603 KAR 7:080. Human service transportation delivery.

603 KAR 7:080. Human service transportation delivery.

RELATES TO: KRS Chapters 96A, 151B, 157, 163, 194, 195, 202A, 202B, 205, 209, 210, 216, 273, 281, 645, 49 U.S.C. Chapter 53

STATUTORY AUTHORITY: KRS 281.600, 281.605, 281.870, 281.875, 49 U.S.C. Chapter 53

NECESSITY, FUNCTION, AND CONFORMITY: 49 U.S.C. Chapter 53 authorizes the formation and funding of human service transportation deliveries to transportation providers. KRS 96A.095 allows the Transportation Cabinet to accept funding to promote and develop mass transportation services in Kentucky. For the purpose of providing efficient, effective, safe, and coordinated transportation delivery to clients of the program groupings the Empower Kentucky Transportation Delivery work group recommended that a single agency be responsible for the transportation component of the programs. The function of this administrative regulation is to implement the procedures required to administer this program. Since many of the transportation providers are required by federal law or regulation to comply with safety and accountability procedures and the Transportation Cabinet is authorized in KRS 281.600 to establish safety criteria for a commercial transportation provider, all of the transportation providers, except a volunteer transportation provider, which receive funding under the provisions of this administrative regulation shall be required to comply with the same safety and accountability requirements.

Section 1. Definitions. (1) "Broker" is defined in KRS 281.014(8).

(2) "Certificate Types 01, 02, 03, 04, 07, and 08" is defined in KRS 281.873(1)(a)-(f).

(3) "CTAC" is defined in KRS 281.014(10).

(4) "Delivery area" is defined in KRS 281.014(7).

(5) "Human service transportation delivery" is defined in KRS 281.014(6).

(6) "Level of eligibility" is defined in KRS 281.873(1)(g).

(7) "Mass transportation" is defined in KRS 96A.010.

(8) "Mileage reimbursement" means a fixed rate per mile a motor vehicle is operated that:

(a) Does not exceed the expense of operating the motor vehicle; or

(b) Is not considered a benefit of wage payment.

(9) "Provider" means an individual with appropriate operating authority performing transportation operations for human service transportation delivery.

(10) "Recipient" means a person that is receiving benefits under one (1) of the programs listed in Section 3 of this administrative regulation and meets the criteria of the participating program.

(11) "RFP" means request for proposal.

(12) "Subcontractor" is defined in KRS 281.014(9).

(13) "TANF" means an acronym for Temporary Assistance for Needy Families Program administered by the Cabinet for Families and Children.

(14) "Urgent care" means:

(a) An unscheduled episodic situation when there is not a threat to life or limb, but the recipient must be seen within a time frame, which is less than the seventy-two (72) hour required notice, and treatment cannot be delayed; and

(b) Does not include:

1. Emergency trips which are to be addressed by qualified emergency services; or

2. Instances whereby recipients are required to be seen by a licensed medical provider or another licensed medical provider to whom the person is being referred for medical treatment with less than seventy-two (72) hours’ notice. See Section 10(7) of this administrative regulation.

(15) "Volunteer transportation" means transportation provided by a person or entity as a charitable act without the expectation of receiving a benefit, or being paid a wage.

(16) "24-7 (twenty-four seven) human service transportation delivery" means twenty-four (24) hours a day and seven (7) days a week.

Section 2. Newly established transportation regions shall be in effect no later than July 1, 2001, and shall be as follows:

(1) Region 1:

(a) Ballard;

(b) Calloway;

(d) Fulton;

(e) Graves;

(f) Hickman;

(g) Marshall; and

(h) McCracken.

(2) Region 2:

(a) Caldwell;

(b) Christian;

(d) Hopkins;

(e) Livingston;

(f) Lyon;

(g) Muhlenberg;

(h) Todd; and

(i) Trigg.

(3) Region 3:

(a) Daviess;

(b) Hancock;

(d) McLean;

(e) Ohio;

(f) Union; and

(g) Webster.

(4) Region 4:

(a) Breckinridge;

(b) Grayson;

(d) Larue;

(e) Marion;

(f) Meade; and

(g) Nelson.

(5) Region 5:

(a) Adair;

(b) Allen;

(d) Butler;

(e) Edmonson;

(f) Green;

(g) Hart;

(h) Logan;

(i) Metcalfe;

(j) Simpson;

(k) Taylor; and

(l) Warren.

(6) Region 6:

(a) Jefferson;

(b) The following counties shall be added to Region 6 effective July 1, 2001:

1. Bullitt:

2. Oldham;

3. Shelby; and

4. Spencer.

(7) Region 7. The following counties shall be in Region 7 until July 1, 2001:

(a) Bullitt;

(b) Henry;

(d) Shelby;

(e) Spencer; and

(f) Trimble.

(8) Region 8:

(a) Anderson;

(b) Boyle;

(d) Franklin;

(e) Garrard;

(f) Jessamine;

(g) Lincoln;

(h) Mercer;

(i) Scott;

(j) Washington; and

(k) Woodford.

