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Medicaid Enrollment For OPWDD
Transportation Providers
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OPWDD Transportation Provider Enrollment
• Transportation Enrollment Workgroup coordinated discussions among DOH,
OPWDD and stakeholder associations over the previous six months
• Provider concerns were acknowledged and OPWDD/DOH consensus has
been reached for programmatic resolution
• There will be continued collaboration between DOH, OPWDD, DOT, OMIG
on all aspects of the implementation
3
Auto-Enrollment of Program-Owned
Transportation Providers
To be completed by 1/1/2017
• The following will be auto-enrolled as Medicaid transportation
providers
– OPWDD certified site based day habilitation
– Site-based pre-vocational
– Supervised and supportive IRA providers
• ICF providers
– Auto-enrolled-if they are also a provider of any OPWDD funded HCBS waiver
service
– If they are not Medicaid enrolled, ICF providers will be required to complete
the necessary enrollment forms (10/1/2016)
4
Subcontracted Transporters
Effective at expiration of current contract
• OPWDD subcontractors must seek enrollment
– Subcontractors will be required to complete necessary enrollment forms to
become a Medicaid transportation provider at the date of expiration of their
existing contract
– Enrollment will occur on a rolling basis as current contracts end
• A provider using subcontractors is responsible for ensuring its
subcontractors are compliant with requirements of Medicaid
enrollment
5
Licensure Requirements
Effective currently
• As per OPWDD’s February 5, 1992 guidance regarding Article 19-A of
the NYS Vehicle and Traffic Law, drivers are required to maintain both
19-A certification and CDL licensure only if all three of the following
conditions are met:
– The driver transports OPWDD eligible individuals to/from day vocational, academic or
religious instruction or religious services, including nursery schools, day care centers and
camps
– The vehicle used for transport has a manufacturer’s seating capacity of 10 or more
passengers (excluding the driver)
– The driver transports under the above conditions more than 29 days a year
• All other provisions of this memo remain in effect.
(continued)
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Licensure Requirements (continued)
Effective 12 Month from Enrollment
• All enrolled providers and subcontracted transporters must have their
drivers enrolled in a LENS program, or a similar program that provides
automatic updates of motor vehicle infractions.
• All drivers including the drivers defined above, must also have their
driving abstracts reviewed to ensure acceptable driving record (DOH
and OPWDD will set standards for non-acceptable driving records).
7
DOT Passenger Authority and Exemptions
Effective 1/1/17
• A waiver of DOT authority
– Please note no blanket waivers will be issued
– Waiver requests should be submitted to DOT no later than October 1, 2016
• All Medicaid enrolled transporters using ambulette vehicles,
must obtain DOT operating authority, unless they seek and
receive a waiver from this requirement from DOT.
– In the event that a provider that submitted a timely waiver request has not heard
from DOT by January 1, 2017, the provider will be deemed to be in compliance until
it hears from DOT
• DOT inquires and requests for waivers can be sent to:
[email protected].
8
OMIG Audit Protocols
Effective upon Medicaid Enrollment
• OMIG audit protocols and guidance for OWDDD transportation
providers
– Medicaid enrolled transporters who are reasonably expected to receive or
claim at least $500,000 in a consecutive 12 month period of time are required
to maintain a compliance plan that meets standards as determined by OMIG
– All OPWDD funded providers that contract for transportation services, must
ensure that transporter is not listed on the Medicaid Exclusion List
– Any new audit procedures and protocols will be developed and promulgated by
OMIG
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Vehicle Retirement Age
Effective as described below
• OPWDD will survey providers to find out age and description of
current vehicles. Once survey results have been analyzed, further
guidance will be provided.
• Targeted phase in to vehicle retirement 10 years for ambulettes and
10 or more passenger vehicles (pending result of survey).
10
Documentation Requirements
Effective as described below
• Since Medicaid funds OPWDD transportation services (indirectly),
certain documentation is required for transportation to and from
certified day habilitation and site-based pre-vocational services.
• While there is no prescribed format for such documentation, the
required elements need to include:
– Medicaid enrollee’s name
– Date of the transport
– Address and times of trip origination and destination (GPS data would be
accepted to meet this requirement)
(continued)
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Documentation Requirements (continued)
Effective as described below
– Driver’s license number
– Driver’s printed name
– Driver’s signature
• It is not necessary to create duplicate logs as long as the required
elements are available, upon request.
– For example it would be acceptable if elements of this documentation are kept
in day habilitation program or certified residence logs
(continued)
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Documentation Requirements (continued)
Effective as described below
• For certified residential programs, the same documentation
requirements would apply to agency provided or subcontracted
transportation, with two exceptions:
– Addresses are not required to be provided, however the purpose of the trip
should be included -- for example, “community inclusion activities”.
– The “time documentation” would consist of recording the time that the vehicle
left the certified residence and the time the vehicle returned to the certified
residence.
• The above requirements would not be applicable to vehicles
operated by a Public Transportation Authority (e.g., CDTA, MTA, etc.).