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Family and Children's Medicaid Admin. Letters
DMA ADMINISTRATIVE LETTER NO: 04-12, NEMT Vendor obligations and =
Policy=20
Implementation timeline
DATE: 5/31/12
SUBJECT: NEMT Vendor Obligations and Policy Implementation=20
Timeline
DISTRIBUTION: County Directors of Social Services
Business Officers
Medicaid Supervisors
Transportation Coordinators
Medicaid Eligibility Staff
I. Background
Change Notice 01-12, Non-Emergency Medicaid Transportation (NEMT), =
revised=20
NEMT policy in order to provide more consistency and oversight of the=20
transportation program. Federal regulations place additional reporting =
obligations on individuals and entities that contract to provide =
Medicaid=20
Services. These additional obligations are outlined below and must be =
included=20
in all NEMT vendor contracts.
Furthermore, in September 2011, the Centers for Medicaid and =
Medicare=20
Services=92 Medicaid Integrity Group conducted a comprehensive program =
integrity=20
review of the North Carolina Medicaid Program. As a result of that =
review,=20
North Carolina was cited for noncompliance with 42 CFR 1002.3(b)(3) =
for=20
failure to ensure that adverse actions against Non-Emergency Medicaid=20
Transportation vendors and providers for program integrity reasons are =
reported to the Department of Health and Human Services Office of =
Inspector=20
General (DHHS OIG). This letter provides a procedure for counties to =
report=20
adverse actions against transportation vendors and providers and a =
form to do=20
so (see Attachment=20
1).
Included as attachments to this Administrative Letter are the =
county=20
contract template (see attachment=20
2) and contract transportation rider (see attachment=20
3), which are revised to include federal and state =
Medicaid=20
vendor reporting requirements. The Local Business Liaisons have shared =
the=20
revised contract template and transportation rider with the counties. =
The=20
DMA-5024, Medicaid Transportation Vendor Documentation, form is =
revised to=20
include the business ownership, control and location information =
specified in=20
II. below (see Attachment=20
4 for revised form). Attachment=20
5 is the DMA-5125B, Medicaid Transportation Suspension =
Notice,=20
which is revised to indicate that the individual is entitled to =
transportation=20
to a critical service (where applicable) during the period of their=20
suspension. In addition, the NEMT Grid, containing implementation =
timelines,=20
is appended as =93attachment=20
6.=94
II. Additional contractual requirements
A. Information on ownership and control (42 =
CFR=20
455.104)
1. NEMT vendors must disclose the following information to the =
county:=20
a. The name and address of each person (individual or =
corporation)=20
with an ownership or control interest in the vendor or in any=20
subcontractor in which the vendor has direct or indirect ownership =
of 5=20
percent or more. The address for corporate entities must include =
as=20
applicable primary business address, every business location, and =
P.O. Box=20
address.
b. Whether any of the persons named, in compliance with =
paragraph a.=20
is related to another as spouse, parent, child, or sibling.
c. The name of any other NEMT vendor in which an owner of the=20
disclosing vendor has an ownership or control interest.
d. The name, address, date of birth, and Social Security =
Number of any=20
managing employee of the vendor.
2. When the disclosures must be provided.
Disclosure is due at any of the following times:
a. Prior to the vendor entering into a contractual agreement =
to=20
provide NEMT services;
b. Upon the vendor executing the contract to provide NEMT=20
services;
c. Upon request of the Medicaid agency during the contract =
renewal=20
process;
d. Within 35 days after any change in ownership of the=20
vendor.
B. Information related to business =
transactions (42=20
CFR 455.105)
Contracts with NEMT vendors must obligate the vendor to furnish =
DMA or=20
HHS, within 35 days of the date on a request, full and complete =
information=20
related to business transactions about:
1. The ownership of any subcontractor with whom the vendor has =
had=20
business transactions totaling more than $25,000 during the 12-month =
period=20
ending on the date of the request; and
2. Any significant business transactions between the vendor and =
any=20
wholly owned supplier, or between the vendor and any subcontractor, =
during=20
the 5-year period ending on the date of the request.
C. Information on persons convicted of =
crimes (42 CFR=20
455.106)
Before the county enters into or renews an NEMT vendor agreement, =
or at=20
any time upon written request by the county, the vendor must =
disclose to the=20
county the identity of any person who:
1. Has ownership or control interest in the vendor, or is an =
agent or=20
managing employee of the vendor; and
2. Has been convicted of a criminal offense related to that =
person's=20
involvement in any program under Medicare, Medicaid, or CHIP since =
the=20
inception of those programs.
III. County response to disclosures and=20
non-disclosures
A. Terminate the enrollment of any vendor =
where any=20
person with a 5 percent or greater direct or indirect ownership =
interest in=20
the vendor did not submit timely and accurate information and =
cooperate with=20
any screening methods required by Medicaid policy.
