SCOPE OF WORK

GENERAL ADMINISTRATION OF THE NET PROGRAM

Program Administration and Operations

The Contractor shall administer and operate the Non-Emergency Transportation (NET) program, including, but not limited to, establishing and maintaining a statewide network of qualified NET providers and brokering NET services for eligible Nevada Medicaid recipients through authorization, coordination, scheduling, management, and reimbursement of NET service requests. The Contractor shall ensure recipients have access to high-quality transportation services using the most cost effective and medically appropriate mode to meet the recipient’s needs.

Compliance Requirements

The Contractor shall operate the NET program in accordance with all applicable Federal and State laws, regulations, and program policies that govern performance of the contractual agreements. Should a question of applicability or interpretation arise, the Nevada Health Authority’s (NVHA) interpretation shall be followed.

Allocation of NET Responsibilities

Nevada is geographically bifurcated into urban areas (Clark County and Washoe County) and rural areas (all remaining 15 counties).

Managed Care Organizations (MCOs) NET Responsibilities

MCOs serving Nevada’s rural areas are responsible for authorizing and providing all NET services for their Medicaid eligible enrolled recipients residing in rural service areas. Therefore, for the purposes of this contract, the Contractor will not be responsible for NET services for MCO members residing in Nevada’s 15 rural counties.

Contractor Responsibilities

The Contractor shall be responsible for providing statewide NET services for the following populations:

All Fee-For-Service (FFS) recipients statewide; and

MCO-enrolled recipients residing in Nevada’s urban areas.

Nevada Check Up (NCU) Population

The NVHA shall add the Nevada Check Up population (also known as the Children’s Health Insurance Program) as an eligible category of recipients for NET services effective upon federal approval.

Rural MCO Responsibilities

MCOs serving rural areas are required to provide NET services for their Nevada Check Up enrollees residing in the rural areas. Therefore, for the purposes of this contract, the Contractor will not be responsible for NET services for MCO Check Up members residing in the rural areas.

Contactor Responsibilities

When determined to be effective based on federal approval, the Contractor shall provide NET services for:

All FFS Nevada Check Up recipients statewide; and

MCO-enrolled Nevada Check Up recipients residing in Nevada’s urban areas

NVHA Oversight, Policy Guidance, and Program Modifications

The NVHA shall provide assistance, as needed, with the interpretation and clarification of NVHA policy and shall notify the Contractor of any changes that affect the NET program. Any discrepancies in interpretation of the contract, policies or program requirements shall be resolved at the NVHA’s discretion. The NVHA reserves the right to expand service categories or implement additional value-added services within the scope of this contract when determined to be in the NVHA’s best interest.

Duties and Responsibilities of Contractor

Authorization, Management, and Payment of NET Services

Covered Modes of Transportation and Expenses

Contractor shall authorize, coordinate, manage and issue payment for all NET services for eligible recipients. Covered services shall include but are not limited to: public transportation inclusive of fixed route and paratransit, taxicabs, transportation network companies (TNCs), wheelchair accessible vans, community non-professional drivers, stretcher vehicles, secure behavioral health transports, gas mileage reimbursement (GMR), commercial airline services, and other travel related expenses such as meal and lodging.

Service Delivery and Innovation

Contractor cannot render transportation services. NET services under this Contract may be provided through a network of subcontracted transportation providers although the NVHA will consider innovative service delivery models as proposed. The Contractor is encouraged to propose alternative ideas for providing the requested service to promote access to care while minimizing administrative costs. The maximum allowable for administrative costs is 15% of the Contractor’s overall cost.

Subcontractor Payments and Network Adequacy

As detailed in subsequent sections of this contract, the Contractor shall be responsible for payment of all transportation services furnished by subcontractors. Payment rates shall be sufficient to establish and maintain a provider network that ensures adequate access to care throughout all urban and rural areas of the state.

Regional Transportation Commission Paratransit Services

Paratransit Eligibility Referrals and Authorization

Paratransit services are shared-ride, door-to-door or curb-to-curb services for individuals with physical, cognitive or visual impairments that impact a person’s ability to independently use a public fixed-route transit system either all of the time, temporarily or under certain circumstances. Paratransit vehicles are often wheelchair accessible vehicles.

When a recipient appears to qualify for paratransit services, the Contractor shall refer the recipient to the applicable Regional Transportation Commission (RTC) for an assessment to determine paratransit eligibility within 60 days. If the recipient is deemed eligible for paratransit services, the Contractor shall authorize that mode of transportation when appropriate.

RTC Direct Reimbursement and Contractor Reporting Responsibilities

In certain counties where RTC paratransit services are available, NVHA may contract directly with the RTC to reimburse for RTC paratransit assessments and services provided to eligible Medicaid recipients through the certified public expenditures process.

In such cases, the Contractor is not responsible for payment of paratransit assessment or rides. The Contractor shall provide accurate data on the number of referrals made for paratransit assessments and authorized rides to the applicable RTC in a format and on a schedule approved by the NVHA.

