Provider Service Expectations Transportation Services SPC 107 Provider Subcontract Agreement Appendix N Purpose: Defines requirements and expectations for the provision of subcontracted, authorized and rendered services. Services shall be in compliance with the Provider Subcontract Agreement and the provisions of this service expectations document. 1.0 Service Definition WWC follows the definitions and guidelines as defined for Specialized Transportation in the DHS Family Care contract and the Medicaid Waivers manual, SPC 107. Specialized transportation is the provision of services or items which permit an individual to gain access to community services, activities and resources, and Medicaid covered medical services. This service may consist of items such as tickets or other fare medium or services where the provider directly conveys a participant and her or his attendant, if any, to destinations. Whenever possible, family, neighbors, friends or community agencies who can provide this service without charge will be utilized. Specialized transportation services are intended to maintain or improve the participant s mobility in the community, increase independence and community participation and prevent institutionalization. Community should be broadly defined and should not be limited to the boundaries of any particular municipality. The MCO should have a written policy to ensure the community criteria are consistently and equitably applied. Specialized Transportation is categorized as follows: a. Other transportation (medical, includes common carrier and SDS directed SMV) b. Community transportation (non-medical) The Family Care benefit package excludes ambulance transportation, which is available through the Medicaid State plan. 2.0 Standards of Service Medicaid Waiver Standards - Provider must follow Medicaid Waiver Standards for Specialized Transportation 2.1 Services. These Provider Service Expectations reflect the Waiver Standards and WWC policies and procedures. An asterisk* reflects a Waiver Standard throughout the document. 2.2 2.3* 2.4 2.5 Medicaid Title 19 Standards for Specialized Medical Vehicle (SMV) transportation. SMV is defined as a vehicle equipped with a lift or ramp for loading wheelchairs. It is also equipped with passenger restraint devices for each passenger. The driver of a SMV must have first aid and CPR certification. Providers of Specialized Medical Vehicle services must provide verification of Medicaid Certification. Mass transit carriers are regulated under s.85.20, and the provision of specialized transportation is regulated under s.85.21 of Wisconsin Statutes. Service must be provided in a manner which honors member s rights such as consideration for member preferences (scheduling, choice of provider, direction of work), and consideration for common courtesies such as timeliness and reliability. WWC subcontracted providers of long-term care services are prohibited from influencing members choice of long-term care program, provider, or Managed Care Organization (MCO) through communications that are misleading, threatening or coercive. WWC and/or the WI Department of Health Services may impose sanctions against a provider that does so.
Per Wisconsin Department of Health Services (DHS), any incidents of providers influencing member choice in a Family Care program must be reported to DHS immediately. 3.0 Service Descriptions SPC 10720 / 10721 Transportation - Community - Non-Medical related transportation (car, van, taxi, bus, or lift/ramp equipped vehicle) other than an SMV that is used to transport a member to an activity or authorized service that meets a long term care outcome. Examples are supported employment, day service, or adult day 3.1 care. Community transportation is a curb to curb service meaning member is picked up and dropped off at the curb of the point of origin and destination, respectively with assistance to board and disembark from the vehicle as needed and referred but not to enter or exit a building at the point of origin or destination. SPC 10710 / 10711 Transportation Medical related transportation (car, van, taxi, bus or lift/ramp equipped vehicle) other than an ambulance or SMV to a Medicaid covered service. Common Carrier is an curb to curb service meaning member is picked up and dropped off at the curb of the point of origin and destination, 3.2 respectively with assistance to board and disembark from the vehicle as needed and referred but not to enter or exit a building at the point of origin or destination. If the member needs a companion along, transportation is provided to the companion free of charge. SPC 10710 / 10711 Specialized Transportation Other - SDS medical Members eligible for this service must have decision-making authority over a budget for the purchase of such services. Such members are not limited to providers in the MCO s network (although the credentials of specialized medical vehicle providers must be verified by the MCO), do not require MCO prior authorization to purchase any transportation service 3.3 from a qualified provider to any Medicaid coverable medical service if the member s budget is sufficient to pay the cost, and advanced scheduling of routine trips is not required if the member can obtain transport. Legally responsible relatives may be paid for providing this service if they meet the conditions under Article VIII.P.2. SPC 10710 / 10711 Specialized Medical Vehicle (SMV) A vehicle equipped with a lift or ramp for loading wheelchairs. It is also equipped with passenger restraint devices for each passenger, including restraint 3.4* devices for persons in wheelchairs or on cots or stretchers. The driver of an SMV must have first aid and CPR training. 4.0 Units of Service and Reimbursement Guidelines Transportation services is billed with the indicated SPC, procedure code and modifiers at the specified contracted rate as defined in Provider Subcontract Agreement, Appendix A. SPC 10710/10720 WWC specific codes to specify that transportation is provided with an authorized bus pass, bus token, or taxi voucher issued by WWC. 10710 (modifier RD) represents Medical 10720 (modifier RI) represents Non-Medical (community) 4.1 The following service descriptions and unit combinations are included in the WWC benefit package: Transportation for medical purposes Applies to taxi companies, volunteer driver organizations, and other general transportation providers SPC 107.10 (RD)- each pass, each voucher, per token, or per trip at negotiated rates* with provider SPC 107.11 (RD)- per mile reimbursement at negotiated rates* with provider *SMV providers are reimbursed at Medicaid established rates Transportation for non-medical (community) purposes Applies to taxi companies, volunteer driver organizations, and other general transportation providers SPC 107.20 (RI)- each pass, each voucher, per token, or per trip at negotiated rates with provider SPC 107.21 (RI)- per mile reimbursement at negotiated rates with provider 4.2* Providers may not charge co-payment fees to WWC members authorized for transportation funding by WWC.
