NON-EMERGENCY MEDICAL TRANSPORTATION PROGRAM TRANSPORTATION PROVIDER MANUAL. Virginia Operations

Transcription

1 NON-EMERGENCY MEDICAL TRANSPORTATION PROGRAM TRANSPORTATION PROVIDER MANUAL Virginia Operations

2 Table of Contents MANUAL PURPOSE... 4 GENERAL DESCRIPTION OF THE TRANSPORTATION PROGRAM... 4 LOGISTICARE RESPONSIBILITIES... 4 GEOGRAPHIC CONSIDERATIONS... 6 VA OPERATIONS BUSINESS OFFICES... 7 Virginia Call Center Norton... 7 Regional Offices... 7 TRANSPORTATION SCHEDULING PROCEDURES... 8 Gatekeeping... 8 What can the Transportation Providers do to help the system work smoothly?... 8 Member Registration and Reservations... 9 Levels of Service for Transportation... 9 Urgent Care Complaint Process Transportation Notification Transportation Assignment Procedures HOURS OF OPERATION Reservation and Service Regional Offices TRANSPORTATION PERFORMANCE STANDARDS TRANSPORTATION PROVIDERS' RESPONSIBILITIES Administrative, Reservation Receipt and General Responsibilities Other Riders Vehicle Inspections Driver and Attendant Qualifications Page 2 of 78

3 Driver Training Driver Discipline Transportation Provider Staff Orientation Insurance, Licensure & Certification REIMBURSEMENT OF TRANSPORTATION PROVIDERS Invoicing Payment Terms Transportation Provider Maintenance of Records Trip Log Accident/Incident/Moving Violations Procedures TRANSPORTATION PROVIDER TRANSPORTATION AGREEMENTS LIST OF ATTACHMENTS Page 3 of 78

4 MANUAL PURPOSE The purpose of this LogistiCare Non-Emergency Medical Transportation ( NEMT ) Provider Manual is to give Transportation Providers an overview of the NEMT program as well as some important guidelines and processes. In particular, this Manual will: Provide a general description of the Medicaid and Title XXI transportation program Discuss the Broker's responsibilities and organization Discuss driver, attendant, and vehicle requirements Discuss transportation scheduling procedures Discuss transportation scheduling requirements Discuss transportation performance standards Discuss transportation delivery procedures Discuss Transportation Providers' responsibilities GENERAL DESCRIPTION OF THE TRANSPORTATION PROGRAM NEMT is a Medicaid and FAMIS benefit available to members that have no other means of transportation available. NEMT services are important to nursing facility residents, the frail and elderly, members with disabilities and any members who need critical services such as dialysis, rehabilitation, physical therapy, or chemotherapy, and have no other transportation available. In Virginia, prior to 2001, NEMT eligible members had freedom of choice to obtain services from any qualified Medicaid transportation provider. During that time, eligible members usually arranged their own transportation to covered services directly with transportation providers. In addition to increases in utilization and expenditures, provider and member fraud and abuse were significant issues under this arrangement. Consequently, DMAS (Department of Medical Assistance Services) examined ways to manage NEMT services more effectively. As a result, in October 2000, DMAS divided the Commonwealth into seven (7) regions and turned to a broker model for the management of the Medicaid NEMT program. LogistiCare Solutions, LLC ( LogistiCare ), has been the statewide broker operating in all seven (7) regions throughout the Commonwealth of Virginia since LogistiCare Responsibilities LogistiCare will confirm that Medicaid and FAMIS Members that are eligible for NEMT services receive transportation service that is safe, reliable and on time. This section sets forth the nature and scope of the brokerage services required under the DMAS RFP and LogistiCare s resulting contract with DMAS and contracts with managed care organizations that operate Medicaid managed care programs in Virginia. As the NEMT broker, Page 4 of 78

5 LogistiCare coordinates all aspects of the program, including reservations, transportation provider contracting, complaint management and quality assurance, and claims payment for the full range of transportation services, including taxicabs, vans, mini-buses, wheelchair vans, stretcher vans, ambulances, fixed-route public transportation, and travel related expenses. The actual transportation services are provided by independent transportation providers LogistiCare is not a transportation provider and performs no direct transportation services. LogistiCare is responsible to DMAS for the performance of the following tasks: 1. Recruit and maintain an adequate NEMT provider Network; 2. Operate a toll-free call center for trip requests; 3. Verify member Medicaid or FAMIS fee-for-service eligibility and/or ALTC eligibility; 4. Assess member NEMT service eligibility in accordance with DMAS policy; 5. Verify that the purpose of the trip is to receive a service covered by Medicaid or FAMIS (e.g., confirm appointments with service providers); 6. Assign and schedule trips on a per-trip or recurring basis with the most appropriate cost-effective NEMT provider, consistent with the transportation needs of the member (e.g., curb-to-curb or door todoor delivery, etc.); 7. Assure compliance with driver and vehicle requirements; 8. Adhere to the prompt pay regulations and reimburse NEMT providers for services rendered within 30 days of receipt of a properly completed and fully reconciled trip invoice (Ch. 43, Virginia Public Procurement Act, Section to 4356); 9. Develop and implement a system that tracks complaints, and complaint resolutions; 10. Develop and implement a monitoring system and quality assurance plans; 11. Provide administrative oversight; 12. Submit management reports to DMAS, subcontract with a third party to conduct annual member, facility and other service provider, and NEMT provider satisfaction surveys, and submit an annual transportation report and ad hoc reports; 13. Submit claims/encounter files as scheduled by DMAS 14. Protect member confidentiality under HIPAA; 15. Maintain adequate staff and facilities; and, 16. Participate in member appeals as requested by DMAS. Page 5 of 78

6 The basic steps LogistiCare follows to arrange transportation, authorize services and reimburse Transportation Providers for services are described below. 1. Customer Service Representatives (CSR s) receive reservation telephone call from the Member (or representative) requesting non-emergency transportation services. 2. The CSR will review the trip request and verify the Member s program eligibility for the requested date of service. 3. The CSR will assess the Member s eligibility for transportation services in accordance with current DMAS transportation policy including that the Member has no other transportation available. 4. The CSR will verify that the trip is to a covered service. 5. The CSR (and the utilization review department, if necessary) will authorize the transportation service level and inform the Member of the transportation arrangements. If necessary, the CSR will verify the transportation need by confirming the appointment with the medical facility. 6. LogistiCare will assign the trip to the most appropriate and cost effective Transportation Provider available consistent with the needs of the Member. 7. Transportation Providers must confirm the pick-up with the Member 24 hours ahead of the scheduled medical appointment to reduce the possibility of rider no-shows. 8. LogistiCare makes payment to the Transportation Provider promptly upon receipt of a properly completed and verified trip invoice. These procedures will vary when public transportation, mileage reimbursement or other appropriate transportation services are used and will be explained in more detail in different sections of this manual. Geographic Considerations LogistiCare will schedule transportation to Medicaid Services only within the area customarily used for healthcare services by the community in which the Member resides. LogistiCare may schedule transportation outside the area only if appropriate medical resources are not available within the area, or a health care provider has referred the Member to covered services outside of the area. This includes limited out-of-state transportation services. As a general rule, LogistiCare will only authorize out-of-state NEMT services to and from health care providers not more than fifty (50) miles beyond the Virginia boundaries, although other out-of-state NEMT services may be authorized on a case by case basis. All out-of-state transports require the transportation provider to have a US DOT number issued by the FMCSA (Federal Motor Carrier Safety Administration). Page 6 of 78

7 VA Operations Business Offices Virginia Call Center Norton LogistiCare s Call Center in Norton, VA will accept Member reservation calls during normal reservation hours, but is also staffed 24/7 with key personnel that can assist Members with their transportation needs and provide support for technical and operational issues for Transportation Providers outside the normal operating hours of our local regional offices. This site is staffed with trained CSR s, a Call Center Manager, Lead Customer Service Representatives, Claims Manager, Supervisor and Lead Claims Clerk, a Trainer and a Facilities and Utilization Review Department, with a RN as supervisor. Location: 798 North Park Ave. NW Norton, VA Phone: (276) Fax: (276) Billing: (866) ext Reservations: Regional Offices The Regional Offices are staffed with LogistiCare personnel that can respond to Provider calls and give Transportation Providers immediate assistance with trip assignments, reports, performance reviews and help to resolve some billing issues. The Regional Offices also conduct all orientations and driver training on a weekly basis, or as needed. Each Transportation Provider will have an assigned Regional Office based upon its geographic service area. The Assistant Transportation Coordinators (ATCs) staffed in the Regional Offices are trained to assign and dispatch trip reservations to the most appropriate Transportation Provider considering location, level of service, and cost. In addition, each office has a Regional Manager, Administrative Assistant, Regional Supervisor or Lead Assistant Transportation Coordinator, and Field Monitor. The Region 3 office in Richmond, VA also serves as the LogistiCare s Central Business Office. The Vice President of Operations, Assistant General Manager, Director of Operations, Operations Manager, Ride Assist Call Center, Quality Assurance Department, and Compliance/Credentialing Department are all based in this office. There are also three Healthcare Managers located throughout the state to facilitate member and facility outreach and training. Page 7 of 78

8 Toll Free Contact Numbers Member reservation line: Facility Reservation Line: Claims Department: Regional Office Transportation Provider Toll Free Numbers: Region 1 (Norton): Region 2 (Forest): Region 3 (Richmond): Region 4 (Norfolk): Region 5 & 6 (Charlottesville): Region 7 (Herndon): Transportation Scheduling Procedures Gatekeeping The gatekeeping function ensures that NEMT services are authorized and provided according to the terms and limitations of LogistiCare s obligations under its contract with DMAS/Medicaid MCOs and as required under the Virginia Medicaid and Title XXI Program regulations. NEMT services are intended only for eligible Members who have no other means of transportation to covered medical services. Additionally, reservations for transportation services must be made five (5) days or more in advance of the appointment, except in the case of urgent care. A CSR will determine the Member s eligibility for NEMT services in a three-step process. 1. The CSR will confirm the Member s eligibility by accessing a list of eligible members provided by DMAS. 2. The CSR will confirm that the Member is being transported to a Medicaid covered service. Members can only be transported to service providers that will directly bill Medicaid for their services. 3. The CSR will confirm that the Member has no other viable means of transportation available. The proprietary software systems and algorithms employed by LogistiCare are designed to maintain the necessary data online to promote accurate eligibility determinations. The database is continuously updated as new eligibility information becomes available. What can the Transportation Providers do to help the system work smoothly? The trip details contained on trip reservations sent to transportation providers are derived in part from Member eligibility files received from DMAS (or MCOs), from the information received from Members (or their representatives) during phone reservation, or from medical providers on Transportation Request Forms. That Page 8 of 78

9 information may not always be accurate or complete. The Transportation Provider plays an important role in identifying gaps and errors in this information. Transportation Providers should inform their assigned regional office if address information or scheduled pick-up or appointment times are inaccurate. Any Transportation Provider who has reason to believe that a Member should not be transported should contact LogistiCare immediately. This notification should include Member s name, job number and date, as well as the reason the transport is inappropriate. Such reasons may include that Member has access to transportation, there is a closer medical provider available, Member is not being transported to a covered service, or Member is assigned to the wrong level of service (assigned to wheelchair or stretcher but Member is able to walk). Member Registration and Reservations Our LogistiCAD NEMT management software has been customized to easily capture all of the information required by DMAS. Client registration information is entered into LogistiCAD as individual transportation requests are approved. Client registration data is updated as new information becomes available about the client. Information about the Member's transportation reservation is divided into two primary parts. The pick-up and drop-off locations, which are obtained from the Member or caller The transportation specifics such as the level of service, time of pick-up, special needs of the Member The LogistiCAD software generates a pick up time, or be ready time, based on the mileage of the trip. The assigned Transportation Provider may not modify these times once they have received their daily trip manifests, however, a Transportation Provider may offer Members alternative pick-up times to better coordinate vehicle routes and multi-load opportunities. Any changes to pick-up times must be communicated to and authorized by LogistiCare in advance. The Transportation Provider should notify their assigned regional office, facility and Members of any schedule time changes. Reservation information is tracked in the LogistiCAD system based on a confirmation number or trip number that is given to the Member as well as to the assigned Transportation Provider. Any reference to specific transportation reservations should include the scheduled date of service as well as the specific trip number. Levels of Service for Transportation The basic criteria established by DMAS for the determination of levels of transportation has been incorporated into the standard operating policies and procedures and training materials used by the LogistiCare and our CSR s. Our staff is trained to ask appropriate questions, including, but not limited to: Does the Member have his or her own wheelchair? Is the Member transferable (i.e., does not require a lift or ramp equipped vehicle)? Will treatment impact the Member s ability to walk? Page 9 of 78

