Schedule A - Statement of Work - Hybrid.docx

Enter your company name Schedule A – Statement of Work

RFP 260000002254

Non-Emergency Medical Transportation (NEMT) Broker for Medicaid Fee for Service (FFS) Beneficiaries This schedule identifies the anticipated requirements of any Contract resulting from this RFP. The term “Contractor” in this document refers to a bidder responding to this RFP, as well as the Contractor who is awarded the contract. The term “bidder” is used to identify where specific responses to the RFP are required. Yellow fields are also used to identify areas where a bidder response is required.

The Contractor must respond to each requirement or question and explain how it will fulfill each requirement. Attach any supplemental information and reference it appropriately within your response.

Background The Michigan Department of Health and Human Services (MDHHS) is the single State agency that administers and supervises the Michigan Medicaid program in accordance with the Title XIX of the Social Security Act1902 (a)(10)(A) and (e), 42 CFR (Code of Federal Regulations), MCL 400.106, 1984 PA 246. Federal law at 42 CFR 431.53 requires Medicaid to ensure necessary transportation for beneficiaries to and from services that Medicaid covers. The NEMT benefit must be covered in an equitable and consistent manner.

The Michigan Department of Health and Human Services (MDHHS) Non-Emergency Medical Transportation (NEMT) benefit provides coverage of transportation and related services for trips to/from one-time or ongoing services included within Medicaid policy coverage (including medical care and treatment, medical equipment/supplies, appointments to obtain medical evidence for eligibility verification purposes only) and to/from facilities providing services Medicaid covers that do not charge for care. NEMT coverage includes transportation and related services to Medicaid-covered services within Michigan, designated borderland areas, as well as prior authorized out-of-state medical care. As defined in policy (Michigan Medicaid Provider Manual, Non-Emergency Medical Transportation chapter), NEMT services may include mileage, meals, fees and tolls, lodging, and medically necessary special allowances for beneficiaries enrolled in: FFS Medicaid, FFS Healthy Michigan Plan (HMP), MIChild, and dually-enrolled FFS Medicaid/Children’s Special HealthCare Services (CSHCS). FFS beneficiaries residing in Nursing Facilities, enrolled in HDE-SNP plans, PACE or who are incarcerated are excluded.

Scope The Contractor must work with the Michigan Department of Health and Human Services (MDHHS) Non-Emergency Medical Transportation (NEMT) Program Manager to establish and administer a comprehensive NEMT program for eligible fee-for-service (FFS) Michigan Medicaid beneficiaries. A monthly capitated rate is applied per eligible FFS beneficiary residing in the contract area, and is payment inclusive for both NEMT services and administrative duties.

The MDHHS broker contracts to date have been limited to provision of NEMT services for fee-for-service (FFS) Medicaid beneficiaries residing in Wayne, Oakland, and Macomb Counties. The MDHHS is extending this Request for Proposal to include the potential provision of services to FFS Medicaid beneficiaries statewide. As such, the bidder’s responses and costs must be differentiated into 2 geographic regions:

1. Provision of services limited to the Wayne, Oakland, and Macomb Counties.

2. Provision of services statewide (upper and lower peninsulas) including Wayne, Oakland and Macomb Counties.

Bidder’s must submit a proposal to provide NEMT services both in Wayne, Oakland, and Macomb Counties, and services statewide (including Wayne, Oakland and Macomb Counties). The State may award based on bidder’s responses and ability to provide services in accordance with the evaluation criteria. Award of a contract does not guarantee the provision of services statewide.

The Contractor will work with MDHHS to:

Function as the State’s designated NEMT broker/authorizing party for eligible FFS beneficiaries, administering the program in compliance with Contract requirements, Michigan Medicaid Policy (as outlined in the Medicaid Provider Manual and Medicaid Policy Bulletins), Michigan Office of Inspector General Program Integrity requirements, State and Federal Regulations, to:

1. Field beneficiary calls, verify beneficiary eligibility, and schedule the least-costly mode of transportation or other NEMT service(s) that meets the beneficiary’s medical and functional needs, and to assure that timely NEMT services are provided to eligible FFS Medicaid beneficiaries.

2. Determine reimbursement rates for all NEMT providers*, sufficient to ensure provision of services.

3. Recruit and manage an adequate transportation network of subcontracted transportation providers* including ongoing recruitment, scheduling, reimbursement, compliance monitoring, and ongoing transportation provider/driver and vehicle recordkeeping assuring that drivers and vehicles meet qualification requirements.

4. Recruit and manage a robust network of volunteer drivers ongoing including recruitment, scheduling, monitoring, and mileage reimbursement.

5. Submit beneficiary level prior authorization requests to MDHHS via the Community Health Automated Medicaid Processing System (CHAMPS), as applicable for services when required.

6. Obtain Medical Needs Forms (MNF) as required for Special Allowances requests, including for special transportation needs (i.e. wheelchair lift-equipped or Medi-Van vehicles), and for beneficiaries requiring medically necessary attendants (other than a parent/guardian).

7. Verify subcontracted transportation provider and transportation provider/driver* enrollment in CHAMPS, and monitor maintenance of valid, active enrollment for all dates NEMT services are provided.

8. Provide reimbursement for all NEMT services as allowed in policy, including but not limited to mileage reimbursement for individuals (beneficiaries) transporting themselves or eligible beneficiary family members/friends/individuals with vested interest.

