AllCare Health NEMT Policies and Procedures

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Table of Contents

Overview and Purpose ......................................................................................................................................... 1

Overview .............................................................................................................................................................. 1

Purpose ................................................................................................................................................................ 1

Policy .................................................................................................................................................................... 1

Definitions ............................................................................................................................................................ 1

Desk Procedure .................................................................................................................................................... 3

Oversight and Monitoring ..................................................................................................................................17

References ..........................................................................................................................................................22

Revision History ..................................................................................................................................................24

Overview and Purpose

Overview

AllCare CCO will provide non-emergent medical transportation to and from medical and remedial care and services.

Purpose

To ensure access and availability for non-emergent medical transportation to and from medical and remedial care and services that are paid for by AllCare CCO.

Policy

Definitions

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“Ambulance Transports”: Ground or air ambulance transports. Transporting a member via

ambulance is required when a medical facility or provider states the member’s medical

condition requires the presence of a health care professional during the

emergency or non-emergency transport. This includes neonatal transports “Attendant”: An attendant may be the member’s mother, father, stepmother, stepfather, grandparent, or guardian. The attendant may also be any adult the parent or guardian authorizes. An attendant may also be the member’s brother, sister, stepbrother, or stepsister if the attendant is at least 18 years of age, and the parent or guardian authorizes it. “Direct threat”: A significant risk to the health or safety of others. A direct threat is one that

cannot be eliminated or reduced to an acceptable level through the provision of auxiliary aids

and services or through reasonably modifying policies, practices, or processes.

“Health-Related Services”: Non-covered services under Oregon’s Medicaid State Plan intended to improve care delivery and overall member and community health and well-being, as defined in OAR 410-141-3845. Health-related services include flexible services and community benefit initiatives. “Member”: An OHP client enrolled with a managed care entity (MCE) such as a CCO “Member Representative”: An individual who can make OHP-related decisions for a member who is not able to make such decisions themselves “NEMT Liaison”: An AllCare CCO employee who is responsible for coordinating with the NEMT subcontracted partner, members, providers, other external healthcare staff, and AllCare Staff “NEMT services”: air and ground transportation services, including where allowed by Oregon Administrative Rules, mileage, meals, and lodging expenses required by AllCare members and, if necessary, the member’s attendant(s), from, to or within the Service Area for covered medical, dental, or behavioral health services which have been prior authorized by AllCare CCO as needed. NEMT services do not include transportation by ambulance when the member’s emergency physical condition requires the use of such a transportation service Special Needs”: Members identified by the state’s eligibility file and Program Eligibility Reporting

Code (PERC) definition. These are members who have high health care needs, are identified as

aged, blind, limited mobility, disabled, those with complex medical needs, multiple chronic

conditions, mental illness, chemical dependency, those receiving Medicaid-funded long- term

care or long-term services or who are children receiving CAF (Child Welfare) or Oregon Youth

Authority (OYA) services.

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“Secured transport”: Services for the involuntary transport of members who are in danger of harming themselves or others.

Desk Procedure

1. AllCare CCO will provide NEMT services for our members. 2. AllCare CCO members have the right to:

a. Receive information regarding their AllCare CCO membership and transportation benefit

b. Be treated with respect and due consideration for their privacy c. Receive information on available treatment options and alternatives, presented in

a manner appropriate to the member's condition and ability to understand. d. Participate in decisions regarding his or her health care, including the right to

refuse treatment. e. Be free from any form of restraint or seclusion used as a means of coercion,

discipline, convenience or retaliation, as specified in other Federal regulations on the use of restraints and seclusion

f. If the privacy rule, as set forth in 45 CFR parts 160 and 164 subparts A and E, applies, request and receive a copy of his or her medical records, and request that they be amended or corrected, as specified in 45 CFR 164.524 and 164.526.

g. AllCare CCO members have the right to be furnished health care services 3. AllCare CCO members have the right to file grievances regarding NEMT services, including

without limitation concerns about: a. Service denial (in full or in part) b. Driver safety c. Service quality d. Appropriateness of service e. Access to service

4. Member grievances concerning NEMT service may be reported to the NEMT

provider or directly to AllCare CCO.

a. Any grievances reported to the NEMT provider must be sent to

AllCare CCO

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b. AllCare CCO grievances are handled by the AllCare Health Quality

Management Department per their guideline QIP COMP OHP 01

Grievance Policy/Procedures

5. Members or their representatives can schedule NEMT services, including: a. Multiple or single NEMT services at one time for recurring appointments up to 90

days in advance; and b. Same-day NEMT services.

