Current through Register Vol. 50, No. 9, March 1, 2024
RELATES TO: KRS 96A.010-96A.370,
157.280,
163.470,
202B.010,
216.2925,
216.2927,
45 C.F.R. 164, 49 C.F.R. 655,
42 U.S.C.
12102, 49 U.S.C. 53
NECESSITY, FUNCTION, AND CONFORMITY:
KRS
281.870(3) requires the
cabinet to promulgate administrative regulations specifying the duties and
responsibilities of the Coordinated Transportation Advisory Committee (CTAC).
KRS
281.875 requires the cabinet to promulgate
administrative regulations concerning the human service transportation delivery
program. This administrative regulation establishes procedures governing the
human service delivery program on behalf of the CTAC and the procedures
required to provide efficient, safe, and coordinated transportation delivery to
clients of the human service transportation delivery program.
Section 1. Definitions.
(1) "Ambulance stretcher transportation"
means an ambulance service used for transporting sick or injured people who are
also bedridden.
(2) "Broker" is
defined by
KRS
281.014(8).
(3) "Certificate type 07 and certificate type
08" means a classification type assigned to a recipient that meets the
definition established in either
KRS
281.873(1)(e) or
281.873(1)(f).
(4) "CTAC" is defined by
KRS
281.014(10).
(5) "Delivery area" is defined by
KRS
281.014(7).
(6) "Eligible provider" means a
transportation provider that has contracted with the regional broker, obtained
a valid Medicaid provider number from the Department for Medicaid Services, and
been approved by the cabinet to provide services to human service
transportation delivery recipients upon verification of applicable
transportation operating authority.
(7) "Escort" means an individual attendant
whose presence is required to assist a recipient during transport.
(8) "Human service transportation delivery"
is defined by
KRS
281.014(6).
(9) "Medical necessity" means that a covered
benefit is determined to be needed in accordance with
907
KAR 3:130.
(10) "Medical service area" means the
Medicaid recipient's county of residence and contiguous counties.
(11) "Mileage reimbursement" means a fixed
rate set by the Commonwealth per mile that a motor vehicle is operated while
the recipient is a passenger.
(12)
"Provider" means an individual with appropriate operating authority performing
transportation operations for human service transportation delivery.
(13) "Recipient" means a person who is
receiving benefits under one (1) of the service programs listed in Sections 3,
5, or 6 of this administrative regulation and who complies with the criteria of
the participating program.
(14)
"Safety sensitive person" means a person who has direct involvement in a
recipient's trip, including:
(a)
Scheduling;
(b)
Dispatching;
(c) Driving;
or
(d) Maintaining the vehicle
fleet.
(15) "Special
circumstance" means an occasion for a broker to provide a trip after normal
working hours, such as for a patient receiving dialysis, chemotherapy, or
radiation treatment available only on nights and weekends, or TANF
transportation for evening shift employment.
(16) "Subcontractor" is defined by
KRS
281.014(9).
(17) "TANF" means the Temporary Assistance
for Needy Families Program administered by the Cabinet for Health and Family
Services.
(18) "Urgent care" means
an unscheduled episodic situation:
(a) In
which there is not a threat to life or limb, but the recipient needs to be seen
within twelve (12) hours in order to avoid the likely onset of an emergency
medical condition; and
(b) That
does not include an emergency trip that is to be addressed by a qualified
emergency service.
(19)
"Volunteer transportation" means transportation provided by a person or entity
as a charitable act without the expectation of receiving a benefit or
payment.
Section 2.
Program availability.
(1) Active human
service transportation delivery programs shall be available to eligible
recipients in all 120 counties of the Commonwealth of Kentucky as divided into
geographically coordinated service regions. The regions shall be as follows:
(a) Region 1, which shall include the
following counties:
1. Ballard;
2. Calloway;
3. Carlisle;
4. Fulton;
5. Graves;
6. Hickman;
7. Marshall; and
8. McCracken;
(b) Region 2, which shall include the
following counties:
1. Caldwell;
2. Christian;
3. Crittenden;
4. Hopkins;
5. Livingston;
6. Lyon;
7. Muhlenberg;
8. Todd; and
9. Trigg;
(c) Region 3, which shall include the
following counties:
1. Daviess;
2. Hancock;
3. Henderson;
4. McLean;
5. Ohio;
6. Union; and
7. Webster;
(d) Region 4, which shall include the
following counties:
1. Breckinridge;
2. Grayson;
3. Hardin;
4. Larue;
5. Marion;
6. Meade; and
7. Nelson;
(e) Region 5, which shall include the
following counties:
1. Adair;
2. Allen;
3. Barren;
4. Butler;
5. Edmonson;
6. Green;
7. Hart;
8. Logan;
9. Metcalfe;
10. Simpson;
11. Taylor; and
12. Warren;
(f) Region 6, which shall include the
following counties:
1. Bullitt;
2. Henry;
3. Jefferson;
4. Oldham;
5. Shelby;
6. Spencer; and
7. Trimble;
(g) Region 8, which shall include the
following counties:
1. Anderson;
2. Boyle;
3. Casey;
4. Franklin;
5. Garrard;
6. Jessamine;
7. Lincoln;
8. Mercer;
9. Scott;
10. Washington; and
11. Woodford;
(h) Region 9, which shall include the
following counties:
1. Boone;
2. Campbell;
3. Carroll;
4. Gallatin;
5. Grant;
6. Kenton;
7. Owen; and
8. Pendleton;
(i) Region 10, which shall include Fayette
County;
(j) Region 11, which shall
include the following counties:
1.
