Non-Emergency Medical Transportation Services

Transcription

1 Request for Proposals for Non-Emergency Medical Transportation Services Proposal Number RFP-DSSOC03-07 Orange County Department of Social Services David Jolly, Commissioner 11 Quarry Road Goshen, NY 10924

2 I. GENERAL INFORMATION A. INTRODUCTION. The Orange County Department of Social Services (DSS) is hereby announcing its intent to contract for Non-Emergency Medical Transportation Services. The County of Orange, through the Department of Social Services is seeking proposals for the provision of non-emergency medical transportation for Medicaid eligible individuals on a prior approval basis consistent with New York State Department of Health Rules and Regulations (18 NYCRR and 92 ADM-21). The Orange County Department of Social Services anticipates awarding a contract to one(1) Proposer to administer all non-emergency medical transportation services delivered to Medicaid eligible individuals. Administration of medical transportation services includes, but is not limited to the following activities: Operate a toll free call center to receive requests for transportation from approximately 39,000 Medicaid recipients in the County of Orange; Determine the eligibility of the recipient based on their Medicaid status; If eligible for transportation, determine the mode of transportation required and schedule transportation with a transportation provider who has been issued a Medicaid provider I.D. by the New York State Department of Health; Provide the transportation vendor with a prior authorization number for the trip based on the established rate for the County of Orange and the number of miles associated with the trip; Coordination of services designed to deliver quality transportation services at the lowest possible cost; Coordination of Orange County s existing waivers as well as future waivers; Coordination and payment of the mileage reimbursement program for consumers who provide their own transportation; Coordination and payment of a fixed transportation routing system in the City of Newburgh, Town of Newburgh and Town of New Windsor; Analysis and reporting of transportation service utilization trends and factors, including representation of utilization by geographic zones and mode of transport. The Orange County Department of Social Services has identified the following goals as being consistent with this Request for Proposals. a. Enhance transportation services to recipients of Medicaid services throughout the county of Orange. b. Coordinate transportation services with local health care providers to maximize in-county transportation and health care services for Medicaid recipients. c. Reduce the average cost per trip associated with the Medical Transportation Services. d. Maximize the use of public transportation and mileage reimbursement when available. 3

3 e. Provide the most cost effective, efficient method of transportation available based on the needs of the consumer. B. ISSUING OFFICE. This RFP is issued by the DSS, which is the sole contact for information relating to the RFP. C. INQUIRIES. Written inquiries only regarding this RFP should be referred to: Lydia Mowry Director of Program Integrity Orange County Department of Social Services Box Z, Quarry Road Goshen, NY Fax: All inquiries must be received in writing by July 27, All inquiries requiring a response will be responded to as an addendum to the Request for Proposals by August 10, D. INCURRING COST. The DSS shall not be held liable for any costs incurred in the preparation and production of a proposal in response to this RFP or for any work performed prior to the issuance of a fully executed contract. E. REJECTION OF PROPOSALS. This RFP does not commit the DSS to award a contract, or to procure, or to contract for services or supplies. The DSS reserves the right to accept or reject any or all proposals received as a result of this request; to negotiate with all qualified sources; or to change or cancel, in part or in its entirety, this RFP if it is in the interests of Orange County, or the DSS, to do so. The contracting office of the DSS may require the Proposers selected to participate in negotiations and to submit price, technical, or other revisions, of their proposals as may result from negotiations. F. AMENDMENTS TO REQUEST FOR PROPOSALS. Amendments to this RFP may be necessary and will be furnished by mail or via The Orange County Purchasing website ( to all prospective Proposers who have requested such materials. G. PERTINENT DATES. Release of RFP: July 13, 2007 Written Inquiry Deadline: July 27, 2007 Submission of Proposals: August 31, 2007 Selection of Contractor: September 14, 2007 Commencement of Services: January 1, 2008 These dates are approximations. The DSS reserves the right to alter these dates to best serve the interests of the DSS. 4