6. NEMT service requirements for member drop-offs and pick-up protocols: a. NEMT drivers may not drop members off at an appointment more than 15 minutes

prior to the office or other facility opening for business unless requested by the member or, as applicable, the Member’s guardian, parent, or representative

b. NEMT drivers may not pick up Members from an appointment more than 15 minutes after the office or facility closes for business unless the appointment is not reasonably expected to end within 15 minutes after closing, or as requested by the member, or as applicable, the Member’s guardian, parent, or representative

7. AllCare CCO provides a toll-free call center for members to request rides

8. Members may not be billed for any transport to and from medical services that are covered and where denied reimbursement

9. Members may not be billed for any approved rides provided for health related services

10. Transportation providers will be considered “participating providers” for the purposes of OAR 410-141-3520

a. NEMT providers are subject to all the Participating Provider credentialing requirements of OAR 410-141-3510 prior to providing services.

11. AllCare CCO requires NEMT service providers obtain and maintain insurance at limits no less than is required under OAR 410-136-3060

12. AllCare CCO requires all vehicles used for NEMT services to meet certain requirements for the comfort and safety of the members:

a. The interior of the vehicle shall be clean and free from any debris impeding a member’s ability to ride comfortably;

b. Smoking is prohibited in the vehicle at all times;

c. Comply with appropriate local, state, and federal transportation

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safety standards regarding passenger safety and comfort;

d. Follow a preventative maintenance schedule for each vehicle that

incorporates at least all of the maintenance recommended by the

vehicle manufacturer.

13. AllCare CCO requires all of the following prior to hiring an NEMT driver;

a. The driver must have a valid driver license.

i. The license must be the class of license with any required endorsements that permits the driver to legally operate the vehicle for which they are hired to drive;

b. The driver must pass a criminal background check;

c. Drivers authorized to provide NEMT services must receive training on their job duties and responsibilities;

d. For authorized out-of-state NEMT services in which the transportation provider solely performs work in the other state and for which the CCO has no oversight authority, the CCO is not responsible for requiring that the subcontractor’s vehicle and standards meet the requirements set forth in this rule.

14. Verification of Eligibility for NEMT Services

a. AllCare CCO and their delegates must verify that the member is eligible

for services

i. Member must be an AllCare CCO member at the time of the ride

ii. NEMT subcontractor can determine eligibility by using the AllCare

CCO provider portal

iii. Verification is made with member name, OHP ID, and date of

birth

b. AllCare CCO and their delegates must verify that the transportation is a

covered NEMT service

i. Rides to and from primary care providers do not require

approval from AllCare CCO

ii. All other NEMT rides for initial specialist or out-of-service area

provider to follow the procedure outlined in the NEMT Liaison

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iii. For NEMT rides for full benefit dual eligible (FBDE) CCO members

who have Medicare as their primary insurer and AllCare CCO as

their secondary insurer by primary AllCare CCO:

1. AllCare CCO must verify eligibility and coverage for

medical services for with such members’ Medicare fee-

for-service, Medicare Advantage (MA) or Dually-eligible

Special Needs Plan (DSPN) Plans, or directly with such

member’s Medicare provider

2. AllCare CCO must verify the services for FBDE members

that require NEMT travel to a Medicaid or Medicare

covered appointment within the CCOs service area or

outside the service area if NEMT services are not

available within the CCO’s service area and for which the

CCO is responsible for cost-sharing, including the NEMT

services

c. AllCare CCO permits members’ representatives to make requests for

NEMT Services on behalf of members. Representatives may include the

member’s:

i. Community Health Worker

ii. Care Coordinator

iii. Intensive Care Coordinator

iv. Foster parent

v. Adoptive parent

vi. Or other Provider delegated with this authority

15. Out-of-Service-Area and Out-of-State Transportation

a. Provide NEMT services outside the service area under the following circumstances:

i. The member is receiving an OHP-covered health care service

that is not available in the service area but is available in

another area of the state;

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ii. The member is receiving an OHP-covered service where the

service location is no more than 75 miles from the Oregon

border and contiguous to the CCO’s service area;

b. If it is determined that no local medical provider or facility, as outlined

in OAR 410-136-3080, will provide OHP-covered medical services for

the member; or the member is receiving an OHP-covered service

outside of Oregon that is not available in Oregon.

