Application for Section 1915(b)(4) Waiver / Fee for Service / Selective Contracting Program

Application for Section 1915(b)(4) Waiver / Fee for Service / Selective Contracting Program PRA Disclosure Statement According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 0938-1148. The time required to complete this information collection is estimated to average 40 hours per response, including the time to review instructions, search existing data resources, gather the data needed, and complete and review the information collection. If you have comments concerning the accuracy of the time estimate(s) or suggestions for improving this form, please write to: CMS, 7500 Security Boulevard, Attn: PRA Reports Clearance Officer, Mail Stop C4-26-05, Baltimore, Maryland 21244-1850. July, 2013

Contents Section A... 1 Face-Sheet... 1 Type of request... 1 Effective Dates... 1 State Contact... 2 Part I / Program Overview and Description... 3 Tribal Consultation... 3 Waiver Services... 3 Program Description... 3 Statutory Authority... 6 Waiver Authority... 6 Sections Waived... 6 Delivery Systems... 7 Reimbursement... 7 Cabinet Responsibilities... 7 Procurement... 8 Restriction of Freedom of Choice... 9 Provider Limitations... 9 State Standards... 9 Populations Included in Waiver... 10 Included Populations... 10 Excluded Populations... 10 Part II / Access... 11 Timely Access Standards... 11 Capacity Standards... 11 Coordination and Continuity of Care Standards... 12 Part III / Quality... 14 Quality and Contract Monitoring... 14 Part IV / Program Operations... 19 Beneficiary Information... 19 Individuals with Special Needs... 19 Part V / Transportation Broker Selection Process... 21 Overall quality in transportation delivery... 21 Part VI / Transportation Broker... 23 Part VII / Orientation Program... 25

Part VIII / Subcontractors and Volunteers... 26 Section B... 28 Waiver Cost-Effectiveness and Efficiency / Efficient and economic provision of covered care and services... 28

Transportation OMB control 0938-1148 Section A Face-Sheet Type of request o The Commonwealth of Kentucky of Kentucky requests a waiver/amendment under the authority of section 1915(b) of the Act. The Medicaid agency will directly operate the waiver. o The name of the waiver program is Non-Emergency Transportation (NEMT). This is: an initial request for new waiver. All sections are filled. a request to amend an existing waiver, which modifies Section/Part Effective Dates o X A renewal request Section A is: o X replaced in full carried over with no changes changes noted in BOLD. Section B is: o X replaced in full carried over with no changes changes noted in BOLD. o This waiver/renewal/amendment is requested for a period of two (2) years beginning October 1, 2013 and ending September 31, 2013. 1

State Contact o The Commonwealth of Kentucky contact person for this waiver is Lee Guice and can be reached by telephone at (502) 564.4321 or fax at (502) 564.0509 or e-mail at Lee.Guice@ky.gov

Part I / Program Overview and Description Tribal Consultation Describe the efforts the Commonwealth of Kentucky has made to ensure that federally recognized tribes in the Commonwealth of Kentucky are aware of and have had the opportunity to comment on this waiver proposal. o There are no federally recognized tribes in the Commonwealth of Kentucky. Waiver Services Please list all existing state plan services the Commonwealth of Kentucky will provide through this selective contracting waiver. o Non-emergency Transportation (NEMT) Services Program Description Provide a brief description and history of the proposed selective contracting program or changes requested to the existing program. Please include the estimated number of enrollees served throughout the waiver period and describe the services included in the waiver. o The Human Service Transportation Delivery (HSTD) program, developed under the Empower Kentucky Project provides non-emergency, non-ambulance medical transportation services to eligible Department for Medicaid Services (DMS), Department for Vocational Rehabilitation and Department of the Blind recipients. o In December 1998, the Centers for Medicare & Medicaid Services granted the Commonwealth of Kentucky a 1915(b)(4) Waiver for the delivery of non-emergency transportation services. This waiver provided the flexibility needed for the commonwealth to implement efficient and cost-effective programs and to develop new or different approaches in the delivery of health care transportation services.

