HomeMy WebLinkAboutbocc.res.108.2014CONTRACT #1/5
RESOLUTION OF THE BOARD OF COUNTY COMMISSIONERS
OF PITKIN COUNTY, COLORADO
APPROVING A MEMORANDUM OF UNDERSTANDING BETWEEN PITKIN
COUNTY, COLORADO AND THE NORTHWEST COLORADO COUNCIL OF
GOVERNMENTS (NWCCOG) FOR IMPLEMENTATION OF THE NON-
EMERGENT MEDICAL TRANSPORTATION (NEMT) BROKERAGE PROGRAM
RESOLUTION NO. /a< 2014
RECITALS
The Non -Emergent Medical Transportation program (NEMT) is a Colorado
Department of Healthcare Policy & Financing Program (HCPF) whereby the
Department of Human Services in each county is required to provide
transportation for any Medicaid client with no other means of transportation to
and from medical appointments. Northwest Colorado Council of Governments
(NWCCOG) has received approval by HCPF to enter into agreements with
smaller counties outside of the front range for NWCCOG to implement and
administer the NEMT program as authorized by Colorado Medicaid.
2. NWCCOG will act as an authorized agent of Pitkin County Health and Human
Services in ensuring that NEMT program activities including approvals for
transportation, billing, reimbursement of transportation providers or Medicaid
recipients, and retention of appropriate records of said services are provided.
3. Pitkin County Board of County Commissioners recognizes the importance of a
single access point for transportation resources for Medicaid qualified recipients
and agrees that the NWCCOG Mobility Management Program is well suited to
undertake this task as a billing agent for Pitkin County;
NOW, THEREFORE, BE IT RESOLVED by the Board of County Commissioners of
Pitkin County, Colorado to approve and authorize the Chair to sign the Memorandum of
Understanding with Northwest Colorado Council of Governments (NWCCOG) for
implementation of the Non -Emergent Medical Transportation (NEMT) Brokerage
Program.
NTRODUU�, FIRST READ, AND SET FOR PUBLIC HEARING ON THE
DAY OF &_,, ,.2014.
NOTICE OF PUBLIC HEARING AND TITLE AND SHORT SUMMARY OF THE
RESOLUT PUBLISHED IN THE ASPEN TIMES WEEKLY ON THE �D
DAY OF %-y- Qw, 2014.
NOTICE OF PUBLIC HEARING AND THE FULL TEXT OF THE RESOLUTION
POSTED ON THE OFFICIA PITKIN COUNTY WEBSITE ( www.aspenpitkin.com )
ON THE O!'*DAY OF 2014.
ADOPTED,AFTER FINAL READING AND PUBLIC HEARING ON THE
DAY OF 2014.
PUBLISHED BY TITLE AND SHORT SUMMARY,E�/9,
R�AD�O�PTION, IN THE
ASPEN TIMES WEEKLY ON THE � DAY OF &em , 2014.
POSTED BY TITLE AND SHORT SUMMARY ON THE OFFICIAL PITKIN
COt� Y� K ITE ( www.aspenpitkin.com) ON THE ..- DAY
OF 2014.
0
APPROVED AS TO FORM
Joh Ely, Coun mey
BOARD OF COUNTY COMMISSIONERS
By�,�
Robert A. Ittner, Jr., Chair
Date:
MANAGER APPROVAL
n6JnPPeac-o , e6ulmanager
CONTRACTa)5'
Memorandum of Understanding
This is a Memorandum of Understanding (MOU) regarding Non -Emergent Medical Transportation
Brokerage Program between Pitkin County Human Services (Party A) and Northwest Colorado Council of
Governments (Party B) Mobility Management Program.
I. Purpose and Scope
The purpose of this Memorandum of Understanding (MOU) is to clearly identify the roles and
responsibilities of each party as they relate to the implementation and administration of Non -
Emergent Medical Transportation (NEMT) billing services as authorized by Colorado
Medicaid. The intent of this program is to provide 2 distinct levels of support to Pitkin County
Human Services which includes:
1. The timely processing and administration of NEW billing services for Pitkin County
Human.Services, the Coordination of Transportation providers providing Medicaid
covered transportation services (Mobility vehicles, wheelchair vans, ambulance, taxi,
stretcher van, train, airplane, bus, private vehicle) and Medicaid qualified
transportation recipients with a single access point administrated through the
Northwest Colorado Council of Governments Mobility Management Program.
II. MOU Terms
The term of this MOU Agreement commences: September 1, 2014 and is open ended with a
30 day termination provision as stated in Section VIII.
III. Overall/General MOU Provisions
All named parties agree to the following provisions:
1. To ensure that program activities are conducted in compliance with all applicable
Colorado laws, rules and regulations as outlined by The Colorado Department of Health
Care Policy'
and Financing.
2. To ensure that program activities are conducted in compliance with HIPPA Privacy
Practices, the Colorado Medicaid Privacy Practices standards, and as an authorized
agent of Summit County Human Services.