4 H. ADDITIONAL INFORMATION MAY BE REQUIRED BY THE ORANGE COUNTY DEPARTMENT OF SOCIAL SERVICES. The DSS may award a contract based upon offers received without discussion of such offers with the Proposers. Each offer, therefore, should be submitted in the most favorable terms from a price and technical standpoint, which the Proposer can make to the DSS. However, the DSS reserves the right to request additional data or oral discussions or presentations in support of written proposals from any or all of the Proposers. In addition, the DSS reserves the right to make on-site visits to the Proposer s place of business to assess and/or evaluate Proposer qualifications. If DSS elects to have oral discussions or presentations in support of written proposals from any or all of the Proposers, these meetings will occur on September 4, 2007, between the hours of 1:00 PM 5:00 PM, at our Goshen Office, located on Quarry Rd. I. TERMS OF AN AGREEMENT RESULTING FROM THE ACCEPTANCE BY THE ORANGE COUNTY DEPARTMENT OF SOCIAL SERVICES OF A PROPOSAL IN RESPONSE TO THIS REQUEST FOR PROPOSALS. 1. TERM. The initial term for the accepted proposal shall be from January 1, 2008 through December 31, The County maintains the option to extend the agreement for two (2) additional one-year terms. The successful Proposer is required to provide all services outlined in this RFP. 2. APPROVAL OF AGREEMENT. Any contract resulting from this RFP is subject to the approval of the Commissioner of Social Services, the Personnel Office, the Budget Office, the Office of Risk Management, and the Office of the County Attorney and is not valid until signed by the County Executive. 3. AVAILABILITY OF FUNDS. Any contract awarded as a result of this RFP is contingent upon the availability of funds to the DSS. In the event that funds become unavailable during the term of any contract resulting from this RFP, such contract will be terminated by the DSS without further cost. 4. PAYMENT. The selected Proposer will bill the DSS in twelve monthly installments for Administrative costs. Transportation payment to the vendors will be issued by the New York State Department of Health, through the prior authorization process currently used to manage and pay claims through this electronic system. The proposer will be required to issue prior authorizations in a manner consistent with the emedny System. It is the intent of the Department of Social Services to allow the proposer the ability to coordinate and arrange two(2) transportation services for which reimbursement will be handled through the County of Orange as a Schedule E, Administrative expense. These include the Orange County Westchester Medical Center waiver and the development of a fixed routing system within the zip code area. Payment for the optional second and third years of the proposal shall include a negotiated adjustment, based upon the performance of the vendor, utilization of medical transportation services, the annual average cost per trip as well as increases in Medicaid lives covered. Any increase will not exceed Orange County s percentage of Medicaid growth rate for MMIS. Any request for price 5

5 adjustment must be supported by cost reports, utilization rates and increased trip volume. 5. TERMINATION FOR DEFAULT OR FOR THE CONVENIENCE OF THE ORANGE COUNTY DEPARTMENT OF SOCIAL SERVICES OR THE COUNTY. Performance under any contract resulting from this RFP may be terminated by the DSS whenever: The contractor shall default in performance of contract and shall fail to correct such default within the period specified in a written notice; or It is determined that such termination is in the best interest of the DSS and/or Orange County. This AGREEMENT may be terminated if COUNTY deems that termination would be in the best interest of COUNTY, provided that COUNTY shall give written notice to VENDOR not less than thirty (30) days prior to the date upon which termination shall become effective. Such notice is to be made via registered or certified mail, return receipt requested or hand delivered with receipt granted by VENDOR. The date of such notice shall be deemed to be the date the notice is received by VENDOR established by the receipt returned, if delivered by registered or certified mail, or by the receipt granted by VENDOR, if the notice is delivered by hand. 6. DISCLOSURE OF ITEMS MARKED PROPRIETARY. No public disclosure of items marked proprietary submitted under this RFP will be made. Copies of Executed contracts that result from this RFP are available for public disclosure upon request, as are non-proprietary portions of any proposal submitted in response to this RFP. 7. INDEPENDENT PRICE DETERMINATION AND GRATUITIES. By submission of its offer, the Proposer certifies that, in connection with this procurement: The prices in this offer have been arrived at independently, without consultation, communication, or agreement, for the purpose of restricting competition, as to any matters relating to such prices with any other Proposer or competitor; and Unless otherwise required by law, the prices which have been quoted in this offer have not been knowingly disclosed by the Proposer prior to award, directly or indirectly, to any other Proposer or to any competitor; and No attempt has been made or will be made by the Proposer to induce any other person or firm to submit or not submit an offer for the purpose of restricting competition; and No elected or appointed official or employee of the DSS and Orange County shall benefit financially or materially from this contract. This contract may be terminated by the DSS if gratuities were offered or given by the Proposer or his agent to any official or employee of any of the agencies named above. 6