o The Deficit Reduction Act of 2005 offered the opportunity for Kentucky to begin operating the HSTD under the state plan rather than the 1915(b)(4) waiver. In 2006, Kentucky began administering the program under state plan authority. A re-assessment of the program determined that the 1915(b)(4) waiver was the most appropriate authority under which to operate this program. DMS then requested and was granted approval to operate the program under 1915(b)(4) waiver. o The current waiver expires September 30, 2013. The Commonwealth of Kentucky is submitting this application for renewal of the current 1915(b)(4) waiver. o Under 1915(b)(4) and subsequent state plan authorities, DMS contracted with the Kentucky Transportation Cabinet (KYTC) / Office of Transportation Delivery (OTD) to manage the daily operation of the HSTD Program. OTD answers complaints from recipients, subcontractors or regional brokers and resolves complaints in a timely manner. o The HSTD program combines the resources of public and private transportation providers in an efficient, cost effective and easily accessible transportation program throughout the Commonwealth of Kentucky. o DMS maintains oversight of the daily functions of the program and participates in daily communications and regularly scheduled meetings with OTD regarding the program. o EQRO: On December 28, 2012, DMS responded to CMS in writing and provided its plan for establishing an EQRO for its NEMT program. DMS has taken the following steps to provide the NEMT program with EQRO oversight:

o On April 25, 2012, D M S released a request for proposal (RFP) for an EQRO; o DMS signed a contract with Island Peer Review (IPRO), effective September 1, 2012, to provide DMS EQRO / CAHP oversight. DMS is now entering negotiations with IPRO to include language regarding NEMT / EQRO /CAHP independent assessment activities with an effective date of 90 days from the end of the negotiations. We believe the above outline demonstrates DMS intensions for meeting CMS evaluations standards for its NEMT program. o Under the HSTD program, the commonwealth is divided into 15 transportation regions. A regional broker approved by OTD is responsible for coordinating and providing transportation services for each region. Regional brokers provide transportation services to Medicaid recipients within their region by choosing to subcontract with additional providers. o Transportation types used in the HSTD program include commercial vendors, non-commercial group vendors, public transportation, private auto provides, specialty carriers serving the wheelchair bound and disoriented. o Usual service parameters relating to safety, access and non-discrimination is part of the contract. Neither the Commonwealth of Kentucky nor the contracted provider will refuse a participant, or an assignment solely on the basis of age, sex, race, physical or mental handicap, national origin, or type of illness or condition. The Commonwealth of Kentucky will continue to fully comply with all requirements for a formal appeals process.

Statutory Authority Waiver Authority Sections Waived o The Commonwealth of Kentucky is seeking authority under the following subsection of 1915(b): o X 1915(b)(4) - FFS Selective Contracting program o The Commonwealth of Kentucky requests a waiver of these sections of 1902 of the Social Security Act: o Section 1902(a)(1) State-wideness o Section 1902(a)(10)(B) - Comparability of Services o X Section 1902(a)(23) - Freedom of Choice o X Other Sections of 1902 (please specify) o Administering the NEMT program through regional brokers allows Kentucky to secure safe, effective, and efficient transportation for Medicaid recipients. Regional brokers are paid on a capitation basis (risk-based) which allows Medicaid to accurately predict and budget for the program. Regional brokers are responsible for ensuring all transportation providers in their area meet safety and access standards. In the event that contracted providers cannot provide the necessary services, the broker is responsible for finding alternative transportation methods for recipients. Some brokers transport recipients to ensure access standards are met. o Neither brokers nor providers are limited to the types of vehicles that may be utilized for transportation and every effort is made to ensure all members receive transportation that is appropriate for their needs. Providers may have vans, mini-vans, SUVs, and some autos. Both ODT and the Department will continue to

Delivery Systems Reimbursement monitor call logs and complaints in order to ensure that all members have access to appropriate transportation. In the event a situation is identified in which a member needs transportation but the broker does not have a proper vehicle, either for the member s medical needs or geographic location, action will be taken to correct the situation. o Payment for the selective contracting program is: o X the same as stipulated in the state plan o is different than stipulated in the state plan (please describe) o Brokers are paid per member-per-month capitation payments. Brokers pay contracted providers per trip. Broker s participation in the program is risk-based. As a result, the broker must ensure maximum efficiency of the program. The risk-based contract also encourages elimination and reduction of fraud and abuse. o A broker shall promptly reimburse subcontractors within three (3) business days of payment by the cabinet. Subcontractors are reimbursed based on subcontractor rates set by the commonwealth. All payments to providers within a specific region are based on the same subcontractor rates for that region. Subcontractor rates are non-negotiable between the broker and subcontractor Cabinet Responsibilities o The cabinet shall establish provider rates for each certificate type for each human service transportation delivery area. o The rates shall be uniform for the same certificate types for all providers, including the broker in each delivery area.

