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Medicaid Enrollment For OPWDD Transportation Providers 1.

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Presentation on theme: "Medicaid Enrollment For OPWDD Transportation Providers 1."— Presentation transcript:

1 Medicaid Enrollment For OPWDD Transportation Providers 1

2 Transportation Enrollment Workgroup coordinated discussions among DOH, OPWDD and stakeholder associations over the previous six months Provider concerns were acknowledged and OPWDD/DOH consensus has been reached for programmatic resolution There will be continued collaboration between DOH, OPWDD, DOT, OMIG on all aspects of the implementation OPWDD Transportation Provider Enrollment 2

3 The following will be auto-enrolled as Medicaid transportation providers – OPWDD certified site based day habilitation – Site-based pre-vocational – Supervised and supportive IRA providers ICF providers – Auto-enrolled-if they are also a provider of any OPWDD funded HCBS waiver service – If they are not Medicaid enrolled, ICF providers will be required to complete the necessary enrollment forms (10/1/2016) Auto-Enrollment of Program-Owned Transportation Providers To be completed by 1/1/2017 3

4 4 Subcontracted Transporters Effective at expiration of current contract OPWDD subcontractors must seek enrollment – Subcontractors will be required to complete necessary enrollment forms to become a Medicaid transportation provider at the date of expiration of their existing contract – Enrollment will occur on a rolling basis as current contracts end A provider using subcontractors is responsible for ensuring its subcontractors are compliant with requirements of Medicaid enrollment

5 5 Licensure Requirements Effective currently As per OPWDD’s February 5, 1992 guidance regarding Article 19-A of the NYS Vehicle and Traffic Law, drivers are required to maintain both 19-A certification and CDL licensure only if all three of the following conditions are met: – The driver transports OPWDD eligible individuals to/from day vocational, academic or religious instruction or religious services, including nursery schools, day care centers and camps – The vehicle used for transport has a manufacturer’s seating capacity of 10 or more passengers (excluding the driver) – The driver transports under the above conditions more than 29 days a year All other provisions of this memo remain in effect. (continued)

6 Licensure Requirements (continued) Effective 12 Month from Enrollment All enrolled providers and subcontracted transporters must have their drivers enrolled in a LENS program, or a similar program that provides automatic updates of motor vehicle infractions. All drivers including the drivers defined above, must also have their driving abstracts reviewed to ensure acceptable driving record (DOH and OPWDD will set standards for non-acceptable driving records). 6

7 DOT Passenger Authority and Exemptions Effective 1/1/17 A waiver of DOT authority – Please note no blanket waivers will be issued – Waiver requests should be submitted to DOT no later than October 1, 2016 All Medicaid enrolled transporters using ambulette vehicles, must obtain DOT operating authority, unless they seek and receive a waiver from this requirement from DOT. – In the event that a provider that submitted a timely waiver request has not heard from DOT by January 1, 2017, the provider will be deemed to be in compliance until it hears from DOT DOT inquires and requests for waivers can be sent to: operating.authority@dot.ny.gov. operating.authority@dot.ny.gov 7

8 OMIG Audit Protocols Effective upon Medicaid Enrollment OMIG audit protocols and guidance for OWDDD transportation providers – Medicaid enrolled transporters who are reasonably expected to receive or claim at least $500,000 in a consecutive 12 month period of time are required to maintain a compliance plan that meets standards as determined by OMIG – All OPWDD funded providers that contract for transportation services, must ensure that transporter is not listed on the Medicaid Exclusion List – Any new audit procedures and protocols will be developed and promulgated by OMIG 8

9 Vehicle Retirement Age Effective as described below OPWDD will survey providers to find out age and description of current vehicles. Once survey results have been analyzed, further guidance will be provided. Targeted phase in to vehicle retirement 10 years for ambulettes and 10 or more passenger vehicles (pending result of survey). 9

10 Documentation Requirements Effective as described below Since Medicaid funds OPWDD transportation services (indirectly), certain documentation is required for transportation to and from certified day habilitation and site-based pre-vocational services. While there is no prescribed format for such documentation, the required elements need to include: – Medicaid enrollee’s name – Date of the transport – Address and times of trip origination and destination (GPS data would be accepted to meet this requirement) (continued) 10

11 Documentation Requirements (continued) Effective as described below – Driver’s license number – Driver’s printed name – Driver’s signature It is not necessary to create duplicate logs as long as the required elements are available, upon request. – For example it would be acceptable if elements of this documentation are kept in day habilitation program or certified residence logs (continued) 11

12 Documentation Requirements (continued) Effective as described below For certified residential programs, the same documentation requirements would apply to agency provided or subcontracted transportation, with two exceptions: – Addresses are not required to be provided, however the purpose of the trip should be included -- for example, “community inclusion activities”. – The “time documentation” would consist of recording the time that the vehicle left the certified residence and the time the vehicle returned to the certified residence. The above requirements would not be applicable to vehicles operated by a Public Transportation Authority (e.g., CDTA, MTA, etc.). 12


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