16. Attendants for Child and Special Needs Transports

a. This applies to NEMT for children under 12 years of age who are

eligible for NEMT services to and from OHP-covered medical services.

The rule also applies to children and young adults with special

physical or developmental needs regardless of age.

b. Parents or guardians must provide an attendant to accompany

these members while traveling to and from medical

appointments except when:

i. The driver is a Department of Human Services

(Department) volunteer or employee or an Authority

employee;

ii. The member requires secured transport;

iii. An ambulance provider transports the member for non-

emergent services, and the CCO reimburses the ambulance

provider at the ambulance transport rate, per contract or non-

contracted rate policy.

iv. NEMT ambulance transports shall have an attendant when an

ambulance is used to provide wheelchair or stretcher car or

van rides.

v. An attendant may be the member’s mother, father,

stepmother, stepfather, grandparent, or guardian. The

attendant may also be any adult the parent or guardian

authorizes. An attendant may also be the member’s brother,

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sister, stepbrother, or stepsister if the attendant is at least 18

years of age, and the parent or guardian authorizes it.

vi. The member’s parent or guardian may be required to provide

written authorization for an attendant other than the parent or

guardian to accompany the member.

vii. Additional charges for a member’s attendant will not be billed.

1. The attendant must accompany the member from the

pick-up location to the destination and the return trip.

The attendant must also remain with the member

during their appointment. The member’s parent,

guardian, or adult caregiver is responsible to provide

and install safety seats. The member will not be

transported if a parent or guardian fails to provide a

safety seat that complies with state law.

17. Secured Transports

a. Secured transports may be used when:

i. Verification has been made that the secured transporter has

met the requirements of the secured transport protocol

pursuant to OAR 309-033-0200 through 309-033-

0970, and the secured transporter is able to transport the

member who is in crisis or at immediate risk of harming

themselves or others due to mental or emotional problems or

substance abuse; and the transport is to a Medicaid enrolled

facility that the Authority recognizes as being able to treat the

immediate medical or behavioral health care needs of the

member in crisis.

1. One additional attendant may accompany the

member at no additional charge when medically

appropriate, such as to administer medications in-

route or to satisfy legal requirements including, but

not limited to, when a parent, legal guardian, or

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escort is required during transport.

ii. Transports to and from OHP covered medical services for an

eligible member for court ordered medical services will be

authorized with the following exceptions:

1. The member is in the custody of or under the legal

jurisdiction of any law enforcement agency;

2. The member is an inmate of a public institution as

defined in OAR 461- 135-0950 (Eligibility for Inmates);

3. The member’s OHP eligibility has been suspended

pursuant to ORS 411.39 or 411.447.

iii. It is assumed that a member returning to their place of residence

is no longer in crisis or at immediate risk of harming themselves

or others, and is, therefore, able to use non-secured

transportation. In the event that a secured transport is medically

appropriate to return a member to their place of residence,

written documentation will be obtained and signed by the

treating medical professional stating the circumstances that

required secured transport.

1. The documentation and a copy of the order will be

retained in the member’s record for review.

iv. AllCare Health may approve and pay for secured medical

transport provided to a person going to or from a court hearing

or to or from a commitment hearing if there is no other source of

funding for this transport. This rule does not apply to ambulance

providers, ambulance vehicles, or ambulance personnel that are

licensed and regulated by ORS chapter 682 and OAR chapter 333,

divisions 250, 255, 260 and 265, whether providing ambulance or

stretcher transports.

18. Ground and Air Ambulance Transports a. Ambulance transports with a medical technician will be provided when:

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i. A member’s medical condition requires a stretcher; the

length of transport would require a personal care attendant;

and the member does not have an attendant who can assist

with personal care during the ride.

ii. When a member’s medical condition is an emergency as

defined in OAR 410-120-0000, emergency ambulance

transportation must be used. The ambulance will transport the

member to the nearest appropriate facility able to meet the

member’s medical needs.