Transportation providers may not charge a separate transportation fee for an attendant, if needed to 4.3* accompany the participant when accessing the community. Only loaded miles are billable unless otherwise specified in the Provider Subcontract Agreement, Appendix A. 4.4 Loaded miles are defined as the miles that the member is present in the vehicle with the driver. No Show Rides If a member fails to cancel an authorized ride one hour prior to the scheduled ride time and fails to show for the ride, WWC shall reimburse for the authorized ride. Reimbursement for no show rides 4.5 shall be limited to the pickup fee, or as designated in the Provider s Subcontract- Appendix A. Refer to section 8.6 for communication and reporting requirements for No Show rides. 5.0 Staff Qualifications and Training Caregiver Background Checks- Providers will comply with all applicable standards and/or regulations related 5.1* to caregiver background checks as well as comply with the WWC Provider Policy on Caregiver Background Checks. Individual or volunteer providers of transportation services must provide documentation of minimum state required liability insurance coverage, possess a valid driver s license, submit a completed W-9 Form, and provide written assurance of the following; 5.2 a. The vehicle used is mechanically sound, has properly functioning lighting, safety ventilation and braking systems and b. The vehicle has properly inflated tires, without excessive wear Provider will orient and train their staff on the Family Care Program and WWC. Support materials regarding 5.3 the Family Care Program are available on the WWC website at: www.wwcares.org 5.4 All SMV certified agencies must ensure that all drivers have current first aid and CPR training. The transportation services agency must ensure that providers have received training on the following subjects pertaining to the individuals served: A. Policy, procedures and expectations of WWC and the transportation agency including training on; Member rights and responsibilities Abuse and neglect identification and reporting Provider rights and responsibilities Record keeping and reporting Confidentiality laws and regulations Other information deemed necessary and appropriate Interpersonal and communication skills to include: 5.5 i. Cultural, linguistic and ethnic differences ii. Active listening iii. Ethics in dealing with members, family and other providers iv. Conflict Resolution v. Maintaining appropriate personal and professional boundaries with member s served B. Recognizing and appropriately responding to all conditions that might adversely affect the member s health and safety including how to respond to emergencies and member incidents. C. Providers shall ensure that transportation services staff are knowledgeable in the adaption and use of specialized equipment and in the modification of the member environments to assure safety of individuals being transported. Training regarding properly securing mobility devices. 6.0 Supervision and Staff Adequacy The provider shall maintain adequate staffing, vehicles, routes, and scheduling methods to meet the needs of 6.1 members referred by WWC and accepted by the transportation services provider for service. The provider must maintain adequate administrative staff for program operations related to acceptance of referrals, scheduling drivers and routes, tracking referrals, delivery of services and monitoring the quality of the services. 6.2 The transportation provider must have a method of verifying that service was provided as assigned and scheduled. Provider agency will ensure:
Drivers are supervised and assessed to assure they are working effectively with members Performance issues with staff are addressed promptly, WWC teams are kept informed about significant issues that affect the WWC membership Provider staff are working collaboratively and communicating effectively with WWC staff 7.0 Service Referral and Authorization The WWC team will provide a written referral form to the transportation provider that specifies the amount, 7.1 frequency and duration of the services. The transportation services agency must notify the WWC team of ability to service the referral within 1 business day of receiving the referral. 7.2 Verbal confirmation from the WWC team prior to receipt of written referral meets this requirement. This communication should include acceptance or inability to fill the referral by the requested start date. The referral form may be for a one-time trip or an ongoing authorization for a number of trips/miles per week or month. 7.3 For standing authorizations, a new referral form will not be sent for each scheduled trip. The member or a designated representative of the member may coordinate rides as needed within the scope of rides/miles/unit and frequency authorized. The transportation services agency shall give at least 24 hours advance notice to WWC team and member 7.4 when not able to provide authorized trips as requested or scheduled to individual members. Providers may contact the member s WWC team or on-call Unit Manager if the team is not available to request authorization during regular WWC business hours. 7.5 Any trips provided under a verbal authorization will be followed up by a written referral form from the WWC team within seven business days. 7.6 The provider agency will retain copies of the WWC referral forms in the agency file as proof of authorization. Authorizations for Member Services Current and active authorizations are obtained by accessing the WWC Provider Portal. Providers must sign up with WWC to access the portal. The provider agency is responsible for ensuring only currently employed and authorized staff have access to the WWC provider portal and using the member authorization information available on the portal to bill for services accurately. 