10 The transportation level of service gatekeeping process is repeated at appropriate intervals to monitor acute conditions that can change over time. The NEMT program allows for the transport of Members who are ambulatory, wheelchair dependent, stretcher dependent, or require ambulance service. LogistiCare will contract with a variety of Transportation Providers to meet the needs of the Members, including ambulance companies, public bus and rail systems, taxicab companies or charitable organizations. Transportation Providers must contact LogistiCare if they believe that an inappropriate level of service has been ordered for a Member. If a situation requires immediate attention, a Transportation Provider can call the Transportation Provider Line at their assigned regional office for assistance. Otherwise, information can be faxed to their regional office. The following list identifies some special considerations concerning level of transportation. Wheelchair dependent Members must provide their own wheelchair. Wheelchair dependent Members that do not provide their own wheelchair will not be up-graded to stretcher transportation. Members who are stretcher dependent must provide LogistiCare with medical documentation that this is the necessary level of transportation. The NEMT program does not cover emergency transportation of any sort, and emergency calls will be transferred to 911 emergency services. Urgent Care LogistiCare shall arrange transportation services when a Member requests services for urgent care and has no other means of appropriate transportation. Urgent care cases fall into the following three categories: Discharges from facilities Medical test, evaluations or procedures which were scheduled within the last five days Appointments that cannot be scheduled to meet the 5-day rule without effecting the Member s life or limb, such as dialysis, chemotherapy or wound care. LogistiCare may contact the medical provider to confirm the need for urgent transportation. LogistiCare is required to arrange transportation for hospital discharges within a 3-hour window from the time that the call is received. Standard on-time pick-up requirements will be adhered to for scheduled urgent pick-ups. LogistiCAD software allows for the storage of detailed information about individual Member needs. This feature allows LogistiCare to flag Members requiring escort or special services and display that flag for future reservation requests. Page 10 of 78

11 LogistiCare will authorize one escort to accompany the Member or group of Members who are visually impaired, hearing impaired, mentally challenged, under 18 years of age or who otherwise require assistance. Transportation Providers may not charge additional fees for escorts. Complaint Process LogistiCare is responsible for recording and responding to complaints associated with the delivery of services under its contract with DMAS. Complaints include those received from Members, medical providers or facilities, Transportation Providers or any other individual or entity that contacts LogistiCare. Complaints are recorded within the LogistiCAD system and are investigated by the Quality Assurance Department and our regional office staff. Complaints are tracked based on their nature as well as any identified Transportation Provider involved. Excessive complaints concerning a specific Provider may result in a decrease in work assigned to the Provider, or a removal from the NEMT network. Members or medical providers may file complaints about late trips by calling the Ride Assist Center. The ATC will attempt to resolve matters concerning immediate transportation needs. Complaints that do not involve immediate service needs will be assigned to a Quality Assurance Coordinator (QAC). Transportation Providers may register general complaints by calling the Transportation Provider line to their regional office. Transportation Providers will receive a monthly report of complaints that have been validated concerning their company and/or specific drivers, which will also be reviewed during routine meetings with their regional manager. Transportation Assignment and Notification It is LogistiCare s responsibility to send an initial reservation manifest to each Transportation Provider at least 48 hours prior to the date of service. The manifest will show all reservations that have been assigned to each company. Transportation companies must review the manifest and determine that all reservations meet the service levels that they provide and are in the geographic area that they serve. Reservations outside of Provider s service area must be sent back to LogistiCare on the appropriate Reroute form within 24 hours of receipt of the trip manifest, and no later than 24 hours prior to pick-up time. Twenty-four (24) hours before the date of service, Transportation Providers may receive a revised manifest. The revised manifest will include any changes or additional reservations that may have been assigned to a Transportation Provider. Any trips that are assigned to the Transportation Provider within twenty-four (24) hour of the trip pick-up time will also be verbally confirmed with the Transportation Provider. Transportation Providers with appropriate systems and are pre-approved by LogistiCare may download their manifests at their convenience from a secured internet website. Otherwise, manifests will be faxed to the number that each Transportation Provider submits to LogistiCare. Transportation Providers must submit changes to the fax number in writing on their company letterhead to their regional manager. Page 11 of 78

12 Transportation Providers will complete all trips that have been assigned to them on their manifests and not rerouted back to LogistiCare, absent extenuating circumstances. Trips that are rerouted must include a reason. If a Transportation Provider continually receives excessive trip assignments, they should contact the regional manager to confirm that the regional office s information for vehicle capacity is correct. Transportation Providers that reroute reservations without a valid reason, or who do not reroute reservations in a timely fashion, may have liquidated damages assessed and/or trip volume reduced. Return trips for individuals are authorized during the reservation process. However, individuals often do not know an exact return time, therefore, it will appear as "Will Call" on the trip manifest. Members will call the Ride Assist toll free number for their region. The ATC in the Ride Assist Center will in turn contact the Transportation Provider s to advise the member is ready for a return pick-up. The correct return pick-up time must be submitted when Transportation Providers report the return pick-up time on billing forms. Transportation Provider must review trip manifests prior to the scheduled date of service. We recommend the following procedures, at a minimum, be followed. 1. Contact Members the night before the transport to confirm that they are still in need of transportation and thereby reduce the risk of a Member no show. 2. Arrange pick-up times to maximize the ability to appropriately multi-load while still getting the Members to their destinations on time. Reminder: The Transportation Provider must notify LogistiCare of any schedule time changes before performing the trip. Transportation Providers are not authorized to change pick-up times without first contacting LogistiCare. 3. Report all cancellations including rider no shows on your Cancellation Report Form. The Transportation Provider must fax the Cancellation Report Form to LogistiCare by 12:00 each day for the previous day s cancelled transports ( ). Cancellations may also be reported on line via the internet and is strongly encouraged. Only those trips on the manifest for which LogistiCare has assigned a job number are authorized for reimbursement. Payment will not be made for trips not on the manifest or not otherwise authorized by a LogistiCare representative. Transportation Assignment Procedures Reservations are assigned to a Transportation Provider based on numerous and continually changing factors. This assignment is generally made at the time of the initial call but may change prior to the actual trip date. LogistiCare is a purchaser of transportation services from numerous Transportation Providers in the market place. As in any market situation, LogistiCare is free to choose from whom it will buy transportation services, how much it will purchase, and what price it is willing to pay. While Members have no direct right to choose a particular Page 12 of 78

13 Transportation Provider, Members and medical providers can influence LogistiCare s assignments by reporting service and quality issues. Prior to the scheduled date of service, the ATC reviews all reservations and makes any necessary changes to the Transportation Provider assignment. These changes are intended to insure the following: The Transportation Provider assigned can supply the indicated level of service The Transportation Provider assigned is available in the pick-up area indicated The number of reservations assigned to a Transportation Provider does not exceed the Transportation Provider s capacity The trips are assigned in the most cost effective manner Hours of Operation Reservation and Service The call center is staffed to receive reservations Monday through Friday between the hours of 06:00 to 20:00. Our call center is staffed 24/7 to handled ride assistance and urgent reservation requests (including discharges). Regional Offices The regional office s regular business hours are Monday through Friday between the hours of 07:00 18:00. The regional offices will be closed in observance of nationally recognized holidays. Transportation Performance Standards Quantifiable performance standards are an essential element of the NEMT program. Performance goals are used to measure the quality of system components and to target corrective activities to achieve overall quality goals. Specific driver standards of customer service and conduct are incorporated into all Transportation Provider contracts. Additional proactive steps are taken, as outlined below, to maintain compliance with the spirit and intent of the performance standards. 1. Confirm that the information taken at the time of call intake is accurate and complete so that no delays are attributable to bad addresses. Inform Members of the pick-up times that allow on-time arrivals for appointments. Aggressively pursue continued no-show or late cancellations by clients as these practices reduce the entire system's on-time performance. 2. Assign trips to promote the most efficient use of multiple-loaded vehicles and maximize vehicle utilization Page 13 of 78

14 3. Train drivers in the proper use of communications equipment (to include cell phone and 2-way radios). Drivers should be able to utilize equipment to notify their dispatch, LogistiCare, the Member and/or facility of delays, provide trip status information and access emergency assistance if needed. 4. Inform Members and Transportation Providers of any service delay of 15 minutes or more to lessen the impact on Members and treatment facilities, and aggressively use back-up transportation resources to cover breakdowns. 5. Oversee Transportation Provider performance with a Field Monitor who identifies and documents problems and forwards them to the Regional Manager. LogistiCare contracts with multiple Transportation Providers throughout its regions, to allow for sufficient back-up capacity. Transportation Provider s Responsibilities Administrative, Reservation Receipt and General Responsibilities 1. Transportation Provider shall receive trip reservations via fax or internet from LogistiCare each day. For urgent medical appointments, Transportation Provider shall accept telephone orders, (supplemented by a separate fax) from LogistiCare. 2. Transportation Provider shall transport Members and escorts in accordance with the specifications of the reservations provided by LogistiCare and the terms of the Transportation Agreement. Transportation Provider may refuse to transport a Member who, upon consultation with LogistiCare, is determined to be a threat to the health, safety or welfare of either Transportation Provider's employees or other Members, or prevents or inhibits the vehicle from being operated in a safe manner. 3. When a "will call" return trip has been pre-authorized by LogistiCare, the Transportation Provider shall accept telephone orders from Members (or LogistiCare) to give notification of the appropriate pick-up time, which in no event shall be more than 45 minutes of the call. 4. Transportation Provider shall inform LogistiCare of their inability or unwillingness to accept or complete an assignment at least 24 business hours prior to the date of service to allow LogistiCare to make alternative arrangements. 5. Transportation Provider shall establish and maintain both a dedicated telephone line and dedicated fax line for the use by LogistiCare to contact Transportation Provider. Fax lines shall be equipped with a fax machine. LogistiCare must be able reach a supervisor at all times that Members are in the Transportation Provider s vehicles. Drivers will be equipped with two-way communication. (cell phone and/or 2-way radios) 6. Transportation Provider will ensure that all information obtained regarding Members in connection with the Transportation Agreement and the Business Associate Agreement for the Protection of Page 14 of 78

15 Confidential Health Information in Compliance with HIPAA, will be held in the strictest confidence and used only as required in the performance of Transportation Provider's obligations under such Agreements. Other Riders An Escort or personal assistant may ride with a Member at no extra charge. The Escort or personal assistant is expected to assist the patient and the driver as requested. Up to two children may ride with an eligible Member, on a space available basis, also at no charge. The parent or guardian must provide appropriate car seats for infants and children. A parent or guardian must accompany any children below the age of thirteen unless a signed waiver is on file with Logisticare enabling children thirteen and under to be transported without parent or guardian. Escorts, personal assistants and children must be included on the original trip reservation to ensure adequate space on the vehicle. If a Member asks or agrees with a Transportation Provider to make changes to a pick-up time, this information must be submitted in advance to LogistiCare on a Schedule Change Form. Each Transportation Provider s timely pick-up compliance performance will be reported on a monthly basis to both the Transportation Provider and to DMAS. General Vehicle Requirements Prior to the beginning of service under the Transportation Agreement with LogistiCare, the Transportation Provider will submit to LogistiCare a Vehicle Update Form listing all vehicles which will be engaged in the provision of NEMT services. That listing will include Manufacturer, Model, Model Year, Vehicle Identification Number (VIN), and Virginia DMV License Plate Number. Periodic updates of the Vehicle Update Form will be required of the Transportation Provider for the full length of the Agreement. Additionally, any vehicles that a Transportation Provider decommissions must be reported to LogistiCare. All vehicle records shall be submitted to the Compliance and Credentialing Department, located at the Richmond business office. These documents shall be faxed to Vehicle Inspections All vehicles utilized under the NEMT program must be registered with and inspected by LogistiCare on a semiannual basis. LogistiCare s Field Monitors will utilize a standard checklist (see attachment #7). Vehicles that pass inspection will be issued an inspection sticker, which must be placed on the outside of the passenger side, rear window in the lower right corner. Page 15 of 78