9. Submit verified beneficiary level encounters, including voids or adjustments, in a format specified by MDHHS, on a monthly basis, as outlined in the Claims/Encounter Tracking and the Program Integrity sections of this contract.

10. Provide tracking of NEMT service utilization and other reporting as required.

*See Schedule I – Definitions and Explanation of Terms for purposes of this Contract.

Coverage of NEMT Services The Contractor must:

3.1 Ensure provision of NEMT services related to medical services covered by fee-for-service Medicaid, for beneficiaries showing the NEMT benefit plan in CHAMPS Eligibility Inquiry. The NEMT benefit plan is assigned to beneficiaries, residing within the counties included in this contract, with full coverage Medicaid or CHIP, excluding beneficiaries:

1. Enrolled in a Medicaid Health Plan (MHP), Highly Integrated Dual Eligible Special Needs Plan (HDE-SNP), or Program of All-Inclusive Care for the Elderly (PACE).

2. Residing in a nursing home (NH benefit plan).

3. Who are incarcerated.

3.2 Be paid a Per-Member-Per-Month (PMPM) amount.

1. The State will determine the total number of NEMT-eligible beneficiaries for the purpose of that month’s capitation (PMPM) push payment to the Contractor.

2. Off-cycle PMPM payments will be made for new NEMT-eligible beneficiaries added during the month.

3. PMPM payments will be made for NEMT-eligible members retroactively enrolled in Medicaid. These payments will occur with the next pay cycle after notification of retroactive enrollment.

4. Recoupment of PMPM payments will occur for loss of NEMT eligibility due to:

a. Death.

b. Incarceration.

c. Enrollment in a Medicaid Health Plan (MHP), HDE-SNP Plan, or PACE.

d. Placement in a nursing home (NH benefit plan).

e. Loss of full coverage Medicaid or CHIP eligibility.

f. Beneficiary change of residence to outside of one of the counties included in this contract.

5. Recoupment of PMPM payments will occur with the next push payment following the month during which the event causing loss of NEMT eligibility occurs (i.e. the first full month of lack of NEMT eligibility). Recoupment of PMPM payments will be indicated by specific beneficiary.

3.3 Collect, analyze, and maintain information on the eligible beneficiary population and their needs, and respond to changes to ensure network adequacy, sufficient supply of all necessary types of vehicles and transportation services necessary for access to medical services, and adequate staffing to ensure timely responsiveness in meeting NEMT.

3.4 Ensure that NEMT services provided align with the standards of coverage outlined in the current Medicaid Provider Manual, municipal, state, and federal regulations, and the contract. These standards of coverage include the following:

1. The beneficiary is eligible for FFS NEMT services on the date of service (DOS), per CHAMPS Eligibility Inquiry.

2. The transportation or mileage requested is for trips to and from:

a. Medical treatment/services that are benefits Medicaid covers include one-time or chronic and ongoing treatment (e.g. dialysis treatment, substance abuse treatment).

b. Ancillary service providers to obtain a service or item Medicaid covers (e.g., pharmacies, durable medical equipment, prosthetics, orthotics, and supplies [DMEPOS] providers).

c. Medical care, treatment or services that have been prior authorized (e.g. prior authorized out-of-state transportation.

d. Appointments to obtain medical evidence for eligibility verification purposes and/or to obtain a Medical Needs Form when required.

e. Facilities providing services Medicaid covers that do not charge for care such as including but not limited to Veterans Administration (VA) hospitals.

3. The beneficiary reports having no other reliable means of transportation available to meet their medical and functional needs for the date of service requested, regardless of whether the beneficiary previously provided their own transportation.

4. The least costly mode of transportation that meets the beneficiary’s medical and functional needs must be used.

5. NEMT services requested for routine medical care is within the beneficiary's community when available, unless prior authorized.

6. NEMT services may include need for: transportation (including commercial non-emergency accessible wheelchair lift-equipped or Medi-van vehicles), mileage reimbursement, a medically necessary attendant (parent, caregiver, etc.), meals, lodging, fees, tolls, and special allowances as defined in the Medicaid Provider Manual, NEMT chapter.

a. Meals: Authorized meals for beneficiaries, volunteer drivers, or individuals with a vested interest are reimbursed at cost or at the maximum allowable amount, whichever is less, must meet the time, location, and receipt criteria defined in policy and the current Non-Emergency Medical Transportation Rate Schedule located at www.michigan.gov/mdhhs/doing-business/providers/providers/billingreimbursement/non-emergency-medical-transportation .

b. Lodging: Medically necessary lodging may be authorized for a beneficiary and transportation provider for up to 14 consecutive nights. In addition, one medically necessary attendant (or individual with a vested interest) may be authorized if included on the beneficiaries physician-signed MNF. Medically necessary overnight stays beyond 14 nights require prior authorization (PA) from the MDHHS Program Manager. Refer also to policy and the current Non-Emergency Medical Transportation Rate Schedule.

c. Hospital Facility Meal and Lodging Reimbursement: Some hospital facilities (e.g., Michigan Medicine) provide advance expenses for meals or lodging on a per diem basis to Medicaid beneficiaries securing inpatient or outpatient treatment at their facility and their medically necessary attendant (or individual with a vested interest). These facilities seek reimbursement directly from the Contractor after the treatment’s end, and within 12 months of the incurred expense. Refer also to policy and the current Non-Emergency Medical Transportation Rate Schedule.