1. Ambulance services must be licensed providers of

ground or air ambulance services to operate ground or

air ambulances. If the ambulance service provider is

located in a contiguous state and regularly provides

rides to members, the Authority and the contiguous

state must license the ambulance service provider.

19. Modifications for Individuals with Disabilities

a. A “direct threat” means a significant risk to the health or safety of

others. A direct threat is one that cannot be eliminated or reduced to

an acceptable level through the provision of auxiliary aids and

services or through reasonably modifying policies, practices, or

processes.

i. The “direct threat” is identified through an individual

assessment that relies on current medical evidence or the best

available objective evidence that shows:

1. The nature, duration, and severity of the risk;

2. The probability that a potential injury will actually occur;

and whether reasonable modification of policies,

practices, or processes will lower or eliminate the risk.

ii. Criteria, standards, or practices that screen out or tend to screen

out individuals in a protected class from fully and equally

enjoying any goods, services, programs, or activities may not be

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applied unless:

1. The criteria can be shown to be necessary for providing

those goods and services; or

2. It is determined that the screening or exclusion identifies

a direct threat to the health and safety of others.

b. Subcontractors will comply with the Authority’s non-discrimination and

modification rules found at OAR 943-005-0000 to 943-005-0070.

c. Members may use the processes and rights specified in OAR 410-141-3875 through 3915 (Grievance System and Contested Case Hearings Rules).

20. Service Modifications

a. The NEMT provider must have policies and procedures describing

passenger rights and responsibilities including the right to file a

complaint and request reconsideration and provide this information in

all general information materials such as handbooks.

b. The NEMT provider must have policies and procedures that ensure

the safety of all passengers in NEMT vehicles and provide the

information to contractors, subcontractors, and members receiving

NEMT services.

i. A CCO may modify or a member may request modification of

NEMT services when the member:

1. Threatens harm to the driver or others in the vehicle.

2. Has a health condition that creates a health or safety

concern to the driver, others in the vehicle, or the

member as described in OAR 410- 141-3955.

3. Engages in behaviors or circumstances that place the

driver or others in the vehicle at risk of harm.

4. Engages in behavior that, in the CCO’s judgment,

causes local medical providers or facilities to refuse to

provide further services without modifying NEMT

services.

5. Frequently does not show up for scheduled rides.

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Frequently cancels the ride on the day of the

scheduled ride time.

6. Reasonable modifications include, but are not

limited to, requiring members to:

a. Use a specific transportation provider;

b. Travel with an attendant;

c. Use public transportation where available;

Drive or locate someone to drive the member

and receive mileage reimbursement; Confirm

the ride with the NEMT provider on the day of

or the day before the scheduled ride.

d. Before modifying services, the NEMT

provider, a CCO representative, and

the member shall:

i. Communicate about the

reason for imposing a

modification;

ii. Explore options that are appropriate to

the member’s needs;

iii. Address health and safety concerns;

iv. The member may include the

member’s care team in the discussion;

the member may include another

individual of their choosing in the

discussion.

v. Responses to requests for modification

or auxiliary aids based on disability or

other protected class status under state

or federal rule or law must comply with

the Americans with Disabilities Act and

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all other applicable state and federal

laws and rules.

vi. Modification of NEMT services under

this rule may not be due solely to a

request for modification or auxiliary aid

based on disability or other protected

class status.

vii. NEMT services will not be modified to

result in a denial of NEMT services to a

member.

viii. Reasonable efforts will be made to offer an appropriate alternative to meet a member’s needs under the circumstances.