Bourbon;
2. Clark;
3. Estill;
4. Harrison;
5. Madison;
6. Montgomery;
7. Nicholas; and
8. Powell;
(k) Region 12, which shall include the
following counties:
1. Bell;
2. Clinton;
3. Cumberland;
4. Knox;
5. Laurel;
6. McCreary;
7. Monroe;
8. Pulaski;
9. Rockcastle;
10. Russell;
11. Wayne; and
12. Whitley;
(l) Region 13, which shall include the
following counties:
1. Breathitt;
2. Clay;
3. Harlan;
4. Jackson;
5. Knott;
6. Lee;
7. Leslie;
8. Letcher;
9. Owsley;
10. Perry; and
11. Wolfe;
(m) Region 14, which shall include the
following counties:
1. Floyd;
2. Johnson;
3. Magoffin;
4. Martin; and
5. Pike;
(n) Region 15, which shall include the
following counties:
1. Bath;
2. Boyd;
3. Carter;
4. Elliott;
5. Greenup;
6. Lawrence;
7. Menifee;
8. Morgan; and
9. Rowan; and
(o) Region 16, which shall include the
following counties:
1. Bracken;
2. Fleming;
3. Lewis;
4. Mason; and
5. Robertson.
(2) If a company is awarded more than one (1)
region, and those regions geographically touch, the regions shall be
administratively combined and identified as one single region for operating and
monitoring purposes.
Section
3. Service Programs. Excluding nonemergency ambulance stretcher
transportation, nonemergency medical transportation provided to a Medicaid
recipient as established in
KRS
205.6312,
KRS
205.6314, and
907
KAR 3:066 shall be provided as established in this
section.
(1) A broker shall transport a
Medicaid-eligible recipient, excluding a qualified Medicare beneficiary (QMB)
or a Phase 3 KCHIP recipient, with a county code residence in the broker's
delivery area.
(2) The broker shall
be responsible for transportation arrangements if the recipient:
(a) Is coded in the broker's delivery area
but has moved or is living in another human service transportation delivery
area;
(b) Has a county code of
121;
(c) Is physically residing in
the broker's region; or
(d) Is a
state guardianship case.
(3) Services outside a recipient's medical
service area shall require a referral from the recipient's:
(a) Licensed physician;
(b) Physician's assistant;
(c) Advanced practice registered nurse;
or
(d) Qualified mental health
professional as defined in
KRS
202A.011(12).
(4) If a referral pursuant to
subsection (3) of this section cannot be obtained, services may be authorized
by the contracting agency.
(5) A
referral shall be:
(a) To the closest
appropriate medical service provider for the required service;
(b) Valid for six (6) months; and
(c) Made by using the Office of
Transportation Delivery form entitled Kentucky Non-Emergency Medical
Transportation Program Medicaid Medical Referral Form.
(6) A recipient in the Medicaid Lock In
program shall obtain a referral from the recipient's assigned lock-in medical
provider prior to being transported to any other medical provider within or
outside the medical service area.
Section 4. Nonemergency Medical
Transportation.
(1)
(a) Nonemergency medical transportation shall
be available for a:
1. Kentucky Medicaid
eligible recipient; and
2.
Medically-necessary service as established in
907
KAR 3:066.
(b) A Kentucky Medicaid cardholder shall be
transported to a Medicaid-covered service accompanied by a parent, guardian, or
escort if required by
KRS
281.873.
(c) A parent, guardian, or escort shall not
be charged a fare.
(2)
If an operational motor vehicle is registered to a Medicaid eligible recipient
or household member, the recipient shall be denied nonemergency medical
transportation services unless:
(a) The
recipient or a licensed driver in the recipient's home submits a licensed
physician's statement to the Transportation Cabinet that he or she is medically
unable to operate a motor vehicle;
(b) The recipient submits the statement of an
automobile mechanic to the Transportation Cabinet certifying that the vehicle
is mechanically inoperable;
(c) The
recipient submits a statement to the Transportation Cabinet from an employer or
a school indicating that the motor vehicle is used for work or school during
the time the recipient needs to be transported to a medical appointment;
or
(d) The recipient requires a
special lift-equipped vehicle and none is available.
(3) A physician's statement submitted to the
Transportation Cabinet by a recipient shall be valid for six (6) months and may
be renewed every six (6) months.
(4)
(a) A
statement by an automobile mechanic submitted to the Transportation Cabinet by
a recipient shall be valid for thirty (30) days.
(b) A recipient may submit up to three (3)
mechanic's statements per vehicle during a one (1) year time period for each
vehicle owned by the recipient.
(5) An employer statement submitted by the
recipient to the Transportation Cabinet shall be valid for three (3) months and
may be renewed every three (3) months.
(6) A school statement submitted by a
recipient to the Transportation Cabinet shall be valid only during a current
school semester.
(7) A motor
vehicle in the recipient's home may be sold, junked, transferred, or cancelled
out of the household through the services of the recipient's local county
clerk's office.
Section
5. Kentucky Works Program.
(1)
Recipients participating in the Kentucky Works Program shall be transported to
services or TANF component activities in the county of residence or contiguous
county.
(2) Transportation services
covered by the Kentucky Works Program shall include:
(a) Employment;
(b) Child daycare centers;
(c) Job interviews; and
(d) Training.