The following factors shall be considered in determining the rates: o Geographical terrain o Trip distance o Recipient population o Availability of medical and employment facilities o Labor and economic factors Utilization of services Procurement o A forty-five (45) day notice shall be given to all brokers by the cabinet prior to any changes made to the subcontractor rates. o DMS forwards monthly eligible totals per service region to the KYTC / OTD / HSTD at the end of each month. KYTC / OTD / HSTD determine the amount due to each service region based on the capitation amount and number of eligible persons per service region. KYTC / OTD / HSTD send funds via electronic transfer to each service region. DMS reimburses KYTC / OTD / HSTD for the amounts paid to each service region. o The Commonwealth of Kentucky selected the contractor in the following manner: o X Competitive procurement Open cooperative procurement Sole source procurement Other (please describe)

Restriction of Freedom of Choice Provider Limitations o Beneficiaries will be limited to a single provider in their service area. o X Beneficiaries will be given a choice of providers in their service area. (NOTE: Please indicate the area(s) of the Commonwealth of Kentucky where the waiver program will be implemented) X Statewide State Standards Detail any difference between the Commonwealth of Kentucky standards applied for through this waiver and those detailed in the state plan reimbursement documents (4.19 pages), the Commonwealth of Kentucky Quality Strategy or the waiver service contract.

Populations Included in Waiver Included Populations The following populations are included in the waiver: X Section 1931 Children and Related Populations X Section 1931 Adults and Related Populations X Blind/Disabled Adults and Related Populations X Blind/Disabled Children and Related Populations X Aged and Related Populations X Foster Care Children X Title XXI CHIP Children Excluded Populations Indicate if any of the following populations are excluded from participating in the waiver: N/A Dual Eligible N/A Poverty Level Pregnant Women N/A Individuals with other insurance N/A Individuals residing in a nursing facility or ICF/MR N/A Individuals with eligibility of less than 3 months N/A Individuals participating in a HCBS Waiver program N/A American Indians/Alaskan Natives N/A Special Needs Children (State Defined). Please provide this definition N/A Individuals receiving retroactive eligibility Other (Please define): (Qualified Medicare Beneficiary) QMB

Part II / Access Timely Access Standards o Recipients are required to be ready 15 minutes prior to their schedule pickup time to ensure vehicles can continue on their daily routes. However, sometimes situations and circumstances are unavoidable causing delays; such as recipient sicknesses, road hazards and accidents, weather, etc. All brokers are required to randomly survey medical providers each month verifying timely arrivals and return pickups. Recipients have access to the broker and the Commonwealth s toll-free complaint line for assistance, should any recipient experience a delay in service. Transportation providers are under contract to transport timely. Unexplained lateness is not acceptable and providers may be accessed fines and penalties. The Commonwealth also utilizes an array of survey methods to access timelines of service throughout the year. Capacity Standards o The Commonwealth welcomes all willing and qualified providers into the provider network, as long as they meet all statutory, regulatory and program policy requirements. All providers must have a state issued operating authority for vehicles to be on the road. At the beginning of each contract year, the Office of Transportation Delivery requests a listing of all providers in each county who have operating authority via the Commonwealth s Motor Carrier statutes. The lists are distributed to each broker. Brokers are required to contact each provider to inquire if they wish to participate in the Non-Emergency Medical Transportation program. The only time a provider is not allowed to participate is when a provider has previously participated in the program and was terminated, suspended or non-renewed due to compliance and performance issues. o At the beginning of each State Fiscal Year, all providers are required to re-contract with the broker. During this process, the broker collects all vehicle documentation from each provider. Documentation includes Operating authority certificates, fee receipt and/or bus cards, insurance