16 Driver and Attendant Qualifications All drivers or attendants used in performance of services under the Transportation Agreement with LogistiCare must, at a minimum, meet the qualifications listed in Attachment # 5. Each driver's and attendant s records and qualifications are subject to initial and annual review by LogistiCare. LogistiCare may perform interim inspections of driver and attendant records as required by LogistiCare in its sole discretion. Any driver or attendant failing to meet all of the listed qualifications, at any time, must be prohibited from driving under the Transportation Agreement with LogistiCare. All records concerning driver and attendant qualifications should be submitted to the Logisticare s Compliance and Credentialing Department, located at the Richmond business office. Driver Training All drivers utilized by Transportation Providers to deliver transportation services under the terms of this contract must have successfully completed the following training requirements: General orientation Customer service, courtesy, and sensitivity awareness Driver conduct Vehicle orientation, pre-trip inspections National Safety Council DDC-4 defensive driving course (or approved equivalent) Passenger assistance techniques course (or approved equivalent) Proper handling and securement of mobility aids Record keeping requirements Emergency procedures Use of a "spill kit" and the removal of biohazards Passenger Confidentiality-HIPAA Courses and refresher modules will be provided as necessary to maximize quality service delivery. LogistiCare will also provide refresher classes to cover changes in policy, seasonal inclement weather procedures and other applicable topics as necessary. All training materials, including the Provider Manual, will be updated periodically to reflect changes in policy and revised or new procedures. LogistiCare offers a training program that will fulfill these training requirements (PASS class: Passenger Assistance, Safety & Sensitivity). Information regarding this program may be received by contacting the assigned regional office. Use of alternative training programs is allowable, but must be pre-approved by LogistiCare and DMAS. Page 16 of 78

17 Importance of proper wheelchair securement. Drivers who fail to properly secure wheelchair clients will be immediately suspended from operating under this contract. First Occurrence: Driver will be required to attend training. Driver will be reinstated upon successful completion of the class. Second Occurrence: Driver will be permanently suspended from operating under NEMT program. Transportation Provider Staff Orientation A series of orientation/training sessions are conducted for Transportation Provider staff. These sessions are offered at the assigned regional office or the Transportation Provider s base of operations, as appropriate. The purpose of these sessions is to meet face-to-face with the new Transportation Provider's staff and to outline basic information about how the program will operate. The Transportation Provider orientation program includes the following: Overview of NEMT Program and division of responsibilities between LogistiCare and Transportation Providers Vehicle requirements Driver qualifications Driver conduct The use of attendants Scheduling procedures during regular operating hours, including criteria for determining the most appropriate mode of transportation for the Member "After hours" scheduling procedures Urgent care procedures Criteria for trip assignment Dispatching and delivery of services Procedures for obtaining reimbursement for authorized trips Driver customer service standards and requirements during pick-up, transport and delivery Record keeping and documentation requirements for scheduling, dispatching and transporting, including completion of required logs Complaint procedures Denial and appeals procedures Page 17 of 78

18 The orientation session encompasses the requirements of the Transportation Agreement, including those pertaining to vehicles and drivers, and how various events are to be handled and reported. Emphasis is placed on the customer service aspect and it is stressed that drivers are to treat every Member with care and dignity and with a high regard for safety. In addition, the issues of record keeping, reporting, billing and payment are addressed. LogistiCare holds quarterly meetings throughout the State to address these topics. Insurance, Licensure & Certification A copy of all insurance, licensure and certification records required by the Transportation Agreement must be sent to LogistiCare s Compliance and Credentialing Department, located at the Richmond business office. All documents must subsequently be sent to LogistiCare as they are renewed. Reimbursement of Transportation Providers Invoicing On each business day, Transportation Provider shall transmit by fax or via internet, as specified by LogistiCare, a Cancellation Form listing all trips scheduled for performance the previous business day which were not completed. This must be submitted to the Utliziation Review Department by 12:00 PM (noon) the following day via the internet or fax ( ). Cancellations should not be reported on billing logs. Once each week, Transportation Provider shall submit to LogistiCare all completed trip logs for the previous week signed by the appropriate Members, sorted by date of service. Included with each batch of trip logs, Transportation Provider shall submit an invoice sheet showing a summary of charges for trip logs submitted. The original trip logs and summary invoice sheet should be sent via traceable method (Fed Ex, UPS, USPS Certified Mail) LogistiCare will verify all trips submitted for payment against computer records of trips assigned and performed. Trips for which all information is not supplied on the trip log will be denied payment. There will be no payments made for the transportation of escorts or personal assistants. Many Medicaid Members have other insurance coverage. State and federal regulations dictate that Medicaid is always the payer of last resort. As an agent of DMAS, LogistiCare is the payer of last resort for Medicaid NEMT services. Transportation Providers are required to bill the Member's primary insurer before submitting a claim to LogistiCare. LogistiCare will pay such claims only after ALL other possible insurers have denied payment and if the service meets the DMAS transportation guidelines. Transportation Providers must attach the original denial notice to the LogistiCare billing invoice, as applicable. Page 18 of 78

19 Payment Terms Transportation Provider shall submit supporting documentation in the event of a dispute with respect to amounts owed to Transportation Provider. After LogistiCare reviews the documentation to verify charges, and should a discrepancy continue to exist, LogistiCare will pay the uncontested portion and work with Transportation Provider to reconcile any differences. Transportation Provider shall continue to perform its obligation under the Transportation Agreement while working with LogistiCare to reconcile any outstanding contested amounts. LogistiCare will pay invoices by check or electronic transfer twice each month. A payment schedule with payment dates will be provided to you. As a condition of Payment, Provider must submit an Invoice Form and properly completed trip logs to LGTC within 6 months of date of service. All invoices not submitted within 6 months of service will be subject to a ten percent (10%) reduction in the amount that would otherwise be due under the invoice. Invoices submitted more than 210 days after date of service will be disallowed in their entirety. Claims that are denied and returned to Provider because of missing information may be resubmitted with all missing information within six (6) months of the date of service, or 60 days of the date of the denial letter, whichever is later. Claims not resubmitted with all required information within the aforesaid period will be denied in their entirety. Provider shall continue to perform its obligations hereunder irrespective of any outstanding contested amounts. Transportation Providers that make good faith efforts, as determined by LogistiCare in its sole discretion, to submit proper invoices within the required time frame may be allowed extensions to the invoice submission time frame without penalty. Transportation Provider Maintenance of Records Transportation Providers must establish, maintain and provide to LogistiCare within three days of request by LogistiCare, or as otherwise required under the Transportation Agreement, the following records and related information. The following information must also be submitted to LogistiCare: 1. Vehicle records, including at a minimum the following documentation for each vehicle: Manufacturer and model Model year Vehicle identification number Odometer reading at the time the vehicle enters service under this agreement Type of vehicle (minibus, wheelchair van, stretcher van) Capacity (number of passengers) License tag number Insurance certifications Page 19 of 78

20 Special equipment (lift, etc.) 2. Driver records for each driver, including at a minimum the following documentation. Name, date of birth and social security number Copy of the Virginia driver's license, to be updated as the license expires and is renewed Motor Vehicle Record for previous five years obtained from the DMV, to be updated annually Copy of STATE criminal background check Copy of national FBI fingerprint check Copy of 10 panel Drug Screen Basic first aid Passenger Assistance Safety and Sensitivity (PASS) certificate Documentation of any complaints received about the driver and any accidents or moving violations involving the driver Trip Log Transportation Providers are responsible for ensuring that each driver completes a daily Trip Log for every Member that was scheduled for transportation by LogistiCare. LogistiCare shall provide a master blank trip log. All documentation of time shall be in military time. The Trip Log must include the following information: 1. Date of service; 2. Driver s name (as it appears on state issued Driver s License); 3. Driver s signature (written or digital); 4. Attendant s full name (if applicable); 5. Member s name; 6. Member s or attendant s signature (if applicable); 7. Vehicle Identification Number (VIN) or other identifying number on file with the Contractor; 8. Mode of transportation authorized; 9. A unique transportation provider number, assigned by Contractor. For providers of ambulance service, the DMAS ambulance provider number shall be utilized; 10. Actual start time (from base station) (in military time); 11. Each authorized member transported with the actual pick-up time (in military time); 12. Member no-show indicator; 13. Each actual drop off time (military time) for authorized member; 14. Actual number of wheel chairs, attendants, and children, per trip; 15. Actual return time (to base station) in military time; 16. Authorized stamp or signature of the transportation provider; and, 17. Transportation Provider trip cost per trip leg 18. Other pertinent information regarding completion of the trips. Every Member transported by the Transportation Provider shall sign the trip log. If the Member is not physically or mentally capable of signing the trip log, the driver should attempt to obtain a signature from the pick-up or dropoff address (facility). The representative should sign their own name, not the Member s name. If no facility Page 20 of 78

21 representative is able or willing to sign the trip log, the driver must place "Member is unable to sign" and his initials in the Member signature line and give specific information supporting why Member signature is unavailable in the driver s comments line. Under no circumstances should anyone other than the Member sign the Member s name. Accident/Incident/Moving Violations Procedures The Transportation Provider must promptly notify LogistiCare of any accident or incident resulting in driver or passenger injury or fatality. A LogistiCare Transportation Provider Accident/Incident Report shall be submitted to the assigned regional office within the following period after the accident or incident: Accident with injury - Notification within 24 hours Incident with injury - Notification within 24 hours Accident without injury - Notification within 48 hours Incident without injury - Notification within 48 hours Follow up documentation, such as police report shall be submitted within three (3) business days or as soon the documents are available from the police. A sample Transportation Provider Accident and Incident Report must be used to report all accidents or incidents, which occur while delivering NEMT services. A copy of the report is included as an attachment to this Provider Manual, and additional copies can be obtained at the assigned regional office and. The Transportation Provider will cooperate with LogistiCare during any ensuing investigation. State regulations require that: This form must be included in the vehicle information packet stored in the driver compartment or securely stored on or in the driver s side visor. Transportation Provider Transportation Agreements LogistiCare will not establish or maintain service agreements with Transportation Providers that have been determined to have committed Medicaid fraud or been terminated from the Medicaid program. LogistiCare will terminate a service agreement with a Transportation Provider if a pattern of substandard performance is identified and the Transportation Provider fails to take satisfactory corrective action within a reasonable time period. DMAS reserves the right to direct LogistiCare to terminate any service agreement with a Transportation Provider when DMAS determines it to be in the best interest of the State. Page 21 of 78

22 List of Attachments 1. NEMT Program Definitions 2. List of Regional Offices and Ride Assistance Toll Free Numbers 3. Provider Administrative and Performance Responsibilities 4. Vehicle Requirements 5. Driver and Attendant Requirements 6. Sample Cancelation Report 7. Vehicle Inspection Report 8. Vehicle Update Form 9. Provider Employee Update 10. Sample Manifest 11. Sample Trip Log 12. Deficit Reduction Act of Fraud, Waste and Abuse Policy 13. Medicare Advantage Program Requirements 14. Driver Manual Page 22 of 78

23 ATTACHMENT 1 NEMT Program Definitions For purposes of the Transportation Agreement, the Provider Manual, and all Exhibits, the following terms have the meanings as defined below: Ambulance as defined by Code of Virginia , means any vehicle, vessel or craft that holds a valid permit issued by the Virginia Department of Health, Office of Emergency Medical Services (OEMS) and that is specially constructed, equipped, maintained and operated, and intended to be used for emergency medical care and the transportation of patients who are sick, injured, wounded, or otherwise incapacitated or helpless. The word "ambulance" may not appear on any vehicle, vessel or aircraft that does not hold a valid EMS vehicle permit. NEMT services, by definition, includes only to non-emergency ambulance transportation. Agreement means the Transportation Agreement, including all exhibits, and incorporates by reference the Virginia LGTC Provider Manual. Provisions of the Agreement shall prevail in the event of any conflict between the Agreement and any provision of the Provider Manual. Attendant means an employee of Provider, pre-authorized, approved, and whose services are compensated by LogistiCare, who assists the driver and accompanies a member or group of members during transport in order to ensure the safe operation of the vehicle and the safety of the members. Complaint or Grievance means an oral or written expression of dissatisfaction by a Member, a Member s family member or other responsible party, a facility or a Transportation Provider. Client means the party or entity with whom LGTC has a Client Contract. Although the singular form is used Client shall be understood as plural in the event that LGTC is under agreement with more than one party or entity in the state in which Provider operates. Client Contract means the agreement between LGTC and any other party or entity pursuant to which LGTC provides non-emergency transportation management services for covered Participants. Although the singular form is used Client Contract shall be understood as plural in the event that LGTC is under agreement with more than one party or entity in the state or states in which Provider operates. Criminal background check means a national search for past criminal convictions and sex offender status during the past seven (7) years that is conducted by a nationally recognized credentialing organization that is preapproved by LGTC, and conducted pursuant to LGTC s background check requirements. Curb-to-curb means transportation provided to Members who need little if any assistance between the vehicle and the door of the pick-up point or destination. The assistance provided by the driver includes opening and closing the vehicle doors, helping the Member enter or exit the vehicle, folding and storing the Member s Page 23 of 78

