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

foreign languages in a county spoken by five percent (5%) or more of the total cou nty population. (4) The STP shall provide Medicaid Beneficiary information in accordance with 42 CFR 438.10, which addresses ihformation requirements related to written and oral communications provided to Medicaid Beneficiaries, including: languages, format, Transportation Services, Service Area, and the Grievance System. The STP shall notify Medicaid Beneficiaries on at least an annual basis of their right to request and obtain information in accordance with the above regulations. (5) All written materials shall be at or near the fourth (4th) grade reading comprehension level. Suggested reference materials to determine whether the STP's written materials meet this requirement are: (a) Fry Readability Index; (b) PROSE The Readability Analyst (software developed by Education Activities, Inc.); (c) Gunning FOG Index; (d) McLaughlin SMOG Index; (e) The Flesch-Kincaid Index (available in Microsoft Word); or (f) Other software approved in writing by the Agency. (6) The STP shall provide written notice to the Commission of any changes to any correspondences, templates for mass mailings, and/or written materials provided to Medicaid Beneficiaries. The Commission shall review and shall submit all written materials to the AHCA at least forty-five (45) Calendar Days before the effective date of the change. The STP shall provide written notice of changes to the Medicaid Beneficiary Transportation Handbook and any policy changes to Medicaid BenefiCiaries at least thirty (30) Calendar Days before the effective date of the change, but not before the Commission and the AHCA approves, in writing, the STP's written notice. 2008/2009 Medicaid Non-Emergency Transportation Subcontracted Transportation Provider Contract Page 29 of 117  b. The STP shall mail any other mutually agreed upon notices at a date and time agreed to by the Agency for Health Care Administration and the Commission. c. The STP shall not mail or give any written communications to Medicaid Beneficiaries without first obtaining the Commission's written approval of the communication. d. The Commission shall sanction the STP, in accordance with the contract, for any failure on the part of the STP and/or Transportation Providers to obtain the Commission's written approval before disseminating written materials to Medicaid Beneficiaries. 3. Notice of Eligibility and Medicaid Beneficiary Transportation Services Handbook a. Within seven (7) Calendar Days following the STP's determination of a Medicaid Beneficiary's eligibility to receive Transportation Services, the STP shall mail each Medicaid BenefiCiary a copy of its Medicaid BenefiCiary Transportation Services Handbook. b. The Medicaid Beneficiary Transportation Services Handbook shaH include the following information: (1) A Table of Contents; (2) The STP's toll-free Trip scheduling telephone number; (3) Information to explain the different types of coverage available and the time frames for requesting and receiving Transportation Services; (4) Directions on the use of Transportation Services offered by the STP; (5) The extent to which, and how, the STP provides non-business hour, inpatient delivery/return, Urgent Care delivery/return, and Emergency Room discharge Tr~nsportation Services; (6) An explanation of the Grievance System, including the address, telephone number, and office hours of the STP's Grievance staff and the Commission's Ombudsman. The STP shaH specify phone numbers for a grievant to call to present a Complaint, Grievance, or Appeal. Each phone number shall be toll-free within the grievant's geographic area and provide reasonable access to the STP and/or Commission without undue delays; (7) Medicaid Beneficiary rights and responsibilities; 2008/2009 Medicaid Non-Emergency Transportation Subcontracted Transportation Provider Contract Page 30 of 117  (8) Information on Emergency Transportation and how to access those services; (9) Information on oral interpretation services for all languages and alternative communication formats are available, free of charge, and how to access these services; (10) Information that the Medicaid Beneficiary's Transportation Services can continue if the Medicaid Beneficiary files a Complaint, Grievance, or Appeal of a denied authorization and that the Medicaid Beneficiary may have to pay in case of an adverse ruling; (11) Co-payments for the Medicaid Beneficiary; (12) Instructions explaining how Medicaid Beneficiaries may obtain information from the Commission regarding the Quality Improvement Plan and Performance Measure indicators, including Medicaid Beneficiary information; (13) Procedures for reporting Fraud, Abuse, and Overpayment; (14) Information regarding HIPAA relative to the Medicaid Beneficiary's personal health information; and, (15) Information relating to the STP's Medicaid Beneficiary No Show Policy. c. The Medicaid _Beneficiary. Halldbook must dearly specify all. necessary procedural steps for filing Complaints, Grievances, Appeals, and Medicaid Fair Hearings, including: (1) Medicaid Beneficiary rights to file Complaints, Grievances, and Appeals and all requirements and time frames for filing Complaints, Grievances, and Appeals. (2) The Commission's and STP's Grievances and Appeals Coordinator's address, toll-free telephone number and office hours. (3) The availability of assistance to Medicaid Beneficiaries in filing Grievances, Appeals, and Medicaid Fair Hearings. (4) The rules that govern representation at the Medicaid Fair Hearing. (5) A statement explaining the Medicaid Beneficiary's right to request a continuation of Transportation Services during an Appeal and/or Medicaid Fair Hearing and a statement that if the Medicaid Fair 2008/2009 Medicaid Non-Emergency Transportation Subcontracted Transportation Provider Contract Page 31 of 117  Hearing upholds the STP's Action, the STP may hold the Medicaid Beneficiary liable for the cost of any continued Transportation Services. (6) A detailed explanation of the proper procedure for a Medicaid Beneficiary to request a continuation of Transportation Services during an Appeal and/or Medicaid Fair Hearing. B. No Show Beneficiary Education 1. If a Medicaid Beneficiary fails to provide notice of a cancellation to the STP or a Transportation Provider at least twenty-four (24) hours in advance of a scheduled Trip, or the Medicaid Beneficiary is not available, or has decided he/she does not require Transportation Services, then the STP shall classify the Medicaid Beneficiary as a No Show. The STP shall provide the Commission a monthly report listing it's No Show Medicaid Beneficiaries. The No Show Medicaid Beneficiary report shall include the Medicaid Beneficiary's name, phone number, date and time scheduled for transport, and Trip destination. 2. The STP shall contact the Medicaid Beneficiaries who are identified as No Shows and counsel them on the proper usage of NET services and provide technical assistance. The STP shall track the Medicaid Beneficiaries it counseled regarding the No Show policy and keep a record of the technical assistance provided. The STP shall take no action to "lock-in" a Medicaid Beneficiary without written approval provided by the Agency for Health Care Administration's Project Manager. The Commission shall maintain a copy of the AHCA written approval in the STP's contract file. 3. If the No Show Medicaid Beneficiary provides acceptable, verifiable evidence to the STP. that the No Show was due to unforeseen and unavoidable circumstances;ttie SrP shaH not counfti1e missed Trip as a NoShow,ul'lles5 such evidence does not prove the Medicaid