6 8. OWNERSHIP OF INFORMATION. The DSS has the exclusive ownership and unlimited rights to use, disclose or duplicate for any purpose whatsoever, all information, data, designs and materials developed by the Proposer under Contract with Orange County. 9. EXAMINATION OF RECORD. In submitting a proposal, the successful Proposer agrees that the DSS has access to and the right to examine directly all pertinent documents, papers and records of the contractor and/or any subcontractor as related to any contract and/or subcontract resulting from this RFP until six years after final payment has been made pursuant to any contracts awarded as a result of the Department s acceptance of the Proposer s proposal. 10. NEGOTIATED CHANGES. In the event that negotiated changes occur after the awarding of contracts, the same pricing policies called for in the original contracts will remain in effect. 11. CONFIDENTIALITY. The successful Proposer as a result of this RFP agrees to observe the confidentiality provisions of all applicable Federal and New York State laws and regulations relating to confidentiality of records and information gathered, obtained, reviewed, or developed in the performance of the resulting agreement; and further agrees to require each of its employees, partners, and agents assigned to the performance of this agreement to observe said provisions. 12. CONTRACT DOCUMENTS. The RFP, selected proposal, changes and addendum and the actual contract will constitute the basis for a legally binding contract between Orange County on behalf of the DSS and the successful Proposer. J. INSURANCE For all of the Services set forth herein, and as hereinafter amended, successful bidder shall maintain, or cause to be maintained, in full force and effect during the term of this Agreement, at its expense, Worker's Compensation insurance, liability insurance covering personal injury and property damage, and other insurance, with stated minimum coverage, all as listed below. Such policies are to be in the broadest form available on usual commercial terms and shall be written by insurers of recognized financial standing satisfactory to the County who have been fully informed as to the nature of the services to be performed. Except for worker's compensation and professional liability, the County shall be an additional insured on all such policies with the understanding that any obligations imposed upon the insured (including, without limitation, the liability to pay premiums) shall be the sole obligations of successful bidder and not those of the county. Notwithstanding anything to the contrary in this agreement, successful bidder irrevocably waives all claims against the county for all losses, damages, claims or expenses resulting from risks commercially insurable under the insurance described in this addendum. The provisions of insurance by successful bidder shall not in any way limit successful bidder's liability under this agreement. Type of Coverage Worker's Compensation Employer's Liability or similar insurance Automobile Liability Limits of Coverage Statutory $1,000,000 each occurrence $1,000,000 aggregate 7

7 Bodily Injury, Property Damage Comprehensive general Liability, including broad form contractual liability, bodily injury, and property damage Professional Liability (If commercially available for your profession) $1,000,000 each occurrence $5,000,000 each occurrence $1,000,000 aggregate $1,000,000 aggregate $1,000,000 each claim Each policy of insurance shall contain clauses to the effect that (i) such insurance shall be primary without right of contribution of any other insurance carried by or on behalf of the County with respect to its interests, (ii) it shall not be canceled, including without limitation, for non-payment of premium, or materially amended without fifteen (15) days prior written notice to the County, directed to the County s Risk Management Division and the Department Head, and the County shall have the option to pay any necessary premiums to keep such insurance in effect and charge the cost back to Successful Bidder. To the extent it is commercially available, each policy of insurance shall be provided on an "occurrence" basis. If any insurance is not so commercially available on an occurrence" basis it shall be provided on a claims made basis, and all such claims made policies shall provide that: 1. Policy retroactive dates coincide with or precede the Successful Proposer's start of the performance of the Services (including subsequent policies purchased as renewals or replacements); 2. Successful Bidder will maintain similar insurance for at least six (6) years following final acceptance of the Services; 3. If the insurance is terminated for any reason, Successful Bidder agrees to purchase an unlimited extended reporting provision to report claims arising from the Services performed for the County: and 4. Immediate notice shall be given to the County through the Department Head and the County s Risk Management Division, of circumstances or incidents that might give rise to future claims with respect to the Services performed under this Agreement. II. SCOPE OF WORK The Orange County Department of Social Services is seeking proposals in order to select a contractor to provide administration and coordination of non-emergency medical transportation services for Medicaid eligible individuals. Under the Medicaid program, payment will be made for medical transportation when such transportation is essential in order for the individual to obtain allowable and needed medical care and services. In order to be eligible for medical transportation services, an individual must be a Medicaid program recipient receiving medical care and services under the Medicaid program. Payment for non-emergency medical transportation will be made only, when such transportation has been approved by the contractor. Prior approval for payment may be 8

8 denied for a number of reasons, including when the individual has access to and can make use of transportation such as a private vehicle or mass transit, which the individual uses for the ordinary activities of daily living. Emergency ambulance services, as defined in 18 NYCRR Part and in 92 ADM 21, are not covered in this RFP. Currently for Orange County s Medicaid recipients who are enrolled in Medicaid Managed Care programs, transportation services are not provided as part of the scope of benefits for all available Medicaid Managed Care Plans with the exception of one plan (Fidelis). For consumers of that one plan, payment will be made only for non-emergency transportation that is not available through the individual s Medicaid Managed Care provider plan. Generally, the individual should use the least expensive mode of transportation that is appropriate and available based upon his or her medical condition, on the medical provider s location and on the treating medical practitioner s instructions. If the provider is within walking distance, and the individual s condition allows, the individual should walk. For Medicaid eligible individuals who need to be transported out of the common medical marketing area, based on a physician s instruction, payment will be made by the contractor for services at the least costly, yet appropriate, level of service. Medicaid payments can be made only to lawfully authorized vendors of transportation services. In order to be eligible to receive payment the vendor must be lawfully authorized on the date the services are rendered. The Department of Social Services has three specialized transportation projects currently underway for recipients of non-emergency medical transportation. These projects are provided for below and will be continued through The Orange County Department of Social Services currently maintains a transportation routing system for trips to and from the Westchester Medical Center (WMC) in Valhalla, NY. Consumers who request a trip to WMC are required to be transported through a single vendor who offers door to door transportation services Monday through Friday. This method of transportation is coordinated and paid for through the County s Non Emergency Medical Transportation provider. On an annual basis, the Proposer will be required to negotiate and/or publish a competitive bid for the purchase of these services. In regards to the RFP, the Proposer should budget $264,000 annually for these services. If the Proposer is awarded the contract with the County of Orange, the selected vendor will be permitted to negotiate directly with the vendor of this transportation service. Rate increases, decreases or modifications to the service will be permitted, but subject to the approval of the Department of Social Services. The Department of Social Services also operates an approved Dialysis Waiver for trips to and from Dialysis appointments. This waiver allows the Department to bid all trips to one vendor for transportation to and from Dialysis Centers. The management of dialysis trips through one provider has proven to be cost effective and efficient. The Proposer will be required to manage this transportation service under agreement with the County of Orange. In conjunction with the County of Orange, the Proposer will be required to renegotiation of the fee structure and vendor annually. 9