24 wheelchair or other mobility device as necessary, or securing the wheelchair or other wheeled mobility device in the vehicle. It does not include the lifting of any Member. Drivers are to remain at or near their vehicles and are not to enter any buildings. Door-to-Door means transportation provided to Members who need assistance to safely move between the door of the vehicle and the door of the Member s pick-up point or destination. The driver exits the vehicle and assists the Member from the door of the pick-up point (e.g., residence), escorts the Member to the door of the vehicle and assists the Member in entering the vehicle. The driver is responsible for assisting the Member throughout the trip and to the door of the destination. Drivers, except for ambulance or stretcher van personnel, should not enter a residence. In order to receive door-to-door service, the Member must submit a medical certification statement from their physician. The certification must document that the Member has a physical, sensory, mental, developmental or cognitive disability that requires door-to-door assistance to be provided for the safe transport of the Member. Escort means a family member, friend or facility employee who accompanies a Member for the entire trip and stays with the Member at the destination. The Transportation Provider and LogistiCare are not responsible for providing or paying for escorts. Group Trip means any trip that has the same pick-up address and time and same drop-off address and time as a trip for another Participant. Hand-to-Hand means transporting the Member from a person at the pick-up point into the hands of a facility staff member, family member or other responsible party at the destination. Some Members with dementia or developmental disabilities, for example, may need to be transported hand-to-hand. In order to receive hand-tohand service, the Member must submit a medical certification statement from their physician. Job number (also Trip Number or Confirmation Number ) means a unique confirmation number generated by LGTC for each trip reservation for each date of service. Multi-load means a situation in which more than one Participant is transported in a vehicle at the same time to the same or different drop-off addresses. Member as use in the Provider Manual, and Participant as used in the Agreement means any individual covered under the terms of Client Contract and on whose behalf LGTC arranges transportation services. Reroute means a trip reservation that is refused by Provider and that is sent back to LGTC to be directed to a different transportation provider. Shared Ride Trip means any trip that has the same pick-up address and time as a trip for another Participant and whose drop-off address and time are near enough that the two trips could reasonably share the same vehicle. Shared Ride Trip also means any trip that has the same drop-off address and time as a trip for another Participant and whose pick-up address and time are near enough that the two trips could reasonably share the same vehicle. Page 24 of 78

25 Ten-panel drug screen means a urine based drug test that screens for the use of Amphetamines, Barbiturates, Benzodiazepines (including Valium, Restoril, Xanax and Librium), Cocaine, Methadone, Methaqualone, Marijuana, Opiates and Phencyclidine (PCP), and Propoxyphene (Darvon). Urgent trip means an unscheduled episodic situation in which there is no immediate threat to life or limb but the member must be seen on the day of the request and treatment cannot be delayed until the next day (e.g., followup appointments scheduled less than 5 days after the last appointment; unexpected pre-operative appointments; hospital discharges; appointments for new medical conditions or tests when the member must be seen; and, dialysis). The Contractor may verify these appointments with the medical provider. Will call means a pick-up time that is not available at the time of reservation and that will be set based upon the time of a telephone call from the Participant to the Provider (or LGTC) when he or she is ready to be picked-up after a medical appointment. Page 25 of 78

26 ATTACHMENT 2 Regional Office Locations and Contact Information: Region Park Ave, NW Norton, VA Phone: or Fax: or Region London Links Drive, Suite D Forest, VA Phone: or Fax: or Region South Laburnum Avenue Richmond, VA Phone: or Fax: or Region W Freemason Street, Suite 200 Norfolk, VA Phone: or Fax: or Region 5, Angus Road, Suite 235 Charlottesville, VA Phone: or Fax: Region Herndon Parkway, Suite 100 Page 26 of 78

27 Herndon, VA Phone: or Fax: or Page 27 of 78

28 Page 28 of 78

29 ATTACHMENT 3 Provider Administrative and Performance Responsibilities Administrative Requirements 1. Provider shall comply with applicable city, county, state and federal requirements regarding licensing, certification and insurance for all personnel and vehicles. 2. Provider shall utilize only drivers and vehicles that are registered with and pre-approved by LGTC to perform services under this Agreement. 3. Provider shall provide proof that all registered vehicles meet all minimum standards and requirements to perform services under this Agreement. 4. Provider shall provide proof that all drivers and attendants have acceptable MVR, criminal background checks, and drugs screen records as set forth in the Driver and Attendant Qualifications section of this Agreement. 5. Provider shall ensure the safety of the Participants that it transports. 6. Provider shall provide one or more of the following modes of transportation: ambulatory sedan or van, wheelchair van, stretcher van, or non-emergency ambulance. 7. Provider shall provide curb-to-curb service as the standard service although door-to-door or hand-to-hand service may be required in certain circumstances. Services will be provided in at least those geographic service areas identified by Provider on the Provider Questionnaire that accompanies this Agreement. 8. Provider shall establish and maintain both a telephone line and fax line for use by LGTC to contact Provider. Fax lines shall be equipped with a fax machine that provides reasonably unrestricted access to LGTC to send faxes to Provider. Provider shall receive trip reservations via fax or modem from LGTC each day and confirm the receipt thereof in a form acceptable to LGTC. For same day or urgent medical appointments, including hospital discharges, Provider shall accept reservations and job numbers from LGTC by telephone. 9. Provider shall transport Participants, adult escorts, transportation attendants, or personal assistants as applicable and in accordance with the specifications of the reservations provided by LGTC and the terms of this Agreement. Provider, upon consultation with LGTC, may refuse to transport any person who, in the judgment of the Provider, is a threat to the health, safety, or welfare of either Provider s employees or other Participants, or prevents or inhibits the vehicle from being operated in a safe manner. 10. Provider shall reroute trip assignment at least 24-hours prior to the scheduled pick-up time to allow LGTC to make alternative arrangements. This requirement only applies to trip reservations that have been submitted to Provider at least 36 hours prior to the scheduled pick-up time. In the event that Provider does not provide 24-hour notice and LGTC must make, as a result of the short notice, premium price alternate transportation arrangements, Provider will be responsible for any additional charges incurred by LGTC. These charges may be deducted from amounts owed to Provider. This provision does not apply to circumstances beyond the control of Provider (e.g., sudden vehicle breakdown or vehicle accident), which circumstances must be communicated to LGTC at the time they occur. 11. Provider will ensure that all information obtained regarding Participants in connection with this Agreement is held in strict confidence and is used only as required in the performance of Provider s obligations. 12. Provider shall promptly inform LGTC if a Participant is assigned to an improper level of service (i.e., ambulatory patient assigned to a wheelchair trip, or wheelchair bound patient assigned to an ambulatory trip). 13. Provider shall report to LGTC any suspected abuse, neglect or exploitation of children or incapacitated adults, or of any adult over the age of Provider shall obtain and maintain certification from the VA Department of Minority Business Enterprise as a small business, minority-owned business, or women-owned business, if and as applicable. Page 29 of 78

30 15. Provider shall comply with all applicable city, county, state and federal laws and regulations, including all laws and regulations setting requirements regarding licensing, certification and insurance for all transportation related personnel and vehicles. If Provider operates with Taxi license plates, it shall comply with all state and local ordinances for taxis and maintain current licensing with the local taxi authority (if one exists) in each jurisdiction in which it operates. If providing bariatric transport services, Provider must meet the requirements and guidelines established for bariatric transport by the Virginia Department of Health, Office of Emergency Medical Services. If providing ambulance services, Provider must be currently enrolled with DMAS and licensed through the Virginia Department of Health, Office of Emergency Medical Services (EMS). Such laws or regulations shall take priority over any conflicting provision of this Agreement and the enforcement of the conflicting provision of this Agreement is hereby waived. 16. Provider agrees to participate in LogistiCare s quality assurance plan, which may include confirming Members transported by Provider actually attended a Medicaid covered services on the date of transport. Provider agrees to assist in the development of corrective action plans and cooperate with all data collection that may be requested to monitor the results of such corrective action plans. 17. The Agreement does not guarantee a minimum number of trips to be assigned from LGTC, and actual trip volume can vary. 18. Provider shall establish and maintain records, including but not limited to the following, and related information and provide copies thereof within three day notice, or as otherwise required under this Agreement, upon request by LGTC, the Client or its agents. All records shall be maintained and available for review by authorized personnel during the entire term of the contract and for a period of six (6) years thereafter. If an audit is in progress or litigation is in progress or threatened, all documents shall be maintained until such audit and/or litigation is fully resolved. Upon reasonable notice, Provider shall permit LGTC (or designee) to examine and/or audit trip documentation for Participants and will assist LGTC in examining all requested documentation. Providers may be required to maintain documentation for longer periods of time to the extent necessary to comply with applicable laws or regulations or the requirements of LGTC s Clients. a) Copy of Provider s registration with all applicable State agencies or departments. b) Vehicle records, including at a minimum the following documentation for each vehicle: manufacturer and model; model year; vehicle identification number; odometer reading at the time the vehicle enters service under this agreement; type of vehicle (e.g., sedan, wheelchair van, stretcher van); capacity (number of passengers); license tag number; insurance certifications; state issued registration permit and vehicle stamp (if applicable); special equipment (lifts etc.), and date, odometer reading and description of all inspection activity (e.g., verification that vehicle meets vehicle requirements, inspection of equipment such as brakes, tire tread, turn signals, horn, seat belts, air-conditioning/heating, etc.). Records must be maintained of the initial inspection and all subsequent inspections. c) Driver and attendant records, including at a minimum the following documentation: name, date of birth and social security number; copy of driver s license; MVR report for previous three (3) years as reported from Virginia Division of Motor Vehicles; 10 panel drug screen, as detailed in Attachment #5 Criminal background checks, as detailed in Attachment #5 driver training course certificates, and documentation of any complaints received about the driver or attendant and any accidents or moving violations involving the driver. d) All daily vehicle manifests, trip logs and invoice documents. e) Any other records LGTC is required to collect from Provider pursuant to the Client Contract. Page 30 of 78

31 Pick-up and Delivery Standards Transportation Provider must assure that transportation services comply with the following minimum service requirements. 1. LGTC s or Client s staff, or their official agent, may ride on trips with the Participant to monitor service. 2. On time performance of scheduled pick-ups shall be the standard practice. On time means at the scheduled pick up time or up to fifteen minutes after that time at the member s residence or place of initial pick-up. In addition, early arrival of the vehicle is permissible so long as no Participant is required to board the vehicle before the scheduled pick-up time. Arrival more than fifteen minutes after the scheduled pick-up time is considered a late pick-up. The monthly average wait time for all pick-ups performed by Provider may not exceed 15 minutes after the scheduled pick-up time and the actual wait time for any specific pick-up may not exceed 30 minutes after the scheduled pick-up time. 3. The driver shall make his presence known to the Participant upon arrival at the pick-up address and must wait at least fifteen (15) minutes after the scheduled pick-up time before the Participant may be considered a no show. If the Participant is not present for pick up, the driver shall notify Provider s dispatcher before leaving the pick-up location and document the attempted pick-up on the daily trip log. 4. Provider shall deliver the Participant to scheduled medical appointments within fifteen (15) minutes of the medical appointment time as standard practice, however, an earlier drop off before the appointment time may be acceptable in unusual situations on a case-by-case basis. However, in no event shall a Participant be dropped off for a medical appointment more than fifteen (15) minutes before the opening time of a medical office or facility. Provider shall ensure that Participants are picked up at prearranged times for the return trip if the medical service provider follows a regular schedule. The prearranged times may not be changed by Provider or the driver without prior permission from LGTC. Prearranged times for return trips have no 15 minute grace period window. 5. For will call return pick-up reservations from a medical appointment, the Provider shall arrive within 45 minutes after the time Provider is notified that the Participant is ready, or by the close of the business day for the medical service provider, whichever is earlier. For return pick-ups that have a scheduled return time, the Transportation Provider is to pick the member up at that scheduled time. There is no grace period window for scheduled return trips. 6. If a delay of fifteen (15) minutes or more occurs in the course of picking up scheduled riders, Provider must contact waiting Participants at their pick-up points to inform them of the delay and the expected arrival time of the vehicle. Provider must advise scheduled riders of alternate pick-up arrangements when appropriate. 7. If a delay of more than fifteen (15) minutes occurs that will result in a Participant being late for a medical appointment, Provider must contact LGTC who will notify the medical provider of the late arrival or arrange alternative transportation. In the event of a vehicle breakdown, the Provider shall contact LGTC immediately to report the breakdown and to coordinate alternative transportation for Participants on board. 8. For same day hospital discharge reservations, LogistiCare shall advise the Provider of the acceptable window of time to pick the member up. LogistiCare has three (3) hours from the time a hospital discharge is called in to have the member picked up. Therefore, the Provider must provide LGTC with an accurate ETA to pick up the member in order to ensure the three (3) hour window is met. 9. No Participant in a multi-load vehicle shall remain in the vehicle more than forty-five (45) minutes longer that the average travel time for direct transport from point of pick-up to destination. 10. No more than 1% of Provider s assigned trips shall be late or missed pick-ups. Providers with greater than 1% of their assigned trips as missed pick-ups may have their trips reduced. Habitual failure to meet this standard shall be a material breach of this Agreement and may result in termination of this Agreement. 11. An adult escort at least eighteen years of age or older shall be permitted to accompany a child under eighteen years of age. A parent or guardian shall escort a child under thirteen years of age unless a signed waiver is on file with Logisticare enabling children thirteen and under to be transported without parent Page 31 of 78