verification, and completed inspection sheets for each vehicle. Once received from the broker, the Office of Transportation Delivery reviews each provider s vehicle usage and capacity and enters this information into a spreadsheet. The Commonwealth is able to see what authority the provider has for each county they serve and the number of vehicles used. The broker distributes trips to each provider based on the capacity of the vehicles submitted and approved by the broker and Commonwealth. The broker will verify trips completed and billed by the provider to ensure no provider is billing for trips in excess of the vehicle capacity available. Attached is a summary of the vehicles used in the program during FY13. VEHICLE INVENTORY REPORT Active Inactive Total Region 1 88 82 170 Region 2 84 17 101 Region 3 75 9 84 Region 4 127 124 251 Region 5 122 8 130 Region 6 273 3 276 Region 8 117 7 124 Region 10 77 0 77 Region 12 167 10 177 Region 13 455 325 780 Region 14 126 79 205 TOTAL 1,711 664 2,375 Coordination and Continuity of Care Standards o Coordination is key to the program s success. Without coordination, costs would be negatively impacted tremendously. The broker is responsible to ensure providers provide transportation in the most efficient, cost effective manner; all the while ensuring no recipient s transportation is negatively affected. Rather than having one vehicle transport one recipient to a medical

appointment or day program/waiver service; the broker ensures all recipients living in close proximity and going to the same geographic location are scheduled in the same vehicle utilizing resources in the most efficient and effective manner. Brokers know up front distances and mileages through geo-coding and technological advances. In many instances, brokers are able to track vehicles on screen to ensure providers are providing services as scheduled. Successful coordination ensures a recipient s continuity of care. Through coordination, there are standards in place to ensure a recipient is not riding in a vehicle for an excessive amount of time. Transportation providers are encouraged to coordinate services by receiving additional passenger payments encouraging multi-loading, in addition to vehicle mileage, per vehicle capacity. Recipients have access to the broker and the Commonwealth s tollfree complaint line for assistance should any recipient experience a delay in service through coordination efforts.

Part III / Quality Quality and Contract Monitoring Describe the Commonwealth of Kentucky s quality measurement standards. o On September 26, 2012, Centers for Medicare and Medicaid Services (CMS) requested that the Kentucky Department for Medicaid Services (DMS) provide Centers for CMS with a timeline for the procurement of an External Quality Review Organization (EQRO) and a Consumer Assessment of Health Plans (CAHP) survey, each intended to provide oversight of DMS Non-Emergency Transportation (NEMT) program provider activities and consumer satisfaction. o On December 28, 2012, DMS responded to CMS in writing and provided its plan for meeting these two expectations. DMS has taken the following steps to provide the NEMT program with EQRO / CAHP oversight: On April 25, 2012, D M S released a request for proposal (RFP) for an EQRO; DMS signed a contract with Island Peer Review (IPRO), effective September 1, 2012, to provide DMS EQRO / CAHP oversight. o DMS is now entering negotiations with IPRO to include language regarding NEMT / EQRO /CAHP independent assessment activities with an effective date of 90 days from the end of the negotiations. Provide evidence that the Commonwealth of Kentucky: Regularly monitors to determine compliance and takes corrective action if there is a failure to comply. o The Commonwealth has several monitoring tools in place to ensure a quality service at the State level, Broker level, Provider

level and Recipient level. The Department for Medicaid Services (DMS) conducts a yearly monitoring visit at the Office of Transportation Delivery (OTD)to ensure contractual compliance. DMS and OTD are in daily contact with each other ensuring quality standards. DMS, OTD and other program partners meet monthly with brokers to discuss issues that may arise. DMS also conducts their own survey of recipients and transportation providers. Much the same, OTD conducts, at minimum, one on-site assessment each contract year as well as one phone assessment review of each brokerage each contract year. During the assessments all broker functions are reviewed and random vehicles are inspected. Items needed attention are noted and broker follow-up is required. OTD conducts additional surveys throughout the contract year including recipient phone surveys and recipient rider surveys. Each month a broker is required to submit to OTD the following reports: Line Item budgets, monthly summary reports showing number of trips, miles and dollars paid out to each provider -by provider; encounter reports, phone reports, complaint reports, vehicle inventory listings showing active/inactive vehicles during the month, and medical provider verification surveys. Once encounter trip information is received by OTD from the broker, analysis is performed to ensure brokers pay subcontractors per the set subcontract rate. Broker are notified of any discrepancies and correction follow-up is required. (Mr. Cornwall: what evidence to you need in support of this? A copy of one of our assessments and/or reports?) Describe the Commonwealth of Kentucky s utilization measurement standards. o The Office of Transportation Delivery tracks utilization of services monthly. This is accomplished primarily through the use of the monthly summary trip information report and encounter data. The number of trips, miles, and dollars paid out are captured by provider, by county, per service date. Trends are noted and reported to DMS for each month of

