Family and Children's Medicaid MA-3550 MEDICAID TRANSPORTATION

IX. Safety and Risk Management

DSS must assure that all contracted transportation vendors, agency staff, agency-approved volunteers, relatives and friends who transport recipients for mileage reimbursement (including foster care parents) are in compliance with all the following risk management procedures. These requirements do not apply to recipients/FRPs who seek reimbursement for mileage.

Note: Counties are not responsible for monitoring safety and risk management for public transportation vendors because they are well regulated and meet or exceed Medicaid policy safety and risk management standards (for a list of public transportation vendors see http://www.ncdot.gov/nctransit/resources/default.html).

A. County Responsibilities for Safety and Risk Management Monitoring

1. Ensure contracts with vendors include all provisions specified in IX.I.

2. Ensure contracts include a certification and/or assurance of compliance with contractual safety and risk obligations.

3. Conduct an annual review of contractors to ensure all contract requirements are met.

4. Maintain a file for agency staff, agency-approved volunteers, and recipient relatives and friends who are reimbursed directly by the county.

a. For agency staff and agency approved volunteers, the file must include the following:

(1) Driver’s License;

(2) Current vehicle registration/inspection;

(3) Current driving record;

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(IX.A.4.a.)

(4) Liability insurance;

(5) An agreement stating that the staff/agency volunteers will report all changes;

b. For recipient relatives and friends, the file must contain the following:

(1) Driver’s License;

(2) Current vehicle registration/inspection;

(3) Liability insurance;

(4) An agreement stating that the staff/volunteers/recipient relatives and friends will report all changes;

The county is required to review these files monthly to assure that all information is current.

B. Liability Insurance

Sufficient insurance coverage is necessary to adequately protect the agency and the recipients transported. A guide for minimum coverage shall be the amount required for common carrier-passenger vehicles by the North Carolina Utilities Commission (see http://www.ncuc.net/ncrules/chapter02.pdf, Rule 02-36).

1. Commercial Vehicles

a. Agencies should also require contract transportation vendors to carry increased liability limits beyond the minimum statutory requirements.

b. When commercial vehicles (16 passengers or more) are used to provide recipient transportation services, agencies should obtain a copy of the private contractor’s Certificate of Insurance documenting that the DSS Director or designee is an “additional insured.” The party identified as an “additional insured” will be notified 30 days in advance of a contractor dropping any coverage.

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(IX.B.)

2. “For Hire” Vehicles

“For Hire” passenger vehicles are defined as vehicles used for compensation to transport the general public as well as human service recipients and are, therefore, subject to the regulations of the N.C. Public Utilities Commission.

Taxi cabs and public transportation systems do not fall into this category.

Transportation vendors licensed as “For Hire” public conveyance operators must meet statutory requirements for their classification and operator responsibilities. Currently, $1.5 million liability insurance coverage is required on vehicles with a seating capacity of 15 passengers or less and $5 million coverage for vehicles designed to transport more than 15 passengers, including the driver.

3. Taxi Cabs

Liability insurance requirements are set by local ordinances and can vary widely from county to county. DSS must ensure that any Taxi service it uses for NEMT carries at least the minimum liability insurance coverage for their vehicle's particular classification (for minimum liability requirements for passenger vehicles, see http://www.ncdot.org/dmv/vehicle/title/).

4. Agency Owned Vehicles

Agencies that use their own vehicles to provide recipient transportation should carry “Symbol 1,” insurance which provides additional protection in the event of a lawsuit over a vehicle accident involving a volunteer or employee.

5. Non-Owned Auto Coverage

Agencies that do not own vehicles used to provide Medicaid transportation should carry “Symbol 9 – Non-Owned Auto Coverage,” insurance which protects the agency in the event of a lawsuit over a vehicle accident involving a volunteer, employee or contract transportation vendor.