7. NEMT services for parents, guardians or other individuals who are needed to accompany and/or be present with a beneficiary receiving Medicaid-covered services by virtue of age, functional need, and/or condition.

a. Children under 12 years of age must be escorted to medically necessary appointments by a parent, foster parent, caregiver or legal guardian.

b. Children between the ages of 12 and 18 years may travel alone with a consent letter signed by a parent, foster parent, caregiver or legal guardian unless access to the service does not require parental consent* by the Medicaid program.

c. The above are waived for beneficiaries who have been emancipated or are seeking transportation for *health care services for which a minor is legally able to consent (i.e., pregnancy-related, sexually transmitted/venereal disease, HIV/AIDS, substance use disorder, or outpatient CMHSP care).

8. Prior authorization is obtained when required, including NEMT services related to all out-of-state beyond borderland medical services.

9. The standards of Non-Covered Services outlined in current policy (Medicaid Provider Manual, NEMT chapter) applicable on the date of service must be followed. Non-Covered Services include the following, unless otherwise indicated in policy:

a. Waiting time.

b. Trips provided without prior authorization when required.

c. Multiple trips for a single Medicaid visit.

d. When a beneficiary failed to keep their appointment.

e. Trips to and from services that are not covered (e.g., grocery store, non-Medicaid covered medical services).

f. Routine medical care outside a beneficiary’s community when comparable care is available locally, unless prior authorized.

g. Transportation to and from services for individuals who have not met their spend-down.

h. Expenses for services that have already occurred, excluding mileage reimbursement.

i. NEMT services for long-term care (i.e. nursing facility) beneficiaries. Routine, non-emergency medical transportation provided for long-term care residents in a van or other non-emergency vehicle is included in the facility's per diem rate.

j. Transportation for services provided in FQHCs.

k. Transportation for beneficiaries enrolled in: Medicaid Health Plans, PACE, or Medicaid waiver/managed care programs that provide transportation.

l. Transportation for beneficiaries enrolled in Plan First.

m. Transportation for beneficiaries enrolled in Emergency Services Only (ESO).

3.5 Notify beneficiaries promptly when NEMT services are denied, reduced, or terminated.

1. When policy criteria are not met and a request for NEMT services or reimbursement is denied, reduced, or terminated, the beneficiary must be notified verbally at the time of the request or as soon as the determination is made, including the reason for the determination of denial, reduction or termination.

2. Follow-up with a written notice must be sent within one business day of the denial, reduction or termination. The notice must include the reason(s), information regarding due process appeal rights, and the MDHHS Request for Hearing for Medicaid Enrollees, PACE Enrollees, or Waiver Applicants form. The template for the written notice of denial must be approved by MDHHS.

3. The Contractor must be accessible to attend and provide information for hearings, if requested by MDHHS.

4. Determination of lack of Medicaid FFS eligibility is not considered a denial of NEMT services. The beneficiary must be directed to the Medicaid Health Plan in which they are enrolled or to the MDHHS Beneficiary Help Line at 1-800-642-3195 or beneficiarysupport@michigan.gov.

Bidder Response – Statewide

☐ I confirm the above requirement(s) and agree with no exception(s).

Bidder Response – Wayne, Oakland, and Macomb Counties

☐ I confirm the above requirement(s) and agree with no exception(s).

Modes of Transportation The Contractor must:

4.1 Ensure that all eligible beneficiaries have access to, approval of, and that arrangements are made for the most appropriate mode of NEMT that at least minimally meets each beneficiary’s medical and functional needs, regardless of geographic region. This includes but is not limited to transportation provided by subcontracted transportation providers, other commercial providers, rideshare companies, nonprofit organizations, taxicabs, public transportation providers, commercial airlines, volunteer drivers, individuals with a vested interest, and the beneficiary themselves.

4.2 Utilize volunteer drivers whenever possible, as long as the medical and functional needs of the beneficiary are met. It is understood that availability of volunteer drivers may vary geographically.

4.3 Establish mutually agreed-upon, reimbursement rates with subcontracted transportation providers, necessary to maintain network adequacy.

4.4 Ensure that mileage reimbursement for beneficiaries, individuals with a vested interest, and volunteer drivers adheres to the MDHHS Non-Emergency Medical Transportation Rate Schedule current on the date of service. Non-Emergency Medical Transportation or www.michigan.gov >> Billing & Reimbursement >> Provider Specific Information >> Non-Emergency Medical Transportation (NEMT).

Bidder Response – Statewide

☐ I have reviewed the above requirement(s) and agree with no exceptions.

☐ I have reviewed the above requirement(s) and have noted any exceptions below.

Exceptions: List all exceptions here

Bidder must describe:

1. How bidder will ensure network adequacy across all areas of the State to be fully operational by contract begin date.

Insert response to the above requirement

Bidder must describe:

2. How bidder will establish volunteer network across all areas of the State to be fully operational by contract begin date.

Insert response to the above requirement

Bidder Response – Wayne, Oakland, and Macomb Counties

☐ I have reviewed the above requirement(s) and agree with no exceptions.

☐ I have reviewed the above requirement(s) and have noted any exceptions below.