21. Member Reimbursed Mileage, Meals, and Lodging

a. A member’s mileage, meals, and lodging to a covered medical

service may be authorized in order for the member to qualify

for reimbursement.

b. A client’s reimbursement may be disallowed if a reimbursement

request is received more than 45 days after the travel.

c. The member will be reimbursed for mileage, meals, and lodging at

rates not less than the allowable rates.

d. The member must return any documentation required before receiving reimbursement.

e. Reimbursements under the amount of $10 may be held until

the member’s reimbursement reaches $10.

f. Members will be reimbursed for meals when a member travels:

i. Out of their local area as outlined in OAR 410-141-3515(4) (a) and (b);

ii. For a minimum of four hours round-trip.

g. Members will be reimbursed for lodging when: A member would otherwise be required to begin travel before 5

a.m. in order to reach a scheduled appointment;

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i. Travel from a scheduled appointment would end after 9 p.m.; or

the member’s health care provider documents a medical need.

ii. Additional circumstances at the CCO’s discretion.

h. Members will be reimbursed for meals or lodging for one

attendant, which may be a parent, to accompany the member if

medically necessary, if:

i. The member is a minor child and unable to travel without an attendant;

ii. The member's attending physician provides a signed

statement indicating the reason an attendant must travel with

the member;

iii. The member is mentally or physically unable to reach his or her

medical appointment without assistance; or the member is or

would be unable to return home without assistance after the

treatment or service.

iv. Members may be reimbursed for meals or lodging for

additional attendants or under additional circumstances.

i. Overpayments made to a member may be recovered, if:

i. Overpayments occur when the member is paid:

1. For mileage, meals, and lodging, and another resource also paid:

a. The member; or the ride, meal, or lodging provider directly;

2. Directly to travel to medical appointments, and the

member did not use the money for that purpose, did not

attend the appointment, or shared the ride with another

member whom the brokerage also paid directly;

3. For common carrier or public transportation tickets or

passes, and the member sold or otherwise transferred

the tickets or passes to another individual.

4. If an individual or entity other than the member or the

minor member’s parent or guardian provides the ride, the

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brokerage may reimburse the individual or entity that

provided the ride.

22. Service Denials, Grievances and Appeals

a. The grievance and appeal processes and rights specified in OAR 410-141-3835 through 410-141-3915 are available with respect to NEMT services, with the following modifications

i. Prior to mailing a notice of adverse benefit determination to a member, the CCO must provide a secondary review by another employee when the initial screener denies a ride.

ii. AllCare CCO will mail, within 72 hours of denial, a notice of adverse benefit determination to:

1. The member denied the ride; and 2. The provider with which the affected member was

scheduled for an appointment

a. The provider must be part of the CCO’s provider network

b. There must be a provider for a letter to be sent iii. Modified approvals must follow the same course of action for

notification as denials iv. Please see the AllCare CCO Notice of Action-Adverse Benefit

policy and Member Appeals and Grievances Handbook for more information

23. Reports and Documentation

a. Documentation of rides denied and rides provided to members are maintained.

i. For NEMT services provided to members, this documentation will include:

1. All encounter data required in the current contract;

Names of the company and driver transporting the

member.

ii. For NEMT services denied to members, this documentation will include:

1. The name of the member and the individual requesting

the ride on behalf of the member, if applicable;

2. The member's OHP medical care identification number;

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3. The date and time of the request for transportation;

4. The name of the employee who denied a ride;

5. The name of the employee who performed the

secondary review before denying the ride;

6. The reason for the denial and the applicable OAR supporting the denial;

7. The date on the notice of action the brokerage mailed to the member;

8. Documentation on the review, resolution, or

disposition of the matter, if applicable, including the

reason for the decision and the date of the resolution

or disposition;

9. And Notations of oral and written communications with the member.

iii. AllCare CCO shall retain the documentation on NEMT service

denials for three calendar years, even if the CCO, its

brokerage, or subcontractor that denied the service is no

longer a Medicaid enrolled provider before the end of the

three years.

b. Member grievances concerning NEMT service may be reported to

the NEMT provider or directly to AllCare CCO.

i. Any grievances reported to the NEMT provider must be sent

to AllCare CCO

ii. AllCare CCO grievances are handled by the AllCare Health Quality Management Department per their guideline QIP COMP OHP 01 Grievance Policy/Procedures

24. Health related services

a. AllCare CCO also provides transportation with its Health-Related

Services funds, for the coordination and provision of NEMT provided

to members if the member is eligible for NEMT and the request for

NEMT is for a Health-Related Service

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b. AllCare CCO permits members’ representatives to make requests for HRS

Services for transportation on behalf of members.

