the STP when a Medicaid Beneficiary requests out of State Medicaid compensable services. (3) The Commission shall forward the written approval from the Agency for Health Care Administration to the STP authorizing out .. of State Medicaid COITIPensable seryices. (4) At least quarterly, the Commission shall update the STP on the status of Medicaid Beneficiaries receiving Medicaid compensable services out of State. (5) The Commission will forward any notification from AHCA stating that a Medicaid BenefiCiary is ready for transport back to the State. 3. Neither the Agency for Health Care Administration, the Commission, nor the STP shall limit the following types of Trips. The STP shall provide the following types of Trips in addition to the STPs daily Trip allocation: a. Urgent Trips b. Trips to the following types of services: (1) Dialysis; 2008/2009 Medicaid Non-Emergency Transportation Subcontracted Transportation Provider Contract Page 23 of 117 I , (2) Chemotherapy; (3) Wound treatment; (4) Behavioral Health Care; (5) Prescribed Pediatric Extended Care centers (PPECs); or, (6) Any other Trip not specifically set forth above, but that the Agency for Health Care Administration determines, after consultation with the Commission, is in the best interests of the. Medicaid Beneficiary population. 4. The STPs shall comply with the following gate keeper responsibilities: a. Accept requests for Transportation Services directly from Medicaid Beneficiaries, adult family members on behalf of minor Medicaid Beneficiaries, guardians responsible for Medicaid BenefiCiaries, and providers/Licensed Health Care Professionals on behalf of Medicaid Beneficiaries. b. Assure that the Medicaid Beneficiary is a resident of Florida and is currently Medicaid eligible. Medicaid eligibility shall be obtained by contacting a MEVS vendor or similar provider, including the STPs eligibility verification program, through FAXBACK with the Medicaid Fiscal Agent where a fax is sent through an automated system and a report is transmitted back containing Beneficiary eligibility information. c. Determine ... it._ transportation.resources. exist .within ... the .... Medicaid Beneficiary's Household·· regularly and/or specifically for the Trip requested, and may deny a Trip request if the Medicaid Beneficiary has appropriate transportation resources in his/her Household. d. Determine if there is a reason why the Medicaid Beneficiary cannot utilize his/her own transportation (such as the vehicle is broken, out of gas, etc.). If the Beneficiary is unable to utilize his/her transportation, the STP may assist the Medicaid Beneficiary in utilizing his/her own means of transport (fix vehicle, supply gas, etc.). e. Determine whether any person who does not reside in the Medicaid Beneficiary's household can reasonably provide transportation. "Reasonably" is defined to mean both willing and able. The STP shall not demand the use of transportation resources available through any party residing outside the Medicaid Beneficiary's household. 2008/2009 Medicaid Non-Emergency Transportation Subcontracted Transportation Provider Contract Page 24 of 117  f. Require the use of public transportation, where available and appropriate, for Medicaid Beneficiaries who are able to understand common signs and directions. g. Determine if the Medicaid "Beneficiary is ambulatory, requires a mobility device, or requires a stretcher for transport. The STP shall transport Medicaid Beneficiaries who must use a mobility device for ambulation or must remain in a lying position in vehicles appropriate to their level of need. h. Provide Transportation Services only to a Medicaid compensable service. i. Refuse to reimburse the cost of transportation provided for a Medicaid Beneficiary by any relative or member of the same household, exclusive of foster parents. j. Some nursing faCilities, group homes, and personal care homes have one or more vehicles, which are intended to facilitate the general administration of the facility and not necessarily to provide for resident transportation. The STP cannot deny Transportation Services based on the mere existence of a vehicle. The availability of a vehicle for resident transportation must be determined on a case by case basis. If the vehicle is not available for resident transportation at the time required, as represented by the nursing facility manager or director of nurSing, as applicable, the ReCipient/Subcontractor shall exclude such vehicle as an alternate form of available transportation.