(3) Transportation shall be provided for
training at vocational schools, community colleges, universities, and high
schools within the recipient's county or human service transportation delivery
area and contiguous to the human service delivery area.
Section 6. Programs.
(1) Programs under the human service
transportation delivery system shall include:
(a) The nonemergency medical transportation
program;
(b) The Kentucky WORKS
program;
(c) Vocational
rehabilitation as established in KRS Chapter 151B or 157;
(d) Vocational rehabilitation for the blind
as established in KRS Chapter 151B or 163;
(e) Mental health, mental retardation,
development disabilities, comprehensive care, or substance abuse services as
established in KRS Chapter 202A, 202B, 210, or 645; or
(f) The Office of Aging Services as
established in KRS Chapter 205, 209, 216, or 273.
(2) The Department for Medicaid Services
shall provide to the Transportation Cabinet:
(a) A listing of persons eligible to receive
human services transportation including special Medicaid recipient waiver
eligibility;
(b) The address of
each person on the list; and
(c)
The program for which each person on the list is eligible.
(3) A denial of human services transportation
to a recipient shall be as established in
KRS
281.872.
Section 7. Coordinated Advisory
Transportation Committee (CTAC).
(1) CTAC
shall be composed of members designated by the:
(a) Cabinet for Health and Family
Services;
(b) Education Cabinet;
and
(c) Transportation
Cabinet.
(2) The Cabinet
for Health and Family Services and the Transportation Cabinet shall each have
two (2) voting members and the Education Cabinet shall have one (1) voting
member.
(3) CTAC duties and
responsibilities shall include:
(a) Providing
information and assistance to the Transportation Cabinet;
(b) Reviewing and recommending policies and
operating procedures to the Transportation Cabinet; and
(c) Serving on broker evaluation
committees.
Section
8. Transportation Broker Selection Process.
(1) A request for proposal (RFP) and the
process of awarding a brokerage contract for each region shall comply with KRS
Chapter 45A. The RFP evaluation process for broker selection shall address
areas that include the following:
(a) Overall
quality in transportation delivery;
(b) Information regarding administration
including:
1. Human resources, including
staffing and employee categories by classification, number, and
experience;
2. Insurance and risk
management, types and levels of insurance coverage and emergency process, and
training offered to reduce business risk;
3. Billing and accounting practice and
procedures; and
4. Financial
capability; and
(c)
Information regarding operations including:
1.
Scheduling and reservations;
2.
Fleet management;
3. Dispatching
and radio communications;
4.
Computer software and hardware;
5.
Reporting for both the broker and subcontractor;
6. Vehicle inspection or maintenance
programs; and
7. Experience as
established in
KRS
281.875(2).
(2) An applicant shall demonstrate to the
Commonwealth an ability to coordinate trips with:
(a) Local community based governmental
offices;
(b) Training, educational,
or medical centers; and
(c) Other
transportation providers. (3) An applicant shall:
(a) Maintain an office in the awarded
regional area;
(b) Have
infrastructure and other resources including:
1. Telephone and dispatching
capability;
2. Scheduling software;
and
3. A building to serve as a
place of business;
(c)
Safely, securely, and confidentially store and maintain recipient and provider
information;
(d) Demonstrate the
ability to cover the delivery area including information regarding hours, days,
and operator's availability; and
(e) Indicate if education and training
programs are conducted on an ongoing basis.
Section 9. Contractual Agreements.
(1) A contract between the Commonwealth and a
broker shall be for one (1) year with four (4) one (1) year options to
renew.
(2) Contracts shall be on a
fiscal year basis, running July 1 through June 30.
(3) Except for a volunteer provider, each
transportation provider shall have operating authority issued by the
Transportation Cabinet pursuant to KRS Chapter 281 or 96A. (4) A contract
between the Commonwealth and the broker shall be subject to:
(a) Revocation in accordance with
KRS
281.879; and
(b) Termination in accordance with
200 KAR
5:312.
Section 10. Transportation Broker.
(1) A broker shall coordinate the human
service transportation delivery program as provided in
KRS
281.877.
(2) A broker shall make a report to the
cabinet on traffic accidents and moving violations involving either the broker
or subcontractor that occur in route to or while transporting a human service
transportation passenger within twenty-four (24) hours of the
occurrence.
(3)
(a) A broker shall have all completed reports
for payment to the cabinet no later than the seventh day of each month
following the reporting period.
(b)
The cabinet shall reimburse the broker no later than the
15th day of each month if the broker has submitted
the required reports, and if the Medicaid eligible count is received from the
Department for Medicaid Services allowing adequate processing time through the
Commonwealth's processing system.
(c) A broker shall reimburse a subcontractor
or a Medicaid private auto provider as established in
KRS
281.875(1)(f).
(d) A valid subcontractor or private auto
provider invoice postdated after the first of the month shall be included in
the next month's billing.
(e) A
TANF private auto provider shall be paid by a broker within three (3) business
days of receiving the TANF payment from the Transportation Cabinet.
(f) Payment shall be contingent upon a TANF
recipient:
1. Receiving written authorization
from the broker to use his or her private automobile; or
2. Having access to an automobile for
training or employment activities.
(4) A broker shall have an established
operating office located within the awarded delivery area.
(5) A broker shall employ a sufficient number
of staff to accommodate:
(a)
Reservations;
(b) Oversight of
timely pickup and delivery;
(c)
Scheduling;
(d)
Accounting;
(e) Complaint
tracking;
(f) Safety compliance;
and
(g) Reporting to the
cabinet.
