HomeMy WebLinkAboutC14-434 Northwest Colorado Council of Government MOU Memorandum of Understanding between Eagle County,Colorado and the Northwest Colorado Council of Governments This is a Memorandum of Understanding (MOU) is hereby entered into by and between Eagle County, Colorado (the "County)" and the Northwest Colorado Council of Governments ("NWCCOG") (each a "party" and collectively referred to as the "parties") regarding the Colorado Medicaid Non-Emergent Medical Transportation Brokerage Program. Purpose and Scope The purpose of this MOU is to dearly identify the roles and responsibilities of each party as they relate to the implementation and administration of Non-Emergent Medical Transportation (NEMT) billing services as authorized by Colorado Medicaid. The intent of this MOU is to set forth the provisions by which NWCOG will provide 2 distinct levels of support to the Eagle County Department of Human Services,including: 1. The timely processing and administration of NEMT billing services for Eagle County Human Services, the coordination of transportation providers providing Medicaid covered transportation services (mobility vehicles, wheelchair vans, ambulance, taxi,stretcher van,train,airplane, bus,private vehicle). 2. To provide Medicaid qualified recipients with a single access point for transportation resources as administrated through the NWCCOG Mobility Management Program. Ii. MOU Terms The term of this MOU is effective as of November 1,2014 and shall remain in effect until November 30,2015.This MOU may be extended for additional one year periods upon written agreement of the parties. III. MOU Provisions The parties agree to the following provisions: 1. To ensure that NEMT program activities will be conducted in compliance with all applicable Colorado laws, rules and regulations as outlined by The Colorado Department of Health Care Policy and Financing. 2. To ensure that NEMT program activities will be conducted in compliance with HIPPA Privacy Practices,the Colorado Medicaid Privacy Practices standards,and as an authorized agent of Summit County Human Services. 3. That NEMT Claims will be filed in accordance with the timely filing requirements outlined by The Colorado Department of Health Care Policy and Financing. 4. That NEMT Claims reimbursement to transportation providers and Medicaid recipients will occur in a timely fashion not to exceed 15 days from receipt of claim from Medicaid. 5. Prior Authorization (PAR)and eligibility determination will be completed by NWCCOG Mobility Management Program prior to approval or denial of service. 6. Any denial of service will be made in writing, in the client's primary language, and delivered to the client and to the Eagle County Department of Human Services with the appropriate information concerning the reason for denial, the "Client Right to Appeal" language and instructions in the same language that is included on the back of all formal claim denials sent from the County's fiscal agent. See Appendix I Denial of Service Letter,Appendix I I Client Right to Appeal. 7. NWCCOG shall retain 15% of the transportation claims reimbursement to cover administrative expenses associated with the NEMT Services provided by NWCCOG. The remaining 85%of the claims reimbursement will be paid to the transportation provider. Transportation providers are identified as any person or entity other than the qualified Medicaid recipient. When transportation is provided by the Medicaid recipient, spouse of a Medicaid Recipient or parent/guardian of a minor Medicaid recipient,NWCCOG will waive the 15% administration fee and will remit full reimbursement directly to the Medicaid recipient, spouse, or their legal parent/guardian as required by Medicaid policy. 8. NWCCOG shall retain on file appropriate Certification of Transportation Providers in accordance with the NEMT Billing Program. Certifications will include copies of vehicle registrations,appropriate vehicle insurance, and copy of a valid driver's license for the vehicle operator. IV. Individual Party Responsibilities 1. NWCCOG will act as the NEMT Services Broker and facilitate the management of NEMT Services throughout Eagle County. 2. NWCCOG through the Mobility Management Program will approve,refer for transportation,verify receipt of services, bill for approved services,reimburse transportation providers or Medicaid recipients for approved Medicaid NEMT services, and retain appropriate billing records of said services. 