service along with the following information: total number of each type of transport provided (ambulatory, wheelchair, etc), total trips, total recipient no shows, total provider refusals, miles, total unduplicated recipients, total eligibles, total utilization percentage per population, percentage of unduplicated recipients, cost per trip, cost per mile, average length of trip, and total payments made. Provide evidence that the Commonwealth of Kentucky: o Regularly monitors to determine compliance. o Takes corrective action if there is a failure to comply. o Describe the Commonwealth of Kentucky s timely access to care and services measurement standards. o Describe the Commonwealth of Kentucky s measurement standards or monitoring actions regarding the geographic location of providers and Medicaid enrollees. o The Commonwealth welcomes all willing and qualified providers into the provider network as long as they meet all statutory, regulatory, and program policy requirements. All providers must have a state issued operating authority for vehicles to be on the road. At the beginning of each contract year, the Office of Transportation Delivery requests a listing of all providers in each county who have operating authority via the Commonwealth s Motor Carrier statutes. The lists are distributed to each broker. Brokers are required to contact each provider to inquire if they wish to participate in the Non- Emergency Medical Transportation program. The only time a provider is not allowed to participate is when a provider has previously participated in the program and was terminated, suspended, or non-renewed due to compliance and performance issues. Prior to contract, all brokers must pass a readiness test to ensure adequate operations and capacity. Some geographic locations in Kentucky are served by limited providers. Some counties with no available providers.

Therefore, all current brokers have the capability to provide trips themselves if needed. No recipient will be turned away through lack of providers. Providers under contract are required to transport Medicaid recipients prior to other business related interests. Transportation is required to be provided based on the recipient s medical appointment time. Transportation is provided by regulation Monday through Friday 6am-8pm and on Saturday 8am-1pm local time. Urgent care transportation is provided 24/7. Urgent care is defined by regulation as: an unscheduled episodic situation in which there is not a threat to life or limb, but the recipient needs to be seen within (12) hours in order to avoid the likely onset of an emergency medical condition; and that does not include an emergency trip that is to be addressed by a qualified emergency service. Brokers, along with the assistance received from OTD and DMS, verify medical services being sought to ensure they are covered Medicaid services. A trip requested to any non-medically necessary, non-covered service is denied by OTD. However, through coordination with Public Transportation and the Kentucky Public Transit Branch within the Office of Transportation Delivery; recipients have additional options for access to transportation in these type situations. For example, a recipient cannot go to the pharmacy under the NEMT program. Through coordination, however, the transportation provider can still take the recipient to the pharmacy via Public Transit. (Network providers comply with the State s timely access requirements see Part II-A above) Provide evidence that: Provider availability is sufficient to provide adequate access to all services covered under the contract. Services are available when medically necessary.

Network providers comply with the Commonwealth of Kentucky s timely access requirements. o At the time of Medicaid enrollment, recipients are offered a Member handbook which includes Non-Emergency Transportation information. Additional information can be found on the Cabinet for Health and Family Services, Kentucky Department for Medicaid Services website as well as on the Kentucky Transportation Cabinet, Office of Transportation Delivery website. If there is a change in program structure, affected recipients are mailed notices 45 days in advance of the change taking affect through a joint effort of the Department for Medicaid Services and the Office of Transportation Delivery. In addition, informational letters are mailed to recipients when necessary. For example: regarding seat belt usage and the requirement to cancel a trip 24 hours in advance if a recipient has excessive no show trips. Anytime a recipient is denied services through the program, the recipient receives a denial letter, mailed to their address on file, explaining the reason of denial. Administrative Hearing appeal rights are included with each denial letter. Finally, brokers also distribute pamphlets regarding services offered. Additional education materials such as door hangers are left for recipients if a provider arrives for a scheduled pickup but the recipient is a no-show. o Many individuals transported by the program are special needs. The Commonwealth offers accessible modes of transportation, per ADA, to ensure access to transportation for special needs individuals. Reservation call centers are required to be equipped with TDY devices. Brokers often use language lines and interpretations services/ky Relay for those with special needs. Reasonable accommodations are always made to ensure a safe transport. Special needs individuals are afforded the right, per Statute, to have an escort or attendant travel with them at no charge if required.