B. Deny enrollment or terminate the =
enrollment of any=20
vendor where any person with a 5 percent or greater direct or indirect =
ownership interest in the vendor has been convicted of a criminal =
offense=20
related to that person's involvement with the Medicare, Medicaid, or =
CHIP in=20
the last 10 years, unless DMA determines that denial or termination of =
enrollment is not in the best interests of the Medicaid program.
C. Deny enrollment or terminate the =
enrollment of any=20
vendor that is terminated on or after January 1, 2011, under Medicare, =
Medicaid program or CHIP of any other State.
D. Terminate the vendor's enrollment or =
deny=20
enrollment of the vendor if the vendor or a person with an ownership =
or=20
control interest or who is an agent or managing employee of the vendor =
fails=20
to submit timely or accurate information, unless DMA determines that=20
termination or denial of enrollment is not in the best interests of =
the=20
Medicaid program.
E. Terminate or deny enrollment if the =
vendor, or any=20
person with a 5 percent or greater direct or indirect ownership =
interest in=20
the vendor, fails to submit sets of fingerprints in a form and manner =
to be=20
determined by DMA within 30 days of a CMS or a State Medicaid agency =
request,=20
unless DMA determines that termination or denial of enrollment is not =
in the=20
best interests of the Medicaid program.
F. Terminate or deny enrollment if the =
vendor fails=20
to permit access to provider locations for any required site visits, =
unless=20
DMA determines that termination or denial of enrollment is not in the =
best=20
interests of the Medicaid program.
G. The county may terminate or deny the =
vendor's=20
enrollment if CMS or the State Medicaid agency:
1. Determines that the provider has falsified any information =
provided=20
on the application; or
2. Cannot verify the identity of any provider =
applicant.
IV. REPORTING ADVERSE ACTIONS AGAINST =
TRANSPORTATION=20
VENDORS
Effective immediately, counties must notify DMA Quality Assurance =
when they=20
take an adverse action against a NEMT vendor for program integrity =
reasons.=20
Adverse actions include denials and terminations of enrollment or =
contracts.=20
Program integrity reasons include fraud, integrity, or quality.
Examples of program integrity reasons include but are not limited =
to:
=95 Conviction of a criminal offense related to the delivery of an =
item or=20
service under Medicare or under any State health care program
=95 Conviction under Federal or State law, of a criminal offense =
relating to=20
neglect or abuse of patients in connection with the delivery of a =
health care=20
item or service
When an adverse action is taken against a transportation vendor or=20
provider, complete the attached DMA-5142,=20
Office of Inspector General Adverse Action Reporting Form, and submit =
via fax=20
or mail to Division of Medical Assistance, Quality Assurance Section, =
2501=20
Mail Service Center Raleigh, NC 27699-2501 at 919-814-0036 within five =
work=20
days.
V. Revised Vendor Agreement
DSS contract template and contract =93Addendum J, Certification =
Regarding=20
Transportation=94 is revised to obligate NEMT vendors to perform the =
regulatory=20
and policy requirements contained in NEMT policy. The Local Business =
Liaisons=20
have shared the revised contract template and transportation rider =
with the=20
counties. The use of the contract template is optional, but the =
information=20
required by it must be contained in every NEMT contractual agreement =
the=20
county enters into with an NEMT vendor. See Attachment=20
1, contract template and Attachment=20
2, Certification Regarding Medicaid =
Transportation.
VI. DMA-5124, Medicaid Transportation =
Provider=20
Documentation Form
The DMA-5124, Medicaid Transportation Provider Documentation form =
is=20
revised to include the contractual requirements added in II.C. above. =
See=20
attachment=20
3.
VII. clarification of no-show policy for =
critical=20
needs recipients
MA-2910/3550, Medicaid Transportation, VII.G.2. states that =
critical needs=20
recipients, such as those receiving dialysis or chemotherapy, cannot =
be denied=20
transportation to critical services, no matter how many transportation =
appointments they miss. However, transportation to non-critical =
services, such=20
as routine doctor visits, can be suspended for these individuals. =
Indicate on=20
the revised DMA5125B, Medicaid Transportation Suspension Notice, that =
the=20
individual can still receive transportation to a critical need medical =
service=20
during the suspension.
VIiI. Transportation Policy Implementation =
Grid
On March 15, 2012, a =93Dear County Director of Social Services=94 =
letter=20
included a =93NEMT Grid=94 which contained implementation timelines =
for the=20
revised NEMT policy. The identical NEMT Grid is appended to this=20
Administrative Letter as Attachment=20
6.
If you have any questions regarding =
this=20
information, please contact your Medicaid Program =
Representative.
Craigan L. Gray, MD, MBA, JD,
Director
CLG:wa
(This material was researched and written by Shara Britt, Assistant =
Chief,=20
Quality Assurance Section and William Appel, Policy Consultant, Medicaid =
Eligibility Unit.)
<=
!-- TRANSIT - NEXT PAGE -->=
For questions or clarification =
on any of=20
the policy contained in these manuals, please contact your =
local county=20
=
office.
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