32 or guardian. A child between the ages of thirteen and eighteen may travel alone only with a signed parental consent form on file with LGTC. 12. A transportation attendant or personal assistant may ride with a Participant if necessary to assist the Participant. The attendant or assistant shall assist the patient and the driver as requested. 13. Provider must allow service animals in the vehicle, as needed; however, other animals shall not be allowed on board the vehicle. 14. Provider shall confirm the scheduled pick-up time with the Participant at least 24-hours prior to the scheduled pick-up. Page 32 of 78

33 ATTACHMENT 4 Vehicle Requirements All vehicles utilized by Provider in the performance of services under this Agreement must meet the requirements listed below. Each vehicle is subject to an initial and twice per year inspections by LGTC as well as interim inspections as required by LGTC in its sole discretion. All vehicles must be inspected prior to transporting Participants. All vehicles must be made available to Client or its agent(s) for inspection at any time. Inspections performed by LGTC do not replace or excuse the Provider from obtaining vehicle safety inspections as required by state or local law. Documentation of inspections performed by other agencies may suffice as long as LGTC and Client have access to the inspection records, and the inspection standards meet or exceed those of this Agreement. Any vehicle found non-compliant with the following inspection standards, Virginia licensing requirements, safety standards, Virginia Highway and Transportation Department, or ADA regulations, or other State or Federal laws or regulations shall be immediately removed from service and shall pass a re-inspection before it may be used to provide transportation services for Participants under this Agreement. Trips performed on non-compliant vehicles will not be paid. 1. Vehicles shall comply with the Americans with Disabilities Act (ADA) Accessibility Specifications for Transportation as well as Federal Transit Administration (FTA) regulations, as applicable for the type of vehicle utilized by Provider. 2. The number of occupants in the vehicle, including the driver, shall not exceed the vehicle manufacturer s approved seating capacity. 3. All vehicles shall have adequately functioning heating and air-conditioning systems and at all times shall maintain a temperature that is comfortable to the Participant. Functionality shall be defined by temperature readings from the rear of the vehicle, achieving air conditioning to 68 degrees and heating to 74 degrees. 4. All vehicles shall have functioning seat belts and restraints as required by applicable law. All vehicles shall have an easily visible interior sign that states: ALL PASSENGERS SHALL USE SEAT BELTS. Seat belts must be stored off the floor when not in use. 5. Provider shall have at least two seat belt extensions available in each vehicle. 6. All vehicles shall be equipped with at least one seat belt cutter that is kept within easy reach of the driver for use in emergency situations. 7. All vehicles shall have an accurate, operating speedometer and odometer. 8. All vehicles shall have two exterior rear view mirrors, one on each side of the vehicle. 9. All vehicles shall be equipped with an interior mirror for monitoring the passenger compartment. 10. The exterior of all vehicles shall be clean and free of broken mirrors or windows, excessive grime, major dents, or paint damage that detracts from the overall appearance of the vehicles. 11. The interior of all vehicles shall be clean and free of torn upholstery, torn or damaged floor or ceiling covering, damaged or broken seats, protruding sharp edges, dirt or litter, oil, grease, hazardous debris, or unsecured items. 12. All vehicles and component must meet or exceed, and be maintained and operated in accordance with, the manufacturer s, state, federal and local safety and mechanical operating and maintenance standards. 13. All vehicles shall have permanent signage that displays Provider s business name and telephone number on both exterior sides of the vehicle. The business name and phone number must appear in permanently affixed lettering that is a minimum of three inches in height and of a color that contrasts with its surrounding background. To comply with HIPAA, the word Medicaid or the term FAMIS may not be displayed on the vehicle or in the name of the business. 14. The vehicle license number and LGTC s toll-free and local phone numbers (voice and TTY) shall be prominently displayed in the interior of each vehicle. This information, together with complaint procedures provided by LGTC shall be available in writing and stored in a clearly visible location in each vehicle for distribution to Page 33 of 78

34 Participants upon request. 15. Smoking shall be prohibited in all vehicles at all times. All vehicles shall have an easily visible interior sign that states: NO SMOKING. 16. All vehicles shall carry a vehicle information packet containing vehicle registration, insurance card, and accident procedures and forms. 17. All vehicles shall be equipped with a first aid kit stocked with at least the following items: antiseptic cleansing wipes, triple antibiotic ointment, assorted sizes of adhesive and gauze bandages, dressing pads, cold pack, oval eye pad, triangular bandage, insect sting relief pads or cotton applicators, tape, scissors, latex or other impermeable gloves and sterile eyewash. 18. All vehicles shall be equipped with three (3) portable triangular reflectors mounted on stands. Use of flares is prohibited and may not be carried on board. 19. All vehicles shall carry extra electrical fuses. 20. All vehicles shall carry a functioning flashlight and an ice scraper. 21. All vehicles shall be equipped with a spill kit that includes liquid spill absorbent, latex or other impermeable gloves, hazardous waste disposal bags, scrub brush, disinfectant and deodorizer. 22. All vehicles shall be equipped with a current street level map or mapbook of the applicable geographic area with sufficient detail to locate Participant and medical provider addresses. Use of a GPS device does not negate the requirement to equip vehicles with a map. 23. All vehicles shall be equipped with a working fire extinguisher (Class A, B, or C) that shall be securely fastened and stored in a safe location within easy reach of the driver. 24. Provider shall utilize only its own leased or owned vehicles and shall not sublet, subcontract or arrange for transportation under this Agreement from any third party. 25. All vehicles must be equipped with a two-way communications system linking each vehicle with the Provider s primary place of business. Cell phones are acceptable, but pagers are not acceptable substitutes. A vehicle with an inoperative two-way communication system shall be placed out of service until the system is repaired or replaced. 26. All vehicles must properly utilize approved child safety seats when transporting children in accordance with Virginia laws and regulations. Participants are responsible for providing child safety seats when transporting children under the age of eight (8) years old. Upon arrival for transportation, if the Participant does not provide safety seat(s) for any child under age eight (8), the Provider shall not transport the child and shall advise the Participant to reschedule the appointment. 27. All vehicles shall have a functioning interior light within the passenger compartment. 28. All vehicles shall have adequate sidewall padding and the vehicle s floor must be covered with commercial anti-skid flooring or carpeting. Flooring or carpeting in vehicles equipped to transport wheelchair passengers shall not interfere with wheelchair movement between the lift and the wheelchair positions. 29. All vehicles shall be equipped with a retractable step, fixed sideboard (running board), or a step stool approved by LGTC to aid Participant boarding. This step shall be capable of safely supporting 300 lbs and shall be no more than 12 inches above ground level. The step shall have a nonskid top surface no less than eight inches by twelve inches. Removable steps shall be properly secured while the vehicle is in motion. Under no circumstances will a milk crate or similar substitute be accepted as a substitute for a step stool. Wheelchair Vehicle Requirements. All vehicles used to transport wheelchair passengers ( Wheelchair Vehicle ) must meet the Vehicle Requirements set forth above as well as the following additional requirements. 1. Each Wheelchair Vehicle must maintain a floor-to-ceiling height clearance in the passenger compartment of at least fifty-six (56) inches. 2. Each Wheelchair Vehicle must have an engine-wheelchair lift interlock system that requires the Wheelchair Vehicle s transmission to be in park and the emergency brake engaged to prevent vehicle movement when the lift is deployed. 3. All wheelchair ramps used on vehicles shall be certified as capable of regularly servicing a six hundred pounds (600 lbs) load. 4. Each Wheelchair Vehicle with a hydraulic or electromechanical powered wheelchair lift must have the lift mounted so not to impair the structural integrity of the vehicle. Lift capacities for all wheelchair vehicles Page 34 of 78

35 must be reported to LGTC. The lift must meet the following specifications: a) is capable of elevating and lowering a 600-pound load without the outer edge of the lift sagging, or tilting downwards more than one inch, nor shall the platform deflection be more than three (3) degrees under a 600-pound load; b) the lift platform most be at least thirty (30) inches wide and forty-eight (48) inches long; c) the lift platform shall not have a gap between the platform surface and the roll-off barrier greater than 5/8 of an inch. When raised, the gap between the platform and the vehicle floor shall not exceed 1/2 inch horizontally and 5/8 inch vertically; d) the lift controls shall be accessible and operable from inside or outside the vehicle, and shall be secure from accidental or unauthorized operation; e) the lift shall be powered from the vehicle s electrical system. The lift platform shall be able to be raised/lowered manually with passengers and/or shall provide a method to slow free-fall in the event of a power failure or component failure; f) the lift operation shall be smooth without jerking motion. Movement shall be less than or equal to six (6) inches per second during lift cycle and less than or equal to twelve (12) inches per second during stowage cycle; g) the lift platform shall not be capable of falling out of or into the vehicle when in storage in the passenger compartment, even if the power should fail; h) all sharp edges of the lift structure which might be hazardous to passengers shall be padded or ground smooth; i) the lift platform shall have a properly functioning, automatically engaged, anti-roll-off barrier, with a minimum of one (1) inch on the outbound end to prevent ride over; j) it is preferable that the platform when stored not intrude into the body of the vehicle more than twelve (12) inches and shall be equipped with permanent vertical side plates to a height of at least two (2) inches above the platform surface; k) the lift platform surface shall be equipped with non-skid expanded metal mesh or equivalent, to allow for vision through the platform; and l) the lift platform must be equipped with a hand rail on both sides of the platform to assist loading or unloading ambulatory passengers. The handrail shall meet the following requirements: maximum height of thirty-eight inches; minimum knuckle clearance of 1.5 inch; able to withstand a force of 100 pounds; and shall not reduce the lift platform width of at least thirty (30) inches. 5. Each wheelchair position in all vehicles shall have a wheelchair securement device (or tie down ) which shall: a) be placed as near to the accessible entrance as practical, providing clear floor area of 30 inches by 48 inches. Up to six (6) inches may be under another seat if there is nine (9) inches height clearance from floor. All wheelchairs shall be forward facing; b) be tested to meet a 30 mph/20gm standard; c) securely restrain the wheelchair during transport from moving forward, backward, lateral and tilting movements in excess of (2) inches; d) be adjustable to accommodate all wheel bases, tires (including pneumatic), and motorized wheelchairs; e) have a lock system, belt system, or both. If a belt system is used, the cargo strap when not in use Page 35 of 78

36 shall be retractable or stored on a mounted clasp or in a storage box. A tract mounting lock system on the floor shall be flush with the floor and shall not be an obstruction or a tripping hazard. In all cases the straps shall be stored properly when not in use; and f) provide seat belts and/or shoulder harness that are attached to the floor or to the side wall of the vehicle, that shall be capable of securing both the passenger and wheelchair. 6. Each wheelchair entrance door shall: a) maintain a minimum vertical clearance of fifty-six (56) inches and a minimum clear door opening of thirty (30) inches wide; b) have no lip or protrusion at the door threshold of more than 1/2 inch, and c) be equipped with straps or locking devices to hold the door open when the lift or ramp is in use. 7. Wheelchair vehicles assigned to hospital discharges and/or trip requests that require a wheelchair to be provided, shall secure and carry on board one spare wheelchair in good condition with a minimum seat width of twenty (20) inches. Stretcher Vehicle Requirements. Stretcher van service is an alternative mode of non-emergency transportation. It shall be provided to an individual who cannot be transported in a sedan or wheelchair van and who does not need the medical services of an ambulance. All stretcher vehicles must meet the General Vehicle Requirements set forth above as well as the following additional requirements. 1. A driver and an attendant shall staff the vehicle, which shall be specifically designed and equipped to provide non-emergency transportation of individuals on an approved stretcher. A stretcher vehicle shall be used for an individual who: a) Needs routine transportation to or from a non-emergency medical appointment or service. b) Is convalescent or otherwise non-ambulatory and cannot use a wheelchair. c) Does not require medical monitoring, medical aid, medical care or medical treatment during transport. Self-administered oxygen is permitted as long as the oxygen tank is secured safely. 2. The following restrictions apply: a) A stretcher passenger shall not be left unattended at any time. b) The driver and attendant shall confirm that all restraining straps are fastened properly and that the stretcher, stretcher fasteners and anchorages are properly secured. c) The attendant shall be seated in the passenger compartment while the vehicle is in motion and shall notify the driver of any sudden change in the passenger s condition. d) The stretcher vehicle shall not be used: i. for emergency medical transportation; ii. to transport a passenger who requires basic or advanced life support; iii. to transport a passenger who has in place any temporary invasive device (including a saline lock), equipment such as an intravenous administration device, or an airway maintenance device. However, the Participant is eligible for transportation if he/she has a battery-operated ventilator and an adult escort trained to provide ventilator care will travel with the Participant, and if no other medical equipment or care is required. iv. to transport a passenger who requires close observation or medical monitoring; v. to transport more than one (1) stretcher passenger at a time. Non-emergency Ambulance Vehicle Requirements. All vehicles used to transport Participants that require covered Page 36 of 78