Communication and Response Timeframes

The Contractor shall respond to all NVHA communications within a reasonable timeframe, not to exceed five business days. In circumstances requiring immediate assistance as indicated by NVHA, the Contractor shall respond within 24 hours.

Service Quality and Cultural Competency

The Contractor shall ensure that all NET services are delivered properly and efficiently with an emphasis on customer service. The Contractor must promote the delivery of NET services in a culturally competent manner to all recipients, including individuals with limited English proficiency and those from diverse cultural and ethnic backgrounds.

Compliance with the Medicaid State Plan and Services Manual

Contractor must adhere to the Medicaid State Plan and Medicaid Services Manual (MSM), including, but not limited to Chapter 1900 Transportation Services and Chapter 100 Medicaid Program as currently exists and may be amended. Medicaid Program available at the NVHA’s internet website at https://www.nevadamedicaid.nv.gov/ and MSMs at https://www.nevadamedicaid.nv.gov/resources/medicaid-services-manual/.

Non-Discrimination Requirements

Contractor shall not discriminate against any recipient eligible for NET services on the basis of race, color, age, religion, sex, sexual orientation, gender identity, disability, national origin, limited English proficiency, marital status, political affiliation, health status, need for health care services, or level of income and shall not use any policy or practice that has the effect of discrimination on the basis of race, color, national origin, sex, sexual orientation, gender identify, disability, limited English proficiency, marital status, political affiliation, health status, need for health care services or level of income.

BROKERAGE OF NET SERVICES

This section describes the required processes to broker Nevada NET services.

Provider Network

Network Development and Maintenance

Contractor must recruit, establish and maintain an appropriate network of subcontracted qualified transportation providers that is sufficient to provide adequate access to all NET services covered under the contract throughout the State.

Network Planning and Considerations

In establishing and maintaining the transportation provider network, the Contractor must consider, at a minimum, the following factors:

Anticipated utilization of services, including the characteristics and health care needs of Medicaid populations served under this contract.

The number and types of NET providers required to furnish the contracted services.

The geographic location of Medicaid providers and recipients.

The Contractor’s shall ensure access to vehicles with physical accessibility for those recipients with disabilities and recipients in crisis who need secure transport.

Timely Access Standards

The NVHA will provide forthcoming guidance regarding timely access to care standards which the Contractor shall require all subcontracted providers to meet.

Minimum Modes of Transportation

Access to NET services shall be comparable to transportation resources available to the general public and shall, at a minimum, include the following modes of transportation:

Public transportation including fixed-route bus services and paratransit, Gas Mileage Reimbursement (GMR), Private vehicles, Wheelchair accessible vans

Community non-professional drivers, Commercial airline services, Stretcher vehicles, Secure vehicles for behavioral health transports

Amtrak services or coach buses, TNCs

Taxicabs

Non-Discrimination in Provider Participation

Provider Participation Requirements

Contractor shall not discriminate, with respect to participation, reimbursement, or indemnification, against any provider who is acting within the scope of the provider’s license or certification, solely on the basis of that license or certification, in accordance with 42 CFR 438.12(a).

Notice of Network Exclusion

If the Contractor declines to include an individual provider or group of providers in its network, the Contractor shall provide the affected provider(s) written notice stating the reason(s) for its decision.

Network Adequacy Documentation

For purposes of this contract, the NVHA defines “access to care” as a recipient's ability to obtain timely transportation to Medicaid covered services throughout the State. When the Contractor is awarded the contract, supporting documentation must be provided to the NVHA that demonstrates it has the capacity to serve the anticipated recipient enrollment, maintaining a network of providers sufficient in number, mix, and geographic distribution to meet the transportation needs in the service areas throughout the State.

Submission and Updates of Network Documentation

Initial and Ongoing Submissions

Contractor must submit all required documentation at the time it enters into a contract with the NVHA and thereafter whenever there has been a significant change, as defined by the NVHA, in the Contractor’s operations that would affect adequate network capacity or service delivery.

Definition of Significant Change

A significant change includes, but is not limited to, changes in services, benefits, geographic service areas, payments, enrollment of new populations, or a change in ownership. The Contractor and the NVHA shall mutually agree upon the required supporting documentation and formatting upon contract execution.

Use of Existing Medicaid Providers

Whenever possible, the Contractor shall establish subcontracts with existing Medicaid enrolled providers in the State. The Contractor shall not subcontract with current Medicaid recipients. The Contractor shall provide services through subcontracts with public, not-for-profit, and for-profit organizations, and with individual qualified operators.

Access to Medicaid Provider Information

A listing of current Nevada Medicaid providers can be accessed through the following link:

https://www.medicaid.nv.gov/hcp/provider/Resources/SearchProviders/tabid/220/Default.aspx

Provider Sanctions, Exclusions, and Terminations

The NVHA shall provide the Contractor with a file of currently enrolled Medicaid providers at a frequency determined by the NVHA. The Contractor is prohibited from contracting with any providers sanctioned for Medicaid fraud or abuse, as determined by the NVHA. Provider terminations will be communicated to the Contractor as needed.