3. NEW Claims will be filed in accordance with the timely filing requirements outlined by
The Colorado Department of Health Care Policy and Financing.
4. NEW Claims reimbursement to transportation providers will occur in a timely fashion
not to exceed 15 days from receipt of claim from Medicaid.
1
5. Prior Authorization (PAR) and eligibility determination will be completed by Northwest
Colorado Council of Governments (NWCCOG) Mobility Management Program prior to
approval or denial of service.
e. Any denial of service will be made in writing and delivered to the client and to the Pitkin
County Human Services with the appropriate information concerning the reason for
denial and "Client Right to Appeal" language and instructions in the same language that
is included on the back of all formal claim denials sent from the department's fiscal
agent. Appendix I Denial of Service Letter, Appendix II Client Right to Appeal
7. Northwest Colorado Council of Governments (NWCCOG) shall retain 15% of the
transportation claims reimbursement to cover administrative expenses associated with
this service. The remaining 85% of the claims reimbursement will be paid to the
transportation provider. Transportation providers are identified as any person or entity
other than the qualified Medicaid recipient. When transportation is provided by the
Medicaid recipient, Spouse of a Medicaid Recipient or parent/guardian of a minor
Medicaid recipient, Northwest Colorado Council of Governments will waive the 15%
administration fee and will remit full reimbursement directly to the Medicaid recipient,
spouse, or their legal parent/guardian as required by Medicaid policy.
8. Northwest Colorado Council of Governments shall retain on file appropriate
Certification of Transportation Providers in accordance with the NEMT Billing Program.
Certifications will include copies of vehicle registrations, appropriate vehicle insurance,
and copy of a valid drivel's license for the vehicle operator.
IV. Individual Party Responsibilities
Northwest Colorado Council of Governments will act as the NEMT Services Broker and
facilitate the management of NEMT Services throughout Pitkin County.
Northwest Colorado Council of Governments through the Mobility Management Program
will approve, refer for transportation, verify receipt of services, bill for approved services,
reimburse transportation providers for approved Medicaid NEMT services, and retain
appropriate billing records of said services.
Pitkin County Human Services will refer all individuals requesting NEMT services to the
Northwest Colorado Council of Governments Mobility Management Program.
Pitkin County Human Services will forward any Medicaid request for NEMT reimbursement
paperwork to Northwest Colorado Council of Governments (NWCCOG) within one week of
receipt to facilitate timely processing of Medicaid Claims.
Northwest Colorado Council of Governments (NWCCOG) shall provide a written report of
accountability for paid NEMT services on a monthly basis to the Director of Pitkin County
2
Human Services. This accountability report will be available by the 16`b of each month and
account for the activity processed in the prior calendar month.
V. MOU Operational Framework
The following describes how Northwest Colorado Council of Governments (NWCCOG) and
Pitkin County Human Services will work together on the Key MOU scope and activities.
Pitkin County Human Services will direct any individuals requesting NEMT services to
Northwest Colorado Council of Governments (NWCCOG) Mobility Management Program.
Pitkin County Human Services will forward any Medicaid Transportation Reimbursement
Forms to Northwest Colorado Council of Governments (NWCCOG) Mobility Management
Program for processing.
Northwest Colorado Council of Governments (NWCCOG) Mobility Management Program
will verify eligibility for NEMT services, obtain prior authorizations where required, verify
appropriateness of service, refer approved recipients to transportation providers as needed,
process all NEMT billing functions after proper documentation is received from the
transportation recipient, make timely reimbursement to the transportation provider
following payment of claims, and submit a monthly accountability report to Pitkin County
Human Services on all claims processed. Appendix ill: NEW Flow Char[, Appendix IV: NEMTAccoun[ability
Report
V1. Budget
Northwest Colorado Council ,of Governments (NWCCOG) shall retain 15% of the
transportation claims reimbursement as stated in Section III, Number 7 to cover
administrative expenses associated with this service. The remaining 85% of the claims
reimbursement will be paid to the transportation provider. When transportation is self -
provided by the Medicaid member the 15% administrative fee shall be waived as outlined in
Section III, Number 7. There will be no additional cost to the Colorado Medical Assistance
Program. Appendix V: NEMTSample Budge[
VII. Forms
The following describes the forms utilized in the NEMT Work Flow
Form 1: Medicaid Trip Request Checklist. Appendix VI
Form 2: Medicaid Transportation Reimbursement Form. Appendix vu
Form 3: Monthly Accountability Report Sample. AppendlxlV
Form 4: Denial of Service Letter and Client Right to Appeal. Appendixl, Appendix 11
Form 5: NEMT Services Flow Chart, Appendixlll
3
VIII. Modification and Termination
1. Modification of this agreement can be made by mutual consent of Northwest Colorado
Council of Governments (NWCCOG) Mobility Management Program Manager with
approval of the NWCCOG Executive Director, and the Director of Pitkin County Human
Services. All modifications will be made in writing and signed by both parties.