6. Staff and Volunteers

Staff, agency-approved volunteers (including foster care parents) who transport recipients for mileage reimbursement must maintain minimum liability insurance coverage for their vehicle's particular classification (for minimum liability requirements for passenger vehicles, see http://www.ncdot.org/dmv/vehicle/title/). This applies to family members, friends, etc., paid by the agency to transport the recipient.

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(IX.)

C. Licensed Operator

The DSS is required to ensure that all drivers (including county employees, contractors, contractor employees, and volunteers) are at least 18 years of age and properly licensed to operate the specific vehicle used to transport recipients. This applies to family members, friends, etc., reimbursed by the agency to transport the recipient, but not to recipients and financially responsible persons.

D. State Inspection

The DSS is required to ensure that all vehicles used to transport recipients (whether owned by the county, county employee, contractor, contractor employees, or volunteers) have valid State registration and State inspection. This applies to family members, friends, etc., reimbursed by the agency to transport the recipient, but not to recipients and financially responsible persons.

E. Alcohol and Drug Testing

DSS shall require both private and public contract transportation vendors to participate in a random alcohol and drug testing program which meets the requirements of the Federal Transit Authority (FTA) (see http://www.access.gpo.gov/nara/cfr/waisidx_09/49cfr655_09.html). The vendors shall be contractually obligated to pay for the alcohol and drug testing program.

F. Background Checks

The county and its vendors shall perform a criminal background check on all employed or agency volunteer drivers through the North Carolina Law Enforcement Division or, if not a resident of North Carolina for at least 5 consecutive years, the National Crime Information Center (NCIC) prior to employment or volunteer enlistment and quarterly thereafter. Conviction, guilty plea or plea of no contest to any of the following is grounds for disqualification from employment/volunteer service:

1. Murder,

2. Rape or aggravated sexual abuse,

3. Kidnapping or hostage taking,

4. Assault with intent to kill,

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(IX.F.)

5. A federal crime of terrorism,

6. Unlawful possession, use, sale, distribution, or manufacture of an explosive device,

7. Unlawful possession, use, sale, distribution, or manufacture of a weapon,

8. Elder abuse/exploitation,

9. Child abuse/neglect,

10. Conspiracy to commit any of the above.

G. Driving Records

The county is required to have a driver screening policy. The driving records of all drivers (see below for exception), including agency employees who transport recipients and contract transportation vendors, shall be reviewed every 12 months. Drivers must have no more than two chargeable accidents or moving violations in the past three years and must not have a driver’s license suspension or revocation within the past five years.

Applicants for driver positions shall be required to submit a copy of their driving record for the last three years prior to the date of application. Driving records may be obtained from the Department of Motor Vehicles (DMV). Accept the DMV information provided by the applicant unless questionable.

The driver screening policy does not apply to recipients, financially responsible persons, or family and friends of the recipient.

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(IX.)

H Medicaid and Medicare Exclusions

The county must check the following state and federal data bases to assure that each transportation vendor, including the vendor’s owners and managers, is not excluded from participation in federal health care programs. https://providertracking.dhhs.state.nc.us/default.aspx and http://oig.hhs.gov/exclusions/index.asp). Any vendor, owner or manager that has been excluded from participation in Medicaid or Medicare cannot be a Medicaid transportation vendor. Federal and state exclusion inquiries must be completed when negotiating a contract, on a monthly basis after contract has been awarded, and when a contracted vendor reports a change. Exclude county transportation systems from these inquiries.

1. Each transportation vendor must furnish information to allow the county to complete the Medicaid/Medicare Exclusion Inquiries. Any public transportation vendor that contracts with an outside source is responsible for obtaining and furnishing the information from the outside source to the county DSS. Document this information on the DMA-5124, Non-Emergency Medical Transportation Provider Documentation form and get the vendor to provide his signature and the current date.

2. Check all organization/business names, owner’s names and/or managers’ names by utilizing the following instructions:

a. Office of Inspector General (OIG) Database

(1) Access the federal website at: http://oig.hhs.gov/fraud/exclusions/exclusions_list.asp.