Prohibited Providers

The Contractor shall not contract with any enrolled Medicaid providers, subcontracted transportation providers or employees of subcontracted transportation providers who are:

On the list of debarred individuals by the Office of the Inspector General (OIG) at the following link: https://oig.hhs.gov/exclusions/index.asp, Listed on the Federal Debar list at the following link: https://sam.gov/SAM/

Prohibition on Conflicts of Interest

Pursuant to 42 C.F.R. 440.170(a)(4)(ii)(A), the Contractor is prohibited from providing non-emergency medical transportation services or making a referral or subcontracting to a transportation service provider if the Contractor has a financial relationship with the transportation provider or if the Contractor has an immediate family member that has a direct or indirect financial relationship with the transportation provider. The Contractor shall comply with 42 C.F.R. 440.170(a)(4)(ii)(A) in regard to determining whether a “financial relationship” exists and whether an associated individual qualifies as an “immediate family member” for purposes of compliance with this section

Disclosure of Financial Relationships

The prohibitions described in 1.2.1 (K)(1) do not apply if there is documentation to support the following:

a. Transportation is provided in a rural area, as defined at 42 C.F.R. 412.62(f), and there is no other available Medicaid participating provider or other provider determined by the NVHA to be qualified except the Contractor.

b. Transportation is so specialized that there is no other available Medicaid participating provider or other provider determined by the NVHA to be qualified except the Contractor.

c. Except for the Contractor, the availability of other Medicaid participating providers or other providers determined by the NVHA to be qualified is insufficient to meet the need for transportation.

Subcontractors

Authorizing Subcontractors

Subcontracting Scope and Contractor Responsibility

a. The Contractor may only subcontract with transportation providers and must maintain oversight and responsibility for any functions.

b. In referring or subcontracting for non-emergency transportation with transportation providers, the Contractor may not withhold necessary non-emergency transportation from a Medicaid recipient or provide non-emergency transportation that is not the most appropriate and a cost-effective means of transportation for that beneficiary for the purpose of financial gain, or for any other purpose.

Exceptions and Approval Requirements

This requirement does not apply to community non-professional drivers, public transportation providers, individuals receiving gas mileage reimbursement, taxicab services or a governmental entity who may be receiving direct reimbursement from the Contractor. If the Contractor would like to subcontract any administrative or brokerage duties, approval from the NVHA is required prior to subcontracting and must be included in the contract proposal. The Contractor shall be liable for the full cost of services resulting from a prohibited referral or subcontract.

Subcontracting Requirement and Oversight

Regulatory Compliance and Subcontractor Evaluation

All subcontracts shall comply with the requirements of 42 CFR Part 438, as applicable to the services or activities delegated under the subcontract. The Contractor must evaluate each prospective subcontractor’s ability to perform any delegated activities.

Direct Contracting with Medicaid Providers

When Medicaid enrolled providers operate their own vehicles, the Contractor is encouraged to subcontract with these providers directly for transport of recipients who receive treatment at the provider’s facility on a regular basis.

3. Anti-Kickback Clause

Subcontractors may not offer or make any payment or other form of remuneration, including any kickback, rebate, cash, gifts, or service in kind to the Contractor in order to influence referrals or subcontracting for non-emergency medical transportation provided to a Medicaid beneficiary.

Required Subcontract Provisions

All subcontracts for the provision of transportation services shall, at a minimum, specify the following requirements:

Clearly defined roles and responsibilities of the Contractor and subcontractor.

Detailed scope of services required from the subcontractor.

Insurance requirements.

Description of how delegated services, activities, and tasks will be performed by the subcontractor.

Pickup and delivery requirements.

Driver and vehicle requirements.

Training and orientation requirements for subcontractors and drivers.

Procedures the Contractor will employ to monitor the subcontractor and how non-compliance will be addressed by the Contractor.

Contract effective date and duration, termination, and renewal options.

Reporting requirements for subcontractors and expectations regarding driver logs.

Financial terms of the agreement including billing schedules and terms of payment for the various modes.

Subcontractor dispute resolution procedures.

Staffing, vehicle, equipment, and service standards necessary to perform contracted services.

Confidentiality relating to recipient data; and

An agreement by the subcontractor to comply with all mandatory terms and conditions of the Contractor’s contract.

Compliance with Driver and Vehicle Requirements

Driver and Vehicle requirements shall be included in all agreements with subcontractors. The Contractor may establish additional requirements on vehicles and drivers that are subject to prior approval from the NVHA. The Contractor shall ensure that all subcontractors adhere to these requirements as well as any other applicable Federal and State requirements.

Requirements for Drivers

All subcontracted drivers transporting Medicaid recipients shall meet, at a minimum, the following requirements:

Minimum Age, Licensing, and Competency

All drivers, shall be at least 18 years of age and at all times during their employment, have a current and valid Nevada driver’s license to operate the transportation vehicle they are assigned and shall be competent in their driving habits.

Driving Record and Criminal History

Drivers shall have no more than one chargeable accident and no more than two moving violations within the last three years.