c. Representatives may include the member’s:

i. Community Health Worker

ii. Care Coordinator

iii. Intensive Care Coordinator

iv. Foster parent

v. Adoptive parent

vi. Or other Provider or agency delegated with this authority

d. Requests to the pharmacy or grocery score are considered an HRS

service for all NEMT eligible CCO members

e. Individual transportation requests using HRS flexible spending require

plan approval

i. The procedure is outlined in the NEMT Liaison Desk

Procedure

Oversight and Monitoring

AllCare Quality Assurance Plan for NEMT

1. AllCare CCO will conduct a readiness review of NEMT brokerages or other entities providing NEMT Services prior to entering into a contract with an NEMT Provider.

2. AllCare CCO will audit NEMT provider annually or more often if needed 3. AllCare CCO and NEMT provider will conduct a biweekly NEMT Workgroup to

maintain ongoing quality improvement activities a. Workgroup shall discuss situational issues that arise between meetings and/or

ongoing operational matters related to quality and accessibility of NEMT services. b. Participants may include, but are not limited to, the following individuals or their

delegates: i. AllCare staff: Vice President Population Health, Director Compliance, Care

Coordination Supervisor, NEMT Liaison, clinical staff or Medical Director.

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i. Vendor staff will be identified for regular attendance and should include individuals with authority over operations, ride scheduling, driver management, training, or other positions as deemed appropriate.

4. AllCare CCO and NEMT provider will conduct quarterly Quality Assurance Meetings a. Quality Assurance meetings shall be held no less than once a quarter. b. Meetings are to ensure high-level alignment and review of continuous quality

activities. Meetings are also to ensure ongoing, active partnership between AllCare and subcontracted NEMT Vendor(s).

c. Participants should include representatives of senior management within AllCare and Vendor organizations and may include, but are not limited to the following:

i. AllCare: Vice President Population Health, Vice President Compliance, Vice President Marketing, Chief Operating Officer, Medical Director, Care Coordination Supervisor

ii. Vendor shall provide attendees lists to include individuals at or above a Manager/Director level who hold authority over such areas as: finance, contracting, member services, information/technology and compliance.

iii. Additional attendees with direct interest may attend regularly or as invited 5. AllCare CCO conducts member satisfaction surveys on a quarterly basis.

a. Follow up member satisfaction surveys will be sent to, and collected from, a minimum of ten percent (10%) of all members who scheduled NEMT rides during the prior quarter

b. Members in all counties of the service area must be represented c. Survey data will be presented at the NEMT Quality Assurance Meeting

6. AllCare CCO ensures all NEMT Services paid for are properly approved and actually rendered a. AllCare CCO conducts an annual analysis to match physical health and

Behavioral Health claims/encounters with NEMT claims/encounters b. AllCare CCO requires the NEMT liaison to verify appointments with the

provider office for NEMT trips for initial visits to specialists and/or out of the area providers

i. The procedure is outlined in the NEMT Liaison Desk Procedure 7. AllCare CCO requires NEMT providers and any subcontractors to have the

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following: a. Procedures for monitoring and improving quality of transportation

including that provided by fixed route (e.g. public transit); b. Documentation to show compliance that all vehicles:

i. Are clean and free of clutter or debris ii. Are smoke and vape free iii. Include safety belts, first aid kits, fire extinguisher, roadside

assistance devices, flashlight, tire traction devices, disposable gloves, and anything else required for roadside safety

c. Documentation demonstrating vehicles are accessible for members, including those members with disabilities, or other Special Health Care Needs (e.g., wheelchair restraints for wheelchairs)

i. Vehicles that transport wheelchairs and/or stretchers must have equipment to securely transport and show compliance with the ADA and ORS 659A.103

d. Policies and procedures to ensure all drivers including subcontracted drivers:

i. Have a valid driver license 1. License must be valid for the class of vehicle the

driver is driving ii. Have a clean driving history iii. Are not on the OIG exclusion list