(9) Region 9:

(a) Boone;

(b) Campbell;

(d) Gallatin;

(e) Grant;

(f) Kenton;

(g) Owen; and

(h) Pendleton.

(i) The following counties shall be added to Region 9 effective July 1, 2001:

1. Henry; and

2. Trimble.

(10) Region 10: Fayette.

(11) Region 11:

(a) Bourbon;

(b) Clark;

(d) Harrison;

(e) Madison;

(f) Montgomery;

(g) Nicholas; and

(h) Powell.

(12) Region 12:

(a) Bell;

(b) Clinton;

(d) Knox;

(e) Laurel;

(f) McCreary;

(g) Monroe;

(h) Pulaski;

(i) Rockcastle;

(j) Russell;

(k) Wayne; and

(l) Whitley.

(13) Region 13:

(a) Breathitt;

(b) Clay;

(d) Jackson;

(e) Knott;

(f) Lee;

(g) Leslie;

(h) Letcher;

(i) Owsley;

(j) Perry; and

(k) Wolfe.

(14) Region 14:

(a) Floyd;

(b) Johnson;

(d) Martin; and

(e) Pike.

(15) Region 15:

(a) Bath;

(b) Boyd;

(d) Elliott;

(e) Greenup;

(f) Lawrence;

(g) Menifee;

(h) Morgan; and

(i) Rowan.

(16) Region 16:

(a) Bracken;

(b) Fleming;

(d) Mason; and

(e) Robertson.

Section 3. Service Programs. (1) Excluding nonemergency ambulance stretcher transportation, nonemergency medical transportation, pursuant to KRS Chapter 205, 907 KAR 1:060, and 907 KAR 3:066, shall be provided as follows:

(a) A broker shall transport any Medicaid-eligible recipient with a county code residence in the broker’s delivery area. The broker shall be responsible for transportation arrangements when the recipient is coded in the broker’s delivery area, but has moved or is living in another human service transportation delivery area.

(b) Services outside the recipient’s county or contiguous county shall have a referral by the recipient’s licensed medical provider before transport.

(c) Nonemergency medical transportation shall be for a medically-covered and medically-necessary service in accordance with Medicaid regulations. The nonemergency Medicaid cardholder shall be transported to a Medicaid-covered service accompanied by a guardian or escort when necessary.

(d) A parent or a guardian shall accompany a minor the age of twelve (12) years and under to a Medicaid-covered service. A parent or a guardian may accompany a minor between the ages of thirteen (13) and seventeen (17). The parent, guardian or escort shall not be charged a fare.

(2) Transportation pursuant to the Kentucky Works Program shall be provided as follows:

(a) Recipients shall be transported to covered services or TANF component activities in the county of residence or contiguous county. Transportation services shall include employment, child daycare centers, job interviews, and training.

(b) Transportation shall be provided for training at vocational, community colleges, universities and high schools within the recipient’s county or human service transportation delivery area and contiguous to the human service delivery area.

(c) The broker shall pay a TANF recipient before or during the month of transportation services. Payment shall be contingent upon the TANF recipient receiving necessary authorization from the broker to use his or her private automobile, or the TANF recipient having access to an available automobile, to training, or employment activities.

(3) Other programs under the human service transportation delivery system shall include:

(a) Vocational rehabilitation pursuant to KRS Chapter 151B or 157;

(b) Vocational rehabilitation for the blind pursuant to KRS Chapter 151B or 163;

(c) Mental health, mental retardation, development disabilities, comprehensive care or substance abuse services pursuant to KRS Chapter 202A, 202B,210, or 645; and

(d) Office of Aging Services under KRS Chapter 205, 209, 216, or 273.

(4) The state government agencies responsible for implementing the programs set forth in this section shall provide to the Transportation Cabinet:

(a) A monthly list of the persons eligible to receive human services transportation pursuant to the programs set forth in this section, including special Medicaid recipient waiver listings;

(b) The address of each person on the list; and

(5) A denial of a service as provided in subsections (1), (2), and (3) of this section shall be pursuant to the provisions of Section 14 of this administrative regulation.

Section 4. Coordinated Advisory Transportation Committee (CTAC). (1) CTAC shall be composed of members designated by the:

(a) Cabinet for Health Services;

(b) Cabinet for Families and Children;

(d) Transportation Cabinet.

(2) The Cabinets for Health Services, Families and Children, and the Transportation Cabinet shall each have two (2) voting members and Workforce Development shall have one (1) voting member.

(3) CTAC duties and responsibilities shall include:

(a) Providing information and assistance to the cabinet;

(b) Reviewing and recommending policies and operating procedures to the cabinet; and

Section 5. Transportation Broker Selection Process. (1) A request for proposal (RFP) and the process of awarding a brokerage contract for each region shall comply with KRS Chapter 45A. The RFP evaluation process shall, at a minimum, address areas that include the following:

(a) Overall quality in transportation delivery;

1. Administration:

a. Human resources, including staffing and employee categories by classification, number, and experience;

b. Insurance and risk management, types and levels of insurance coverage and emergency process, and training offered to reduce business risk;

c. Billing and accounting practice and procedures; and

d. Financial capability.