Drivers shall not have had their driver’s license, commercial or other, suspended or revoked in the previous five years.

Drivers shall not have any prior convictions for child abuse, elder abuse, sexual abuse, crime of violence, or Medicaid fraud.

Any driver who has been convicted of a felony must receive written approval from the NVHA before employment by the Contractor.

Professional Conduct and Appearance

All drivers shall be courteous, patient and helpful to all passengers and maintain a neat and clean appearance.

Prohibition on Alcohol and Substance Use

No driver or attendant shall use, possess, or be under the influence of alcohol, narcotics, marijuana (recreational or medical), illegal drugs or any substances that may impair ability to safely perform assigned duties. The transportation provider shall not use drivers who are known abusers of alcohol, narcotics, drugs, or medications that would endanger the safety of recipients, regardless of whether those drugs are legally prescribed or not.

Identification and Credentials

All drivers and attendants shall wear visible, legible organization identification while on duty.

Smoking and Vaping Prohibition

Smoking or vaping is prohibited in the vehicle, during recipient assistance, or in the presence of any recipient.

Use of Electronic Devices

Drivers shall comply with all applicable laws regarding use of handheld wireless communication devices as required in NRS 484B.

Passenger Safety and Securement

Drivers shall assist passengers in a professional manner with boarding and seating, ensure that all seat belts are fastened properly, and confirm that wheelchairs and wheelchair passengers are properly secured.

For recipients who need a secure behavioral health transport, all drivers must ensure that safety protocols are strictly adhered to while guaranteeing recipient safety during loading, transport and unloading.

Passenger Assistance and Mobility Support

Drivers shall provide necessary assistance, support, and verbal directions to passengers, including assistance to recipients with limited mobility, and safe storage of mobility aids and wheelchairs.

Scope of Driver Responsibilities

Drivers shall provide transportation services only and shall not render medical care, personal care services, child-care services, or assist with specialized equipment unless expressly trained to do so.

Driver Training Requirements

The Contractor shall ensure that its subcontractors provide classroom and behind-the-wheel training for all drivers within 30 days of beginning service under this agreement. Driver training shall, at a minimum, include defensive driving techniques, wheelchair securement, and lift operation (when applicable), cultural and disability sensitivity training, passenger assistance techniques, first aid, and customer service.

Drivers that provide secure behavioral health transport must receive the required training outlined in Nevada Administrative Code 433.415.

The Contractor must ensure that all required training is documented and maintained by subcontracted transportation providers and available upon request to the Contractor and the NVHA.

Non-Discrimination in Subcontracting

Pursuant to 42 CFR 438.214(c), the Contractor must develop policies and procedures which strictly prohibit discrimination against particular providers that serve high-risk populations or specialize in conditions that require costly treatment.

Vehicle Requirements

Vehicle Maintenance and Regulatory Compliance

The Contractor shall ensure that all subcontractor vehicles are properly maintained and comply with this Contract. All Vehicles and their components shall comply with or exceed applicable State, Federal, and manufacturer, mechanical operating and maintenance standards. Vehicles shall comply with the Americans with Disabilities Act (ADA) regulations.

Minimum Vehicle Requirements

All vehicles used to provide NET services under this contract shall, at a minimum, meet the following requirements:

Two-Way Communication Systems

Vehicles shall be equipped with a two-way communication system linking vehicles used in delivering the services under this contract with the transportation provider’s principal place of business. Pagers are not an acceptable substitute.

Climate Control

All vehicles shall be equipped with adequate heating and air-conditioning.

Seat Belts and Child Safety Restraints

All vehicles shall have functioning, clean and accessible seat belts for each passenger seat position pursuant to NRS 484D.484. Child safety seats shall be used for children under age six and weighing 60 pounds or less. Child safety seats shall meet the standards and be used in a manner prescribed in NRS 484B.157.

Speedometer and Odometer

All vehicles shall have a functioning speedometer and odometer.

Exterior Mirrors

All vehicles shall have two exterior side view mirrors, one on each side of the vehicle.

Interior Passenger Monitoring Mirror

All vehicles shall be equipped with an interior mirror for monitoring the passenger compartment.

Exterior Vehicle Condition

The exterior of the vehicle shall be clean and free from broken mirrors or windows, excessive grime, major dents or paint damage that detract from the overall appearance of the vehicles.

Interior Vehicle Condition

The interior of vehicle shall have passenger compartments that are clean, free from torn upholstery or floor or ceiling covering, damaged or broken seats, protruding sharp edges and shall also be free of dirt, oil, grease or litter.

Interior Vehicle Condition for Secure Behavior Health Transports

All vehicles used for secure behavioral health transports must be configured to have a separated driver and passenger compartment which prohibits the passenger from accessing the driver or being able to control the vehicle. The vehicle must also prohibit a recipient from being able to exit the vehicle while in motion. Additionally, all vehicles must meet the requirements outlined in NAC 433.435.

Each secure transport must have an attendant and driver who meet all of the training requirements outlined in section 1.2.2.E.11.b.