9 The Department of Social Services is also requesting the development of a fixed route transportation system within the geographic area of the county represented by two zip codes, and With more than 13,000 trips provided with a destination and origin address within these two zip codes on an annual basis, the need for a fixed routing system is clearly evident and supported. As the planning for the development of this project will require the sharing of confidential data, most importantly the addresses of origin points, Proposers are not required to develop this system in conjunction with the RFP. Rather, upon receipt of an award, the Proposer will be required to work with the DSS in developing a competitive bid process for this service. Proposers are also required to manage the personal gasoline reimbursement and public transportation utilization for the County of Orange. Based on current trends, providers should budget $150,000 annually to provide reimbursement for costs associated with both gasoline reimbursement and public transportation utilization. These funds are provided on a 100% reimbursement basis, with the Proposer being reimbursed for their expenditures of both gasoline reimbursement and public transportation costs. If expenditures trends or real expenditures exceed $150,000, funds will be available to meet the changing costs. In 2005, 10,760 trips were reimbursed directly to consumers who had their own transportation and were eligible for gasoline reimbursement. In 2006, 10,878 trips were reimbursed through the gasoline reimbursement. The total costs per year for gasoline reimbursement included $39,515 in 2005 and $118,743 in In 2006, the mileage rate was increased substantially to enhance the number of consumers who selected this option as gasoline reimbursement represents a savings of approximately one (1) dollar per mile. Proposers should make every effort to support this mode of transportation. Public transportation providers in the County of Orange do not accept a prior authorization number for transportation. Orange County provided transportation to 5,238 trips on available public transportation during the year 2005 and 7,775 in Current trends place this number at approximately 8,000 for Trips scheduled on a public transportation route must be paid for by the Proposer and subsequently reimbursed by the County of Orange. In 2005, $5,959 was spent on public transportation, this figure increased to $8,646 in The Department of Social Services will also require performance measures to be tied directly to project funding. These measures include the following: a. Health Care Provider Visits: (1.5% of annual budget, measured and authorized quarterly). 50% of all health care providers with a vested interest in transportation for their consumers will receive a minimum of one face to face customer service meeting with the Proposer. A report of all visits, including corrective action plans if warranted will be provided to the DSS on a quarterly basis. b. Fraud, Waste and Abuse: (4% of annual budget, measured and authorized annually). 350 on-site (street level), verification visits will be required on an annual basis. These visits must include an on-site monitoring of scheduled livery or ambulette trips to insure that consumers are receiving the authorized service. A 4% performance bonus and/or reduction will be authorized based on the Proposer s ability to conduct 350 on-site (street level) verification visits on an annual basis. 10