3. The County,through its Department of Human Services,will refer all individuals requesting NEMT services to the NWCCOG Mobility Management Program. 4. The County,through its Department of Human Services, will forward any Medicaid request for NEMT reimbursement paperwork to NWCCOG within one week of receipt to facilitate timely processing of Medicaid Claims. 5. NWCCOG shall provide a written report of accountability for paid NEMT services on a monthly basis to the Director of Eagle County Human Services.This accountability report will be available by the 16th of each month and account for the activity processed in the prior calendar month. V. MOU Operational Framework The following describes how NWCCOG and the County will work together on the MOU scope and activities. 1. The County,through its Department of Human Services will direct any individuals requesting NEMT services to NWCCOG Mobility Management Program. The Department of Human Services will forward any Medicaid Transportation Reimbursement Forms to NWCCOG Mobility Management Program for processing. 2. NWCCOG Mobility Management Program will verify eligibility for NEMT services, obtain prior authorizations where required,verify appropriateness of service,refer approved recipients to transportation providers as needed, process all NEMT billing functions after proper documentation is received from the transportation recipient,make timely reimbursement to the transportation provider or Medicaid recipient following payment of claims,and submit a monthly accountability report to the County Department of Human Services on all claims processed. See Appendix Ill: NEMT Flow Chart,Appendix IV:NEMT Accountability Report. VI. Budget NWCCOG shall retain 15% of the transportation claims reimbursement as stated in Section III, Number 7, above, to cover administrative expenses associated with the NEMT Services provided by NWCCOG.The remaining 85%of the claims reimbursement will be paid to the transportation provider. When transportation is self-provided by the Medicaid member the 15% administrative fee shall be waived as outlined in Section III, Number 7, above. There will be no additional cost to the Colorado Medical Assistance Program. See Appendix V: NEMT Sample Budget. VII. Forms The following describes the forms utilized in the NEMT Work Flow Form 1: Medicaid Trip Request Checklist. Appendix VI Form 2: Medicaid Transportation Reimbursement Form. Appendix VII Form 3: Monthly Accountability Report Sample. Appendix IV Form 4:Denial of Service Letter and Client Right to Appeal. Appendix I,Appendix I I VIII. Modification and Termination 1. Modification of this agreement can be made by mutual consent of NWCCOG Mobility Management Program Manager with approval of the NWCCOG Executive Director, and the Director of Eagle County Department of Human Services, with approval of the Eagle County Board of County Commissioners. All modifications will be made in writing and signed by both parties. 2. This agreement can be terminated according to the following provisions. - Either party may terminate this agreement upon 30 days written notice to the other. - The action of termination has been preceded by reasonable efforts on the part of both parties to address whatever problems or barriers have emerged that have threatened the integrity of this MOU. IX. Effective Date and Signatures This MOU shall be effective upon the signatures of the County and NWCCOG. It shall be effective as November 1,2014. XI. Independent Contractor This MOU is not intended to create any agency or employment relationships between the parties nor is it intended to create any third party rights or beneficiaries. XII. Applicable Law This MOU and the parties' conduct hereunder shall be subject to local, state and federal laws and regulations, including requirements associated with confidentiality of information and HIPPA privacy requirements. Signatures and Dates: COUNTY OF EAGLE,STATE OF COLORADO, By and Through Its BOARD OF COUNTY COMMIS:ill:MRS By: 77:;11/1\/tL/-- n ; ` ,Chairman Attest: of : B � . .