Letter to CMS - Medicaid Managed Care Policies - Agency for ...

Agency For Health Care Administration
Managed Care Organizations
Transportation Audit Tool
Transportation Review Tool
Item Number Standard Found in Handbook Reference Comments
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The health plan ensures that all transportation providers maintain
sufficient liability insurance to meet requirements of FL law.
The health plan is responsible for the cost of transporting an enrollee from
a nonparticipating facility or hospital to a participating facility or hospital
if the reason for transport is solely for the health plan’s convenience.
The health plan approves and processes claims for transportation services
in accordance with the requirements set fort in this Contract.
If the health plan subcontracts for transportation services, it provides a
copy of the model subcontract to BMHC for approval before use.
Before providing transportation services, the health plan provides BMHC
a copy of its policies and procedures for approval relating to the
following:
a. How the health plan determines eligibility for each enrollee and what
type of transportation to provide that enrollee.
b. The health plan’s procedure for providing prior authorization to
enrollees requesting transportation services.
c. How the health plan reviews transportation providers to prevent
and/or identify those who falsify encounter or service reports,
overstate reports, or upcode service levels, or commit any form of
fraud or abuse as defined in s. 409.913, F. S.
d. How the health plan deals with providers who alter, falsify, or destroy
records before the end of the retention period; make false statements
about credentials; misrepresent medical information to justify
referrals; fail to provide scheduled transportation; or charge enrollees
for covered services.
e. How the health plan provides transportation services outside of its
service area.
The health plan reports immediately, in writing to BMHC, any
transportation-related adverse or untoward incident (see s. 641). The
health plan also reports, immediately upon identification, in writing to
MPI, all instances of suspected enrollee or transportation services provider
fraud or abuse.
Y N N/A Exhibit 5
Y N N/A Exhibit 5
Y N N/A Exhibit 5
Y N N/A Exhibit 5
a. Y N N/A
b. Y N N/A
c. Y N N/A
d. Y N N/A
e. Y N N/A
Y N N/A
Managed Care Organizations Page 3
Transportation Audit Tool F1_03_10
Florida Medicaid
Exhibit 5
s. 641.55, F. S.
s. 409.913, F. S.
Exhibit 5