10 c. Customer Satisfaction: (2% of annual budget, measured and authorized quarterly). Based on a scale of 0% to 100%, Proposer will develop and conduct a consumer satisfaction survey geared towards measuring consumer satisfaction and addressing consumer complaints. On a quarterly basis, Proposer will provide the DSS with an average score of customer satisfaction surveys. If the average, gross score of a minimum of 200 surveys results in an average that exceeds 80%, the performance measure associated with this target may be authorized. A 2% performance bonus and/or reduction will be authorized based on the performance measure noted above. d. Call Center: (1.5% of annual budget, measured and authorized quarterly). A 1.5% performance bonus and/or reduction will be authorized if all calls are answered within 6 rings and hold time is limited to an average of less than 3 minutes. Results for this measure will be provided to the DSS on a quarterly basis. e. Average Cost Per Trip: (4% of annual budget, measured and authorized annually). A 4% performance bonus and/or reduction will be authorized if the Proposer is successful in maintaining the average cost per trip for the Orange County Non- Emergency Medical Transportation Program for a period of one year. The average costs of taxi (livery) trips between September and December 2007 will be considered the base months when verifying this performance measure in f. Reduction of Out of County Travel: (2% of annual budget, measured and authorized annually). A 2% performance bonus and/or reduction of the annual budget may be authorized if the proposer is successful in reducing the number of trips authorized to and from out of County medical facilities. The performance measures noted above are non negotiable and will be required to be contracted by the awarded Proposer. All Proposers should consider this carefully and include in their proposal a clear, validated method of measuring and reporting on each of the performance measures noted above. The Successful Proposer will be responsible for the performance of the following activities: a. Receive and dispose of all transportation requests from Medicaid eligible individuals or their representatives. 1. Receipt of requests for Medical Transportation - The Proposer must have the ability to receive a large number of telephone and fax requests from eligible recipients, their representative(s), or an ordering medical practitioner. The Proposer must establish at least a single telephone and fax number for the acceptance of transportation requests, accept requests for service up to one year in advance, and accept multiple requests for service at the same time. The Proposer is urged to implement a system for accepting separate incoming calls from transportation providers and medical practitioners. The Proposer should implement a system that will require all Medicaid eligible individuals in need of transportation for nonemergency or non-urgent medical care, to request such services a minimum of 72 hours in advance. Requests must be received in a timely 11

11 and polite manner. Sufficient staffing and telephone lines must be available to allow all calls to be answered in a reasonable time (e.g. 6 rings). The time a telephone call may be placed on hold should not exceed 3 minutes. The Proposer must also accommodate requests for same day transportation services when urgent care is required. Urgent care means that level of care ordered and verified by the individual s physician, by phone or fax, to be necessary on the day the request is made. The contractor must establish a system for receiving requests from medical practitioners for urgent or discharge transportation, including periods of time after normal business hours and on weekends (24 hours a day, 7 days a week.) 2. Processing Requests for Medical Transportation - Upon receipt of a request for medical transportation, the Proposer s staff must perform the following tasks: a. Confirm the individual s eligibility status as a Medicaid recipient, utilizing the emedny System. Requires the Proposer to be a registered user of the emedny System operated through the New York State Department of Health. b. Explain the rules and regulations of the Medicaid medical transportation program. c. Interview the individual to determine their normal means of transportation, nature and severity of illness, caller s address, location of required medical service, transportation needs, whether the required medical service is a Medicaid covered service and other unique circumstances which have an effect on the need for payment for transportation services. d. Obtain the Medical Practitioner s instructions to support and justify the request for prior authorization for non-emergency ambulance, ambulette and invalid coach. The utilization of such modes of transport is a medical decision and requires the recommendation of a medical practitioner. The Proposer shall allow one trip pending receipt of such medical practitioner order. The Proposer will provide the individual or medical practitioner with a standard form to be completed. Once the Proposer s staff receives the completed form, the information on the form will be reviewed, and the request for prior authorization for non-emergency transportation will be approved or denied based upon Medicaid program criteria. e. Orange County expects the Proposer will develop and implement an automated system to manage the reservations, scheduling and routing of requests for non-emergency medical transportation. f. Determine whether to approve or deny the transportation request based on the information gathered from all sources and application of the relevant medical transportation rules and regulations. Assign a unique prior approval number to the trip(s). g. Select an appropriate transportation mode and vendor based on cost and consumer preference, telephone the vendor to arrange the transportation and send the trip order to the vendor. h. Generally, the recipient should use the least expensive mode of transportation that is appropriate based on his or her medical condition and the individual s provider of medical services location. 12

12 The Proposer agrees that if the lowest cost, appropriate level of transportation is not available, the requested trip will be scheduled at the next higher level of transportation service. i. As required, Proposer staff will process changes to trip requests. 3. Special requirements Specific rules must be applied to special requirements. The Successful Proposer will cooperate with the Department in the development and implementation of guidelines for authorizing multiple trips for recipients attending regularly scheduled medical care; day treatment programs; transportation outside the common medical marketing area; air ambulance transportation; nursing home transportation; and hospital admissions and discharges. Prior authorization is not required for emergency medical transportation. Callers requesting emergency transportation will be directed to call emergency service (911). Requests for transportation out-ofarea will be reviewed and payment made only when sufficient medical documentation is received, and reviewed, and approved by the Contractor. 4. Correspondence As required, the Proposer will generate and mail correspondence to recipients and vendors regarding program requirements, changes in medical transportation program regulations, eligibility issues, etc. Should a request for transportation services be denied for an individual, a letter will be sent explaining the reason for the decision, and explaining the recipient s right to question the decision by requesting a Fair Hearing. The Orange County Department of Social Services will provide the Successful Proposer with a list of all program correspondence and processing requirements. 5. Quality standards When applicable and based on Local, State and Federal law, the Successful Proposer must develop and implement procedures to ensure that all vendor vehicles and drivers meet program regulatory standards. For example, all ambulance and ambulette vendors must certify annually in writing their compliance with New York State Department of Transportation, Department of Health and Department of Motor Vehicles regulations. The Proposer must mail a letter to effected vendors and monitor their responses to ensure they are in compliance with regulatory requirements. The Proposer is expected to detail its plan to develop and implement procedures in coordination with the Department to measure vendor performance. The purpose of such procedures is to develop and apply standards to assure recipients receive quality transportation services at the lowest cost. Vendor performance addresses, but is not limited to, such issues as failure to meet appointments, timeliness of vehicle pick up and delivery, refusals to take longer trips, total travel time, etc. 6. Record keeping and Reporting The Successful Proposer must maintain complete records of all medical transportation activities in order to document that all Medicaid medical transportation rules and regulations are being followed. These records are used to provide a basis for reporting to the Orange County Department of Social Services on program activities. It is the responsibility of the Successful Proposer to report monthly regarding costs per trip, by mode and by vendor, on or before the 15 th of the month following the month of service. The Successful Proposer is expected to provide the 13

