INSTRUCTIONS REQUIREMENTS - Pennsylvania

1 COMMONWEALTH OF Pennsylvania . DEPARTMENT OF PUBLIC WELFARE. OFFICE OF MEDICAL ASSISTANCE PROGRAMS. MEDICAL ASSISTANCE. TRANSPORTATION. PROGRAM. INSTRUCTIONS . &. REQUIREMENTS . Prepared by the Division of Medical Assistance Transportation Programs Bureau of Managed Care Operation This Page Intentionally Left Blank TABLE OF CONTENTS. Contents Scope of Services .. 1. MATP Executive Summary .. 3. Glossary of Terms .. 7. General Responsibilities .. 17. 1. Inform and Educate Recipients and Other Stakeholders .. 20. A. Outreach .. 20. B. Written Materials .. 21. C. Limited English Proficiency (LEP) .. 21. 2. Operate an MATP Telephone Line .. 22. A. Telephone 22. B. Hearing Impaired/Disabilities .. 22. 3. Manage the Program to Ensure Cost-Effective and Appropriate Transportation Services are Provided.

2 23. A. Data and Reporting .. 23. B. Waivers .. 23. 4. Maximize Cost-Effectiveness and Quality Services through Coordination with Local Programs and Stakeholders .. 24. A. Trip Coordination .. 24. B. Service 24. 5. Verify Recipient Eligibility and Need .. 24. A. 24. B. Application .. 25. 6. Authorize Transportation Services, Schedule, and Dispatch Trips .. 25. MATP I&R Rev. 10/2012 i TABLE OF CONTENTS. A. Eligible MATP Services .. 25. B. Determination of Mode of Transportation .. 25. C. Transportation to Service Providers .. 26. D. Mileage Reimbursement .. 26. E. Fixed Route Public Transportation .. 28. F. Quarter Mile Rule .. 28. G. 28. H. 29. I. Methadone Maintenance .. 31. J. Denial of Services .. 31. K. Urgent Care .. 31. L. No-Show Sanction Policy.

3 32. M. Escort Policy Guidance .. 32. N. Curb-to-Curb Service .. 33. O. Door-to-Door Service .. 33. P. Exceptional Transportation .. 33. Q. Incident 34. R. Fraud and Abuse .. 34. 7. Recruit and Maintain Adequate Transportation Provider Networks .. 34. A. Provider Networks .. 34. B. Provider Contracts .. 35. C. Driver Criminal History and Child Abuse Clearance Checks and Training .. 35. D. Monitoring .. 35. 8. Maintain Confidentiality of Information .. 36. MATP I&R Rev. 10/2012 ii TABLE OF CONTENTS. 9. Maintain a Complaint and Denial Process .. 37. 10. Review, Monitor, and Report Provider and Sub-contractor Fraud and Abuse .. 38. A. Obligation to screen for Medical Assistance excluded providers (Form J) .. 38. B. Obligation of providers and fiscal agents to disclose information on ownership and control (Form K).

4 39. C. Obligation of providers and fiscal agents to disclose information on ownership and convictions (Form L) .. 39. D. Obligation to furnish upon request the information related to business transactions totaling more than $25,000 (Form M) .. 40. E. Reporting suspected Fraud and Abuse to the Department .. 40. Fiscal REQUIREMENTS .. 43. 1. Budget Project Report Submittal .. 45. 2. Fiscal Reporting 45. A. General Guidelines When Completing 45. 3. Monthly Reporting .. 48. 4. Monthly Methadone Reporting .. 49. 5. Quarterly Reports (I&R, pg. 95) .. 49. 6. Least Costly and Most Appropriate Requirement .. 50. 7. Usual and Customary Charge .. 50. 8. Responsibility to Negotiate .. 50. 9. Payer of Last 51. 10. Recipient Fraud .. 51. 11. Deceased Recipients.

5 51. 12. Interest Bearing Accounts .. 51. 13. Retroactive Costs .. 52. MATP I&R Rev. 10/2012 iii TABLE OF CONTENTS. 14. Notification of Fare Increases PENNDOT Shared Ride 52. 15. Subcontracts .. 52. 16. Premium 52. 17. Record Keeping and Retention .. 53. 18. Audits .. 53. 19. Performance Audits .. 54. 20. Sanctions .. 54. 21. Allocation Termination .. 54. 22. Balance of Funds .. 54. 23. 54. 24. Limitations on Purchases .. 54. 25. Bidding and 55. 26. Title to Property .. 55. 27. Disposition of Property .. 55. 28. Multiple Reimbursements .. 55. 29. Payment Procedures .. 56. 30. Key Dates .. 57. Exhibits .. 63. Exhibit 1: Basic Informational Brochure .. 65. Exhibit 2: Recipient Welcome Brochures .. 67. Exhibit 3: Suggested Outreach Venues.