(2) Click on “online searchable database” located on the right side of the webpage.

(3) Enter the individual’s name, (Last, First) or the business name and click on “Search” (the spelling of names must be correct).

(4) Results will display, and if a match is found, print the screen for the vendor’s file.

(5) To determine if the vendor is the same individual/business as the one displayed as excluded, click on the “SSN/EIN” field at the far left. Enter the SSN of the Individual or the Employer ID Number (EIN) in this screen and click “Verify”. Print this screen for the vendor file.

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(IX.H.2.a.)

(6) Enter the results of the inquiry on the DMA-5124, Medical Transportation Provider Documentation form.

(7) If a vendor is excluded from participation in the Medicaid Transportation program due to Medicaid or Medicare exclusion, notify the vendor in writing and place a copy of the notification in the vendor’s file.

b. NC DHHS Provider Penalty Tracking Database (PPTD)

The NC DHHS Provider Penalty Tracking Database is available to a county designated user. The designated user must have access to OLV. The PPTD database is labeled “SB926” in the WIRM portal. Matches are completed using the owner’s Social Security Number and using the owner’s full name.

(1) Sign on to the WIRM portal and click on SB926. Owner’s information will be entered on the lower right side of the page.

(2) Enter the owner’s SSN and complete the match. Results will display, and if a match is found, print the screen for the vendor’s file.

(3) Enter the owner’s name (first and last) and complete the match again. Results will display, and if a match is found, print the screen for the vendor’s file.

(4) For initial search or when a change is reported, record findings from the match process on the DMA-5124, Medical Transportation Provider Documentation form.

(5) If no match is found, document this on the DMA-5124, Medical Transportation Provider Documentation form.

(6) Complete the DMA-5124A, Medical Transportation Provider Documentation Addendum form when completing the monthly matches.

(7) If a vendor is excluded from participation in the Medicaid Transportation program due to Medicaid or Medicare exclusion, notify the vendor in writing and place a copy of the notification in the vendor’s file.

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(IX.H.)

3. State and County officials, employees and their agents may visit vendor facilities to make certification and compliance surveys, inspections, and audits of business records. Such visits including unannounced visits must be allowed at any time during normal hours of operation. Failure to grant immediate access upon reasonable request may result in termination of the contract.

I. Transportation Contract

A written contract, signed by the vendor, must be obtained by the agency when purchasing private transportation. The document must authorize services and include the following contract requirements:

1. A guarantee the contractor will meet all safety and liability requirements for its vehicles and employees as specified in B through G above;

2. An obligation to maintain records documenting compliance with all vehicle and employee requirements specified in B through G above;

3. An obligation that no more than one quarter of one percent of all trips be missed by the vendor (vendor no-show) during the course of the contract year;

4. An obligation to meet on-time performance standards such that no more than five percent (5%) of trips should be late for recipient drop off to their appointment per month (past the recipient’s appointment time);

5. An obligation to provide names of all owners, managers, management entities, and subcontractors;

6. An obligation to report any changes such as insurance provider, business ownership or management or exclusion from participation in Medicare;

7. An obligation to allow monitoring of records to ensure all contract requirements are met;

8. An obligation to report all no-shows on a daily basis and cancellations on a monthly basis;

9. If the county agrees to pay for no-shows or driver wait time, an obligation that all charges for no-shows or driver wait time are separately invoiced from transportation reimbursable costs;

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(IX.)

10. An obligation to record all recipient complaints which deal with matters in the vendor’s control, including the date that the complaint was made, the nature of the complaint and what steps were taken to resolve the complaint.

Example 1: A recipient complains about the speed of the vehicle in which he was transported. This complaint must be logged.

Example 2: A recipient complains that the driver was late. This complaint must be logged.

Example 3: A recipient complains that one of the other passengers was talking on a cell phone for the entire trip. There is no need to log this complaint.

11. An obligation to use the provided transportation billing codes on invoices to the county DSS for reimbursements.