13 Department with reports of complaint calls and their resolution on a monthly basis. Should a recipient request a Fair Hearing to review a decision made concerning non-emergency medical transportation, the Proposer s staff must be readily available to provide to the Department all pertinent information in verbal and/or written format. If required, Proposer s staff must be available to attend a Fair Hearing at the Department s Orange County offices. 7. Recipient and Vendor Fraud The Proposer must monitor possible fraud, both by vendors and recipients who incorrectly claim Medicaid eligibility. Suspected fraud must be reported to Orange County Department of Social Services in writing within twenty-four (24) hours of identification, or by the close of the next business day. Orange County shall be held harmless for cost incurred due to the fraudulent conduct of transportation providers or individuals. The Proposer must develop procedures to support Orange County Department of Social Services initiatives to identify and address fraudulent activities. 8. Written Procedures The Proposer will develop formal written procedures and guidelines for all aspects of the Medicaid medical transportation program. Such procedures and guidelines will be distributed to all staff and updated to reflect changes in program requirements. 9. Staff Training The Proposer will provide regular staff training to ensure all personnel have sufficient knowledge of the requirements of the Medicaid medical transportation program. 10. Data Transfer - It is essential that the vendor understand and have access to the New York State Department of Health, emedny System. This system allows for vendors approved in the State of New York, to access eligibility information on consumers in the Medicaid Program. It also offers the proposer the ability to generate a prior authorization number for the transportation that was scheduled for the eligible consumer. Determining eligibility and being able to understand that consumer s level of access to transportation is essential as some consumers have restrictions, access to third party health insurance or access to transportation through a managed care plan which may limit the ability of the transportation vendor to be paid for trips scheduled through the call center. By the submission date of this Request for Proposals, the proposer must have an approved method for communicating with the emedny System. Most importantly, the proposer must have access to a data exchange method which allows for the transfer of data to produce prior authorizations for transportations. A prior authorization number is created by the trip data provided to the emedny System, the vendor does not create the prior authorization. The vendor provides the data elements required by the emedny System, which produces a prior authorization. The PA is then available to the transportation vendor once the trip is completed through the epaces System currently operated by the NYS Department of Health. III. PROPOSAL INSTRUCTIONS 14

14 A. OVERVIEW. All Proposers submitting a proposal as required under this RFP must follow the instructions established in this section as well as the format provided in Attachment A. B. PREPARATION OF PROPOSALS. The information necessary to prepare a proposal is contained in the Scope of Services and the proceeding attachments: Attachment A (Proposal Format and Content), Attachment B (Non-Emergency Medical Transportation Program Statistics), and Attachment C (Orange County Non-Emergency Transportation Services Time Line). C. EVALUATION CRITERIA. Prospective Proposers are advised that the selection of a Proposer for contract award is to be made after careful evaluation of the proposals received by the evaluation committee. The evaluation committee will consist of representatives from the DSS, or representatives from other departments as deemed appropriate. Proposals will remain valid until the execution of a contract by Orange County, unless otherwise rejected consistent with this RFP. a. Proposals received will be evaluated and scored by a team at the Orange County Department of Social Services (OCDSS). Proposals shall be evaluated based on a scale of 0-2, with 0 as does not meet criteria, 1 as meets criteria, 2 as exceeds criteria. b. The evaluation process is designed to award the proposal to the proposer with the best combination of attributes based on the evaluation criteria. A score shall be calculated for each criterion for each proposal. The total of the scores for all criteria in each proposal will be known as the Proposer s final score. Criteria and scores are as follows: CRITERIA SCORE (0-2) Proposal is responsive to the required work (Scope of Services) and details a reasonable work plan under one or more models for billing Proposal clearly describes professional qualifications and prior experience in similar projects Proposal depicts a clear understanding of the model proposed and represents a high quality program for delivering non-emergency medical transportation Appropriateness of budget and total proposed costs Proposer s demonstrated capabilities (equipment, financial solvency, location) Appropriateness of the model for developing and implementing vendor relationships Proposed work plan and ability to start up January 1, 2008 Client References Proposer has an accepted data exchange agreement and or 15

