OAR 410-136-3300
Reports and Documentation
(1)
Brokerages shall maintain documentation of rides denied and rides provided to clients. This documentation shall include, but is not limited, to:(a)
The name of the client and the person requesting the ride on behalf of the client, if applicable;(b)
The client’s OHP medical care identification number;(c)
The date and time of the request for transportation;(d)
The mode of transport authorized for the client and a justification for authorizing a mode of transport that is not reasonably understandable;(e)
The location for picking-up the client and the destination;(f)
The medical reason for the appointment;(g)
The availability of other transportation resources and the justification for authorizing a ride when the client has other resources;(h)
The subcontractor assigned to give the ride and the date and time the brokerage notified the subcontractor of the assignment;(i)
The name of the employee who approved a ride; and(j)
In the case of a denial of a ride:(A)
The name of the employee who denied a ride;(B)
The name of the employee who performed the secondary review before denying the ride;(C)
The reason for the denial and the applicable Oregon administrative rule that supports the denial;(D)
The date on the notice of action the brokerage mailed to the client;(E)
Documentation on the brokerage’s review, resolution, or disposition of the matter, if applicable, including the reason for the decision and the date of the resolution or disposition; and(F)
Notations of oral and written communications with the client.(2)
The brokerage shall retain the documentation on denials of rides for three calendar years, even if the brokerage is no longer a Medicaid enrolled provider before the end of the three years. The Authority may request this information at any time during the three year retention period.(3)
The brokerage shall maintain billing files organized by subcontractor that justify the number of transports and with cross references to actual rides and specific clients.(4)
The brokerages shall report monthly on estimated revenue and expenses that affect the balance of the working capital reserve amount. The report must contain the following costs as they pertain to providing NEMT services:(a)
Sub-totals of administrative expenses, including:(A)
Salaries and wages of the brokerage’s employees;(B)
Payroll related expenses for the brokerage’s employees;(C)
Other employee related expenses, such as recruitment and advertising;(D)
Computer hardware and software purchased, leased or licensed;(E)
Office supplies such as stamps, paper or printing;(F)
Non-computer related equipment purchased, leased or licensed;(G)
Telephone;(H)
Administrative support and other indirect charges;(I)
Education and training;(J)
Building expenses such as leases, rents, security, janitorial services and repairs that retain the property’s operating condition but do not add to the permanent value of the property;(K)
Subcontractor identification and drug testing, such as fingerprinting and drug analysis;(L)
Legal expense not related to the Authority, such as attorney fees; fines or penalties;(M)
Indirect expenses, such as accounting, human resources, risk management or insurance;(N)
Sub-contracts for operations or temporary employees;(O)
Required driver training, if applicable;(P)
The client satisfaction survey, if applicable;(Q)
Software maintenance, if applicable; and(R)
Details of other administrative expenses not specified above.(b)
The number and costs of the following:(A)
Stretcher car rides;(B)
Wheelchair rides;(C)
Ambulatory rides;(D)
Secured transports;(E)
Bus tickets;(F)
Bus passes;(G)
NEMT ambulance transports;(H)
Reimbursements to clients; and(I)
Commercial transports.(c)
The amount of credits to subcontractors.(d)
Information on the brokerage’s working capital reserve, including:(A)
The Authority-calculated working capital reserve;(B)
The estimated working capital reserve as of the beginning of the fiscal year;(C)
The estimated working capital reserve as of this report; and(D)
The difference between sub-sections (B) and (C).(5)
The financial reports must show the number of rides that volunteer drivers provide.(6)
Brokerages must submit the financial report required in Section (4) of this rule within 45 days of the end of the reporting month.(7)
Brokerages shall submit a cost allocation plan that includes anticipated expenses, certified by the brokerage’s Chief Financial Officer, to the Authority no later than April 1 of each year for the upcoming fiscal year.(8)
The Authority may request, and the brokerage shall provide, other reports or information not specified in sections (1), (3), (4) and (6) of this rule.
Source:
Rule 410-136-3300 — Reports and Documentation, https://secure.sos.state.or.us/oard/view.action?ruleNumber=410-136-3300.