2. Operations:

a. Scheduling and reservations;

b. Fleet management;

c. Dispatching and radio communications;

d. Computer software and hardware;

e. Reporting for both the broker and subcontractor; and

f. Vehicle inspection or maintenance programs.

(b) Experience. In accordance with KRS 281.875(2) and (3), a person that submits a request for proposal to be a broker under the human service transportation delivery program shall be required to submit documentation that he or she has at least one (1) year experience working with persons with special needs. The cabinet shall be prohibited from awarding higher scores, or giving any type of preferential treatment to any person that submits a request for proposal to be a broker, who is also a transportation provider, over a person who submits a request to be a broker and is not a transportation provider;

1. Local community based governmental offices;

2. Training, educational or medical centers; and

3. Coordination with other transportation providers.

(d) Operational characteristics which include:

1. Locations of operations;

2. Infrastructure and other resources;

3. Storage of records;

4. Security and confidentiality of recipient and provider information;

5. Coverage of the delivery area hours, days, and operators availability; and

6. Education and training programs.

(2) Contractual agreements between the Transportation Cabinet and brokers.

(a) Each contract between the cabinet and broker shall be for one (1) year with three (3) one (1) year options to renew.

(b) Contracts shall be on a fiscal year basis, running July 1 through June 30.

(3) Operating authority. Except for a volunteer provider, each transportation provider shall have operating authority issued by the Transportation Cabinet pursuant to KRS Chapter 281 or 96A.

(4) A contract between the cabinet and the broker shall be subject to revocation in accordance with KRS 281.879. Furthermore, the contract shall be subject to termination by the Commonwealth in accordance with 200 KAR 5:312.

Section 6. Transportation Broker. (1) A broker may coordinate the human service transportation delivery program with general public transportation as provided in KRS 281.877.

(2) The broker shall make reports to the cabinet on all traffic accidents and moving violations involving either a broker or subcontractor while transporting a human service transportation passenger.

(3)(a) The broker shall have all reports pertinent for payment to the cabinet not later than the seventh of each month following the reporting period.

(b) The cabinet shall reimburse the broker not later than the 15th of each month, if the broker has submitted the required reports.

(c) Brokers shall promptly reimburse subcontractors and Medicaid private auto providers within three (3) business days of being paid by the cabinet each month for each valid invoice trip documentation.

(d) A valid subcontractor or private auto provider invoice postdated after the first shall be included in the next month’s billing.

(e) TANF private auto providers shall be paid before the service month.

(4) The broker shall have an established operating office located within the awarded delivery area.

(5) The broker shall employ an adequate staff to accommodate reservations, oversight of timely pickup and delivery, scheduling, accounting, complaint tracking, safety compliance and reporting to the cabinet.

(6) All brokers shall provide transportation services for recipients eligible under Section 3 of this administrative regulation.

Section 7. Orientation Program. (1) All brokers shall provide an orientation program to each subcontractor and potential subcontractor. The program shall at a minimum include:

(a) How and when payment will be made;

(b) Rates;

(d) Driver conduct;

(e) Driver qualifications;

(f) Reporting requirements;

(g) Communication systems;

(h) Pickup and delivery standards;

(i) Training;

(j) Drug and alcohol testing;

(k) Safety;

(l) Confidentiality;

(m) Levels of transportation;

(n) Escort and attendants;

(o) Contract compliance;

(p) Scheduling and availability and standard state transportation requirements; and

(q) The role of the program coordinator as required by KRS 281.872.

(2) Orientation meetings between the broker and subcontractor shall be held before the subcontractor provides transportation services. Subsequent meetings may be held to clarify new policies and administrative regulations, or as directed by the cabinet.

Section 8. Subcontractors and Volunteers. (1) A subcontractor, who has signed a contract with a broker to provide human service transportation delivery within a specific delivery area, shall meet human service transportation delivery requirements, including proper operating authority by county or city.

(2) The subcontractor shall not enter into an agreement with a broker without the prior approval of the Transportation Cabinet. Each broker shall submit and request approval of the cabinet for each potential subcontractor. The subcontractor shall submit the following documentation to the broker:

(a) A copy of the subcontractor’s operating authority;

(b) Proof of the subcontractor’s vehicle liability insurance;

(d) A copy of all vehicle lease agreements; and

(e) All contracts shall, at a minimum, include:

1. Payment administration as required in KRS 281.875(1)(f);

2. Hours of operations and other scheduling requirements;

3. Rates for services;

4. Pickup and delivery standards;

5. Contract duration; and

6. Termination clause and compliance penalty provisions.

(3) Brokers and subcontractors shall ensure and provide documentation to the cabinet that all drivers during employment shall:

(a) Be legally licensed by the Commonwealth of Kentucky to operate the transportation vehicle to which they are assigned;

(b) Be courteous, patient and helpful;

(d) Have no more than two (2) convictions for moving violations in the last three (3) years;

(e) Have no prior convictions for a drug or alcohol-related offense in the last five (5) years, if a driver or attendant;

(f) Have no convictions of any sexual crime or crime of violence;

(g) Have a preemployment drug test; and

(h) Receive orientation and safety training.