(6)
(a) A broker or subcontractor shall
immediately report an allegation of criminal wrongdoing relating to the human
service transportation program or Medicaid or an allegation of Medi-caid fraud
to the Transportation Cabinet.
(b)
A broker shall immediately report recipient abuse or neglect to the Cabinet for
Health and Family Services.
(7) The cabinet shall utilize the
peer-to-peer review process within the Department for Medi-caid Services for
any questionable documentation received from a medical provider during the
delivery of transportation services.
(8) A broker shall require a subcontracting
transportation company to provide its drivers with name tags and company photo
identification.
(9) A broker that
receives a complaint in writing from the Transportation Cabinet shall respond
in writing:
(a) Within twenty-four (24)
business hours of the complaint; or
(b) Immediately if a complaint is marked
urgent.
Section
11. Orientation Program.
(1) A
broker shall provide an orientation program for each subcontractor or potential
subcontractor as established in
KRS
281.875(1)(j).
(2)
(a) An
orientation meeting between a broker and subcontractor shall be held before
transportation services are provided.
(b) A subsequent meeting shall be held as
needed or requested by the cabinet, broker, or subcontractor.
Section 12.
Subcontractors and Volunteers.
(1) A
subcontractor who has signed a contract with a broker to provide human service
transportation delivery within a specific delivery area shall meet human
service transportation delivery requirements, including:
(a) Proper operating authority by state,
county, or city; and
(b) The use of
authorized and qualified vehicles.
(2) A subcontractor shall not enter into an
agreement with a broker without the prior approval of the Transportation
Cabinet.
(3) A broker shall submit
and request approval of the cabinet for a potential subcontractor.
(4) A subcontractor shall not assign a trip
to any other provider.
(5) A
subcontractor shall submit the following documentation to the broker:
(a) A copy of the subcontractor's operating
authority;
(b) Proof of insurance
including the subcontractor, or independent contractor's vehicle liability
insurance, and proof of Kentucky workers' compensation insurance
coverage;
(c) A copy of the broker
and subcontractor's agreement;
(d)
A copy of all vehicle lease agreements; and
(e) A copy of the Medicaid provider's
enrollment letter.
(6) A
contract shall include:
(a) Payment
administration as established in
KRS
281.875(1)(f);
(b) A copy of the hours of operation and
other scheduling requirements;
(c)
The rates for services;
(d) Pickup
and delivery standards;
(e)
Contract duration;
(f) Termination
clause and compliance penalty provisions;
(g) Signed HIPAA confidentiality agreement
statements for subcontractor or volunteer employees; and
(h) A current list of all safety sensitive
persons within the subcontractor's company.
(7) A broker or subcontractor shall provide
documentation to the cabinet certifying that all drivers and escorts during
employment shall:
(a) Be legally licensed by
the Commonwealth of Kentucky to operate the transportation vehicle to which
they are assigned;
(b) Be
courteous, patient, and helpful;
(c) Be eighteen (18) years of age or
older;
(d) Have no more than two
(2) convictions for moving violations in the last three (3) years;
(e) Have no convictions of any sexual crime
or crime of violence;
(f) Have had
a pre employment drug test; and
(g)
Have received orientation and safety training that includes:
1. First aid training;
2. Training regarding blood borne
pathogens;
3. Passenger assistance
training; and
4. Intellectual or
developmental disability awareness training if offered by the
cabinet.
(8)
A person who has been convicted of a misdemeanor or a felony during the last
five (5) years shall drive or escort passengers only after review and approval
by the broker, subcontractor, and the cabinet.
(9) A volunteer transportation provider shall
have:
(a) A valid driver's license;
(b) Proof of insurance and registration;
and
(c) A vehicle that meets the
safety needs of the recipient.
(10) In order to receive mileage
reimbursement in the next billing cycle, a private auto provider shall submit a
valid invoice to the broker by the first of each month to allow for payment
within three (3) business days of payment received from the cabinet.
(11) A valid invoice postdated after the
first day of the month shall be included in the next month's billing.
(12) A subcontractor or a private auto
provider shall submit all valid invoices to the broker within six (6) months of
the date of service for reimbursement by the broker.
(13) A subcontractor shall immediately report
to the broker a moving violation or traffic accident that occurs in route or
while transporting a human service transportation passenger.
(14) A subcontractor shall not participate in
determining recipient eligibility or type of transport.
(15) A subcontractor shall not solicit for
assignment of nonemergency Medicaid trips.
Section 13. Vehicle Requirements.
(1) A broker shall assure that transportation
providers maintain vehicles and vehicle equipment.
(2) A vehicle and its components shall comply
with, or exceed, the manufacturer's, state, and federal safety and mechanical
operating and maintenance standards for the particular vehicle and model
used.
(3) A vehicle shall comply
with the Americans With Disabilities Act of 1990, ADA,
42 U.S.C.
12102.
(4) A vehicle that is noncompliant with
licensing requirements, operating authority requirements, or safety
requirements shall be immediately removed from human service transportation
delivery service by the broker.
(5)
(a) A transportation provider shall provide
and use a communication system that links the dispatcher with the provider, and
the provider with the dispatcher. A communication system shall be used:
1. In a manner that facilitates communication
and minimizes time in replacing or repairing out-of-service vehicles;
and
2. In a confidential manner
adhering to 45 C.F.R. Part 164 , the Health Insurance Portability and
Accountability Act of 1996, HIPAA.