6 73. Exhibit 4: Eligibility for the Medical Assistance Transportation Program .. 75. Exhibit 5: Medical Assistance Enrolled Providers .. 77. MATP I&R Rev. 10/2012 iv TABLE OF CONTENTS. Exhibit 6: Excluded Medical Assistance Transportation Providers .. 81. Exhibit 7: Application Process .. 83. Exhibit 8: Statewide No-Show Policy .. 85. Exhibit 9: Written Notice REQUIREMENTS , processes, and policy .. 87. Exhibit 10: OIG regions and contact information .. 89. Exhibit 11: Methadone Maintenance Closest Service Provider Rule .. 91. Exhibit 12: Incident Reporting Process .. 93. Exhibit 13: MATP Funding Status .. 95. Exhibit 14: Grantee On-Site Monitoring .. 97. Exhibit 15: Safety Guidelines .. 99. 1. Recipient Exiting the Vehicle Prior to Scheduled Stop.

7 99. A. Purpose: .. 99. B. Policy: .. 99. C. Procedures Adult Recipients .. 99. D. Procedures for Children .. 100. E. Additional Steps .. 101. 2. Safety Exception to the Ten-Day Appeal Rule .. 101. A. Written Notice Requirement clarification re: situations that may deem immediate termination of services.. 101. Forms .. 103. Form A: Waiver Request Form .. 105. Waiver Request Form Sample .. 106. Form B: Written Notice Form - Page 1 .. 107. Written Notice Form - Page 2 .. 108. MATP I&R Rev. 10/2012 v TABLE OF CONTENTS. Form C: OIG 12 - Page 1 (Printable from ) .. 109. OIG 12 - Page 2 (Printable from ) .. 110. Form D: Budget Projection Report .. 111. Budget Projection Report .. 112. Budget Projection Report .. 113. Form E: Monthly Data File Form Format.

8 115. INSTRUCTIONS For Submitting Monthly Trip Level Data .. 116. Form F: Monthly Report Forms .. 117. Monthly Report Forms .. 118. Monthly Report Forms .. 119. Form G: Monthly Methadone Report (Sample) .. 121. Form H: Quarterly Reports Components Actual Expenditure Report .. 123. Quarterly Reports Components Actual Expenditure Report .. 124. Quarterly Reports Components Personnel Report - Transportation (Sample First Quarter) .. 125. Quarterly Reports Components Personnel Report - Administration (Sample First Quarter) .. 126. Quarterly Reports Components Transportation Report (Sample First Quarter) .. 127. Quarterly Reports Components Transportation Report (Sample First Quarter) .. 128. Quarterly Reports Components 129. Quarterly Reports Components Narratives.

9 131. Quarterly Reports Components Trip and Client Data Report .. 133. Quarterly Reports Components Trip and Client Data Report .. 134. Form I: MATP Application 135. Form J: Disclosure of 141. MATP I&R Rev. 10/2012 vi TABLE OF CONTENTS. Form K: Disclosure of Ownership and Control Page 1 .. 143. Disclosure of Ownership and Control Page 144. Form L: Disclosure of Ownership and Convictions Page 1 .. 145. Disclosure of Ownership and Convictions Page 2 .. 146. Form M: Disclosure of Significant Business Transactions Page 1 .. 147. Disclosure of Significant Business Transactions Page 2 .. 148. MATP I&R Rev. 10/2012 vii TABLE OF CONTENTS. This Page Intentionally Left Blank MATP I&R Rev. 10/2012 viii COMMONWEALTH OF Pennsylvania . DEPARTMENT OF PUBLIC WELFARE.

10 OFFICE OF MEDICAL ASSISTANCE PROGRAMS. MEDICAL ASSISTANCE. TRANSPORTATION. PROGRAM. SCOPE OF SERVICES. Prepared by the Division of Medical Assistance Transportation Programs Bureau of Managed Care Operations EXECUTIVE SUMMARY. This Page Intentionally Left Blank MATP I&R Rev. 10/2012 2. EXECUTIVE SUMMARY. MATP EXECUTIVE SUMMARY. Federal regulations require that the State Medical Assistance agency assure that transportation is available for recipients to and from medical providers. The Department of Public Welfare (Department) carries out this mandate by providing both emergency and non-emergency medical transportation services. Emergency medical transportation services are funded separately through the Medical Assistance Outpatient appropriation.