(4) Any person who has been convicted of a felony during the last five (5) years shall drive or attend passengers only after review and approval by the broker, subcontractor and the cabinet.

(5) Volunteer transportation providers shall have:

(a) A valid driver's license;

(b) Proof of insurance and registration; and

(6) The subcontractor and the private auto provider shall submit a valid invoice to the broker by the first of each month to allow for accounting, payment processing, and mailing time for payment to be paid within three (3) business days of payment received from the cabinet.

(7) A valid invoice postdated after the fifth day of the month shall be included in the next month’s billing.

(8) Subcontractors and private auto providers shall submit all valid invoices within six (6) months of the date of service for reimbursement by the broker.

(9) A subcontractor shall report any moving violations or traffic accidents to the broker within thirty (30) days.

(10) A subcontractor shall not participate in determining recipient eligibility or type of transport.

Section 9. Vehicle Requirements. (1) The broker shall assure that all transportation providers maintain all vehicles and vehicle equipment adequately. Vehicles and all components shall comply with or exceed the manufacturers, state and federal, safety and mechanical operating and maintenance standards for the particular vehicles and models used. Vehicles shall comply with all applicable federal laws including the Americans With Disabilities Act of 1990 (ADA). Any vehicle found noncompliant with the Cabinet, Department of Vehicle Regulation’s licensing requirements, operating authority requirements, safety standards, or requirements shall be removed from service immediately. All vehicles shall meet the following requirements:

(a) The transportation provider shall provide and use a two (2)-way communication system linking all vehicles used in delivering the services. The two (2)-way communication system shall be used in a manner that facilitates communication and minimizes the time in which out-of-service vehicles can be replaced or repaired;

(b) All vehicles shall be equipped with adequate heating and air conditioning for driver and passengers. Any vehicle with a nonfunctioning climate control system shall be placed out-of-service until appropriate corrective action is taken;

(c) All vehicles shall have functioning, clean and accessible seat belts for each passenger seat position and belts shall be stored off the floor when not in use. Each vehicle shall utilize child safety seats when transporting children under age five (5). Each vehicle shall have at least two (2) seat belt extensions provided. Additionally, each vehicle shall be equipped with a seat belt cutter, mounted above the driver’s door, for use in emergency situations;

(d) All vehicles shall have a functioning speedometer and odometer;

(e) All vehicles shall have a functioning interior lights within the passenger compartment;

(f) All vehicles shall have adequate sidewall padding and ceiling covering;

(g) All vehicles shall be smooth riding;

(h) All vehicles shall have two (2) exterior rear view mirrors, one (1) on each side of the vehicle;

(i) All vehicles shall be equipped with an interior mirror which shall be either clear-view laminated glass or clear-view glass bonded to the back which retains the glass in the event of breakage. This interior mirror shall be for monitoring the passenger compartment;

(j) The vehicle’s interior and exterior shall be clean and have exteriors free of broken mirrors or windows;

(k) The vehicle shall have passenger compartments that are clean, free from torn upholstery or floor covering, damaged or broken seats, and protruding sharp edges and shall also be free of dirt, oil, grease or litter;

(l) The vehicle floor shall be covered with commercial anti-skid, ribbed rubber flooring or carpeting. Ribbing shall not interfere with wheelchair movement between the lift and the wheelchair positions;

(m) All vehicles shall have the transportation provider’s name, vehicle number, and the program coordinator’s customer service phone number prominently displayed within the interior of each vehicle. This information shall also be available in written form on each vehicle for distribution to riders on request;

(n) All vehicles shall have the following signs posted in all vehicle interiors, easily visible to the passengers:

1. "No Smoking, Eating or Drinking;" and

2. "All passengers shall use seat belts";

(o) All vehicles shall be equipped with a functional fire extinguisher and shall display a current inspection tag or sticker;

(p) All vehicles shall include a retractable step, or a step stool as approved by the cabinet to aid in passenger boarding. The step stool shall be used to minimize ground-to-first-step height, shall have four (4) legs with antiskid tips, sturdy metal with nonskid tread, with a height of eight and one-fourth (8 1/4) inches, a width of fifteen (15) inches, and a depth of fourteen (14) inches or an equally suitable replacement. Under no circumstances shall a milk crate or similar substitute be considered a viable alternative for a step stool. Milk crates or similar substitutes shall not be permitted on any vehicle;

(q) All vehicles shall have on board three (3) portable triangular reflectors mounted on stands;

(r) All vehicles shall include a vehicle information packet to be stored in the driver compartment, or securely stored on or in the driver’s side visor. This packet shall include:

1. Vehicle registration;

2. Insurance card;

3. Bus or vehicle card; and

4. Accident procedures and forms;

(s) All vehicles shall be provided with a fully equipped first aid kit and a "spill kit" including: liquid spill absorbent, latex gloves, hazardous waste disposal bags, scrub brush, disinfectant and deodorizer; and

(t) Each vehicle shall contain maps with sufficient detail to locate recipients and destinations.