(b) A vehicle shall be equipped with adequate
heating and air conditioning for driver and passengers. A vehicle with a
nonfunctioning climate control system shall be placed out-of-service until
appropriate corrective action is taken.
(c) A vehicle shall have functioning, clean,
and accessible seat belts for each passenger seat.
(d) Seat belts shall be stored off the floor
when not in use.
(e) A vehicle
shall utilize child safety seats pursuant to
KRS
189.125.
(f) A vehicle shall have at least two (2)
seat belt extensions provided.
(g)
A vehicle shall be equipped with a seat belt cutter mounted above the driver's
door for use in emergency situations.
(h) A vehicle shall have a functioning
speedometer and odometer.
(i) A
vehicle shall have functioning interior lights within the passenger
compartment.
(j) A vehicle shall
have adequate sidewall padding and ceiling covering.
(k) A vehicle shall be smooth
riding.
(l) A vehicle shall have
two (2) exterior rear view mirrors, one (1) on each side of the
vehicle.
(m) A vehicle shall be
equipped with an interior mirror that:
1. Is
used to monitor the passenger compartment; and
2. Shall be either clear-view laminated
glass, or clear-view glass bonded to the back that retains the glass in the
event of breakage.
(n) A
vehicle's interior and exterior shall be clean and free of:
1. Broken mirrors or windows;
2. Torn upholstery or floor
covering;
3. Damaged or broken
seats;
4. Protruding or sharp
edges;
5. Dirt, oil, or grease;
or
6. Litter.
(o) The vehicle floor shall be covered with
commercial anti-skid, ribbed, rubber flooring, or carpeting. Ribbing shall not
interfere with wheelchair movement between the lift and the wheelchair
positions.
(p) A vehicle shall have
the transportation provider's name, vehicle number, and the program
coordinator's customer service phone number prominently displayed within its
interior. This information shall also be available in written form on each
vehicle for distribution to a rider on request.
(q) A vehicle shall have the following signs
posted in the vehicle interior, easily visible to the passengers and driver:
1. "No Smoking, Eating or Drinking;"
and
2. "All passengers shall use
seat belts".
(r) A
vehicle shall be equipped with a functional fire extinguisher and shall display
a current inspection tag or sticker.
(s) A vehicle with a floor threshold of
greater than twelve (12) inches shall include a retractable step or a step
stool to aid in passenger boarding. A step stool shall:
1. Be used to minimize ground-to-first-step
height;
2. Have four (4) legs with
antiskid tips;
3. Be made of sturdy
metal with nonskid tread;
4. Have a
height of eight and one-fourth (8 1/4) inches, a width of fifteen (15) inches,
and a depth of fourteen (14) inches; and
5. Not be milk crate or similar
substitute.
(t) A
vehicle shall have on board three (3) portable triangular reflectors mounted on
stands.
(u) A vehicle shall include
a vehicle information packet to be stored in the driver compartment or securely
stored on or in the driver's side visor. This packet shall include:
1. Vehicle registration;
2. Insurance card;
3. Bus or vehicle card; and
4. Accident procedures and
forms.
(v) A vehicle shall
be provided with a fully equipped first aid kit and a "spill kit" including:
1. Liquid spill absorbent;
2. Latex gloves;
3. Hazardous waste disposal bags;
4. Scrub brush; and
5. Disinfectant and deodorizer.
(w) A vehicle shall contain maps or
global positioning devices with sufficient detail to locate recipients and
destinations.
(x)
1. A vehicle shall have the transportation
provider's company signage posted on the exterior of the vehicle identifying
the company's legal name.
2.
Signage shall be displayed on the driver and passenger side doors in two (2)
inch block letters.
(6) A lift-equipped vehicle used to transport
wheelchair passengers shall meet the requirements and specifications of the
Americans with Disabilities Act of 1990, ADA.
Section 14. Scheduling.
(1)
(a) The
recipient or his or her guardian shall call the regional broker of the coded
county of the recipient's residence at least seventy-two (72) hours prior to
the scheduled appointment to schedule a trip.
(b) If a recipient is not county coded to the
county of residence, the broker shall assist with arranging service with the
assigned county coded broker.
(c)
Weekends and holidays shall be included in determining the seventy-two (72)
hour period for scheduling.
(2)
(a) All
brokers shall provide scheduling services between 8 a.m. and 4:30 p.m., Monday
through Friday, and from 8 a.m. to 1 p.m. on Saturday.
(b) Transportation services shall be provided
between 6 a.m. and 8 p.m., Monday through Friday, and from 8 a.m. to 1 p.m. on
Saturday.
(c) Scheduling services,
transportation services, and business functions shall be closed for:
1. New Year's Day;
2. Memorial Day;
3. July 4th;
4. Labor Day;
5. Thanksgiving Day; and
6. Christmas Day.
(3)
(a) The broker shall have paging services
available after normal scheduling hours for urgent care transportation
service.
(b) Urgent care
transportation service shall be provided twenty-four (24) hours a day, seven
(7) days a week, including any holiday.
(c) Urgent care transportation service may be
requested at any time.
(d) TANF
recipients may request immediate transportation from employment or training,
including transport of a recipient's child from a daycare facility, due to an
illness or a family emergency.
(e)
In-patient discharges shall be provided during the human service transportation
operating hours established in subsection (2)(b) of this section, and shall not
require a seventy-two (72) hour notice of scheduling in advance.