2. This agreement can be terminated according to the following provisions.
- That either party provides written notice of termination with a minimum of 30 day
notice.
- The action of termination has been preceded by efforts on the part of all parties to
address whatever problems or barriers have emerged that have threatened the
integrity of this MOU.
IX. Effective Date and Signatures
This MOU shall be effective upon the signatures of Party A and B authorized officials. It shall
be in force from September 1, 2014 to August 30, 2015
Signatures and Dates:
Party A: Pitkin County Health and Human Services
Authorized Signature Date
Party B: Northwest Colorado Council of Governments (NWCCOG)
I I y I�-
Liz Mullen, Executive Director Date
Northwest Colorado Council of Governments
El
MEMBER
JURISDICTIONS
City of Glenwood
Springs
City of Steamboat
Springs
Town of Carbondale
EAGLE COUNTY
Basalt
Eagle
Gypsum
Minturn
Red Cliff
Vail
GRAND COUNTY
Fraser
Granby
Grand Lake
Hot Sulphur Springs
Kremmling
Winter Park
JACKSON COUNTY
Walden
PITKIN COUNTY
Aspen
Snowmass Village
SUMMIT COUNTY
Dillon
Frisco
Montezuma
Silverthorne
PO Box 2308 • 249 Warren Ave • Silverthorne, 00 80498. 970-468-0295 • Fax 970-468-1208 • www.nwccog.org
Appendix I
[Date]
[Name of Client]
[Address I]
[Address II]
[City, State, Zip]
Ms. [Name]:
Following your request for Non Emergent Medical Transportation Services a review of your case was
conducted. You are currently not eligible to receive Non Emergent Medical Transportation Services
for the following reasons
1. [list reason here]
Should you feel this determination to be in error, please consult the Client Appeal Rights process
included with this letter.
Sincerely,
Laurie Patterson
Mobility Program Assistant
Northwestern Colorado Council of Governments
970-468-0295 ext 105
Enclosure(0: Client Appeal Rights
Appendix It
CLIENT APPEALS RIGHTS
If you agree with the decision, you do not need to take any further action. If you think the decision is wrong, you can appeal and
ask for a hearing. You may have to appeal hearing with an Administrative Law Judge. You may represent yourself, or have a
lawyer, a relative, a friend or other spokesperson assist you as your authorized representative.
How to Appeal:
1. you must ask for a hearing in writing. This is called a LETTER OF APPEAL.
2. Your letter of appeal must include:
a. Your name, address, phone number and Medicaid number;
b. Why you want a hearing; and
c. A copy of the front page of the notice of action you are appealing.
3. You may ask for a telephone hearing rather than appear in person.
4. Mail or fax your letter of appeals to:
OFFICE OF ADMINISTRATIVE COURTS
633 17TH STREET, SUITE 1300
DENVER, CO 80202
FAX 303-866-5909
5. Your letter of appeal must be received by the Office of Administrative Courts no later than thirty (30) calendar days
of the notice of action is located on the front of this notice.
from the date of this notice of action. The date
ct you by mail with the date, time and place for your hearing with the
6. The Office of Administrative Courts will conta
Administrative Law Judge.
Continued Benefits: To continue receiving the denied services listed on the notice, you must file your request for a hearing in
writing before the effective date on the front of this notice. You may continue receiving services while you are waiting for a
decision on your appeal. If you lose your appeal, you must pay back the cost of the services you received pdurinrocess. he app rani. if
you win your appeal, the State will pay your provider for the service(s) y received during your
appeis responsible for reimbursing you for the amount you paid them during your appeal.
If you have questions about this process, please call:
CUSTOMER SERVICE:
303-866-3513 (within the Denver Metro area)
1-800-221-3943 (outside the Denver Metro area)
Se Habla Espanol
DISCRIMINATION
If you believe that you have been discrimination against because of race, color, sex, age, religion, national origin, disability,
you have the right to file a complainant with: the U.S. Department of Health & Hu82o2. voce phone: 303-844-2024 or man Services, Office for Civil Rights. 999 18th
O 303-844-3439. If you have any
ons, or
er, CO
torfile your complaaiint,'call OCROtoll free t(voice)D at 1-800-368 1019 or 1 800537-7697 (TDD). You may sendeanl email toeed help
OCRcomola� hhs_a°v
STATEMENT OF PENALITIES
If you make a willfully false statement or representation, or use otherfraudulent methods to obtain public assistance or
medical assistance you are not entitled to, you could be prosecuted for theft under state and/or federal law. If you are
convicted by a court of fraudulently obtaining such assistance, you could be subject to a fine and/or imprisonmentfor theft.
7
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P
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Complete
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Web Portal
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check cut and mailed
to Transportation
Provider
Appendix IV
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