7.7 Questions on active authorizations should be directed to the WWC team. For authorization needs during normal WWC business hours (8:00 a.m.-4:30 p.m.), the provider should contact 1) the WWC team, if not available 2) the WWC team s Unit Manager, if not available 3) the On-Call Unit Manager. For authorization of services or products after WWC business hours, providers contact the After-Hours Authorization Line at (877) 657-8766. 8.0 Communication, Documentation and Reporting Requirements WWC communicates with providers regularly in the following formats: Vendor forums Mass notifications via email, fax, or mail Notices for expiring credentialing 8.1 Notices are sent to providers via email when the provider has email available to ensure timeliness of communication. Provider agencies are required to ensure WWC Provider Network, WWC teams, guardians and other identified members of the interdisciplinary team for a member have accurate and current provider contact information to include address, phone numbers, fax numbers, and email addresses. Member Incidents Provider agencies shall report all member incidents to the WWC team. Providers must promptly communicate 8.2 with the WWC team regarding any incidents, situations or conditions that have endangered or, if not addressed, may endanger the health and safety of the member. Acceptable means of communicating member incidents to the WWC team would be via phone, fax or email
within 24 hours. Additional documentation of incidents may be requested by the WWC team or WWC Quality Assurance. 8.3 8.4 8.5 8.6 8.7 Providers and WWC will comply with the WWC Incident Reporting Policy, which is available on the WWC website at: www.wwcares.org > Providers > Provider Policy & Procedure. Provider Wait Time Policy Requirements The transportation services provider/agency shall maintain a wait time policy and procedure as it pertains to all types of transportation provided. Medical and non-medical transport shall ensure the member is on time for the appointment but may have a difference of 60 minutes pick up time for urban transports and 90 minutes for rural transports. Once the vehicle arrives for pick-up, the driver shall wait 5 minutes after the agreed upon pick-up time for medical, community, and regular route transportation. Waiting time refers to the time spent by the SMV provider waiting for the member to return to the vehicle while the member receives medical services (one member up to six hours waiting time). Provider is required to physically wait at the location where the member receives the medical service. The driver must not perform any other transports or activities during the waiting time. The driver is required to document the beginning and ending times for waiting time and total amount of waiting time (if waiting time occurs). Drivers are to document full odometer readings (to the tenth of a mile) from beginning and end of the trip. SMV waiting times are to be documented by the hour (1.0 hour = 1.0 unit) (1 hour 40 minutes = 1.7 units). Provider Ride Time Policy Requirements The transportation services provider/agency shall maintain a ride time policy and procedure as it pertains to all types of transportation provided. Ride time refers to the duration of a one-way trip in a regular route taking into consideration multiple pick-up and drop off stops of riders in a shared route as well as reasonable loading and unloading time. Ride times of 60 minutes for urban transport and 90 minutes rural transport is generally and traditionally accepted. Deviations due to inclement weather, unforeseen circumstances of riders, and unforeseen vehicle maintenance once route has commenced shall be communicated to destination representative (if any) by transportation provider/agency as soon as possible. Provider Inclement Weather Policy Requirements The transportation services provider/agency shall maintain an inclement weather policy and procedure. The inclement weather policy and procedure must be shared with WWC. Provider No Show Policy and Procedure Requirements The transportation services provider/agency shall maintain a No Show policy and procedure. This No Show policy and procedure must be shared with WWC along with any standard communications sent to members who don t comply with the expectations for proper notification of cancelled trips. Provider must promptly report to the WWC team whenever a member does not cancel a trip and does not show for the trip. See section 4.5 regarding reimbursement for no show trips for scheduled rides. The transportation service agency must maintain the following documentation; and make available for review by WWC upon request: Documentation supporting compliance with required standards for staff qualification as indicated above in section 5.0 Verification of criminal, caregiver and licensing background checks Documentation of communications to transportation service staff (drivers) regarding supervision methods by the agency Vehicle safety inspection records Employee time sheets, trip logs, mileage records, etc. that support billing to WWC Policy and procedure regarding supervision methods of drivers; including frequency and intensity of supervision and procedures for responding to complaints, inappropriate practices or matters qualifying as member-related incidents