(4)
(a) A broker may schedule and provide trips
for recipients after the normal hours of operation for a special
circumstance.
(b) The broker may
contact the Transportation Cabinet for guidance.
(5) The broker shall collect the following
information from each eligible recipient requesting transportation services:
(a) Name of recipient;
(b) Recipient's Medicaid identification
number, if applicable;
(c)
Recipient's pickup and delivery address;
(d) Date of appointment;
(e) Time of appointment;
(f) Program identification;
(g) Telephone number;
(h) Type of covered service; and
(i) Special needs including:
1. Child safety seats; or
2. Lift-equipped vehicle.
(6) The broker shall
confirm the trip has been scheduled and shall provide the recipient with a
reservation confirmation number.
(7) In order to waive the seventy-two (72)
hour notice requirement for urgent care, the cabinet shall receive verification
from a:
(a) Physician;
(b) Physician's assistant;
(c) Advanced practice registered nurse;
or
(d) Qualified mental health
professional as defined in
KRS
202A.011.
(8) The verification required by subsection
(7) of this section shall be transmitted by:
(a) Oral verification over a
telephone;
(b) Written verification
on the licensed medical provider's letterhead delivered in person to the
broker; or
(c) Written verification
transmitted electronically by computer or by facsimile on the licensed medical
provider's letterhead and submitted from the licensed medical provider's office
directly to the broker's office.
(9) If verification is not submitted by the
medical provider, the broker may initiate a telephone call to the licensed
medical provider requesting oral verification that the recipient is required to
be seen at the appointed time.
(10)
If the licensed medical provider initiates the call, the broker shall return
the call if there is a question concerning the call's legitimacy.
Section 15. Eligibility.
(1)
(a) With
the Transportation Cabinet and Cabinet for Health and Family Service's
assistance, a broker shall have direct computer access to all relevant data
bases needed to determine eligibility.
(b) If there is a question regarding
eligibility, the broker shall contact the cabinet for assistance in determining
eligibility.
(c) The cabinet shall
investigate all complaints regarding subcontractors and the broker for the
area, and attempt to immediately resolve the problem to the satisfaction of all
parties.
(d) The cabinet shall
forward all complaints relating to Medicaid fraud or abuse to the Cabinet for
Health and Family Services.
(2) A trip for a nonemergency medical
recipient who does not require a special-equipped vehicle may be by taxi,
community or city bus, or private auto and shall be coordinated by the broker
so that, if it is feasible, one (1) recipient may be transported with other
recipients.
(3)
(a) The broker shall ensure as established in
KRS
281.873(6) that an escort
accompanies all Certificate Type 07 and Certificate Type 08 recipients
certified for an escort pursuant to the cabinet's specialty carrier form
entitled Medical Transportation Classification Form.
(b) A Medical Transportation Classification
Form shall be submitted by the broker directly to the physician and sent from
the physician directly to the broker.
(c) One (1) escort shall be required for each
recipient.
(d) A family member may
serve as an escort.
(e) One (1)
escort may serve several recipients if the recipients are grouped and have the
same destination.
(f) An escort
shall not be charged a fare.
(g) A
transportation provider or a provider's employee shall not serve as a
guardian's de-signee for a child twelve (12) years or under.
Section 16. Standards
for Recipients.
(1)
(a) A trip for a recipient may be coordinated
with public transit.
(b) A
recipient shall give all pertinent information needed to the broker, including
a request for an escort required, or information regarding special
needs.
(2) If the
recipient is under the TANF Program, the recipient shall convey to the broker
the number of children to be transported.
(3) Transportation to childcare shall not be
provided under nonemergency medical transportation.
(4) A recipient shall not be under the
influence of alcohol or illegal drugs.
(5) A recipient shall be ready at least
fifteen (15) minutes before scheduled pickup.
(6) Except for medical necessity, a recipient
shall abide by signs in the vehicle and observe safety rules including seat
belt requirements.
(7) A recipient
shall not hold a child in his or her lap during transport.
(8) A recipient shall call seventy-two (72)
hours in advance for the transport unless it is an urgent care
situation.
(9)
(a) A recipient shall cancel a trip as soon
as possible, but no less than twenty-four (24) hours in advance. An emergency
cancellation in which a twenty-four (24) hour notice is not possible shall be
accepted by the broker or Cabinet upon review and determination of the
cancellation reason.
(b) A
recipient who fails to show for a scheduled transportation service shall
receive a letter from the Transportation Cabinet informing the recipient of the
recipient's responsibility in scheduling and cancelling trips.
(10) A recipient that engages in
abusive, violent, seriously disruptive, or illegal conduct or contact shall
lose his or her transportation privileges with approval from the
cabinet.
(11) If a recipient poses
an immediate danger to the driver or other passengers, the driver shall call
for emergency assistance.
(12) A
recipient may call a broker or the cabinet's toll free complaint phone line to
lodge a complaint.
(13) Failure to
abide by subsections (3) through (11) of this section shall be cause for trip
denial as established in
KRS
281.872.
Section 17. Program Coordinators. The cabinet
shall employ program coordinators as established in
KRS
281.872.
Section 18. Cabinet Performance Monitoring
and Oversight.