Vehicle Identifications and Contact Information

All vehicles shall have the transportation provider’s name, vehicle number, and the vendor’s toll free and local phone number prominently placed within the interior of each vehicle.

Complaint Procedures

Written complaint procedures shall be available in each vehicle for distribution to recipients upon request.

Smoking Prohibition and Required Signage

Smoking is prohibited in all vehicles while transporting Medicaid recipients. All vehicles shall display the following signs, easily visible to the passengers:

“NO SMOKING/VAPING”

“ALL PASSENGERS MUST USE SEAT BELTS”

Vehicle Documentation Packet

All vehicles shall carry a vehicle information packet containing current vehicle registration, insurance card and accident procedures and forms.

First Aid Kit

All vehicles shall be equipped with a fully stocked first aid kit.

Maps and Navigation Resources

Each vehicle shall carry a current map of the applicable State(s) with sufficient detail to locate recipients and medical providers.

Vehicle insurance Coverage

In compliance with NAC 706.191, all vehicles shall have a minimum of combined single limit insurance coverage for vehicles at all times during the contract period.

Exemption from NTA Certificate

Common motor carriers or contract motor carriers that are providing transportation services pursuant to this contract are exempt from the Nevada Transit Authority (NTA) Certificate of Public Convenience and Necessity pursuant to NRS 706.158 and NRS 706.745.

Noncompliance and Corrective Action

Any vehicle or driver found out of compliance with this contract, contract requirements, or any applicable State or Federal regulations shall be immediately removed from service and suspended pending the completion of the Contractor’s investigation.

Within 15 calendar days of identifying a deficiency, the Contractor shall:

Determine the corrective actions required to remedy the deficiency; and

Establish a deadline by which the transportation provider must implement these corrective actions.

All identified deficiencies and corresponding corrective actions shall be documented and maintained in the vehicle and driver’s permanent records.

Vehicle Inspection Requirements

The Contractor shall develop and implement an annual inspection process, in addition to any applicable State vehicle inspection requirements, to verify that all subcontracted provider vehicles meet the minimum vehicle standards outlined in this contract This inspection shall ensure that all safety and passenger comfort features are in proper working order, including but not limited to brakes, tire, tread, signals, horn, seat belts, air conditioning/heating.

Prior to execution of this contract and the service agreement between the Contractor and each transportation provider, the Contractor shall complete an in-person initial inspection of all vehicles intended to be used under this contract. Records of all inspections shall be maintained by the Contractor.

Required Verifications for Subcontractors

General Oversight and Compliance

The Contractor shall ensure adequate oversight of all subcontracted transportation providers and shall ensure compliance with all applicable local, State and Federal laws, regulations and permit requirements. These oversight duties and required verifications are further outlined in Chapter 1900 of the Medicaid Services Manual (MSM). At a minimum, the Contractor shall verify that each subcontracted transportation provider maintains, at all times, the following:

Insurance Coverage

Insurance coverage that complies with 49 C.F.R. 387 subpart B, and N.A.C. §706.191(1-3), including provisions requiring notification of the status of the policy to the Nevada Health Authority (NVHA) upon expiration, termination, or at any time requested.

Controlled Substances and Alcohol Testing Program

A controlled substances and alcohol use testing program which complies with the requirements of 49 C.F.R. Part 382.

Criminal Background Checks

Criminal background checks conducted periodically that meet the criteria set forth in MSM Chapter 100.

Required Vehicle Signage

Required vehicle signage on all vehicles identifying operation under any exemption from Nevada Transportation Authority (NTA) regulation.

Documentation of Regulatory Exemptions

Documentation maintained within each vehicle evidencing any exemption from NTA regulation.

Subcontractor Agreements

The Contractor must ensure each subcontractor maintains a current and valid agreement with the Contractor.

Use of Exempt Motor Carriers

As a contracted agent of the NVHA, and subject to the requirements of NRS 422.2705 and NRS 706.745, the Contractor may utilize the services of motor carriers that are exempt from certain certification requirements of the NTA of the Department of Business and Industry.

Safety Inspection Program

Prior to exercising this option, the Contractor shall, with the assistance of the NTA, establish and utilize an inspection program designed to ensure that vehicles used by these motor carriers, and their operations, are safe.

Insurance Requirements for Exempt Motor Carriers

The Contractor shall also require exempt motor carriers to submit proof of a liability insurance policy, a certificate of insurance, or a surety that is substantially equivalent in form and equal to or greater than the coverage required by the Department of Motor Vehicles (DMV) pursuant to NRS 706.291 for a similar situated motor carrier.

Before the Driver is Allowed into Rotation

The Contractor shall certify that transportation providers meet all applicable insurance requirements, vehicle safety standards, and driver background and drug tests cited in NRS Chapter 706.