Part IV / Program Operations Beneficiary Information Describe how beneficiaries will get information about the selective contracting program. o Upon application, each member receives a Medicaid / managed care member handbook detailing the services available to the member, including a description of the NEMT transportation program o Notices are sent throughout the region when a new broker enrolls in the NEMT provider network o DMS and OTD both have webpages regarding the services offered o NEMT brokers offer pamphlets and brochures describing their services o NEMT brokers discuss services upon notification that a member needs NEMT services o Members are provided a toll free number to call for information o Members are provided an informational fact sheet containing provider names and telephone number(s), as well as procedures for obtaining transportation, filing complaints and appeals, and information for after-hours access o A comprehensive selection of information related to NEMT services is available in local offices that provide eligibility determinations for Medicaid Individuals with Special Needs o X The Commonwealth of Kentucky has special processes in place for persons with special needs o DMS contracts with KYTC / OTD / HSTD to administer the NEMT program. o KYTC / OTD / HSTD contracts with regional brokers who are responsible for the actual arranging and providing NEMT services.

o KYTC / OTD / HSTD regulatory language for selecting the regional brokers can be found in 603 KAR 7:080 Human Service Transportation Delivery http://www.lrc.ky.gov/kar/603/007/080.htm which includes special needs considerations when planning NEMT transportation. For example, where appropriate, transportation brokers must provide: o Child safety seats o Lift-equipped vehicle o When arranging public transportation, the broker shall consider all pertinent information needed for the broker to provide transportation including the use of an escort required and other information related to the member s special needs. o In accordance with KRS 281.875(2) and (3) http://www.lrc.state.ky.us/krs/281-00/875.pdf if a business entity submits a request for proposal to be a transportation broker under the human service transportation delivery program shall be required to submit documentation that the business entity has at least one (1) year experience working with persons with special needs.

Part V / Transportation Broker Selection Process o A request for proposal (RFP) and the process of awarding a brokerage contract for each region shall comply with KRS Chapter 45A. The RFP evaluation process shall, at a minimum, address areas that include the following: Overall quality in transportation delivery Administration o Human resources, including staffing and employee categories by classification, number, and experience; o Insurance and risk management, types and levels of insurance coverage and emergency process, and training offered to reduce business risk; o Billing and accounting practice and procedures; and o Financial capability. Operations o Scheduling and reservations o Fleet management o Dispatching and radio communications o Computer software and hardware o Reporting for both the broker and subcontractor o Vehicle inspection or maintenance programs Experience o In accordance with KRS 281.875(2) and (3), a person that submits a request for proposal to be a broker under the human service transportation delivery program shall be required to submit documentation that he or she has at least one (1) year experience working with persons with special needs. The cabinet shall be prohibited from awarding higher scores, or giving any type of preferential treatment to any person that submits a request for proposal to be a broker, who is also a transportation provider, over a person who submits a request to be a broker and is not a transportation provider;

Ability to coordinate trips with: o Local community based governmental offices o Training, educational or medical centers o Coordination with other transportation providers Operational characteristics which include: o Locations of operations o Infrastructure and other resources o Storage of records o Security and confidentiality of recipient and provider information o Coverage of the delivery area hours, days, and operators availability o Education and training programs Contractual agreements between the Transportation Cabinet and brokers o Each contract between the cabinet and broker shall be for one (1) year with three (3) one (1) year options to renew. o (b) Contracts shall be on a fiscal year basis, running July 1 through June 30. Operating authority o Except for a volunteer provider, each transportation provider shall have operating authority issued by the Transportation Cabinet pursuant to KRS Chapter 281 or 96A. o A contract between the cabinet and the broker shall be subject to revocation in accordance with KRS 281.879. Furthermore, the contract shall be subject to termination by the Commonwealth in accordance with 200 KAR 5:312.

Part VI / Transportation Broker o A broker may coordinate the human service transportation delivery program with general public transportation as provided in KRS 281.877. o The broker shall make reports to the cabinet on all traffic accidents and moving violations involving either a broker or subcontractor while transporting a human service transportation passenger. o The broker shall have all reports pertinent for payment to the cabinet not later than the seventh of each month following the reporting period. o The cabinet shall reimburse the broker not later than the 15th of each month, if the broker has submitted the required reports. o Brokers shall promptly reimburse subcontractors and Medicaid private auto providers within three (3) business days of being paid by the cabinet each month for each valid invoice trip documentation. o A valid subcontractor or private auto provider invoice postdated after the first shall be included in the next month s billing. o TANF private auto providers shall be paid before the service month. o The broker shall have an established operating office located within the awarded delivery area. o The broker shall employ an adequate staff to accommodate reservations, oversight of timely pickup and delivery, scheduling, accounting, complaint tracking, safety compliance and reporting to the cabinet.

o All brokers shall provide transportation services for recipients eligible under Section 3 of this administrative regulation.