1. This must be conducted monthly iv. Have passed a drug test, criminal background check and sex

offender status 1. This must be conducted annually or more often is

needed v. Have completed all necessary trainings including those for

NEMT, HIPAA and FWA 1. This must be conducted annually

vi. Have completed the Passenger Service and Safety course 1. This must be completed again every three years

vii. Have completed training for the level of services being

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provided (e.g., door to door vs, curbside to curbside) and how to assist members with disabilities, and other Special Health Care Needs

viii. Have completed Cultural Competency training such as Implicit Bias, ACEs, etc.

ix. AllCare and NEMT vendor will ensure all NEMT staff or

subcontracted drivers have access to all mandatory and

continuing training and education as required by OHA and

other regulatory agencies relevant to provision of NEMT

services.

e. Documentation for (3)(d) must be maintained for 10 years f. Evidence of mandatory insurance requirements (Workers Comp,

Comprehensive General Liability, Automobile Liability and Sexual Misconduct)

i. Certificates of Insurance demonstrating all requirements are met with insuring company name and address, policy numbers, current policy dates, and the required additional insureds being named.

8. AllCare CCO and our NEMT providers requires members are notified when calling that calls to the NEMT Call Center are monitored and recorded for quality assurance purposes

9. All calls are recorded a. AllCare CCO requires that a statistically valid sample of incoming and

outgoing calls to/from the NEMT Call Center be used for quality control, program integrity, and training purposes.

b. AllCare CCO monitors and audits at least one percent (1%) of calls of each NEMT Call Center staff member on a monthly basis

10. AllCare CCO monitors and document all complaint, grievances, and quality improvement concerns (QIC) about NEMT Services

a. All complaints, grievances and QIC must be submitted to AllCare CCO Quality department

b. Any complaint, grievances, or QIC relating to driver performance

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including failing to show up for a requested must be reviewed and with documented follow up from the AllCare NEMT liaison in conjunction with the Quality department

i. Required follow up includes determining whether: 1. The member suffered any harm as a result of the

incident (e.g. driver’s failure to provide the ride), 2. Rescheduling of appointments was or is necessary, 3. Any additional recourse or Corrective Action with the

driver or the Subcontracted NEMT Provider is appropriate.

11. AllCare CCO requires NEMT providers to report any and all incidents that occur during transportation of a member

a. Incidents include, but are not limited to: i. Traffic or vehicle accidents ii. Safety concerns or direct threats from passengers, other

vehicles or people iii. Injuries to the member, attendant or driver

b. NEMT providers must notify AllCare CCO as soon as possible of the incident

c. AllCare CCO will notify the OHA by email within twenty-four (24) hours of becoming aware of the Incident

i. The incident is to be described with particularity including, without limitation:

1. The name of the driver, 2. The name of the passenger, 3. The location of the Incident, 4. The date and time of the incident, 5. A description of the incident and any injuries

sustained as a result and 6. Whether the driver or the passenger required

treatment at a Hospital. d. If applicable, a police report number will be included with such

Administrative Notice or shall provide the full police report to OHA as

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soon as possible after providing Administrative Notice of the Incident. e. AllCare CCO ensures cooperation in any related investigation.

Reporting

NEMT provider must report operations data monthly to NEMT Liaison.

NEMT provider must provide all NOAs to Compliance Manager on a monthly basis.

NEMT provider must report all complaints, grievances and QIC to Quality Department as soon

as collected

NEMT provider must report all accidents and safety incidents to NEMT Liaison as soon as

possible of the occurrence

AllCare CCO must report incidence to OHA within 24 hours of notification

AllCare requires subcontractor to report and monitor call center employees and drivers

that have foreign language proficiency. The NEMT Liaison tracks this data to ensure

adequate offerings.

References

410-141-3920 through 410-141-3965; 410-141-3845; 410-141-3510; 410-141-3520; 410-136-3060; 410-

136-3080; 309-033-0200 through 309-033-0970; 461-135-0950 ORS 411.439 or 411.447; ORS chapter

682 and OAR 333 divisions 250, 255, 260 and 265; 943-005-0000 to 943-005-0070; 410-120-0000; 410-

141-3875 through 3915; 410-141-3955; 410-141-3515; 410-141-3835 through 410-141-3915; 45 CFR

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Revision History

{07/11/2016}: Document created

{03/30/2018}: revised

{09/11/2019}: Changed template

{1/9/2020}: revised and added QA plan; renamed as NEMT CCO 01