(1) A broker shall demonstrate
operational readiness to the cabinet in an onsite inspection in the following
areas:
(a) Hours of service and
operation;
(b) Scheduling
procedures;
(c) Pickup and delivery
standards;
(d) Urgent care and
immediate TANF transportation;
(e)
Driver conduct, qualification, and training;
(f) Passenger requirements;
(g) Vehicle requirements, inspections, and
vehicle inventory;
(h) Back-up
service;
(i) Appeals and complaint
procedures;
(j) Telephone systems
and reporting procedures, including TTY;
(k) Computer and technological
capabilities;
(l) Driver manifest
form procedures submittal and receipt;
(m) Roles and job descriptions of staff;
and
(n) Educational and orientation
procedures.
(2) A broker
shall develop a Transportation Cabinet approved operational procedures manual
for each region. The manual shall:
(a) Be
developed by the broker to outline the basic operations procedure for that
region;
(b) Include the procedure
for reservations and dispatch, requirements for eligibility and intake, a call
center, out of region services, coordination, and recipient classification
levels; and
(c) Be reviewed by the
cabinet each year during the broker's assessment while on-site. If there are
changes made to the plan in between the annual on-site assessment, the broker
shall notify the Cabinet.
(3) Each broker shall set up toll free lines
giving the human service transportation delivery recipients and the general
public information about the availability of services.
(4)
(a) A
broker shall be available for scheduled visits by the Transportation Cabinet
twice a year to assess operations and performance, and discuss service
issues.
(b) A subsequent meeting or
visit may be held as needed or requested by the broker or the
cabinet.
(c) One (1) meeting shall
consist of a comprehensive assessment compliance review by the
cabinet.
(d) A broker shall be
available for periodic conference calls with the cabinet to discuss issues,
policy, and procedures.
(5)
(a) A
driver performing under the human service delivery network shall be subject to
random drug and alcohol testing.
(b) A new hire safety-sensitive employee for
a transportation provider shall be required to pass a preemployment drug
test.
(c) A provider shall develop
a drug and alcohol policy.
(6)
(a) Each
broker shall submit the results of random drug and alcohol screenings to the
Kentucky Transportation Cabinet on a monthly basis.
(b) All broker and subcontractor trips shall
be reported and the dollar amount paid for each one (1) way trip.
(c) This information shall be reported in a
computer ACCESS or Excel format pursuant to each broker's contract with the
Finance and Administration Cabinet.
(7)
(a) The
Transportation Cabinet shall compile a monthly report containing operating
information on each program operated by the brokers including rural public
transportation, and denoting fleet, miles, hours, fuel, revenues, and
expenses.
(b) The statistics shall
be used for analysis and reporting to other state agencies and to the Federal
Transit Administration (FTA). The cabinet shall issue a standard monthly
summary form to each broker pursuant to each broker's contract with the Finance
and Administration Cabinet.
(8) The broker shall submit line item invoice
forms each month to the cabinet with the request for reimbursement and detail
current month's expenses broken out by line item, including salaries,
subcontractor payments, maintenance, and fuel.
(9)
(a) The
broker, at its own expense, shall have an independent audit performed for the
past fiscal year.
(b) This audit
shall be conducted in accordance with applicable federal and state law, and be
delivered to the cabinet by March 31 of the following fiscal year of
service.
(10)
(a) Formalized program integrity plans shall
be submitted by the broker to the Transportation Cabinet that define the
broker's program for identifying and deterring any suspected fraud or abuse
activities within the human service transportation delivery program.
(b) The Transportation Cabinet shall issue a
statewide program integrity plan format for all brokers. The program integrity
plan format shall identify ways each broker shall handle allegations of fraud,
waste, and abuse of the program's resources.
(11)
(a)
Each broker shall develop and maintain a quality assurance plan. The plan shall
address the following:
1. The scheduling and
delivery of transportation services;
2. The broker's methodology for the
identification and correction of problems relating to the scheduling and
delivery of transportation services; and
3. Subcontractor payment
efficiency.
(b) The
Transportation Cabinet shall require the broker to compile and provide to the
cabinet data that further tracks the broker's performance including:
1. Those items in Section 25(3) of this
administrative regulation; and
2.
Drug and alcohol reports.
(12)
(a)
Each broker shall have a disaster recovery plan that shall include the broker's
plan to ensure continuous operations and services for recipients if there is an
emergency.
(b) The broker shall not
transport in conditions that may negatively affect the health and safety of a
driver or a passenger.
(c) The
broker shall establish and maintain an inclement weather transportation policy
that has been approved by the Transportation Cabinet. The inclement weather
transportation policy shall detail the broker's plans in response to inclement
weather, including directions for drivers, notifications to recipients and the
media, and a back-up plan to continue providing transportation.
(d) If needed, the broker shall contact the
National Guard or other emergency units to assist in the transport of dialysis
clients or urgent care.
(e) The
broker shall operate on all routes or highways that are deemed safe, thereby
offering limited services during inclement weather.
(13) A broker shall submit monthly vehicle
inventory data listing the number of vehicles used by each transportation
provider in the delivery of human services transportation.
Section 19. Fines and Penalties.
(1) A broker that fails to perform according
to contractual obligations or statutory requirements and whose noncompliance
causes a recipient to miss a scheduled appointment shall receive a written
warning from the Transportation Cabinet outlining the provisions of
noncompliance.
(2) A broker that
receives a second written warning from the cabinet within a thirty (30) day
period shall submit a corrective action plan to the cabinet within ten (10)
days of receipt of the written warning.