(2) Lift-equipped vehicle requirements. All vehicles used to transport wheelchair passengers, at a minimum, meet the following ADA requirements:

(a) A floor-to-ceiling height clearance of at least fifty-six (56) inches for vehicles up to twenty-two (22) feet and of at least sixty-eight (68) inches for vehicles above twenty-two (22) feet in the passenger compartment;

(b) An engine-wheelchair lift interlock system which requires the vehicle’s transmission be placed in park and emergency brake engaged to prevent vehicle movement when the lift is deployed;

(c) A hydraulically or electromechanically powered wheelchair lift mounted so as not to impair the structural integrity of the vehicle that meets the following specifications:

1. Is capable of elevating and lowering a 600-pound load and shall not cause the outer edge of the lift to sag, or tilt downwards more than one (1) inch, nor shall the platform deflection be more than three (3) degrees under 600-pound load;

2. The lift platform is at least thirty (30) inches wide and forty-eight (48) inches long;

3. The lift platform shall not have a gap between the platform surface and the roll-off barrier greater than five-eight (5/8) inch. When raised, the gap between the platform and the vehicle floor shall not exceed one-half (1/2) inch horizontally and five-eight (5/8) inch vertically;

4. The lift controls shall be operable and accessible from inside and outside the vehicle, and shall be secure from accidental or unauthorized operation;

5. The lift shall be powered from the vehicle’s electrical system. In the event of a power failure, the lift platform shall be able to be raised or lowered manually with passengers, and shall provide a method to slow free-fall in the event of power or component failure;

6. The lift operation shall be smooth without any jerking motion. Movement shall be less than or equal to six (6) inches per second during lift cycle and less than or equal to twelve (12) inches per second during stowage cycle;

7. When in storage in the passenger compartment, the lift platform shall not be capable of falling out of or into the vehicle, even if the power should fail;

8. The lift platform shall have a properly functioning, automatically engaged, anti-roll-off barrier, with a minimum of one and one-half (1 1/2) inch on the outbound end, to prevent ride over;

9. It is preferable but not required, that the platform, when in a stored position, not intrude into the body of the vehicle more than twelve (12) inches and be equipped with permanent vertical side plates to a height of at least two (2) inches above the platform surface;

10. The lift platform surface shall be a nonskid expanded metal, mesh or equivalent, to allow for vision through the platform;

11. The lift shall be furnished with reflector tape on each side except the side adjacent to the vehicle and on all step edges, thresholds and the boarding edge of lift platform; and

12. The lift platform on vehicles shall be equipped with a handrail on both sides of the lift platform for the purpose of loading or unloading ambulatory passengers. The handrail shall meet the following requirements: maximum height range thirty (30) inches to thirty-eight (38) inches; knuckle clearance handhold one and one-half (1 1/2) inch; shall be able to withstand force of 100 pounds; the handrail shall not reduce the lift platform width of at least thirty (30) inches; and shall be a ramp-equipped vehicle meeting ADA specifications.

(d) Wheelchair restraint system - for each wheelchair position, a wheelchair securement device (or tie down) shall be provided that shall:

1. Be placed as near to the accessible entrance as practical, providing clear floor area of thirty (30) inches by forty-eight (48) inches. Up to six (6) inches may be under another seat if there is nine (9) inches height clearance from floor. Vehicles in excess of twenty-two (22) feet shall have at least one (1) forward-facing position. Additional positions may be forward facing or rearward, if there is a padded barrier;

2. Be tested to meet a thirty (30) m.p.h./twenty (20) gm standard;

3. Securely restrain the wheelchair during transport from movement forward, backward, lateral and overturning movements in excess of two (2) inches;

4. Be adjustable to accommodate all wheel bases, tires (including pneumatic) and motorized wheelchairs;

5. Be a lock system, belt system or both and acceptable to the cabinet. If a belt system is used the cargo strap shall be retractable or stored on a mounted clasp or in a storage box when not in use. A tract mounting lock system on the floor for wheelchair securement shall be flush with the floor so as not to be an obstruction or become a tripping hazard. In all cases, the straps shall be stored properly when not in use; and

6. Provide seat belts or a shoulder harness that are attached to the floor or to the sidewall of the vehicle, which shall be capable of securing both the passenger and wheelchair.

(e) Wheelchair entrance door shall:

1. Maintain a minimum vertical clearance of fifty-six (56) inches for vehicles or less in length (sixty-eight (68) inches for vehicles over twenty-two (22) feet in length) and a minimum clear door opening of thirty (30) inches wide;

2. Have no lip or protrusion at the door threshold of more than one-half (1/2) inch; and

3. Be equipped with straps or locking devices to hold the door open when the lift is in use.

Section 10. Scheduling. (1) The recipient or his or her guardian shall call the regional broker of the recipient’s county residence at least seventy-two (72) hours prior to the scheduled appointment to schedule a trip.

