23 Miss. Code. R. 201-2.1 - Non-Emergency Transportation (NET) Broker Program
A. The
Division of Medicaid contracts with a Broker to provide non-emergency
transportation (NET) through a NET provider to Medicaid beneficiaries in
appropriate vehicles, depending on the beneficiary's mobility status and
personal capabilities on the date of service.
1. Other non-Medicaid funded sources for
non-emergency transportation services must be utilized first with the Medicaid
NET program being the last resort.
2. Beneficiaries are not allowed to request a
particular NET provider for transportation.
B. The NET Broker is responsible for
administering and operating the NET program in accordance with the Division of
Medicaid's policy including, but not limited to, the authorization,
coordination, scheduling, management, and reimbursement of NET services and
must:
1. Operate statewide.
2. Authorize and schedule NET services within
the following set timeframes:
a) Ninety-eight
percent (98%) of routine NET services within three (3) business days after
receipt of the request, and
b) One
hundred percent (100%) of routine NET services within ten (10) business days
after receipt of the request.
3. Notify the Division of Medicaid prior to
denying a request for transport to a medical provider not geographically
closest to the beneficiary's residence if the NET Broker is unable to obtain a
medical certification from the medical provider certifying that the beneficiary
is unable to be treated at a closer facility. A medical certification is not
required if the transport is to the University of Mississippi Medical Center in
Jackson, MS.
4. Allow long
distance transportation for up to ninety (90) days, if necessary, if a
beneficiary has recently moved to a new area to maintain continuity of care
until the transition of the beneficiary's care to a closer appropriate provider
is completed. The NET Broker must monitor the frequency of these NET
authorizations involving excessive distances per beneficiary.
5. Ensure NET providers arrive at the
drop-off and pick-up destinations within the Division of Medicaid's minimum
requirements.
6. Perform
post-transportation authorizations in instances when prior authorization was
not obtainable.
7. Request
additional information, if necessary, within twenty-four (24) hours of the
initial receipt of a request and place the request on hold. The request must
specify the date the additional information must be submitted. The request for
transport can be denied if the information is not received by the date
specified with the exception of NET service appointments for chemotherapy,
dialysis, and high-risk pregnancy.
8. Provide education to beneficiaries and NET
providers on NET services and procedures.
9. Maintain a current Division of Medicaid
approved NET provider Manual/Operations Procedure Manual.
10. Perform criminal background checks on all
NET drivers to ensure excluded persons or entities are not paid any state or
federal funds in compliance with Mississippi law [Refer to Part 201, Rule
2.6.D.], and ensure NET drivers meet
the Division of Medicaid minimum requirements.
a) The NET Broker must conduct criminal
background checks upon initial hire including, but not limited to:
1) A one-time criminal background check
requiring fingerprinting,
2)
National and state criminal background checks utilizing personal identification
data, including, but not limited to:
(a) Name
and date-of-birth,
(b) Social
security number, or
(c) Driver's
license number.
3) A
Mississippi Sex Offender Registry check, and
4) A Motor Vehicle Record check.
b) The NET Broker must conduct
criminal background checks annually including, but not limited to:
1) National and state criminal background
checks utilizing personal identification data, including, but not limited to:
(a) Name and date-of-birth,
(b) Social security number, or
(c) Driver's license number.
2) A Mississippi Sex Offender
Registry check, and
3) A Motor
Vehicle Record check.
c) Effective April 01, 2015 the NET Broker
must ensure the NET providers comply with the one-time fingerprinting check
requirement as listed below:
1) The NET
Broker must have all NET drivers' fingerprinting checks on file. The NET Broker
is prohibited from reimbursing the NET provider for transportation services by
a NET driver whose fingerprinting check is not on file.
2) New NET providers must submit to the NET
Broker all NET driver fingerprinting checks within ninety (90) days from the
contracted start date.
3) NET
providers must submit to the NET Broker all fingerprinting checks for newly
hired NET drivers within ninety (90) days from the date of employment if hired
after the contracted start date.