37 non-emergency BLS or ALS service must meet the General Vehicle Requirements set forth above as well as the following additional requirements. State or local laws or regulations establishing minimum operational standards for Ambulances shall supersede the following provisions. a) Ambulance vehicle must have at least one (1) gurney that is capable of supporting 400 pounds or more. b) Each gurney must have the capability to be lowered and raised from a height of 18 to a height necessary to load the gurney into the vehicle without requiring the gurney to be manually lifted from the ground. c) Each gurney must be equipped with no less than one safety belt. d) Ambulance vehicle must have the necessary equipment to lock the gurney securely in place while in the vehicle. Page 37 of 78

38 ATTACHMENT 5 Driver and Attendant Requirements All drivers and attendants used to perform services under this Agreement shall, at a minimum, meet the applicable qualifications listed below before performing services under this agreement. Each driver s and attendant s records and qualifications are subject to an initial and annual inspection by LGTC as well as interim inspections as required by LGTC in its sole discretion. Any driver or attendant failing, at any time, to meet all of the applicable qualifications, or any requirements imposed by state or local law, shall be prohibited from providing service under this Agreement. LGTC and the Client reserve the right to disallow any driver or attendant from performing services under this Agreement. Any trips performed by non-compliant drivers will not be paid. 1. All drivers shall be at least eighteen (18) years of age and have had a valid driver s license for at least one (1) year, and have a current valid driver s license to operate the transportation vehicle to which they are assigned. 2. Drivers who receive two or more chargeable accidents and/or moving violations during the preceding three (3) years shall be removed from service. 3. Drivers shall not have had their driver s license suspended or revoked for moving traffic violations in the previous five (5) years. 4. Provider shall secure, maintain and provide to LGTC or Client criminal background checks from Virginia State Police and the national FBI fingerprint database for each driver or attendant before they are allowed to perform services under this Agreement. Provider shall verify that drivers or attendants are not listed on the Virginia Sex Offender Registry or have been convicted of any crime as defined in VA Code (B). In addition, the following will preclude a driver or attendant from providing services under this agreement: (1) conviction for driving while intoxicated or under the influence of a controlled substance within three (3) years prior to delivery of services under this Agreement; (2) plea of guilty or nolo contendere or conviction for any felony that is sexual in nature or involves a child, the elderly, domestic abuse, drugs, weapons or violence in the previous seven (7) years. 5. All drivers must meet current state and federal motor carrier safety regulations and guidelines. 6. Each driver must have competent driving habits. 7. Provider shall not utilize drivers or attendants who are known abusers of alcohol or known consumers of narcotics or drugs/medications that would endanger the safety of Participants. If Provider suspects a driver to be driving under the influence of alcohol, narcotics or drugs/medications that could endanger the safety of Participants, Provider shall immediately remove the driver from providing service under this Agreement. Each driver and attendant shall successfully pass a ten-panel drug screen for traces of illicit drugs prior to providing service under this Agreement. Provider shall ensure that the current laws regarding drug and alcohol testing are enforced for all drivers and attendants. 8. Provider shall ensure that all drivers and attendants have completed the following minimum training requirements. Provider shall submit to LGTC proof that drivers and attendants have completed all required training prior to them providing services under this Agreement. General orientation Customer service, courtesy, and sensitivity awareness Driver conduct Vehicle orientation, pre-trip inspections National Safety Council DDC-4 defensive driving course (or approved equivalent) Passenger assistance techniques course (or approved equivalent) Proper handling and securement of mobility aids Record keeping requirements Emergency procedures Page 38 of 78

39 Use of a "spill kit" and the removal of biohazards Passenger Confidentiality-HIPAA Driver and Attendant Customer Service Standards 1. No driver or attendant shall use alcohol, narcotics, illegal drugs or drugs that impair his or her ability to perform while on duty or abuse alcohol or drugs at any time. A driver or attendant can use prescribed medication as long as his/her duties can still be performed in a safe manner and Provider has written documentation from a physician or pharmacist that the medication will not impact the ability of the driver. 2. No drivers or attendants shall allow firearms, alcoholic beverages in opened containers, unauthorized controlled substances, or highly combustible materials to be transported in the vehicle. 3. No drivers or attendants shall solicit or accept controlled substances, alcohol or medications from Participants. 4. No drivers or attendants shall make sexually explicit comments, or solicit sexual favors, or engage in sexual activity while in the course of their job duties. 5. No drivers or attendants shall solicit additional business or accept money or goods from Participants except for the collection of applicable co-payments as authorized by the Client. 6. Drivers and attendants shall not touch any Participant except as appropriate and necessary to assist the member into our out of the vehicle, into a seat, to secure the seat belt, or to render first aid or assistance for which the driver or attendant has been trained. 7. All drivers and attendants shall wear and have visible a nametag that is easily readable and includes their name and the name of the Provider. 8. No drivers or attendants shall smoke while in the vehicle, while assisting a Participant, or in the presence of any Participant. Participants shall not be allowed to smoke in the vehicle. 9. No drivers or attendants shall wear any type of headphones while on duty, with the exception of handsfree headsets for mobile telephones. Mobile telephones, including texting, may not be used while the vehicle in is motion. 10. All drivers shall park the vehicle so that the Participant does not have to cross streets to reach the entrance of the destination. 11. No drivers or attendant shall leave a Participant unattended at any time and the vehicle should remain visible to the driver when performing door-to-door or hand-to-hand services. 12. All drivers and/or attendants must identify themselves (show their name tag) to the member, facility representative, or other service provider employee, and announce their presence at the entrance of the building at the specified pick-up location if a curbside pick-up location is not apparent. 13. The driver or attendants must open and close the vehicle door when Participants enter or exit the vehicle, and assist the Participants in the process of being seated, including the fastening of seat belts. Drivers shall confirm prior to moving the vehicle that wheelchairs and wheelchair passengers are properly secured and that all Participants are properly belted in their seat belts. 14. All drivers and/or attendants must assist Participants to exit the vehicle and to move to the access area of the Participant s destination. All drivers shall confirm that the delivered passenger is safely inside his or her destination prior to vehicle departure. 15. All drivers and/or attendants must provide physical support or assistance and oral directions to Participants when requested or when necessitated by the member s mobility status and personal condition. Such assistance can include curb-to-curb, door-to-door, and hand-to-hand assistance as indicated on the trip manifest, and may also apply to wheelchairs and mobility-limited persons as they enter or exit the vehicle using a wheelchair lift or ramp. Such assistance shall also include stowage of mobility aids such as canes, walkers and folding wheelchairs. 16. All drivers and/or attendants shall assure that any packages are safely stored before the driver moves the vehicle. Drivers and/or attendants are not responsible for Participant s personal items. 17. All drivers and attendants shall be courteous, patient and helpful to all Participants and be neat and clean Page 39 of 78

40 in appearance. 18. If a Participant or other passenger s behavior or any other condition impedes the safe operation of the vehicle, the driver shall park the vehicle in a safe location out of traffic, notify the Provider, and request assistance. 19. Drivers and attendants shall comply with HIPAA and keep all Participant health care identifying information confidential and not visible to other passengers, and shall not discuss health care identifying information with anyone who is not involved with the Participant s treatment or other health care services. 20. Any driver or attendant who receives two substantiated complaints in a 90-day period must be removed from driving under this Agreement or enter a retraining program. If a driver receives four substantiated complaints within a twelve-month time period, he/she must be permanently removed from driving under this Agreement. 21. All drivers shall maintain a daily trip log that includes the following information: a) Provider name; b) Provider ID number c) vehicle number; d) driver s name (as it appears on driver s license, no nicknames); e) driver s signature f) departure time from and return time to base station g) names of Participants and all other passengers transported h) Participant signature for each drop off i) no show indicator, if applicable; j) actual arrival time at pick-up point; k) actual arrival time at drop-off point; l) date of service and mode of transport authorized; m) name of attendant (if any) and attendant s signature; n) authorization stamp or signature of Provider, and o) any other pertinent information regarding completion of trips. All above items, plus the individual cost of each leg, must be included on the trip log in order to properly process for payment. Page 40 of 78

41 ATTACHMENT 6 Page 41 of 78

42 ATTACHMENT 7 Vehicle Inspection Report Page 42 of 78

43 ATTACHMENT 8 Vehicle Update Form Page 43 of 78

44 Page 44 of 78

45 ATTACHMENT 9 Provider Employee Update Page 45 of 78

46 ATTACHMENT 10 Sample Manifest CLIENT JOE DAY, AGOOD 2009 BEE ST 123 HAPPY AVE Driver, Mike FOR TRAINING PURPOSES ONLY Page 46 of 78

47 ATTACHMENT 11 Sample Trip Log Page 47 of 78

48 ATTACHMENT 12 Deficit Reduction Act of Fraud, Waste and Abuse Policy Federal law requires that entities such as LogistiCare and its subsidiaries that receive at least $5 million in annual payments under a State Medicaid program establish written policies for its employees, contractors and agents that furnish detailed information regarding the federal and state False Claims Acts, the administrative remedies available under the acts, other protection under the acts, and the Company s procedures for detecting fraud, waste and abuse. LogistiCare s policy is to provide detailed information to all employees, contractors and agents about federal and state False Claims Acts and the Company s policies and procedures to detect and prevent fraud, waste and abuse. The information in this policy forms part of its employee manual, its transportation provider manual, and is distributed to all contractors and agents as required by the Deficit Reduction Act of Federal False Claims Act The federal False Claims Act, among other things, applies to the submission of claims by healthcare providers for payment by Medicare, Medicaid and other federal and state healthcare programs. The False Claims Act is the federal government s primary civil remedy for improper or fraudulent claims. It applies to all federal programs, from military procurement contracts to welfare benefits to healthcare benefits. The False Claims Act prohibits, among other things: Enforcement Employee Protection knowingly presenting or causing to be presented to the federal government a false or fraudulent claim for payment or approval; knowingly making or using, or causing to be made or used, a false record or statement in order to have a false or fraudulent claim paid or approved by the government; conspiring to defraud the government by getting a false or fraudulent claim allowed or paid; and knowingly making or using, or causing to be made or used, a false record or statement to conceal, avoid, or decrease an obligation to pay or transmit money or property to the government. Knowingly means that a person, with respect to information: 1) has actual knowledge of the information; 2) acts in deliberate ignorance of the truth or falsity of the information; or 3) acts in reckless disregard of the truth or falsity of the information. The United States Attorney General may bring civil actions for violations of the False Claims Act. As with most other civil actions, the government must establish its case by presenting a preponderance of the evidence rather than meeting the higher burden of proof that applies in criminal cases. The False Claims Act allows private individuals to bring qui tam actions for violations of the False Claims Act. If any employee has knowledge or information that any such activity may have taken place, the employee should notify his or her supervisor or other management official. Transportation providers must have a system in place for reporting potential violations, and such information Page 48 of 78