(2)(a) All brokers shall offer scheduling and transportation services between 8 a.m. to 4:30 p.m., Monday through Friday, and 8 a.m. to 1 p.m. on Saturday.

(b) In addition, transportation services shall be offered between 6 a.m. to 8 p.m., Monday through Friday.

(c) Scheduling and business functions may be closed for New Year’s Day, Memorial Day, July 4th, Labor Day, Thanksgiving Day, and Christmas Day.

(3)(a) The broker shall have, at a minimum, paging services after normal scheduling periods for urgent care services.

(b) Urgent care shall be provided twenty-four (24) hours a day, seven (7) days a week, including any holiday.

(d) TANF recipients may have a need for immediate transportation from employment or training, including transport of a recipient’s child from a daycare facility, due to an illness or a family emergency.

(e) An immediate transportation need may be requested anytime.

(4) The broker may schedule and provide trips for recipients after the normal scheduling hours for special circumstances. The broker may provide the eligible recipient transportation service and may contact the cabinet for guidance. For purposes of this section, special circumstances shall, at a minimum, include dialysis treatments available only on weekends, or TANF transportation for evening shift employment.

(5) The broker shall collect the following information on each incoming call:

(a) Name;

(b) Address of pickup and delivery;

(d) Time of appointment;

(e) Program identification;

(f) Telephone number; and

(g) Special needs including:

1. Child safety seats; or

2. Lift-equipped vehicle.

(6) The broker shall confirm the trip has been scheduled.

(7) In order to waive the seventy-two (72) hour notice requirement, the licensed medical provider verification may be transmitted in any of the following methods:

(a) Written verification on the licensed medical provider’s letterhead delivered by the person directly to the broker;

(b) Written verification transmitted electronically by computer or by facsimile. The transmittal shall include the licensed medical provider’s letterhead or office name and be submitted from the licensed medical provider’s office directly to the broker’s office; or

1. If written verification cannot be submitted, the broker may initiate a call to the licensed medical provider requesting oral verification that the recipient must be seen at the appointed time.

2. If the licensed medical provider initiates the call, the broker may return the call to verify legitimacy of the call.

Section 11. Eligibility. (1)(a) With the cabinet’s direction, each broker shall have direct computer access to all relevant data bases needed to determine eligibility.

(b) If there is a question regarding eligibility, and time does not warrant technological updates, the broker shall contact the cabinet for assistance in determining eligibility.

(c) The cabinet shall initially investigate all complaints regarding subcontractors and the broker for the area and attempt to immediately resolve the problem.

(d) The cabinet shall forward all complaints relating to Medicaid fraud or abuse to the Cabinet for Health Services.

(2)(a) Nonemergency medical recipients who do not require escorts or special-equipped vehicles, may be transported by taxi, community and city bus, or private auto and shall be coordinated by the broker to the greatest extent possible.

(b) Escorts or attendants shall be individuals whose presence is required to assist a recipient during transport.

(3)(a) The broker shall ensure that an escort accompanies all Certificate Type 07 recipients.

(b) One (1) escort only shall be required for each recipient.

(d) One (1) escort may serve several recipients if the recipients are grouped and have the same destination.

(e) Escorts shall not be charged a fare.

Section 12. Standards for Passengers. (1) Passengers may be coordinated with the general public population for transportation services.

(2)(a) Passengers shall give all pertinent information needed to the broker, including a request for an escort required or special needs.

(b) If the recipient is under the TANF Program, the recipient shall convey to the broker the number of children to be transported.

(3) Transportation to childcare shall not be provided under nonemergency medical transportation unless the child is an eligible recipient and in need of covered medical service.

(4) Recipients shall not be under the influence of alcohol or illegal drugs.

(5) Recipients shall be ready within fifteen (15) minutes before scheduled pickup.

(6) Except for medical necessity, recipients shall abide by signs in the vehicle, including no food or drink.

(7) Recipients shall abide by the nonsmoking requirement and observe safety rules.

(8) Recipients shall abide by applicable safety seat belt administrative regulations.

(9) Recipients shall not hold children in laps.

(10) Recipients shall call seventy-two (72) hours in advance for the transport unless it is urgent care or verified by a licensed medical provider request in accordance with Section 10(7) of this administrative regulation.

(11) Recipients shall cancel the trip as soon as possible, but no less than twenty-four (24) hours in advance.

(12) Recipients that engage in violent, seriously disruptive or illegal contact may lose their transportation privileges. Privileges may be removed with approval from the cabinet and applicable state agency.

(13) If a recipient poses an immediate danger to the driver or other passengers, the driver shall call for emergency assistance.

(14) Recipients shall have the right to call a broker or the cabinet’s toll free phone lines to lodge a complaint.

(15) Failure to abide by subsections (3) through (13) of this section shall be cause for trip denial pursuant to Section 14 of this administrative regulation.