Daily Logs

Daily Electronic Log Requirements

The Contractor shall require all subcontractors to maintain a daily electronic log and to implement a contingency (backup) process for any period during which the electronic log is unavailable. The electronic log and any backup documentation shall include, at a minimum, the following information:

Date of transport, Driver’s full name, Driver’s signature or authenticated log-in ID, Vehicle ID number(s), Transportation provider name and identification number, Actual starting time from base/dispatch location(military time), Each authorized recipient, with actual pick-up time (military time), Actual pick-up location, No-show indicator, Actual drop-off time for each authorized recipient (military time), Actual drop-off location, Recipient or authorized rep confirmation of trip (signature, or ID card swipe), Actual number of companions per trip, Actual return time to base/dispatch location (military time), Odometer mileage at each pickup and drop-off location, Authorized stamp and signature of transportation provider, Any other pertinent information regarding the completion of the trip.

Develop and Implement a Monitoring Plan

Contractor Oversight and Accountability

The Contractor shall be responsible for all services provided by subcontracted transportation providers. The Contractor shall ensure adequate oversight of subcontracted transportation providers, including compliance with all applicable State and Federal laws, regulations, and permit requirements. The Contractor shall maintain written procedures for taking appropriate action to address provider noncompliance. All subcontractor forms must be approved by the NVHA prior to implementation.

Subcontractor Agreements and Performance Monitoring

A written agreement between the Contractor and each subcontractor is required and shall clearly define the activities and responsibilities delegated to the subcontractor including the requirements outlined in section 1.2.2.H.1.f. Each agreement shall include procedures for revoking delegated authority or imposing other sanctions if the subcontractor’s performance is deemed inadequate.

Transportation providers must be monitored by the Contractor to ensure compliance with the terms and conditions of their subcontracts, track complaint resolution and promote delivery of courteous, safe, timely and efficient transportation services. Each subcontract shall be reviewed no less than once every three years from the subcontractor’s effective date, or more frequently as necessary to address applicable programmatic, contractual, or regulatory changes.

Corrective Action Procedure

The Contractor shall maintain written procedures for implementing appropriate corrective actions whenever inappropriate or substandard services are furnished, or when required services are not furnished, by the subcontracted providers.

Upon identification of a deficiency or area requiring improvement, the Contractor shall document the finding(s) and a written corrective action plan within 10 business days of discovery. Each corrective action plan shall, at a minimum:

Clearly identify and describe the deficiency

Specify the corrective actions required to remediate the deficiency; and

Establish a remediation timeframe commensurate with the nature and severity of the deficiency.

The remediation timeframe shall not exceed 30 calendar days unless an alternative timeframe is required by applicable State or Federal requirements or is approved by the NVHA.

NVHA Oversight and Quality Assurance Reviews

The Contractor must monitor the subcontractor’s performance on an ongoing basis and is subject to formal review by the NVHA. The NVHA reserves the right to conduct quality assurance reviews of all services under this contract. These reviews may be conducted in an anonymous manner and without advance notice.

Insurance Coverage and Incident Reporting

The Contractor shall maintain insurance coverage in the amounts specified within Attachment D – Insurance for the duration of the contract.

The Contractor shall report to the NVHA in writing any accidents that have occurred in conjunction with a scheduled trip if a recipient was present in the vehicle. Such notification shall be made promptly, but no later than 24 hours after the Contractor is notified of the incident following the reporting requirements outlined in section 1.5.2.B.

Verify Recipient Eligibility

Automatic Enrollment and Effective Date of NET Eligibility

Nevada Medicaid eligibility is established in accordance with federal regulations and is currently determined by the NVHA of Social Services (DSS). This process will transition to the Nevada Health Link (Health Insurance Exchange) for Modified Adjusted Gross Income (MAGI) recipients, beginning in fall 2026. Eligibility for NET services shall commence the day following the date the recipient is determined eligible for Medicaid and shall not be applied retroactively.

Eligibility Data Exchange and File Transmission

The NVHA shall provide the Contractor with a HIPAA compliant 834 eligibility file format suitable for loading into the Contractor’s eligibility verification system. The eligibility files shall be transmitted to the Contractor daily and the fifth day of the month.

The monthly file will serve as a reconciliation file, delivered approximately five days prior to month-end. This file is intended to capture and reconcile any eligibility data not included in the daily transmissions.

Eligibility Verification Prior to Service Authorization

For each recipient requesting NET services, the Contractor shall verify Medicaid eligibility using the 834-eligibility file or the Provider Web Portal (PWP). Eligibility is determined on a month-to-month basis. Due to potential delays in system updates related to eligibility coding, PWP shall not be used as the sole determinant of NET eligibility.

Prior to authorizing NET services, the Contractor shall review MSM Chapter 1900 to identify any recipient subpopulations that are excluded from NET coverage.

Authorization of NET Services

Policies and Procedures

The Contractor shall develop, maintain, and comply with written policies and procedures governing the intake, assessment and authorization of NET service requests. The Contractor shall implement mechanisms to ensure consistent, timely, and equitable authorization determinations in accordance with Medicaid requirements and the recipients medical and functional needs.

Routine (Standard) Authorization Timeframes

For routine, non-urgent transportation requests, the Contractor shall issue an authorization decision as expeditiously as the recipient’s health condition requires but no later than two business days from receipt of the transportation request.