4) The NET Broker may utilize the
fingerprinting record obtained by a previous Medicaid NET provider to meet the
one-time fingerprinting check requirement if the NET driver changes employment.
d) The NET Broker can
not reimburse the NET provider for transportation services rendered if the NET
provider fails to comply with any of the fingerprinting check requirements
listed in Miss. Admin. Code Part 201, Rule 2.1.B.10.
e) The NET Broker must recoup any funds paid
to the NET provider for services rendered by a NET driver who fails the
fingerprinting check.
11. Ensure vehicles meet the Division of
Medicaid's minimum requirements and ensure required vehicle inspections are
performed and documented with submission of inspection reports to the Division
of Medicaid no later than the fifteenth (15 th) day
of the month following the inspection.
12. Maintain an adequate number of NET
providers and trained staff to provide scheduled transports in a given
geographical area.
13. Maintain a
file of current executed NET provider contracts and:
a) Require NET provider enrollment forms to
include disclosure of complete ownership, control, and relationship information
from all NET providers,
b) Include
contract language requiring the NET Broker to notify the Division of Medicaid
of such disclosures on a timely basis, and
c) Provide to the Division of Medicaid upon
request.
14. Make
timely payments to NET providers.
15. Meet quality assurance and monitoring
requirements including, but not limited to:
a) On-street observations,
b) Accident and incident reporting,
c) Statistical reporting of
transports,
d) Statistical
reporting of transport call center operations,
e) Analysis of complaints,
f) Driver licensure, driving records,
experience, training and annual random drug testing of all NET drivers,
g) Participant assistance,
h) Completion of driver transport
logs,
i) Driver communication with
dispatcher, and
j) Routine
scheduled vehicle inspections and maintenance.
16. Maintain all required up-to-date
electronic and data systems.
17.
Meet all of the Division of Medicaid's call center requirements.
18. Conduct the following random validation
checks of monthly requests to verify NET provider claims for reimbursement
match authorized transports and to verify the transports actually occurred. The
NET Broker must document the reason the NET provider failed to properly
authorize or render the service.
a) Three
percent (3%) of pre-transportation requests verifying that a beneficiary's
appointment with the medical service provider is for a covered medical service,
and
b) Two percent (2%) of
post-transportation services verifying a beneficiary's appointment is for a
covered medical service.
19. Submit reports, data or other materials
by the date due as determined by the Division of Medicaid.
20. Obtain a medical certification statement
from the beneficiary's physician if an adult attendant is required to accompany
the beneficiary.
C. The
Division of Medicaid, at its sole discretion, may assess damages if the NET
Broker fails to perform the responsibilities in Rule 2.1.B. resulting in
additional administrative costs to the Division of Medicaid.
1. The Division of Medicaid must give written
notice to the NET Broker of any unmet responsibility that could result in an
assessment of damages and the proposed amount of the damages.
2. The NET Broker has fifteen (15) days from
the date of the notice to dispute the determination.
D. Reporting
1. The NET Broker must report within three
(3) business days all allegations of sexual harassment or physical abuse by a
driver, beneficiary or other passenger to the Division of Medicaid and per
state law to the Mississippi Department of Human Services (MDHS).
a) NET providers must report all allegations
of sexual harassment or physical abuse to the NET Broker.
b) Medicaid beneficiaries should report any
incident of abuse or sexual harassment directly to the NET Broker.
2. The NET Broker must refer
suspected Medicaid fraud, abuse or misuse by beneficiaries, NET providers or
NET Broker staff to the Division of Medicaid's Office of Program Integrity
within three (3) business days after discovery of the suspected Medicaid fraud,
abuse or misuse.
3. The NET Broker
must document all accidents/incidents occurring on a scheduled transport when a
beneficiary is present in the vehicle and submit the accident/incident report
to the Division of Medicaid within forty-eight (48) hours of the
accident/incident.
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