Section 13. Education Guidelines. Each broker shall educate interested persons in the delivery area regarding:

(1) Scheduling procedures contained in Section 10 of this administrative regulation;

(2) Rates for each service type;

(3) Recipient information as required in Section 10(5) of this administrative regulation;

(4) Pickup and delivery standards as provided for in Sections 8 and 12 of this administrative regulation;

(5) Denial of service as provided for in Section 14 of this administrative regulation;

(6) Permissibility of escorts and attendants, as provided for in this administrative regulation and 907 KAR 1:061;

(7) Procedures for governing urgent care provided for in Section 10 of this administrative regulation;

(8) Standards for driver conduct as provided for in Section 8 of this administrative regulation;

(9) Standards for passengers as provided for in Section 12 of this administrative regulation; and

(10) Complaint process as provided for in Section 14 of this administrative regulation.

Section 14. Program Coordinators. (1) The cabinet shall employ a pool of program coordinators as required by KRS 281.872.

(a) These employees shall be responsible for complaint resolution regarding recipients, subcontractors, and brokers.

(b) These employees shall work with other state agencies to resolve complaints.

(2) Issues of eligibility that result in the recipient being denied transportation shall be investigated by the program coordinators.

(3)(a) Eligibility issues shall be attempted to be resolved immediately.

(b) If eligibility cannot be resolved immediately, the recipient shall continue to receive transportation until the program coordinator:

1. Resolves the question of the person’s eligibility; and

2. Verifies to the broker that the person is actually ineligible to receive transportation services.

(4)(a) The cabinet shall inform the recipient, in writing, of a denial of transportation services.

(b) The denial letter shall include information about recipients’ rights, including appeals and representation.

(5)(a) The Department for Community Based Services shall advise each recipient, in writing, of the availability of the program coordinators and the manner in which they may be contacted.

(b) The recipient may contact the program coordinator regarding complaints or questions about the services provided.

Section 15. Cabinet Performance Monitoring and Oversight. (1) The cabinet shall be satisfied as to the operational readiness of the broker. The broker shall demonstrate operational readiness in the following areas:

(a) Hours of service and operation;

(b) Scheduling procedures;

(d) Urgent care and immediate TANF transportation;

(e) Driver conduct and driver qualification and training;

(f) Passenger requirements;

(g) Vehicle requirements, inspections and vehicle inventory;

(h) Back-up service;

(i) Appeals and complaint procedures;

(j) Telephone systems and reporting procedures, including TTY;

(k) Computer and technological capabilities;

(l) Driver manifest form procedures submittal and receipt;

(m) Roles and job descriptions of staff;

(n) Educational and orientation procedures; and

(o) Develop a cabinet approved operational procedures manual for each region.

(2) Each region broker shall set up toll free lines giving the human service transportation delivery recipients and the general public information about the availability of services.

(3)(a) The broker shall be available for visits by the cabinet on a periodic basis to assess operations, performance, and discuss service issues.

(b) At a minimum, one (1) meeting shall consist of a comprehensive compliance review.

(c) The brokers shall also be available for periodic conference calls with the cabinet to discuss issues, policy and procedures.

(4)(a) Drivers performing under the human service delivery network shall be subject to random drug and alcohol testing to be administered by the cabinet.

(b) New safety-sensitive employees of transportation providers shall be required to pass a preemployment drug test.

(d) Brokers shall submit monthly testing activities.

(5)(a) Each broker shall submit on a monthly basis information on each one (1) way trip performed during a month in the broker’s region to the cabinet.

(b) All broker and subcontractor trips shall be reported and the dollar amount paid for each one (1) way trip.

(6)(a) The cabinet shall compile a monthly report containing operating information on each program operated by the brokers, including rural public transportation, denoting fleet, miles, hours, fuel, revenues and expenses.

(b) The statistics shall be used for analysis and reporting to other state agencies and to the Federal Transit Administration (FTA). The cabinet shall issue a standard monthly summary form to each broker.

(7) The broker shall submit line item invoice forms each month to the cabinet with the request for reimbursement and detail current month’s expenses broken out by line item, including salaries, subpayments, maintenance, and fuel.

(8)(a) The broker, at its own expense, shall have an independent audit performed for the past fiscal year.

(b) This audit shall be conducted in accordance with federal and state law, and be delivered to the cabinet upon completion.

(9)(a) Formalized program integrity plans shall be submitted by the broker to the cabinet which define the broker’s program for identifying and deterring any suspected fraud or abuse activities within the human service transportation delivery program.

(b) The cabinet shall issue a statewide program integrity plan format for all brokers.

(10)(a) Each broker shall develop and maintain a quality assurance plan. The plan shall address the following:

1. The scheduling and delivery of transportation services;

2. The broker’s methodology for the identification and correction of problems relating to the scheduling and delivery of transportation services; and

3. Subcontractor payment efficiency.

(b) The cabinet may require the broker to compile and provide to the cabinet additional reports which further track the broker’s performance.

(11)(a) Each broker shall have a disaster recovery plan.

(b) The broker shall not transport in unsafe conditions.

(c) In emergencies, the broker shall contact the National Guard or other emergency units to assist in the transport of dialysis clients or urgent care.

