Reimbursement and Accounting for all Modes of Transports
(1)The following applies to the rate the Authority pays brokerages:
(a)The Authority shall calculate and pay a brokerage a fixed rate for rides based on the following formula: Direct costs plus indirect costs divided by the number of projected monthly rides. “Direct costs” are transportation costs plus administrative costs;
(b)The Authority shall notify the brokerages of their specific ride rates; and
(c)The Authority and the brokerages shall assess any needed modifications to this rate:
(B)When the Authority changes any program affecting eligibility or scope; or
(C)If other factors impact the cost of delivering service.
(2)Brokerages shall account for NEMT services separate from any other services the brokerage provides.
(3)The Authority shall reimburse brokerages after they submit claims data files to the Authority, using the standardized electronic billing format prescribed by the Authority.
(4)The Authority and brokerages shall conduct an annual cost settlement to determine any overpayment or underpayment for costs the brokerage incurred for NEMT services for eligible clients. The following applies to the cost settlement process:
(a)The Authority shall request cost settlement information from the brokerages 6 months after the end of the fiscal year. The request shall include a file detailing the brokerages claims, a template for the brokerages to submit their cost settlement information and instructions for completing the template;
(b)Brokerages shall submit the requested information, certified by a Certified Public Accountant, within 90 days of receiving the Authority’s request;
(c)The Authority shall verify the reported expenses and notify the brokerages in writing of the Authority’s determination;
(d)If the Authority’s determination results in an adjustment to the cost settlement information the brokerages submitted, the brokerages may request an appeal pursuant to OAR 410-120-1560 (Provider Appeals) through 410-120-1700, pertaining to provider appeals.
(5)The Authority shall pay for services the brokerage authorized and provided in good faith, including mailing transit passes to clients. The Authority shall use the rate in effect on the day of the transport or the mailing date of the transit passes. “Good faith” means:
(a)The brokerage verified client eligibility on the date of service or the date of mailing the transit passes, using the Authority’s eligibility information; or
(b)The client eligibility information was inconsistent or not available, and the brokerage used the most recent client information available immediately before the time of service or mailing of transit passes.
(6)Each brokerage may establish a working capital reserve with funds the Authority provides. The following applies to any established working capital reserve:
(a)The working capital reserve shall represent 30 days of cash expenses for normal operating purposes. The Authority may base the reserve on a time other than 30 days if circumstances warrant the change;
(b)The Authority shall calculate the reserve amount as part of the annual cost settlement for the most recent past fiscal year;
(c)The Authority shall base the reserve amount on an average of six months of operating expenses that the brokerage reports in its monthly NEMT financial reports. However, the Authority may base the reserve amount on more or less than six months of expenses when a six-month average does not reflect an accurate accounting of expenses;
(d)Brokerages shall maintain a separate account for the reserve funds; and
(e)The Authority may require the brokerage to return any funds in excess of the amount the Authority calculated, or the Authority may decrease the ride rate to reduce the reserves. If the Authority requires the brokerage to return the excess funds, the brokerage shall do so within 45 days of receipt of the Authority notification.
Rule 410-136-3200 — Reimbursement and Accounting for all Modes of Transports,