Exceptions: List all exceptions here

Bidder must describe:

1. How bidder will ensure network adequacy across Wayne, Oakland and Macomb Counties to be fully operational by contract begin date.

Insert response to the above requirement

Bidder must describe:

2. How bidder will establish volunteer network across Wayne, Oakland and Macomb Counties to be fully operational by contract begin date.

Insert response to the above requirement

Medically Necessary NEMT Special Allowances

5.1 Utilize an MDHHS-approved Medical Needs Form (MNF) to be used in accordance with policy (NEMT chapter of the Medicaid Provider Manual) for all Special Allowances requests, including for special transportation (i.e. wheelchair lift-equipped or Medi-Van vehicles), and for beneficiaries requiring medically necessary attendants (individual with a vested interest or medical attendant) to accompany them to appointments. The form provides verification of medical need for the special transportation and/or special allowance(s) for transportation to Medicaid-covered medical services. A MNF form is not required for beneficiary meals and lodging.

5.2 The MNF must be signed and dated by the beneficiary’s primary care physician/physician assistant/nurse practitioner or specialist familiar with their medical and/or functional status that necessitates the NEMT special allowance(s) required.

5.3 The MNF must be updated annually or more frequently if the type of special allowance(s) required changes due to medical/functional status.

5.4 A letter of medical necessity addressing the need for and type of NEMT special allowance(s) required may be used in lieu of a MNF provided it is on letterhead, signed and dated by the beneficiary’s primary care physician/physician assistant/nurse practitioner or specialist familiar with their medical and functional status that necessitates the NEMT special allowance(s) required.

5.5 Forms and documentation must be maintained in the individual beneficiary’s NEMT record and available to MDHHS upon request.

5.6 Up to two dates of service of courtesy rides (one-way and/or round trip) are allowable while the beneficiary obtains the signed medical needs form/documentation.

Bidder Response

☐ I have reviewed the above requirement(s) and agree with no exceptions.

☐ I have reviewed the above requirement(s) and have noted any exceptions below.

Exceptions: List all exceptions here

Describe how you will comply with the requirement(s)

6. Contact Center and NEMT Service Reservations Direct communication mechanisms must be provided for beneficiary access to request/schedule/update NEMT services, make inquiries about services, and register complaints, including but not limited to a telephone call center, web-based application, and a mobile application. See also systems-related requirements in Sections 23-33 and Schedule D.

The Contractor must:

6.1 Contact Center

1. Establish and maintain a staffed toll-free telephone call center, web-based application and mobile application available 24 hours/day, 7 days/week with the capacity to manage all NEMT-related services, including but not limited to scheduling, inquiries (from beneficiaries, beneficiary designated representatives, providers, Medicaid technicians and MDHHS), and complaints. On State of Michigan holidays, the telephone call center may provide services limited to NEMT service provision required during the holiday and/or within the 24 hours following the holiday, including but not limited to inquiries about previously scheduled rides, urgent NEMT service needs (such as hospital discharges, urgent care/ER visits that do not require an ambulance, etc.)

2. Preferably maintain a physical presence in Michigan; at minimum, provide trained staff dedicated to Michigan calls/inquiries, and knowledgeable about this contract and NEMT services available in different geographic regions of Michigan. The Contractor may directly employ and operate the contact center or engage a subcontractor agency through a Business Processing Outsourcing (BPO) arrangement, provided all requirements of this Contract are met. The Contractor must ensure that all privacy, security, and other Contract requirements are upheld at all locations.

3. Provide clear instruction at the onset of any telephone call using artificial intelligence (AI) agents, that allow the caller to opt out of the use of an AI agent upon one simple prompt. This applies to all potential functions, such as answering caller questions, intake of NEMT requests, booking reservations, and/or log complaints.

4. Have mechanisms identified to handle inquiries from non-English speaking callers (such as a translator service) as well as callers with hearing and/or speech limitations.

5. Utilize a phone system, web-based and mobile applications with the capacity to handle the volume of inquiries required to service Michigan Medicaid/CSHCS beneficiaries within the required quality and performance metrics required by the contract. This includes staffing, system call/inquiry volume capacity, etc. Calls for reservations vs real-time ride assistance must be able to be differentiated, either by separate phone lines or another mechanism.

6. Have a back-up contact center including trained staff knowledgeable about this contract, and capable of servicing the beneficiaries in case of any unplanned shutdown or disruption of the primary center’s communication system. The back-up center must be available within ≤ 30 minutes from any unplanned shutdown/disruption.

7. Process all incoming reservation requests and other inquiries for NEMT services in a timely and responsive manner. Timely is defined as:

a. Less than 24 hours for requests that are received within ≤ 3 calendar days of the requested service date, including ensuring on-time performance standards are met for reservations requests for same-day ground transportation (see also section 7.4.3).

b. Less than 48 hours for requests that are received within > 3 calendar days of the requested service date.

8. Assure that beneficiaries with emergency requests are referred or transferred to 911 or an appropriate local emergency or ambulance service.

9. Schedule NEMT services through the Call Center, as outlined in the Schedule, Assign, and Dispatch Trips section of this RFP.

6.2 Call Center Staffing

1. A physical presence in Michigan is preferred; at minimum trained staff knowledgeable about this contract, NEMT services available in different geographic regions of Michigan, and dedicated to Michigan calls/inquiries is required.

2. The Contractor may utilize artificial intelligence (AI) agents on a limited basis to provide:

a. General Contactor information (phone/fax numbers, website, hours, etc.)

b. Call routing to the Contractor’s trained, live (non-AI) agents

c. Reminder messages

d. Other uses of AI must be approved by the MDHHS Program Manager.

3. The Contractor must ensure that they have trained live (non-AI) staff to handle all calls and act as troubleshooters and problem solvers for NEMT-related issues including:

a. Take in and answer caller questions

b. Intake of NEMT requests

c. Booking reservations

d. Intake of and response to complaints

4. Professional, prompt, culturally sensitive, and courteous customer service is required.

5. The Contractor must employ adequate number of staff to handle the volume of inquiries required to service Michigan Medicaid/CSHCS beneficiaries within the required quality metrics.

6. The Contractor’s employee schedule must ensure adequate staffing at all times and days, to handle the volume of inquiries required to service Michigan Medicaid/CSHCS beneficiaries within the required quality metrics.

6.3 Compliance and Monitoring

1. Call Center compliance and monitoring will align with the Contractor’s overarching Compliance Program.

2. All calls will be recorded for compliance monitoring, quality control, and training purposes as needed.

a. At least 3% of the recorded calls per month must be reviewed for compliance with customer care guidelines, contract requirements, and to identify possible problems or issues.

b. Identified issues will be addressed promptly, with resolution and/or a course of action established within 2 business days.

3. The Contractor must maintain documentation of monitoring activities, to be available upon request by MDHHS.

4. Call performance for the reservation line and ride assistance lines will be calculated separately and will be reported separately in the weekly report.

a. The average speed to answer (ASA) calls for each of these lines must:

1) Average an answer rate of ≥ 95% within 20 seconds and 90% answer rate within 15 seconds.

2) Not exceed 20 seconds for 5% or more of the days of the previous 12-week period. This is a perpetual rolling 12-week period for retrospective review of performance.

b. The average daily call abandonment rate for each of these lines must:

1) Remain below 10%

2) Not exceed ≥ 10% for 10% or more of the days of the previous 12-week period. This is a perpetual rolling 12-week period for retrospective review of performance.

5. Process all incoming reservation requests and other inquiries for NEMT services in a timely and responsive manner. Timely is defined as:

a. Less than 24 hours for requests that are received within ≤ 3 calendar days of the requested service date, including ensuring on-time performance standards are met for reservations requests for same-day ground transportation (see also section 7.4.3).

b. Less than 48 hours for requests that are received within > 3 calendar days of the requested service date.

6.4 Privacy and Confidentiality

1. The Contractor must maintain HIPAA compliance, and train staff regarding maintaining HIPAA compliance, privacy and confidentiality.

a. The Contractor will conduct regular audits of operational procedures, including information technology platforms, to confirm HIPAA compliance.

b. Where necessary, the Contractor will implement operational adjustments and will continue to do so as HIPAA requirements evolve.

c. The Contractor will continue to monitor and maintain the HIPAA compliance program in accordance with all federal and State requirements and regulations.

d. The Contractor’s ongoing compliance activities will involve no additional cost to the State.

2. Except for officially approved purposes directly connected with the administration of the Contract, no information about (or obtained from) any beneficiary in possession of the Contractor must be disclosed to any party other than MDHHS in a form that identifies the beneficiary, without prior written consent of the beneficiary, their legal representative, or a minor’s parent/guardian. The Contractor must modify and maintain comprehensive confidentiality policies and procedures as approved by the MDHHS Program Manager.

3. For eligible beneficiaries 18 and older, for whom a third party (i.e. not a legal guardian) is making NEMT arrangements, the Contractor must arrange services without revealing Medicaid coverage information, and document who the caller is and why they’re making the arrangements.

If the beneficiary is not eligible for services, the Contractor must indicate that the service is denied but must not reveal any information regarding Medicaid coverage. The Contractor must explain to the caller that further coverage detail can only be shared with the beneficiary, legal guardian, or with a release of information on record.

Bidder Response – Statewide

☐ I have reviewed the above requirement(s) and agree with no exceptions.

☐ I have reviewed the above requirement(s) and have noted any exceptions below.

Exceptions: List all exceptions here

Describe how you will comply with the requirement(s):

Bidder must describe:

1. How bidder will ensure contact center/reservations and ride assist agents/mechanisms will establish and maintain up-to-date knowledge of NEMT transportation resources in all areas of the state.

Insert response to the above requirement

Bidder must describe:

2. How the bidder will monitor and maintain compliance with contact center performance expectations including back-up mechanisms for staff shortages, spikes in volumes, and/or system outages to ensure prompt service without exceeding established timeframes.

Insert response to the above requirement

Bidder Response – Wayne, Oakland, and Macomb Counties

☐ I have reviewed the above requirement(s) and agree with no exceptions.

☐ I have reviewed the above requirement(s) and have noted any exceptions below.

Exceptions: List all exceptions here

Bidder must describe:

1. How bidder will ensure contact center/reservations and ride assist agents/mechanisms will establish and maintain up-to-date knowledge of NEMT transportation resources in Wayne, Oakland and Macomb Counties.

Insert response to the above requirement

Bidder must describe:

2. How the bidder will monitor and maintain compliance with contact center performance expectations including back-up mechanisms for staff shortages, spikes in volumes, and/or system outages to ensure prompt service without exceeding established timeframes.

Insert response to the above requirement

6.5 Web-Based Application and Mobile Application

1. The Contractor must provide a web-based application and a mobile application for beneficiary access to request/schedule/update NEMT services, make inquiries about services, and register complaints.

2. The applications must be ADA compliant, including but not limited to, consideration of reading grade level, language translation, and use by individuals with hearing impairments and/or visual limitations.

Bidder Response – Statewide

☐ I have reviewed the above requirement(s) and agree with no exceptions.

☐ I have reviewed the above requirement(s) and have noted any exceptions below.

Exceptions: List all exceptions here

Bidder must describe:

3. The bidder’s web-based and mobile applications capable of servicing beneficiaries Statewide.

Insert response to the above requirement

Bidder Response – Wayne, Oakland and Macomb Counties

☐ I have reviewed the above requirement(s) and agree with no exceptions.

☐ I have reviewed the above requirement(s) and have noted any exceptions below.

Exceptions: List all exceptions here

Bidder must describe:

3. The bidder’s web-based and mobile applications capable of servicing beneficiaries in Wayne, Oakland and Macomb Counties.

Insert response to the above requirement

7. Schedule, Assign and Dispatch Trips

7.1 Arrange transportation for all eligible FFS beneficiaries. This includes transportation related to out-of-state medical services that have been authorized by MDHHS. All requests for out-of-state NEMT services require prior authorization by the MDHHS, unless the location is included on the list of borderland cities and counties in the Medicaid Provider Manual.

7.2 Employ a scheduling and dispatching mechanism that has been proven effective and efficient in a Medicaid NEMT environment. The Contractor’s scheduling system must accommodate advanced reservations, subscription service (regular, repeating, ongoing appointments), requests for urgent service, and track scheduling tasks and key points for reporting purposes as identified in the reporting section of this RFP.

7.3 Verify, prior to approving and arranging for NEMT, that the beneficiary is eligible to receive NEMT.

1. To verify beneficiary eligibility, the Contractor must be able to:

a. Utilize CHAMPS Eligibility Inquiry OR

b. Process 5010 HIPAA-formatted 834 enrollment files, 820 payment files, and 837 encounter files received from MDHHS, utilizing the most current file(s) to verify beneficiary eligibility.

2. During the calendar month of the DOS, the Contractor must verify that the beneficiary has active eligibility for the actual NEMT DOS.

a. If the DOS is the first calendar day of the month, eligibility must be verified prior to providing the NEMT service that day.

b. If eligibility was confirmed prior to the month of the DOS, then eligibility must be re-verified during the calendar month of the DOS.

Bidder Response

☐ I confirm the above requirement(s) and agree with no exception(s)

☐ I have reviewed the above requirement(s) and have noted any exceptions below.

Exceptions: List all exceptions here

7.4 Schedule NEMT services for all eligible beneficiaries obtaining Medicaid covered services.

1. Verify the beneficiary’s eligibility through CHAMPS Eligibility Inquiry at the time of scheduling:

a. If the beneficiary has current eligibility (i.e. on the date of the scheduling request inquiry) or on the actual NEMT DOS, then the Contractor must schedule the NEMT service.

b. If the beneficiary has eligibility on the actual NEMT DOS, then the Contractor must schedule the service.

2. Allow beneficiaries to schedule transportation or other NEMT services, at least 30 days in advance for scheduled medical services.

a. The Contractor must inform the beneficiary that all advanced reservations are dependent upon meeting the beneficiary’s Medicaid eligibility on the actual NEMT date of service (DOS).

b. The Contractor must inform the beneficiary to notify the Contractor of any change in appointment dates/times as soon as possible, understanding that medical providers may change appointments with limited notice.

3. Allow beneficiaries to schedule same-day ground transportation; however, the Contractor may educate (but not deny) beneficiaries to schedule transportation needs as soon as medical appointment dates are known (up to 30 days in advance) with a request for a minimum of 2 days advance notice to allow for better coordination of rides.

4. Schedule air travel that has been prior authorized by MDHHS. If the Contractor receives a direct request for air travel, the Contractor must submit the request to MDHHS for authorization. MDHHS will notify the Contractor of authorizations for air travel with as much advance notice as possible. Related ground transportation needs must be included in authorizing and scheduling air travel.

7.5 Assignment and Dispatch of Trips.

The Contractor must:

1. Assign the most appropriate mode of transportation to meet the beneficiary’s medical and functional need, including any special transport requirements for medically fragile or physically/mentally challenged beneficiaries using the considerations identified on the beneficiary’s medical needs documentation and in the Medicaid Provider Manual. Transportation provision may include: mileage reimbursement, commercial transportation provider companies, non-profit provider transportation, volunteer drivers, public transportation, rideshare companies, taxicab, air travel if required, or ferry transportation where indicated.

2. Public transportation (fixed route or demand response) should be used when it is the most cost-efficient means of transportation that appropriately meets the functional and medical needs of the beneficiary. When utilizing public transportation, the Contractor must:

a. Determine the number of anticipated trips for a given time period and compare the cost of individual tickets/tokens to passes. Passes should be used when beneficiaries have multiple medical appointments during a given time period such that the cost of a pass is less than individual tickets/tokens.

b. Establish procedures for timely distribution of tokens/passes to beneficiaries so that the beneficiaries can be present at medical appointments on time.

1) Procedures must include options for mailing, beneficiary pick-up, electronic (when/where available), or hand delivery to the beneficiary when necessary.

2) For the convenience of beneficiaries with standing orders who use public transit to attend regularly scheduled appointments such as dialysis, chemotherapy, or radiation treatments, the Contractor may provide medical facilities with a specific number of public transit passes. The Contractor will provide a tracking log, instructing the facility to document the unique serial number of the pass issued to each beneficiary, and at the end of the month, report lack of attendance during the month to the Contractor. Any passes that are not distributed must be returned to the Contractor.

3) The Contractor must have a mechanism for beneficiary acknowledgement of receipt of tokens/passes. Record of acknowledgment must be maintained.

c. Monitor public transportation utilization, performing and reporting on pre-transportation and post-transportation validation checks on no less than 2% of public transportation trips used per month.

3. Volunteer transportation should be used when it is the most cost-efficient means of transportation that appropriately meets the functional and medical needs of the beneficiary. When arranging volunteer transportation, the Contractor is responsible for ensuring adherence to all standards and requirements: throughout this contract, in the Medicaid Provider Manual, in Michigan Medicaid Approved Policy Bulletins and Numbered Letters, in municipal, state, and federal regulations, in the Consolidated Appropriations Act of 2021, and including any subsequent changes or additional regulations specific to NEMT.

4. Multi-Loading of Vehicles The Contractor must:

a. Prevent multi-loading of vehicles that would require the beneficiary to be in the vehicle more than 30 minutes longer than the average direct travel time or delay timely arrival for appointments.

b. Allow the beneficiary the right to refuse a ride that includes other beneficiaries (multi-load).

Bidder Response

☐ I have reviewed the above requirement(s) and agree with no exceptions.

☐ I have reviewed the above requirement(s) and have noted any exceptions below.

Exceptions: List all exceptions here

1. Bidder must describe how they will operationalize scheduling of reservations for NEMT services, with the capability of accommodating requests made in advance as well as same day requests.

Insert response to the above requirement

2. Bidder must describe their mechanism for scheduling air travel and out-of-state requests that have been prior authorized by MDHHS.

Insert response to the above requirement

3. Bidder must describe call center reporting and provide a sample report.

Insert response to the above requirement

1. Provision of NEMT Services

8.1 Have a process, system, and criteria for determining and reporting the appropriate mode of transportation, the assigned transportation provider/driver, and ensure that the transport is completed in a timely and efficient manner by licensed, qualified and competent subcontracted transportation provider personnel.

1. The beneficiary must be notified of the upcoming trip the calendar day prior to the scheduled appointment and again when the transportation provider/driver is dispatched.

a. At the time of booking beneficiaries, their representatives and facilities will be given the option to receive notifications via text or phone.

b. Contractor’s subcontracted transportation providers must maintain record of reminder notifications; reports must be available to the State upon request.

2. On-time performance standards must be adhered to, and a monthly performance report must be provided (see 18. Reporting). On-time performance is defined at minimum as:

a. Pick-ups: no more than 15 minutes prior to or post scheduled pick-up time for at least 90% of the trips.

b. Appointment arrival: no later than the actual scheduled time of the appointment for greater than 90% of the trips. Appointment time is defined as the time the beneficiary is instructed by the medical provider to arrive (e.g. 10 minutes prior to appointment for documentation purposes, etc.) and must additionally factor time necessary to get from the drop-off location to the appointment check-in location within the facility. These details must be established at the time of booking.

3. The Contractor must have a mechanism to:

a. Manage subcontracted transportation provider company trip assignments.

b. Manage transportation provider/driver assignments for each trip.

c. Track/monitor vehicle location, including digital/geo-tracking mechanisms, and alternative mechanisms in absence of digital capability.

d. Document pick up and arrival time (alternative mechanisms including digital and non-digital).

e. Reroute and recover trips to ensure timely transportation to/from the appointment.

f. Mask beneficiary phone numbers and email addresses [not share with drivers] unless given explicit permission by the beneficiary. Permission must be recorded in the beneficiary record. The Contractor is not responsible if the beneficiary shares their contact information directly with the driver(s).

g. Maintain a comprehensive audit log of each trip; details must be made available to the State upon request. (See also 16. Contractor Database Requirements for details)

h. Identify and track non-attendance by the beneficiary and provide a monthly beneficiary cancellation report (See also 18. Reporting and 14. Complaint Management).

8.2 Have a process, system, and criteria for determining and reporting all other NEMT services including assigned NEMT providers and ensure that the service is completed in a timely and efficient manner.

Bidder Response: Statewide

☐ I have reviewed the above requirement(s) and agree with no exceptions.

☐ I have reviewed the above requirement(s) and have noted any exceptions below.

Exceptions: List all exceptions here

Bidder must describe:

1. Bidder’s ride reminder/notification mechanisms.

Insert response to the above requirement

Bidder must describe:

2. How bidder will monitor and record/document pick-up and arrival times.

Insert response to the above requirement

Bidder must describe:

3. How bidder will improve 2.a and 2.b on-time performance standards beyond minimum contract requirement.

Insert response to the above requirement

Bidder must describe:

4. How bidder will track/monitor vehicle location (include bidder methods, cost analysis, alternative mechanisms including digital and non-digital).

Insert response to the above requirement

Bidder Response – Wayne, Oakland, and Macomb Counties

☐ I have reviewed the above requirement(s) and agree with no exceptions.

☐ I have reviewed the above requirement(s) and have noted any exceptions below.

Exceptions: List all exceptions here

Bidder must describe:

1. Bidder’s ride reminder/notification mechanisms.

Insert response to the above requirement

Bidder must describe:

2. How bidder will monitor and record/document pick-up and arrival times.

Insert response to the above requirement

Bidder must describe:

3. How bidder will improve 2.a and 2.b on-time performance standards beyond minimum contract requirement.

Insert response to the above requirement

Bidder must describe:

4. How bidder will track/monitor vehicle location (include bidder methods, cost analysis, alternative mechanisms including digital and non-digital).

Insert response to the above requirement

NEMT Provider Network and Agreements

9.1 Establish/maintain network adequacy for NEMT services, employing safety and quality strategies and capacity to deliver all levels of NEMT services to all eligible FFS Medicaid beneficiaries residing within the geographic coverage area of the contract. The network must:

1. Have the capacity to ensure adequate accommodation of all NEMT services, such as mileage reimbursement, meals, and lodging needs.

2. Include a comprehensive array of transportation and driver types to ensure adequate coverage for all beneficiaries requiring transportation. Transportation provision may include:

a. Mileage reimbursement for beneficiaries and/or individuals with vested interest.

b. Transportation provided by commercial transportation provider companies.

c. Free transportation provided by non-profit organizations.

d. Transportation provided by volunteer drivers.

e. Public transportation.

f. Transportation provided by rideshare companies (requires contractual arrangement related to enrollment requirements).

g. Taxicabs.

h. Air travel if required (requires prior authorization by MDHHS).

i. Ferry transportation, where indicated.

3. Ensure that agreements with all providers meet the current minimum requirements for each provider type as indicated in policy, as well as all federal and state laws and regulations governing NEMT vehicles and drivers.

4. Ensure that the provider network is responsive to the varied needs of the population of culturally diverse beneficiaries.

a. The Contractor’s provider network must be responsive to the cultural, language, medical and functional needs of the beneficiaries in all aspect of arranging for and the provision of NEMT services.

b. Ensure that all beneficiaries, including non-English speaking beneficiaries, can access NEMT. Qualified interpretation services, for communication with non-English speaking beneficiaries and/or their representatives, or those for whom English is a second language must be provided.

c. Ensure appropriate accommodations for beneficiaries with, but not limited to, hearing, verbal, and/or visual impairments.

d. The Contractor’s provider network must comply with the Americans with Disabilities Act (ADA) requirements and regulations.

5. Have mechanisms in place to perform regular monitoring activities to ensure driver, passenger, and vehicle criteria are being met.

a. Mechanisms must include real-time spot checks and ride-alongs.

b. Documentation of dates, vehicles, drivers, other monitor details, and findings must be maintained. Documentation of non-compliant findings must include a remediation plan and follow-up.

c. Documentation must be made available to the MDHHS Program Manager upon request.

6. Not provide their own vehicles and/or drivers through the services of any transportation company in which they have an ownership interest.

7. Negotiate service delivery rates with each qualified transportation entity and make payments to each transportation provider/driver based on authorized services rendered.

a. It is permissible for the Contractor to establish mutually agreed-upon, suitable reimbursement rates for each subcontracted and commercial transportation provider.

b. Mileage reimbursement for beneficiaries, individuals with a vested interest, and volunteer drivers must adhere to the MDHHS Non-Emergency Medical Transportation Fee Schedule (Non-Emergency Medical Transportation).

Bidder Response – Statewide

☐ I have reviewed the above requirement(s) and agree with no exceptions.

☐ I have reviewed the above requirement(s) and have noted any exceptions below.

Exceptions: List all exceptions here

Bidder must describe:

1. How bidder will establish/maintain network adequacy for NEMT services and capacity to deliver all levels of NEMT service across all areas of the state.

Insert response to the above requirement

Bidder must describe:

2. How bidder will ensure that the provider network is responsive to the varied needs of the population of culturally diverse beneficiaries across all areas of the state, including cultural, language, and functional needs (physical, hearing/verbal/visual).

Bidder Response – Wayne, Oakland, and Macomb Counties

☐ I have reviewed the above requirement(s) and agree with no exceptions.

☐ I have reviewed the above requirement(s) and have noted any exceptions below.

Exceptions: List all exceptions here

Bidder must describe:

1. How bidder will establish/maintain network adequacy for NEMT services and capacity to deliver all levels of NEMT service across all areas of Wayne, Oakland, and Macomb Counties.

Insert response to the above requirement

Bidder must describe:

2. How bidder will ensure that the provider network is responsive to the varied needs of the population of culturally diverse beneficiaries, including cultural, language, and functional needs (physical, hearing/verbal/visual) across all areas of Wayne, Oakland, and Macomb Counties.

Insert response to the above requirement

Non-Network Providers The Contractor is permitted to use non-network providers such as taxicabs, as long as they are licensed or registered through the appropriate state authority (e.g., Secretary of State, Licensing and Regulatory Affairs, Michigan Department of Transportation) or equivalent(s) in the state in which they are operating, meet driver requirements of that authority, and are compliant with NEMT policy as outlined in the Michigan Medicaid…