Policy and procedure regarding work rules, work ethics and reporting variances to the transportation agency supervisor 9.0 Quality Assurance Purpose 9.1 WWC quality assurance activities are a systematic, departmental approach to ensuring and recognizing a specified standard or level of care expected of subcontracted providers. These methodologies are established to review and inspect subcontracted provider performance and compliance. WWC will measure a spectrum of outcomes against set standards to elicit the best picture of provider quality. WWC provider quality assurance practices: 1. establish the definition of quality services; 2. assess and document performance against these standards; and 3. detail corrective measures to be taken if problems are detected 9.2 9.3 9.4 It is the responsibility of providers and provider agencies to maintain the regulatory and contractual standards as outlined in this section. WWC will monitor compliance with these standards to ensure the services purchased are of the highest quality. Resulting action may include recognition of performance at or above acceptable standards, working with the provider to repair and correct performance if it is below an acceptable standard, or action up to termination of services and/or contract should there be failure to achieve acceptable standards and compliance with contract expectations. Quality Performance Indicators Legal/Regulatory Compliance- evidenced by regulatory review with no deficiencies, type of deficiency and/or effective and timely response to Statement of Deficiency Education/Training of staff- Effective training of staff members in all aspects of their job, including handling emergency situations. Established procedures for appraising staff performance and for effectively modifying poor performance where it exists. Performance record of contracted activitieso tracking of number, frequency, and outcomes of assigned WWC Quality Teams related to provider performance o tracking of successful service provision (member achieving goals/outcomes, increased member independence and community participation, etc) Contract Compliance- formal or informal review and identification of compliance with WWC contract terms, provider service expectation terms, applicable policies/procedures for WWC contracted providers Availability and Responsiveness- related to referrals or updates to services, reporting and communication activities with WWC WWC Sources and Activities for Measuring Provider Performance Member satisfaction surveys Internal or external complaints and compliments Onsite review/audits Statement of Deficiency (SOD)- state regulated entities Quality Teams- as assigned based on significant incidents, trend in quality concerns or memberrelated incidents, or issued Statement of Deficiency. Tracking of performance and compliance in relation to the subcontract agreement and appendices Statistical reviews of time between referral and service commencement Expectations of Providers and WWC for Quality Assurance Activities Collaboration: working in a goal oriented, professional, and team based approach with WWC
representatives to identify core issues to quality concerns, strategies to improve, and implementing those strategies Responsiveness: actions taken upon request and in a timely manner to resolve and improve identified issues. This may include submitted documents to WWC, responding to calls, emails, or other inquiries, keeping WWC designated staff informed of progress, barriers, and milestones achieved during quality improvement activities Systems perspective to improvement: approaching a quality concern, trend, or significant incident with the purpose of creating overall improvements that will not only resolve the issue at hand, but improve service and operations as a whole Member-centered solutions to issues: relentlessly striving to implement solutions with the focus on keeping services member-centered and achieving the goals and outcomes identified for persons served WWC is committed to interfacing with providers to collaboratively and proactively discuss issues identified with processes and assist with implementing improvements and reviewing the impact of the changes as a partner in the mission to serve members. PSE #: 6.6107 Date Issued January 1, 2012 DT Approval Date: Document Owner K Lubinski State Approval Date: N/A Contract Reference Subcontract Appendix N Next Review Date: 8/1/2016 Revision History: Revision # Date Description of Changes/Reason Requested By When Staff Instructed 1 1-18-11 Initial Draft of PSE / Jennifer C-S 2 3-23-11 Work Plan Workgroup Changes Workgroup 3 5-23-11 Updates and Clarifications 4 6-7-11 Updates from Provider Forum discussion on 6/2/11 5 10-5-11 Update Added 4.4 to define loaded miles for billing purposes. 6 10-13-11 Update to define No Show rides in sections 4.5 and 7.7 7 9-18-12 Reviewed for 2013 contracts, minor changes, tracked changes, updated SPC codes Section 4.1 8 10/18/12 Dana Reviewed for minor changes D. Puhl 9 10/20/13 10 10/21/13 11 11/10/14 12 10/27/15 Reviewed for inclusion with 2014 subcontract agreement; added 7.2 and renumbered section; minor revision to 3.1 Reviewed for minor changes and added to 7.6 with Waiting Time Updated service definition in sections 1.0 and 3.0; added 3.3 and 4.7; revision to 7.1 to add language about process for verbal authorizations Re-formatted to standard layout, standardized language used, updated to reflect new provider policies and contract language K Lubinski D Puhl K Lubinski S. Strittmater