49 may be reported anonymously. Federal and state law as well as LogistiCare policy prohibit any retaliation or retribution against any person who reports suspected violations of these laws to law enforcement officials or who file lawsuits on behalf of the government. Anyone who believes that he or she has been the subject to any such retaliation or retribution should also report this to their supervisor or other appropriate person, as provider by their employer s policy covering such matters. Program Fraud Civil Remedies Act of 1986 The Program Fraud Civil Remedies Act of 1986 ( PFCRA ) authorizes federal agencies such as the Department of Health and Human Services to investigate and assess penalties for the submission of false claims to the agency. The conduct prohibited by the PFCRA is similar to that prohibited by the False Claims Act. For example, a person may be liable under the PFCRA for making, presenting, or submitting, or causing to be made, presented, or submitted, a claim that the person knows or has reason to know: is false, fictitious, or fraudulent; includes or is supported by any written statement that: omits a material fact; is false, fictitious, or fraudulent as a result of such omission; and include such material fact; or is for payment for the provision of property or services which the person has not provided as claimed. If a government agency suspects that a false claim has been submitted, it can appoint an investigating official to review the matter. The investigating official may issue a subpoena to further investigate, or may refer the matter to the Department of Justice for proceedings under the False Claims Act. If, based on the investigating official s report, an agency concludes that further action is warranted, it may issue a complaint regarding the false claim. A hearing following the detailed due process procedures set forth in the regulations implementing the PFCRA would be held. State False Claims Acts Several states have enacted False Claims Acts that are similar in substance and procedure to the Federal laws described, above. At present, these States include AR, CA, DE, DC, FL, GA, HI, IN, IL, LA, MA, MI, MN, MO, MT, NH, NJ, NM, NY, NV, OK, RI, TN, TX, VA, and WI. In addition, the municipalities of Chicago and New York City have enacted False Claims Acts that are similar in substance and procedure to the Federal laws described above. Fraud, Waste And Abuse / Company Detection LogistiCare has numerous policies and procedures for detecting fraud, waste and abuse. Some of our more important procedures are (1) the gate keeping protocol performed during the reservation process; (2) the detailed verification process for each invoice submitted by transportation providers; (3) recertification of standing orders, (4) sampling patient attendance records with health care facilities; (5) background check requirement for transportation providers; (6) field monitor activities; and (7) requirement of preauthorization and job number. LogistiCare takes seriously any allegation of fraud, waste or abuse, and appropriately investigates any such allegation. Providers are required to report suspected cases of fraud, waste, abuse or other impropriety. Providers must cooperate in any investigations initiated by LogistiCare or any government agency, as required by law. Page 49 of 78

50 ATTACHMENT 13 Medicare Advantage Program Requirements To the extent that any LGTC Client offers NET services to Medicare beneficiaries, the Centers for Medicare and Medicaid Services ( CMS ) and associated laws, rules and regulations regarding the Medicare Advantage ( MA ) Program require that the Client provide for compliance of contracted network providers and their respective employees with certain MA program requirements including, without limitation, inclusion of certain mandatory provisions in MA provider participation agreements and/or associated documents including agreements between LGTC and subcontracted transportation providers, as applicable. A list of some of these requirements can be found in the CMS Managed Care Manual, Chapter 11, Section 100.4, as published by CMS and available on the CMS website. Additionally, revisions to certain applicable regulations can be found in 74 Fed. Reg (January 12, 2009) (amending 42 C.F.R. Parts 422 and 423). As such and in addition to the terms and conditions in the Agreement between LGTC and Provider, Provider agrees to the following terms and conditions to the extent applicable to NET services rendered to Medicare beneficiaries enrolled in MA health benefit plans. In the event of a conflict between the contract between LGTC and Provider related to services rendered to Medicare beneficiaries and applicable provisions of this Medicare Advantage Program Provider Requirements Addendum ( Addendum ), this Addendum shall control. II. Definitions. For purposes of this Addendum the following additional terms shall have the meaning set out below: (1) Covered Services means those Medically Necessary medical, related health care and other services covered under and defined in accordance with the applicable Medicare beneficiary s MA Plan. (2) Dual Eligible Member means a Medicare beneficiary who is also entitled to medical assistance under a state plan under Title XIX ( Medicaid ) of the Social Security Act (the Act ). (3) First Tier Entity means LogistiCare Solutions, LLC.. (4) Health Plan means the entity that offers the MA health benefit plans with which Medicare beneficiaries participate. (5) MA Plan means the one or more MA health benefit plans offered or administered by Health Plan(s) for Medicare beneficiaries and under which Provider renders services to Medicare beneficiaries. (6) Medicare Advantage Program or MA Program means the federal Medicare managed care program for Medicare Advantage (formerly known as Medicare+Choice) products run and administered by CMS, or CMS successor. (7) Medicare Contract means Health Plan s contract(s) with CMS to arrange for the provision of health care services to certain persons enrolled in an MA Plan who are eligible for Medicare under Title XVIII of the Social Security Act. (8) State means the state in which Provider provides the Covered Services. Page 50 of 78

51 (9) State Medicaid Plan the State s plan for medical assistance developed in accordance with Section 1902 of the Act and approved by CMS. (10) Medicare beneficiary means those designated individuals eligible for traditional Medicare under Title XVIII of the Social Security Act and CMS rules and regulations and enrolled with Health Plan. II. Additional MA Program Obligations and Requirements. Provider agrees to the following terms and conditions to the extent applicable to NET services rendered to Medicare beneficiaries. A. Audits; Access to and Record Retention. Provider shall permit audit, evaluation and inspection directly by Health Plan, the Department of Health and Human Services (HHS), the Comptroller General, the Office of the Inspector General, the General Accounting Office, CMS and/or their designees, and as the Secretary of the HHS may deem necessary to enforce the Medicare Contract, physical facilities and equipment and any pertinent information including books, contracts (including any agreements between Provider and its employees, contractors and/or subcontractors providing services related to services provided to Medicare beneficiaries), documents, papers, medical records, patient care documentation and other records and information involving or relating to the provision of services under the Agreement, and any additional relevant information that CMS may require (collectively, Books and Records ). All Books and Records shall be maintained in an accurate and timely manner and shall be made available for such inspection, evaluation or audit for a time period of not less than ten (10) years, or such longer period of time as may be required by law, from the end of the calendar year in which expiration or termination of the agreement under which Provider renders services to Medicare beneficiaries occurs or from completion of any audit or investigation, whichever is greater, unless CMS, an authorized federal agency, or such agency s designee, determines there is a special need to retain records for a longer period of time, which may include but not be limited to: (i) up to an additional six (6) years from the date of final resolution of a dispute, allegation of fraud or similar fault; (ii) completion of any audit should that date be later than the time frame(s) indicated above; (iii) if CMS determines that there is a reasonable possibility of fraud or similar fault, in which case CMS may inspect, evaluate, and audit Books and Records at any time; or (iv) such greater period of time as provided for by law. Provider shall cooperate and assist with and provide such Books and Records to Health Plan and/or CMS or its designee for purposes of the above inspections, evaluations, and/or audits, as requested by CMS or its designee and shall also ensure accuracy and timely access for Medicare beneficiaries to their medical, health and enrollment information and records. Provider agrees and shall require its employees, contractors and/or subcontractors and those individuals or entities performing administrative services for or on behalf of Provider and/or any of the above referenced individuals or entities: (i) to provide Health Plan and/or CMS with timely access to records, information and data necessary for: (1) Health Plan to meet its obligations under its Medicare Contract(s); and/or (2) CMS to administer and evaluate the MA program; and (ii) to submit all reports and clinical information required by Health Plan under the Medicare Contract. [42 C.F.R (e)(4), (h), (i)(2)(i), (i)(2)(ii) and (i)(4)(v)] B. Privacy and Accuracy of Records. In accordance with the CMS Managed Care Manual and the regulations cited below, Provider agrees to comply with all state and federal laws, rules and regulations, Medicare program requirements, and/or Medicare Contract requirements regarding privacy, security, confidentiality, accuracy and/or disclosure of records (including, but not limited to, medical records), personally identifiable information and/or protected health information and enrollment information including, without limitation: (i) HIPAA and the rules and regulations promulgated thereunder; (ii) 42 C.F.R (a)(13); and (iii) 42 C.F.R ; (d) 42 C.F.R and 42 C.F.R regarding certain reporting obligations to CMS. Provider also agrees to release such information only in accordance with applicable state and/or federal law, including pursuant to valid court orders or subpoenas. C. Hold Harmless of Medicare Beneficiaries. Provider hereby agrees: (i) that in no event including, but not limited to, non-payment by Health Plan or First Tier Entity, Health Plan s determination that services were not Medically Page 51 of 78

52 Necessary, Health Plan s or First Tier Entity s insolvency, or breach of the agreement between Provider and First Tier Entity that is the subject hereof or the agreement between First Tier Entity and Health Plan, shall Provider bill, charge, collect a deposit from, seek compensation, remuneration or reimbursement from, or have any recourse against a Medicare beneficiary for amounts that are the legal obligation of Health Plan and/or First Tier Entity; and (ii) that Medicare beneficiaries shall be held harmless from and shall not be liable for payment of any such amounts. Provider further agrees that this provision (a) shall be construed for the benefit of Medicare beneficiaries; (b) shall survive the termination of the agreements between Provider and First Tier Entity and First Tier Entity and Health Plan regardless of the cause giving rise to such termination; and (c) supersedes any oral or written contrary agreement now existing or hereafter entered into between Provider and Medicare beneficiaries, or persons acting on behalf of a Medicare beneficiary. [42 C.F.R (g)(1)(i) and (i)(3)(i)] D. Hold Harmless of Dual Eligible Members. With respect to those Medicare beneficiaries who are designated as Dual Eligible Members for whom the State Medicaid agency is otherwise required by law, and/or voluntarily has assumed responsibility in the State Medicaid Plan to cover those Medicare Part A and B Member Expenses identified and at the amounts provided for in the State Medicaid Plan, Provider acknowledges and agrees that it shall not bill Medicare beneficiaries the balance of ( balance-bill ), and that such Medicare beneficiaries are not liable for, such Medicare Part A and B Member Expenses, regardless of whether the amount Provider receives is less than the allowed Medicare amount or Provider charges due to limitations on additional reimbursement provided in the State Medicaid Plan. Provider agrees that it will accept First Tier Entity s payment as payment in full or will bill the appropriate State source if Health Plan has not assumed the State s financial responsibility under an agreement between Health Plan and the State. [42 C.F.R (g)(1)(iii).] E. Accordance with Health Plan s Contractual Obligations. Provider agrees that any services provided to Medicare beneficiaries shall be consistent with and comply with the requirements of the Medicare Contract. [42 C.F.R (i)(3)(iii).] F. Prompt Payment of Claims. First Tier Entity will process and pay or deny claims for Covered Services within the timeframe set forth in the agreement between Provider and First Tier Entity. [42 C.F.R (b).] G. Delegation of Provider Selection. As applicable, Provider understands that if selection of providers who render services to Medicare beneficiaries has been delegated to First Tier Entity by Health Plan, either expressly or impliedly, then Health Plan retains the right to approve, suspend or terminate such downstream or subcontracted arrangements to the extent applicable to Medicare beneficiaries enrolled with Health Plan. [42 C.F.R (i)(5).] H. Compliance with Health Plan s Policies and Procedures. Provider shall comply with all policies and procedures of Health Plan to the extent applicable to the services rendered by Provider. Such policies may include written standards for the following: (a) timeliness of access to care and member services; (b) policies and procedures that allow for individual medical necessity determinations (e.g., coverage rules, practice guidelines, payment policies); and (c) Health Plan s compliance program which encourages effective communication between Provider and Health Plan s Compliance Officer and participation by Provider in education and training programs regarding the prevention, correction and detection of fraud, waste and abuse and other initiatives identified by CMS. [42 C.F.R ; 42 C.F.R (i)(4)(v); 42 C.F.R (b); 42 C.F.R (a)(5); 42 C.F.R (b)(4)(vi)(C) & (D) & (G)(3).] I. Delegation (Accountability) Provisions. Provider agrees that to the extent Health Plan, in Health Plan s sole discretion, elects to delegate any administrative activities or functions to First Tier Entity, the following shall apply: Page 52 of 78