15 approved data transfer plan with the NYS DOH. Proposed staffing plan including resumes, supervision and inservice training Proposal depicts a clear understanding of the New York State Medicaid Program. Proposed contractor has an established track record with providing medical transportation services under the guidelines of the New York State Medicaid Program. Performance targets identified by the proposer and their relationship to project funding. D. SUBMISSION OF PROPOSALS. Proposals in response to this RFP are hereby solicited from all qualified and eligible Proposers. Responses to this RFP must be submitted in the original and three copies in a sealed envelope addressed in the following format: David Jolly Commissioner Orange County Department of Social Services Box Z, Quarry Rd. Goshen, NY To be considered, proposals must be received by the DSS no later than 5:00 PM on August 31, Upon request, receipts will be provided for proposals that are hand delivered. Our hand delivered address is 11 Quarry Road, Goshen NY The DSS reserves the right to reject any and all proposals received in response to this RFP. Late proposals will not be accepted. E. COVER LETTER FOR PROPOSAL. The cover letter must contain the following: Name, title and telephone number of the individual to be contacted regarding the RFP Identity of the representative authorized to bind firm to a contract F. SIGNATURE ON PROPOSAL. An official authorized to bind the Proposer must sign the proposals. The proposals must also provide the following information concerning the individuals with authority to negotiate for and contractually bind the Proposer: Name, Title, Address, and Telephone Number. G. SELECTION OF SUCCESSFUL PROPOSER. A decision by the DSS selecting successful Proposers or rejecting all proposals in response to this RFP shall be made by September 14, The successful Proposer must provide services to the DSS in accordance with the terms of the contract documents. 16

16 ATTACHMENT A PROPOSAL FORMAT AND CONTENT In order for Proposers to be considered for an award, the terms, conditions and instructions contained in this RFP, its cover letter and attachments must be met. Any proposals, which do not meet these criteria, may be considered non-responsive. The proposal should be submitted in one volume and that volume subdivided into three easily identified sections as follows: 1. Section 1 - Technical Proposal. This section shall describe the Proposer s approach and plans for accomplishing the work outlined in the Scope of Work. 2. Section 2 - Cost Proposal. This section shall contain all information related to the project costs. 3. Section 3 - Organizational Support and Experience. This section shall contain all pertinent information relating to the Proposer s organization, personnel and experience that would substantiate the Proposer s qualifications and capabilities to perform the services required by the scope of the RFP. Specific instructions regarding the structure of each section are described below. Section 1 Technical Proposal: a. Provide a narrative overview description of your proposed service for the Non-Emergency Medical Transportation Services program. b. Specify how the program will be established to handle the large volume of trip requests specified in Attachment B, in a timely, friendly and efficient manner. c. Provide details of any automated phone system capabilities you will employ. d. Provide details regarding how your call center will establish eligibility and determine if the consumer has Managed Care coverage that prevents fee for service non emergency medical transportation. e. Provide details regarding access to the call center for medical professionals. f. Provide details regarding how the mode of transportation will be determined. Specifically describe how the medical necessity form required for ambulette trips will be received, verified and stored. g. Provide details regarding any medical staff maintained by your organization and their role in the service delivery process. h. Currently, the County offers a fee schedule to transportation vendors which include a curb fee for pick up, based on mode and a dollar amount per mile traveled, with descending costs for trips beyond 25 miles and 50 miles. Specify how your organization will determine the mileage for each trip scheduled and calculate the total costs for the prior authorization. i. If your organization proposes to change the existing per mile fee structure, provide details regarding your proposed change and the benefit to Orange County. j. Provide details regarding how the call center will encourage the use of public transportation and/or gasoline reimbursement. 17