(d) The broker shall operate on all routes or highways that are deemed safe, thereby offering limited services during inclement weather.

Section 16. Right to Choose Transportation Provider. (1) Persons participating in the human service transportation delivery program and designated a level of eligibility under a Certificate Type 07 or 08 shall be ensured the freedom of personal choice in selecting an eligible provider, which may include the broker within the delivery area in accordance with KRS 281.874(1).

(2)(a) The broker shall schedule the trip with a participating provider if the recipient does not express a preference.

(b) A person expressing a personal preference under this section shall contact the broker in accordance with KRS 281.874(2), to arrange transportation services, even if the person is requesting an eligible subcontractor to provide the services.

(3)(a) In accordance with KRS 281.874(2), the broker may select himself or herself if that broker also provides transportation services.

(b) However, the broker shall establish a scheduling and reservation system of trip distribution approved by the cabinet.

(c) If the recipient allows the broker to choose a provider, the criteria for trip distribution shall include, in order of priority:

1. Coordination;

2. Cost efficiencies; and

3. If the first two (2) criteria are not met, the broker shall rotate 07 and 08 trips among providers, including the broker.

(4)(a) The broker and transportation provider shall evaluate routes presently utilized by the eligible recipients.

(b) If the broker determines that a route is inefficient, the broker shall elect a more efficient route.

(5) The Transportation Cabinet shall resolve any disputes regarding choice of transportation provider.

Section 17. Cabinet Responsibilities. (1) Pursuant to KRS Chapter 45A, the Transportation Cabinet shall select and contract with a transportation broker in each region established in this administrative regulation.

(2)(a) The cabinet shall establish provider rates for each certificate type for each human service transportation delivery area.

(b) The rates shall be uniform for the same certificate types for all providers, including the broker in each delivery area.

1. Geographical terrain;

2. Trip distance;

3. Recipient population;

4. Availability of medical and employment facilities;

5. Labor and economic factors; and

6. Utilization of services.

(3) A forty-five (45) day notice shall be given to all brokers by the cabinet prior to any changes made to the subcontractor rates.

Section 18. Safety and Accountability. (1) The broker and subcontractors shall maintain all records for five (5) years.

(2) All broker employees and employees of the subcontractors shall sign confidentiality statements regarding access to and disclosure of confidential information or records.

(3) Collection and retention of records to be maintained by each broker and subcontractor pertaining to human service transportation delivery shall, at a minimum, include:

(a) Encounter data;

(b) Complaint tracking;

(d) Trip invoices;

(e) Phone reports;

(f) Subcontractor requests;

(g) Audits;

(h) Line-item budgets; and

(i) Monthly pay document submittals.

(4) Collection and retention of encounter data on each trip shall be made by the broker, if the broker provides transportation services, and by each subcontractor.

(5) Failure of a broker to record all data and broker trips required by the cabinet shall be grounds for the cabinet to terminate the broker’s contract.

(6) Each transportation broker/provider and subcontractor subject to the provisions of 601 KAR 1:005 shall comply with the provisions of that administrative regulation.

(7) Each transportation broker/provider and subcontractor not subject to the provisions of 601 KAR 1:005 shall comply with the provisions of the following federal regulations:

(a) 49 C.F.R. 653, "Prevention of Prohibited Drug Use in Transit Operations", effective October 1, 1999; and

(b) 49 C.F.R. 654, "Prevention of Alcohol Misuse in Transit Operations", effective October 1, 1999.

(8)(a) Each transportation broker/provider and subcontractor, who operates a motor vehicle which is not subject to the provisions of 601 KAR 1:005, shall maintain each of the vehicles in a safe operating condition.

(b) Each motor vehicle being operated pursuant to the provisions of this administrative regulation, and which is not subject to the provisions of 601 KAR 1:005, shall be inspected on an annual basis by an automotive technician.

(c) Prior to being operated pursuant to this administrative regulation, the transportation broker/provider shall have proof that the motor vehicle has passed a safety inspection by an automotive technician.

Section 19. Adoption Without Change. (1) The following federal regulations are adopted without change:

(a) 49 C.F.R. 37, "Transportation Services for Individuals With Disabilities (ADA)", effective October 1, 1999;

(b) 49 C.F.R. 38, "Americans With Disabilities Act (ADA) Accessibility Specifications for Transportation Vehicles", effective October 1, 1999;

(d) 49 C.F.R. 653, "Prevention of Prohibited Drug Use in Transit Operations", effective October 1, 1999; and

(e) 49 C.F.R. 654, "Prevention of Alcohol Misuse in Transit Operations", effective October 1, 1999.

(2) This material may be inspected, copied, or obtained, subject to applicable copyright law, at the Office of Transportation Delivery, 3rd Floor, State Office Building Annex, 125 Holmes Street, Frankfort, Kentucky 40622, Monday through Friday, 8 a.m. to 4:30 p.m. The telephone number is (502) 564-4733. (25 Ky.R. 1492; Am. 2889; eff. 6-10-99; 27 Ky.R. 838;1309; 1459; eff. 12-21-2000.)