(3) A broker that receives a third written
notice from the cabinet within a thirty (30) day period shall:
(a) Receive a written reprimand outlining the
provisions of non-compliance;
(b)
Receive notice in writing of a fine of $1,000 as established in
KRS
281.872(3).
Section 20. Broker
Appeal Process.
(1) A broker shall have
fifteen (15) days to appeal the notice of a fine pursuant to
KRS
281.872(3).
(2) An appeal shall be in writing and mailed
to: Kentucky Transportation Cabinet, Executive Quality Management Committee
(EQMC), Office of Transportation Delivery, 200 Mero Street, Frankfort, Kentucky
40622.
(3) The appeal of a fine
shall be received ten (10) days prior to the next regularly scheduled EQMC
meeting in order to be included on that agenda.
(4) An imposed fine shall be deducted from
the monthly capitated payment made to the broker prior to the issuance of the
monthly invoice.
Section
21. Revocation.
(1) A broker who
is required to pay a fine pursuant to
KRS
281.872(3) shall be subject
to having his or her contract revoked by the Transportation Cabinet within
ninety (90) days of:
(a) The notice of a fine
if it is accepted by the broker and not appealed; or
(b) The date of the EQMC hearing
decision.
(2) A broker
whose contract is revoked shall be prohibited from participating in the human
service transportation delivery program for five (5) years.
Section 22. Recipient Appeal
Process. A Medicaid recipient shall have the right to appeal a denial of
transportation as established in
907
KAR 1:563.
Section
23. Right to Choose Transportation Provider.
(1) A participant may select an eligible
subcontractor or the broker for the area, if the broker also provides
transportation services within the delivery area, as established by
KRS
281.874.
(2)
(a) The
broker shall schedule the trip with a participating provider if the recipient
does not express a preference.
(b)
A person expressing a personal preference under this section shall contact the
broker as established in
KRS
281.874(2).
(3) If the recipient allows the
broker to choose a provider, the criteria for trip distribution shall include
in order of priority:
(a)
Coordination;
(b) Cost
efficiencies; or
(c) If the first
two (2) criteria are not met, rotating certificate type 07 and certificate type
08 trips among providers, including the broker.
(4)
(a) The
broker and transportation provider shall evaluate routes presently utilized by
the eligible recipients.
(b) If the
broker determines that a route is inefficient, the broker shall elect a more
efficient route.
(5) The
Transportation Cabinet shall resolve any disputes regarding choice of
transportation provider.
Section
24. Cabinet Responsibilities.
(1)
(a) The Transportation Cabinet shall
establish provider rates for each certificate type for each human service
transportation delivery area.
(b)
The rates shall be uniform for the same certificate types for all eligible
providers, including the broker in each delivery area.
(c) The following factors shall be considered
in determining the rates:
1. Geographical
terrain;
2. Trip
distance;
3. Recipient
population;
4. Availability of
medical and employment facilities;
5. Labor and economic factors; and
6. Utilization of services.
(2)
(a) A forty-five (45) day notice shall be
given to all brokers by the cabinet prior to any changes made to the
subcontractor rates.
(b) A broker
may waive the forty-five (45) day notice requirement in writing to the
cabinet.
Section
25. Safety and Accountability.
(1) A broker or subcontractor shall maintain
records for five (5) years.
(2)
Employees of a broker or subcontractor shall sign confidentiality statements
regarding access to, or disclosure of, confidential information or
records.
(3) Collection and
retention of records to be maintained by each broker or subcontractor
pertaining to human service transportation delivery shall include:
(a) Encounter data;
(b) Complaint tracking;
(c) Monthly summary reports;
(d) Trip invoices;
(e) Phone reports;
(f) Subcontractor requests;
(g) Audits;
(h) Line-item budgets;
(i) Monthly pay document submittals;
and
(j) Vehicle inventory
reports.
(4) Collection
and retention of encounter data on each trip shall be made by the broker if the
broker provides transportation services, and by each subcontractor.
(5) Failure of a broker to timely record and
report all data and broker trips as established in
KRS
281.875 shall be grounds for the Commonwealth
to terminate the broker's contract.
(6) A transportation broker or subcontractor
exempted in
601 KAR
1:005 shall comply with the provisions of 49 C.F.R.
Part 655.
(7)
(a) A transportation broker, provider, or
subcontractor who operates a motor vehicle that is not subject to the
provisions of
601 KAR
1:005 shall maintain each of the vehicles in a safe
operating condition consistent with Section 13 of this administrative
regulation.
(b) A motor vehicle
being operated pursuant to the provisions of this administrative regulation
that is not subject to the provisions of
601 KAR
1:005 shall be inspected on an annual basis by an
automotive technician.
(c) Prior to
a motor vehicle being operated pursuant to this administrative regulation, the
transportation broker or provider shall obtain written proof that the motor
vehicle has passed a safety inspection by an automotive technician.
Section 26.
Incorporation by Reference.
(1) The following
items are incorporated by reference:
(a)
"Medical Transportation Classification Form", June 2011; and
(b) "Kentucky Non-Emergency Medical
Transportation Program Medicaid Medical Referral Form", June 2011.
(2) This material may be
inspected, copied, or obtained, subject to applicable copyright law, at the
Office of Transportation Delivery, Transportation Cabinet Building, 200 Mero
Street, Frankfort, Kentucky 40622, Monday through Friday, 8:00 a.m. to 4:30
p.m. The telephone number is (502) 564-4733.
STATUTORY AUTHORITY:
KRS
281.870,
281.875