Part VII / Orientation Program o All brokers shall provide an orientation program to each subcontractor and potential subcontractor. o The program shall at a minimum include: o How and when payment will be made o Rates o Vehicle requirements o Driver conduct o Driver qualifications o Reporting requirements o Communication systems o Pickup and delivery standards o Training o Drug and alcohol testing o Safety o Confidentiality o Levels of transportation o Escort and attendants o Contract compliance o Scheduling and availability and standard state transportation requirements o The role of the program coordinator as required by KRS 281.872. o Orientation meetings between the broker and subcontractor shall be held before the subcontractor provides transportation services. o Subsequent meetings may be held to clarify new policies and administrative regulations, or as directed by the cabinet.

Part VIII / Subcontractors and Volunteers o A subcontractor who has signed a contract with a broker to provide human service transportation delivery within a specific delivery area shall meet human service transportation delivery requirements, including proper operating authority by county or city. o The subcontractor shall not enter into an agreement with a broker without the prior approval of the Transportation Cabinet. o Each broker shall submit and request approval of the cabinet for each potential subcontractor. o The subcontractor shall submit the following documentation to the broker: o A copy of the subcontractor s operating authority o Proof of the subcontractor s vehicle liability insurance o The draft of the broker and subcontractor s agreement o A copy of all vehicle lease agreements o All contracts shall, at a minimum, include: o Payment administration as required in KRS 281.875(1)(f) o Hours of operations and other scheduling requirements o Rates for services o Pickup and delivery standards o Contract duration o Termination clause and compliance penalty provisions o Brokers and subcontractors shall ensure and provide documentation to the cabinet that all drivers during employment shall: o Be legally licensed by the Commonwealth of Kentucky to operate the transportation vehicle to which they are assigned; o Be courteous, patient and helpful; o Be at least eighteen (18) years of age; o Have no more than two (2) convictions for moving violations in the last three (3) years; o Have no prior convictions for a drug or alcohol-related offense in the last five (5) years, if a driver or attendant; o Have no convictions of any sexual crime or crime of violence; o Have a pre-employment drug test; and

o Receive orientation and safety training. o Any person who has been convicted of a felony during the last five (5) years shall drive or attend passengers only after review and approval by the broker, subcontractor and the cabinet. Volunteer transportation providers shall have: o A valid driver's license; o Proof of insurance and registration; and o A vehicle which meets the safety needs of the recipient. o The subcontractor and the private auto provider shall submit a valid invoice to the broker by the first of each month to allow for accounting, payment processing, and mailing time for payment to be paid within three (3) business days of payment received from the cabinet. o A valid invoice postdated after the fifth day of the month shall be included in the next month s billing. o Subcontractors and private auto providers shall submit all valid invoices within six (6) months of the date of service for reimbursement by the broker. o A subcontractor shall report any moving violations or traffic accidents to the broker within thirty (30) days. o A subcontractor shall not participate in determining recipient eligibility or type of transport.

Section B Waiver Cost-Effectiveness and Efficiency / Efficient and economic provision of covered care and services Provide a description of the Commonwealth of Kentucky s efficient and economic provision of covered care and services. Project the waiver expenditures for the upcoming waiver period. Trend rate from current expenditures (or historical figures): % Year 1 from: / / to / / Projected pre-waiver cost Projected Plan cost Delta: Trend rate from current expenditures (or historical figures): % Year 2 from: / / to / / (Use projected trend rate from previous year) Projected pre-waiver cost Projected Plan cost Delta: Year 3 (if applicable) from: / / to / / (For renewals, use trend rate from previous year and claims data from the CMS-64) Projected pre-waiver cost Projected Plan cost Delta: Year 4 (if applicable) from: / / to / / (For renewals, use trend rate from previous year and claims data from the CMS-64) Projected pre-waiver cost Projected Plan cost Delta: Year 5 (if applicable) from: / / to / /

(For renewals, use trend rate from previous year and claims data from the CMS-64) Projected pre-waiver cost Projected Plan cost Delta: