Schedule I - Definitions and Explanation of Terms.docx

Enter your company name Schedule I – Definitions/Explanation of Terms

RFP 260000002254

Non-Emergency Medical Transportation (NEMT) Broker for Medicaid Fee for Service (FFS) Beneficiaries The terms used in this Contract will be construed and interpreted as defined below unless the Contract otherwise expressly requires a different construction and interpretation.

Refer also to the NEMT chapter of the Michigan Medicaid Provider Manual at:

Non-Emergency Medical Transportation or www.michigan.gov/medicaidproviders >> Billing & Reimbursement >> Provider Specific Information >> Non-Emergency Medical Transportation (NEMT).

Contractor’s Employees: Refers to all employees with assigned duties related to the contract. This includes permanent and long-term temporary employees at staff, supervisory and managerial levels.

Individual With a Vested Interest: A transportation provider who is a relative or friend of a beneficiary and who has a personal stake or interest in the livelihood of a beneficiary.

Medically Necessary Attendant: An individual, other than the driver of the vehicle or an individual with a vested interest, who assists a beneficiary due to their physical, mental, or developmental status on trips to and from a service or appointment that Medicaid covers.

Medivan: A commercial vehicle used for transport of a beneficiary that needs door to door or curb to curb service due to medical condition. The beneficiary is able to transfer in and out of the vehicle, but may need assistance. This could include vehicles such as a limousine, ambu-cab or nonwheelchair van. Drivers are expected to assist the beneficiary as needed.

Mileage: Total round-trip mileage, rounded up to the nearest mile and verified using an online mapping service or a Global Positioning System device.

Missed Trip: A trip that was scheduled but did not occur, excluding cancelled and denied trips. Examples include: beneficiary was not present at time/location of scheduled pick up, transportation provider/driver did not show, transportation provider/driver was excessively late causing a missed appointment, trip was “cancelled” after the scheduled pick-up time (by either the beneficiary or transportation provider/driver).

Mode of Transportation: Commercial and nonprofit transportation, Fixed route, demand response and deviated route public transportation, Volunteer drivers, Mileage reimbursement (Individuals with a vested interest, Beneficiaries providing their own NEMT in their personal vehicle) NEMT Providers: Includes any NEMT service provider type (public transit, commercial or nonprofit transportation entity, volunteer driver, individual with a vested interest, beneficiary receiving reimbursement, medically necessary attendant, and any other entity providing any NEMT services).

Push Payments: Refers to the monthly advance capitation (PMPM) payments to the Contractor. Paid via CHAMPS on the third Thursday of the month.

Off-Cycle Payments: Refers to transactions subsequent to the regularly scheduled monthly PMPM payments, including but not limited to for newly NEMT-eligible beneficiaries added subsequent to the monthly payment, recoupment credits related to beneficiary loss of NEMT eligibility in the prior month(s).

Round Trip: When a beneficiary is transported from their residence, or another location, to a Medicaid-covered service and then returned to their original point of origin.

Service Level/Ride Type: Refers to the level of vehicular accommodation/non-standard features required, including such as: Ambulatory (no vehicular accommodation/non-standard features required), Wheelchair lift, Walker with Lift, Medivan/Ambulette.

Special allowances: includes medically necessary wheelchair lift-equipped vehicle, Medi-Van vehicle, medically necessary attendant (other than a parent/guardian), and other special circumstances supported by medical documentation.

Subcontracted Transportation Provider: A commercial transportation company subcontracted by the broker (Contractor), employing drivers (Transportation Providers/Drivers) who provide transportation services to beneficiaries.

Transportation Network Company: Also known as a rideshare company.

Transportation Provider/Driver: An individual (e.g. an employee of a public, commercial or nonprofit transportation entity, volunteer driver, individual with a vested interest, or medically necessary attendant) who provides transportation services to beneficiaries.

Trip: Transportation of a beneficiary from their residence, or another location, to a Medicaid-covered service. A-Leg is the first trip of the day, i.e. from the originating location to the destination; B-leg is the return trip/second trip of the day, i.e. from the destination back to the originating location.

Unloaded Mileage: Mileage traveled when the beneficiary is not in the vehicle.

Waiting Time: The time that a vehicle is waiting at a Medicaid-enrolled provider’s facility in order to transport the beneficiary to another location during the same trip.

Wheelchair Lift Equipped Vehicle: A vehicle owned by a commercial or nonprofit provider that is equipped for a beneficiary who requires a wheelchair and that provides door-to-door service due to their inability to ambulate. Drivers of these vehicles are expected to assist and escort the beneficiary. This definition also includes demand response paratransit transportation services. The vehicle must be properly equipped to secure the wheelchair in compliance with regulatory requirements.

RFP 260000002254 NEMT Broker for Medicaid FFS 40 image1.png