53 (1) Reporting Responsibilities. The Health Plan and First Tier Entity will agree in writing to a clear statement of such delegated activities and reporting responsibilities relative thereto. [42 C.F.R (i)(3)(ii) and 42 C.F.R (i)(4)(i)] (2) Revocation. In the event CMS or Health Plan determines that First Tier Entity does not satisfactorily perform the delegated activities and any plan of correction, any and all of the delegated activities may be revoked upon notice by the Health Plan to First Tier Entity. [42 C.F.R (i)(3)(ii) and 42 C.F.R (i)(4)(ii)] (3) Monitoring. Any delegated activities will be monitored by the Health Plan on an ongoing basis and formally reviewed by the Health Plan at least annually. [42 C.F.R (i)(3)(ii) and 42 C.F.R (i)(4)(iii)] (4) Credentialing. The credentials of medical professionals, if any, affiliated with Provider and/or First Tier Entity will either be reviewed by Health Plan or, in the event Health Plan has delegated credentialing to First Tier Entity, First Tier Entity s credentialing process will be reviewed and approved by Health Plan, monitored on an ongoing basis and audited at least annually. [42 C.F.R (i)(3)(ii) and 42 C.F.R (i)(4)(iv)] (5) No Assignment of Responsibility. Provider understands that Provider and/or First Tier Entity may not delegate, transfer or assign any of Provider s or First Tier Entity s obligations with respect to Medicare beneficiaries or any delegation agreement between Health Plan and Provider and/or First Tier Entity without Health Plan s prior written consent. J. Compliance with Laws and Regulations. Provider agrees to comply with all applicable Medicare laws, rules and regulations, reporting requirements, CMS instructions, and with all other applicable state and federal laws, rules and regulations, as may be amended from time to time including, without limitation: (a) laws, rules and regulations designed to prevent or ameliorate fraud, waste and abuse including, but not limited to, applicable provisions of Federal criminal law, the False Claims Act (31 U.S.C et. seq.), and/or the anti-kickback statute (section 1128B(b) of the Act); (b) applicable state laws regarding patients advance directives as defined in the Patient Self Determination Act (P.L ), as may be amended from time to time; (c) Federal Health Insurance Portability and Accountability Act of 1996 (HIPAA) administrative simplification rules found at 45 C.F.R. parts 160, 162, and 164; and (d) laws, rules and regulations and CMS instructions and guidelines regarding marketing. Additionally, and to the extent applicable, Provider agrees to maintain full participation status in the federal Medicare program and shall ensure that none of its employees, contractors, or subcontractors is excluded from providing services to Medicare beneficiaries under the Medicare program. [42 C.F.R (b)(4) and 42 C.F.R (a)(8)] K. Accountability. Provider hereby acknowledges and agrees that Health Plan oversees the provision of services by Provider to Medicare beneficiaries and that Health Plan shall be accountable under the Medicare Contract for such services regardless of any delegation of administrative activities or functions to Provider or First Tier Entity. [42 C.F.R (i)(1); (i)(4)(iii); and (i)(3)(ii)] L. Benefit Continuation. Upon termination of Provider s status as a participating provider with Health Plan (unless such termination was related to safety or other concerns), Provider will continue to provide health care benefits/services to Medicare beneficiaries in a manner that ensures medically appropriate continuity of care and for the time period required by applicable law. Specifically, for Medicare beneficiaries who are hospitalized on the date of such termination, services will be provided through the applicable Medicare beneficiary s date of discharge. [42 C.F.R (g)(2)]. The parties acknowledge the provisions set for in this paragraph K are not applicable to NET services. Page 53 of 78

54 ATTACHMENT 14 Page 54 of 78

55 Before transporting clients for LogistiCare, all drivers must complete the following: 1. LGTC Orientation 2. Driver Requirements and Responsibilities 3. Passenger Assistance, Service and Safety (PASS) 4. Dealing with Emergencies [Accidents, Incidents and Breakdowns] 5. Basic First-Aid 6. Blood borne Pathogens 7. Defensive Driving 8. HIPAA Requirements 9. Lifts, Ramps and Wheelchair Securement LGTC Orientation Who are we? LogistiCare is the Non-Emergency Transportation (NET) Broker for the Virginia Department of Medical Assistance Services (DMAS) Began Virginia Medicaid NET in 2001 with partial state coverage expanded to cover the entire state in 2003 LogistiCare headquarters are in Atlanta, GA and currently operates in 33 states plus Washington, D.C. LogistiCare operates 24/7/365 Transportation is arranged for Medicaid recipients or members of Managed Care Organizations (MCO) who have no other means of transportation, and who need to see a physician or a health care facility for an authorized covered service. Covered Services under Medicaid include: o Hospital Discharges o Doctors Visits, Physical Therapy, X-Rays, Dialysis, and other Medical appointments o Adult Day Care, Day Support, and Supported Employment Services Where are we? LogistiCare operates six regional offices throughout the state (Forest, Charlottesville / Augusta County, Herndon, Norfolk, Norton, and Richmond) and a network operations center/call center in Norton. Drivers are to utilize the following phone numbers to contact LogistiCare, depending on which region they operate in: o Region 1 (Norton): Provider o Region 2 (Forest): Provider o Region 3 (Richmond): Provider o Region 4 (Norfolk): Provider o Region 5 & 6 (Charlottesville): Provider Page 55 of 78

56 o Region 7 (Herndon): Provider Below is a map showing each Region, along with the Toll Free numbers that the Members use to contact LogistiCare. These numbers are not to be used by Transportation Providers or their drivers. Transportation Providers and their drivers are to use the numbers listed on the previous page. Page 56 of 78

57 Driver Requirements a. Are at least 18 years of age and have had a valid driver s license for at least one year. b. Have a current valid driver s license to operate the transportation vehicle to which they are assigned. c. Drivers shall have no more than two chargeable accidents or moving violations in the last three years. d. Drivers shall not have had their driver s license suspended or revoked for moving traffic violations in the previous five years. e. Drivers shall not have been convicted of any crime as defined in Va. Code (B). The Contractor must require that the transportation provider secure, maintain, and provide criminal background checks to DMAS from Virginia State Police and the national FBI fingerprint database on each driver before the driver transports members under this contract. f. All drivers and attendants shall be courteous, patient, and helpful to all members and be neat and clean in appearance. g. No driver or attendant shall use prescription medications that impact the ability to perform while on duty, alcohol, narcotics, or illegal drugs and no driver shall abuse alcohol or drugs at any time. The transportation provider shall not use drivers who are known abusers of alcohol or prescription drugs or known consumers of illegal narcotics or drugs. h. All drivers and attendants shall wear a visible nametag that is easily read and identifies the employee, the employer, and the Contractor. The driver shall show the nametag to the member, facility, or other service provider employee upon arrival for picking up the member. i. Vehicles always shall be smoke free. Drivers and attendants shall not smoke while in the vehicle, while assisting a member, or in the presence of any member. j. Drivers shall not use mobile telephones (including texting) or headphones while the vehicle is in motion. k. Drivers or attendants must exit the vehicle to open and close vehicle doors when members enter or exit the vehicle. Drivers or attendants must provide an appropriate level of assistance to members when requested or when necessitated by the member s mobility status and personal condition. This includes curb-to-curb, door-to-door, and hand-to-hand assistance, as shown in the manifest. l. If a curbside pick-up is not being made, drivers and attendants shall identify themselves, show their identification and announce their presence at the entrance of the facility or residence at the specified pick-up location or to attending facility staff. m. Prior to moving the vehicle, drivers and attendants shall assist members as needed to be seated and confirm that all seat belts are fastened properly. n. Prior to starting the vehicle, drivers and attendants shall properly secure all wheelchairs and wheelchair passengers. o. Drivers and attendants shall provide necessary assistance, support, and oral directions to members, including assistance to members with limited mobility, and with the loading, securing and storing of mobility aids and wheelchairs. p. Before departing the drop-off point, drivers shall confirm that the delivered members are safely inside their destination. Page 57 of 78

58 q. Drivers and attendants shall not touch any member except as appropriate and necessary to assist the member into or out of the vehicle, into a seat, to secure the seat belt, or to render first aid or assistance for which the driver has been trained. r. Drivers and attendants shall not solicit or accept money, goods or additional business from members. s. Drivers must be familiar with and knowledgeable of the streets and highways of the areas in which they are transporting. t. Drivers and attendants must comply with HIPAA, by keeping all members health care identifying information confidential, and not visible to other passengers, and by not discussing health care identifying information with anyone who is not involved with the member s treatment or other health care services. Services include: Curb-to-Curb; Door-to-Door; Hand-to-Hand Curb-to-Curb Assist passengers in opening the vehicle door, assist in the process of being seated; confirm all seat belts are fastened properly and that the door of the vehicle is secured before moving the vehicle. Assist by folding and storing the passenger s wheelchair or other mobility device as necessary. Assist passengers in the process of exiting the vehicle. Before departing drop-off point, shall confirm that the delivered passengers are safely inside their destination. Shall not transport passenger to any destination other than what is assigned and authorized by LogistiCare. Most transports are curb-to- curb unless otherwise noted on the trip manifest. Door-to-Door: Hand-to-Hand Transportation provided to Members who need assistance to safely move between the door of the vehicle and the door of the Member s pick-up point or destination. The driver exits the vehicle and assists the Member from the door of the pick-up point (e.g., residence), escorts the Member to the door of the vehicle and assists the Member in entering the vehicle. The driver is responsible for assisting the Member throughout the trip and to the door of the destination. Drivers, except for ambulance or stretcher van personnel, should not enter a residence. Transporting the Member from a person at the pick-up point into the hands of a facility staff member, family member or other responsible party at the destination. Some Members with dementia or developmental disabilities, for example, may need to be transported hand-to-hand. Page 58 of 78

59 Upon Arriving at a Location: Always Identify yourself All drivers shall wear and have clearly visible an easily readable name/identification tag Drivers shall show their name/identification tag to the passenger and/or facility staff. Passengers are not required to be transported before their scheduled pick up time WHAT IS CONSIDERED LATE? A-Leg more than 15 minutes past the scheduled pick up time B Leg (Scheduled) more than zero (0) minutes past the scheduled pick up time Will Call more than forty-five (45) minutes after initial notification that passenger is ready for pick-up Escorts One escort that has been arranged with LogistiCare prior to transport may attend each passenger.. Minors (children) 17 and under can be transported without an escort only after a Minor Consent Form has been completed and approved by LGTC prior to transport. Pick up and Drop off Locations Drivers must pick up and deliver passenger(s) to designated locations as listed on the manifest. It is strictly against LogistiCare policy to do otherwise! Appropriate Assistance Drivers shall not touch any passengers except as appropriate and necessary to assist passenger into or out of the vehicle, into a seat, to secure the seat belt, to secure wheelchair, or to render first aid or assistance for which driver has been trained. Use your discretion and BE CAREFUL and AWARE! Solicitation Drivers shall not solicit or accept money, goods or additional business from passengers at any time. No Eating or Drinking is allowed during transport of passengers. Page 59 of 78

60 Drivers shall not smoke while in the vehicle, while assisting a passenger or in the presence of any passenger or facility staff representative. Use of headphones at any time is strictly prohibited with the exception of hands-free headsets for mobile telephones. Drivers shall not use mobile phones while vehicles are in motion (while driving). Drivers must be familiar with the streets and highways of the areas in which they are transporting. Use maps, driving directions, GPS navigation systems, etc. Getting lost is not an option! When You Know That Transportation is going to be late... Promptly Notify LogistiCare Provider Line Notify the awaiting customer and/or facility at the pick-up point. No Shows If a driver arrives to pick up a passenger and the passenger is not at the pick up address, or if the passenger informs you that they are not going to the scheduled appointment, the driver (YOU) or the provider company MUST notify the Regional Office Provider Line as soon as possible. To eliminate or lessen the chance of a rider NO SHOW, one good and recommended practice is to contact the passenger the night before or the morning of the scheduled appointment to verify that the member will still be attending their appointment. Page 60 of 78

61 HIPAA- Health Insurance Portability and Administration Act of 1996 The law requires that all information that may individually identify a patient be used with utmost care and only in connection with the treatment of that patient. All information about passengers, including their names, Medicaid number, doctor s name, and address, must be kept in strict confidence. Trip information is provided on a faxed or downloaded document known as the Trip Manifest. The Manifest lists: 1. Trip Number Identifies trip by an assigned number issued by LGTC 2. Pick up and drop off time and address 3. Dir Comment (Directions/Comments) Notifies driver of any special needs or directions 4. Patient identification- Name and contact information The Trip Log: 1. Drivers must submit original trip logs with all proper signatures 2. Drivers must fill out trip logs in their entirety 3. Drivers must utilize their full name as it appears on their driver s license 4. Trip logs with incorrect information will result in a denial of payment. 5. Complete and accurate information is the responsibility of the DRIVER. 6. If member is unable to sign, you must have a caretaker at the point of pick-up and point of drop off sign for the member. Page 61 of 78

62 7. Drivers may NEVER sign for the member Examples of these documents are on the following pages. Important Terms A-Leg - First part of trip at the pick-up point, can be a residence or a facility B-Leg - Second part of a trip, the return from a facility to a residence for example Will Call - Usually the return part of a trip when the return time is not known or scheduled (for instance, a doctor s appointment). Drivers must arrive within 45 minutes of notification that the member is ready for pick-up. Vehicle Inspection LogistiCare has Field Monitors that conduct routine inspections of all Transportation Provider vehicles. Vehicles must abide by regulations set forth by local and state regulations, the ADA, DMAS, and LogistiCare. The following page shows a sample Vehicle Inspection Report that your vehicle, depending on the applicable level of service, must be able to pass at all times. Page 62 of 78

63 Page 63 of 78

64 CLIENT JOE DAY, AGOOD 2009 BEE ST 123 HAPPY AVE Driver, Mike FOR TRAINING PURPOSES ONLY Page 64 of 78