For the purpose of computing time for this section, the day the transportation request is received is considered Day 0 and the following business days are counted as Day 1 then Day 2.

If the Contractor cannot issue an approval or denial decision within two days of the request, the Contractor can issue a request for additional information (RAI) necessary to determine whether an approval or denial decision is appropriate. An authorization extension is permissible for up to three additional calendar days when:

The recipient requests the extension; or

The Contractor demonstrates to the NVHA that additional information is required and that the extension is in the best interest of the recipient.

Expedited and Urgent Authorization

The Contractor shall provide expedited authorization decisions for requests involving scheduled medical appointments that will occur prior to the standard three calendar day timeframe.

When the NVHA determines, or when the circumstances indicate, that a delay in transportation could jeopardize the recipient’s health or ability to obtain medically necessary care, the Contractor shall authorize transportation immediately, including same-day authorization.

For secure behavioral health transportation requests, the Contractor must promptly authorize and identify an appropriate subcontractor to provide the required mode of transportation within three hours.

Subscription (Recurring) NET Services

The Contractor shall establish procedures for authorizing subscription (recurring) NET services for recipients who require frequent, ongoing transportation to medically necessary services, including but not limited to dialysis, chemotherapy, adult day care, or other recurring treatment services.

Subscription transportation may be authorized for a defined period based on medical necessity, provider orders, or treatment plans.

Once approved, subscription trips shall not require trip-by-trip authorization or ongoing appointment verification during the authorized period.

Subscription authorizations shall be subject to annual review and renewal, consistent with medical necessity, and program requirements.

The Contractor shall maintain documentation supporting the initial authorization and any subsequent renewal, modification, or termination of subscription services.

Verification of Eligibility and Appointment

Prior to authorizing transportation, the Contractor shall verify:

The recipient's Medicaid eligibility qualifies for NET services; and

That the transportation request is for a Medicaid-covered service.

The Contractor shall verify the medical appointment directly with the recipient’s medical provider. If the appointment cannot be verified after at least three attempts, the Contractor may deny the transportation request in accordance with written policies and applicable appeal rights.

Special Authorization Circumstances

Pending Provider Enrollment

There may be a scenario when a recipient requests transportation to an enrolled Medicaid facility (including hospitals and affiliated clinics); however, the rendering provider of the facility who the recipient has an appointment with is not yet enrolled. Due to potential delays in the provider enrollment process, the Contractor shall authorize transportation under the assumption that the rendering provider will be enrolled under Nevada Medicaid’s allowance for retroactive provider enrollment.

Dual-Eligible Recipients

Because Medicaid must always be the payor of last resort and Medicare has limited NET services, it is cost effective to authorize transportation for recipients with full Medicare and Medicaid dual eligibility to a Medicaid-covered service for which Medicare is the primary payer. These recipients have an eligibility status of Full Benefit Dual Eligible, Qualified Medicare Beneficiary Plus and Specified Low Income Medicare Beneficiary Plus. Additionally, the Contractor shall authorize the transportation regardless of whether the rendering provider is actively enrolled with Nevada Medicaid.

MCO Authorizations

For MCO-enrolled recipients, when a MCO authorizes a medical service, including out-of-area services, the Contractor shall also authorize the associated transportation request to that service.

Denial or Reduction of Authorization

If the Contractor denies or reduces the requested NET service, the Contractor shall issue a Notice of Decision (NOD) to the recipient. The NOD shall include the reason for denial or reduction in service, and instructions on how to file an appeal, in accordance with Chapter 3100 of the Medicaid Services Manual (MSM) Level of Need Assessment. All NODs must follow the requirements in Section 1.3.9.A

Level of Need Assessment Once determined eligible, the Contractor shall assess the recipient’s level of transportation need in accordance with State Plan and MSM 1900 requirements. The assessment shall:

Determine the medical necessity of transportation for the requested service;

Identify the appropriate mode of transportation based on the recipient’s physical, cognitive, and medical condition, including wheelchair, stretcher, and special accommodations requirements;

Consider recurring or subscription transportation needs as applicable;

Be fully documented in the recipient’s record for verification, audit, and quality monitoring purposes.

Special Circumstances, Populations, and Geographic Considerations

Catchment Areas

Recipients residing near the state line or border may be geographically closer to out-of-state providers than in-state providers for primary or specialty care. In such cases, covered medically necessary services may be routinely rendered by out-of-state providers within areas the NVHA identifies as “catchment areas.”

Services furnished by out-of-state providers within a catchment area shall be treated as in-state services for authorization and NET purposes.

Recipients Residing in Rural Areas

Authorization and Scheduling

For trips originating in designated rural counties, authorization and scheduling shall be conducted in accordance with standard scheduling requirements set forth in MSM Chapter 1900 and shall not be considered as out-of-area travel.