17 k. Provide details as to how the prior authorization process will be completed. l. Provide details regarding your organizations experience with trip data transfers to create prior authorizations with the New York State Department of Health and their emedny vendor Computer Sciences Corporation. m. To establish a prior authorization, the costs of the trip must be calculated prior to submission to the emedny System. Describe any automated system currently used by your organization that determines costs per trip. n. Provide details regarding your organization s back up to communicate with emedny in the event that a mass data transfer is unsuccessful and required direct data entry in the emedny System in order to generate the prior authorization. o. Provide details as to how relationships with transportation providers will be established. p. Specify how urgent care requests and special transportation requirements will be addressed, including but not limited to service to clients residing in rural areas of Orange County as well as air transportation. q. For the Westchester Medical Center Transportation System, Dialysis Waiver and Fixed Routing Project, describe how your organization will approach the annual renegotiation of these transportation services. r. Describe your proposed approach to identifying and responding to instances of consumer and vendor fraud. s. Describe your proposed approach to implementing a program of quality assurance related to the transportation services provided. t. Describe your proposed approach to program evaluation and reporting, including but not limited to trip and expenditure data collection and analysis, and consumer satisfaction. u. Describe how the performance measures required under this RFP will be met, validated and reported to the County of Orange, Department of Social Services. v. Describe your specific plan for achieving medical transportation cost savings (average cost per trip). w. Describe how your organization will establish consistent face to face meetings with the Orange County Department of Social Services Medical Transportation implementation team. x. Describe how your proposed program will be implemented. Include your anticipated staffing pattern and related job descriptions for the staff positions, which will be responsible for both administration/management and direct service delivery. Provide a work plan for program start-up and implementation that supports a January 1, 2008 start date. y. Propose any additional specific performance targets for your organization and how these targets will be measured and reported to OCDSS. Orange County is interested in vendors who are willing to propose specific performance measures tied directly to the program funding. If specific performance measures are developed and tied to funding, the measures should be consistent with the goals provided for this RFP. z. Provide any other information that you feel would distinguish your organization s approach to the delivery of services under the Non- Emergency Medical Transportation Services program. 18

18 Section 2 - Cost Proposal: a. Provide a line item budget for your proposed program of Non-Emergency Medical Transportation Services, clearly distinguishing administrative costs from transportation costs by providing costs in two separate proposals, as noted below. Administrative a. Designate all involved personnel costs, both direct service and administrative, full-time equivalency (FTE s) and fringe benefit rates. b. Designate all OTPS (other than personnel services) costs, travel, supplies, telephone, insurance and other essential program costs. c. Provide a budget narrative that describes the basis for your administrative budget. d. The Department of Social Services limits administrative overhead costs to 13% of the annual budget. Transportation a. Budget $150,000 for gasoline and public transportation utilization and describe in the budget narrative how these payments will be made to consumers and public transportation vendors. b. Budget $264,000 for the Westchester County fixed route system. Describe how your organization will negotiate and select a vendor beyond the initial agreement with the current vendor. Section 3 - Organizational Support and Experience 1. A brief history and description of your organization. Provide a copy of your organization s most recent annual financial report. 2. Identify your organization s professional staff members who would be directly involved in the County engagement, the experience each possesses, and the location of the office from which each will work. 3. Give the name and title of person(s) authorized to bind the Proposer, the main office address and telephone number (including area code). 4. Detail your organization s experience with the administration, provision and coordination of non-emergency medical transportation services. In particular, you should address the following: a. Understanding of, and experience in, professional transportation coordination and delivery activities, including the scheduling, dispatching and provision of passenger transportation. b. Capability to receive and process a large volume of telephone requests for non-emergency medical transportation. c. Ability to learn and implement the rules and regulations for Medicaid eligible individuals. d. Ability to utilize automated systems to support coordination and administration services. 19

19 e. Capacity to establish a partnership with Orange County Department of Social Services for planning and implementation of coordination services. f. Capacity to establish a partnership with various transportation vendors for the coordination of transportation services. g. Ability to develop and implement an RFP for transportation vendor services which recognizes the priorities and capacities of the Department. 5. Provide at least two (2) references from similar projects in size and scope including name, address and telephone number of contact person. 6. Provide any additional information that would distinguish your organization in its service to Orange County. 20

20 Attachment B: Non Emergency Medical Transportation Program Statistics OCDSS has experienced dramatic increases in Medicaid eligible cases through the second half of 2002 and all of During those months, our total number of cases grew at an average rate of 400 cases per month. This resulted in a 13 million-dollar increase in local Medicaid dollars expended on an annual basis. In 2004, our Medicaid growth rate has slowed considerably to an average rate of 150 cases per month. By 2005 through 2006, the average Medicaid caseload rate leveled out at less than 1%. Medicaid Caseload Information, May 2007 Medicaid Total MA Only Cases TANF / MA SSI Only Eligible Lives / Categories Cases Cases Recipients Cases 22,354 14,481 1,926 5,947 39,115 The County of Orange had 39,115 eligible people residing throughout the State of New York that are eligible for Non-Emergency Medical Transportation. Of these 39,115 eligible lives, the County provided the following transportation services for 2005 and Trip Data, 2005 and 2006 (one way data) Medicaid Taxi Trips Ambulette Trips Gasoline Public Stretcher Van Categories Reimbursement Transportation ,904 34,460 10,760 5, ,644 35,196 10,878 7, Through May ,240 14,622 7,308 5, A majority of callers request numerous trips through a single phone call. As the data noted above offers one way trips, not round trips, the call volume will be approximately 25% of each total, with an average call completion time of seven minutes. 21