�+ i t`fi y �. Teak J.Simonton,Clerk to the Board °RA°� �', , Northwest Colorado Council of Governments(NWCCOG) Liz Mullen,Executive Director Date Northwest Colorado Council of Governments 'o ui o ovr,�N� :°� PO Box 2308.249 Warren Ave•Silverthome,CO 80498-970-468-0295•Fax 970-468-1208•www.nwccog.org Appendix I MEMBER [Date] JURISDICTIONS City of Glenwood Springs [Name of Client] City of Steamboat [Address 1] Springs [Address II] [City,State,Zip] Town of Carbondale EAGLE COUNTY Ms. [Name]: Basalt Eagle Followin g your request for Non Emergent Medical Transportation Services a review of your case was Gypsum Mintum conducted.You are currently not eleigble to receive Non Emergent Medical Transportation Services Red Cliff for the following reasons Vail GRAND COUNTY 1. [list reason here] Fraser Granby Grand Lake Should you feel this determination to be in error,please consult the Client Appeal Rights process Hot Sulphur Springs included with this letter. Kremmling Winter Park Sincerely, JACKSON COUNTY Walden PITKIN COUNTY Aspen Snow mass Village Laurie Patterson SUMMIT COUNTY Mobility Program Assistant Dillon Frisco Northwestern Colorado Council of Governments Montezuma 970-468-0295 ext 105 Sliverthome Enclosure(s): Client Appeal Rights Appendix II CLIENT APPEALS RIGHTS If you agree with the decision,you do not need to take any further action.If you think the decision is wrong, you can appeal and ask for a hearing. You may have to appeal hearing with an Administrative Law Judge.You may represent yourself,or have a lawyer,a relative,a friend or other spokesperson assist you as your authorized representative. How to Appeal: 1.You must ask for a hearing in writing.This is called a LETTER OF APPEAL. 2.Your letter of appeal must include: a.Your name,address,phone number and Medicaid number; b.Why you want a hearing;and c.A copy of the front page of the notice of action you are appealing. 3.You may ask for a telephone hearing rather than appear in person. 4.Mail or fax your letter of appeals to: OFFICE OF ADMINISTRATIVE COURTS 633 17TH STREET,SUITE 1300 DENVER,CO 80202 FAX 303-866-5909 5.Your letter of appeal mustbereceived by the Office of Administrative Courts no later than thirty(30)calendar days from the date of this notice of action.The date of the notice of action is located on the front of this notice. 6.The Office of Administrative Courts will contact you by mall with the date,time and place for your hearing with the Administrative Law Judge. Continued Benefits:To continue receiving the denied services listed on the notice,you must file your request for a hearing in writing before the effective date on the front of this notice.You may continue receiving services while you are waiting for a decision on your appeal.If you lose your appeal,you must pay back the cost of the services you received during the appeal.If you win your appeal,the State will pay your provider for the service(s)you received during your appeal process.Your provider is responsible for reimbursing you for the amount you paid them during your appeal. If you have questions about this process,please call: CUSTOMER SERVICE: 303-866-3513(within the Denver Metro area) 1-800-221-3943(outside the Denver Metro area) Se Habla Espanol DISCRIMINATION If you believe that you have been discrimination against because of race,color, sex,age,religion, national origin,or disability, you have the right to file a complainant with:the U.S.Department of Health&Human Services,Office for Civil Rights.999 18th Street,Suite 417,Denver,CO 80202.Voice phone:303-844-2024 or TOD 303-844-3439.If you have any questions,or need help to file your complaint,call OCR toll-free at 1-800-368-1019(voice)or 1-800-537-7697 (TDD).You may send an email to OCRcomolaintthhs.aov. STATEMENT OF PENALITIES If you make a willfully false statement or representation,or use other fraudulent methods to obtain public assistance or medical assistance you are not entitled to,you could be prosecuted for theft under state and/or federal law.If you are convicted by a court of fraudulently obtaining such assistance,you could be subject to a fine and/or imprisonment for theft. Appendix Ill NEMT Services Flowchart Initial NEMT , i request Info collection Confirm P L. Medic ici ,P nt/PAR P R t ` l° kliet +' Complete AIM Medicaid \iffhp j . "ta Client _ _ Referral for Transportation Transportation ' - A ~ ocas . _ . .- scheduling Reimbursement l . Request farm Received 1\, Post Billing entered to i from either Medicaid fr`' � Appointment W, Portal Recipient self- L. ,. . a 1 or Trarport stn fitutftir 2_,..r",,,.,--"' Billing Processed by Medicaid i' . 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