Rural Service Delivery Flexibilities

The NVHA recognizes the operational challenges the Contractor may encounter when establishing and maintaining an adequate network of transportation providers in rural areas due to remote locations, increased travel distances, and extended travel times. As permitted under federal authority and the NVHA’s State Plan, the Contractor is authorized to implement approved service delivery flexibilities when transporting recipients in rural areas. Applicable flexibilities, payment methodologies, and effective dates are defined in the NVHA State Plan pages governing transportation services.

Mileage Reimbursement for Rural Travel

To mitigate the operational impacts associated with long distance travel in rural areas, the Contractor shall reimburse transportation providers for mileage at the Internal Revenue Service (IRS) business mileage rate for authorized rural trips.

Exceptions for Special Populations

Provider Selection for Designated Medicaid Populations

Certain Medicaid populations, as identified by the NVHA, may require specialized or consistent transportation arrangements in order to access medically necessary services. These populations may include recipients with intellectual, developmental, cognitive, behavioral, or mental health conditions for whom changes in drivers, vehicles, routing, or ride configurations may reasonably be expected to impede the recipient’s ability to safely or effectively utilize NET services.

In such circumstances, and when supported by documented need, the NVHA may permit recipients to select a preferred transportation provider within the authorized mode of transportation to ensure continuity of service and access to care. Examples include , but are not limited to, recipients who require familiarity with a driver or service routine due to cognitive limitations, or recipients whose behavioral health conditions limit their ability to tolerate shared rides, unfamiliar drivers, or accompanied transportation.

If the recipient does not identify a preferred provider, the Contractor shall assign the most appropriate available provider.

Higher Level of Transportation for Certain Pregnancy Conditions

Recipients who are verified to have a high-risk pregnancy, or who are in their eighth month of pregnancy or later, shall be eligible for a higher mode of transportation such as curb-to-curb when they would otherwise qualify for public transportation, when medically appropriate, to ensure continued access to covered services during that time.

For recipients who would otherwise be authorized for public transportation, the Contractor shall override the public transportation mode and authorize curb-to-curb transportation for the duration of the pregnancy and for up to six months post-delivery.

Limited NET Coverage for Recipients with Emergency Medicaid Eligibility

Recipients who qualify solely for Medicaid for the purposes of receiving Emergency Medical Services only are generally ineligible for NET services. The exception is when Nevada Medicaid authorizes dialysis services for recipients with an Emergency Medical aid category. Such recipients with an Emergency Medicaid only shall be eligible for NET exclusively for transportation to and from the authorized dialysis services.

The Contractor will manually verify Emergency Medical aid categories through the PWP.

Minor Recipients Involved with the Child Welfare System

The Child Welfare System in Nevada is divided by region. Specifically, child welfare services are operated by Clark County Department of Family Services in Clark County, Washoe County Human Services Agency in Washoe County, and the State of Nevada Division of Child and Family Services in the remaining 15 counties. When a recipient is receiving intervention services through one of the Child Welfare entities, NET services must be as flexible as possible for this vulnerable population, as requested and outlined by the Child Welfare Agency. Flexibility shall include last-minute accommodations to scheduling, additional attendants as needed and potential use of a dedicated subcontractor(s) for consistency in transportation.

Additionally, to maximize federal funding and offset state or county general funds, when one of the child welfare entities transports a recipient, the Contractor must offer gas mileage reimbursement to that child welfare entity. If the transport by a child welfare entity staff is over 100 miles in a day, then the Contractor must also allow meal reimbursement.

Attendants for Recipients

General Requirements

Attendants must be authorized to accompany a recipient during transport when determined medically necessary to ensure a recipient’s safe access to Medicaid-covered services with the exception of secure behavioral health transports.

The Contractor is not responsible for providing attendants.

Minor Recipients (Under Eighteen Years of Age)

Transportation services shall not be authorized for minor recipients unless a parent, legally responsible individual (LRI), or another authorized adult caregiver accompanies the minor with the exceptions outlined in section 1.2.8.B.2. Any recipient under 18 years of age must be accompanied by at least one attendant.

Transportation without an attendant may be authorized only under the following circumstances with documented verification:

The recipient is legally married, The recipient is legally emancipated, The recipient is obtaining Medicaid-covered family planning services.

The recipient is 15 years of age or older, and a completed and signed Parental Consent Form authorizing transportation without an attendant has been obtained.

A delay in transporting the minor between medical facilities would be medically detrimental and a parent or LRI is not available. In such cases, a Consent and Release of Liability form shall be completed and signed by an authorized representative of the transferring facility prior to transport.

The Contractor shall authorize attendant(s) for minor recipients under the following conditions:

One attendant who is at least 18 years of age; or any age when the attendant is the parent of the minor recipient.

When medically necessary, two attendants may be authorized for children 12 months of age and under.

Adult Recipients (Eighteen Years of Age and Older)

The Contractor shall authorize one attendant for an adult recipient when documented medical, physical, cognitive, or behavioral conditions require assistance during transport.

The Contractor must cover the transportation costs of an authorized attendant.

No more than two attendants shall be authorized for an adult recipient. Requests for more than two attendants require prior consultation with and approval by the NVHA.

Examples of medical necessity for authorizing two attendants include, but are not…