Grievance Procedures Public Comment Period on Website

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Informations

• Publié par: Insya
• Nombre de lectures: 19
• Langue: English

Extrait

News Media Contact: Connie Deane
Community Liaison
239-252-8192 or 8365
www.colliermpo.net
www.colliergov.net
www.twitter.com/CollierPIO
www.facebook.com/CollierGov
www.youtube.com/CollierGov





2885 South Horseshoe Drive, Naples, FL 34104  [phone]  Fax [phone]

Nov. 2, 2010
FOR IMMEDIATE RELEASE

NOTICE OF THE OPENING OF THE PUBLIC COMMENT PERIOD FOR THE COLLIER
COUNTY TRANSIT SERVICES MEDICAID GRIEVANCE PROCEDURE
__________________________________________________________________________________
WEDNESDAY, NOV. 3, 2010

The Collier Metropolitan Planning Organization (MPO) has opened a public comment period for the
adoption of the Collier County Transit Services Medicaid Grievance Procedure. In past, Medicaid and
Collier County Local Coordinating Board Grievance Procedures were combined into one document. The
new Medicaid contract requires additional steps in the grievance process. Therefore, the currently adopted
grievance process will continue to exist for the local grievance practices and procedures and the Medicaid
grievance procedures will be added as the Medicaid Grievance Procedure. It is noted that the Medicaid
grievance procedure is federally mandated. The adopted Medicaid Grievance Procedures will be
incorporated in the current Transportation Disadvantaged Service Plan.
Adoption of the Medicaid Grievance Procedure is scheduled to occur at the Local Coordinating Board for
the Transportation Disadvantaged meeting on December 8 and the ratification is scheduled to occur at the
MPO Board meeting on December 10.
As part of the MPO’s Public Involvement Process (PIP), the draft Medicaid Grievance Procedures will
be on display at the customer service desks at the following sites for public review and comment from Nov.
3 until Dec.3 as well as on the MPO Web site at: http://colliermpo.net. To access the Medicaid Grievance
Procedures on this Web site, select public documents, then scroll down to the Collier County Transit
Services Medicaid Grievance Procedure.
 Collier County Government Complex  Collier County Growth Management Division
3301 Tamiami Trail East 2885 S. Horseshoe Dr. Naples Naples

-more-
Notice of the Opening of the Public Comment Period for the Collier County Transit Services Medicaid Grievance Procedure /Page 2 of 2

 Naples City Hall  Everglades City Hall
735 8th Street South 102 Copeland Avenue N. Naples Everglades City

 Marco Island City Hall  Career and Service Center
th50 Bald Eagle Drive 750 S. 5 Street
Marco Island Immokalee

 All Collier County Public Libraries

The MPO’s Public Involvement/Participation Plan is designed to ensure opportunities for the public to
express its views on transportation issues and to become active participants in the decision making process.
All comments received will be considered for inclusion in the development of the final report.
The MPO’s planning process is conducted in accordance with Title VI of the Civil Rights Act of 1964
and Related Statutes. Any person or beneficiary who believes that he or she has been discriminated against
because of race, color, religion, sex, age, national origin, disability, or familial status may file a complaint
with FDOT District One Title VI Coordinator Ms. Robin Parrish at 863-519-2675 or by writing Ms. Parrish
at Post Office Box 1249, Bartow, FL 33831.
Any person requiring special accommodations at this meeting because of a disability or physical
impairment should contact the MPO Director up to 72 hours prior to the meeting by calling [phone].
For more information call Interim MPO Director, Lorraine M. Lantz at [phone].

###
[News Media: If you have any questions, please contact Community Liaison Connie Deane at 239-252-
8192 or 8365.]

TDSP Addendum

Collier County Transit Services

Medicaid Grievance Procedure


As per the requirements set forth in Section 641.511, F.S., and with all applicable
federal and State laws and regulations, including 42 CFR 431.200 and 42 CFR 438,
Subpart F, “Grievance System,” Collier County Transit Services as the Community
Transportation Coordinator for Collier County, Florida hereby adopts the
Procedures for Addressing Medicaid Beneficiary Grievance and Complaints as set
forth in the 2009 Medicaid Non-Emergency Transportation (NET) Program
Contract.

VII. GRIEVANCE SYSTEM

A. Overview

1. Description

a. Complaint process – The Complaint process is the Commission’s and the STP’s
procedure for addressing Medicaid Beneficiary Complaints, which are expressions
of dissatisfaction about any matter other than an Action that are resolved at the
Point of Contact rather than through filing a formal Grievance.

b. Grievance process – The Grievance process is the Commission’s and the STP’s
procedure for addressing Medicaid Beneficiary Grievances, which are expressions
of dissatisfaction about any matter other than an Action.

c. Appeal process – The Appeal process is the Commission’s and the STP’s
procedure for addressing Medicaid Beneficiary Appeals, which are requests for
review of an Action.

d. Medicaid Fair Hearing process – The Medicaid Fair Hearing process is the
administrative process which allows a Medicaid Beneficiary to request the State
to reconsider an adverse decision made by the Commission or the STP.

2. General Requirements

a. The Commission and the STP shall have a Grievance System in place that
includes a Complaint process, a Grievance process, an Appeal process, and
access to the Medicaid Fair Hearing system. The Grievance System shall comply
with the requirements set forth in Section 641.511, F.S., if applicable and with all
applicable federal and State laws and regulations, including 42 CFR 431.200 and
42 CFR 438, Subpart F, “Grievance System.”
b. The STP must develop and maintain written policies and procedures relating
to the Grievance System. Before implementation, the Commission must give the
STP written approval of the STP’s Grievance System policies and procedures.

c. The STP shall refer all Medicaid Beneficiaries who are dissatisfied with the STP
or its Actions to the STP’s Grievance/Appeal Coordinator for processing and
documentation in accordance with this Contract and established policies and
procedures.

d. The STP shall provide reasonable assistance to Medicaid Beneficiaries in
completing forms and other procedural steps, including, but not limited to,
providing interpreter services and toll-free numbers with TTY/TDD and
interpreter capability.

e. The STP shall acknowledge, in writing, the receipt of a Grievance or a request
for an Appeal, unless the Medicaid Beneficiary requests an expedited resolution.

f. The STP shall not allow any of the decision makers on a Grievance or Appeal
were involved in any of the previous levels of review or decision-making when
deciding any of the following:

(1) An Appeal of a denial that is based on lack of Medical Necessity; and,

(2) A Grievance regarding the denial of an expedited resolution of an
Appeal.

g. The Medicaid Beneficiary, and/or the Medicaid Beneficiary’s representative,
shall be allowed an opportunity to examine the Medicaid Beneficiary’s case file
before and during the Grievance or Appeal process, including all Medical Records
and any other documents and records.

h. The Medicaid Beneficiary and/or the Medicaid Beneficiary’s representative or
the representative of a deceased Medicaid Beneficiary’s estate shall be
considered as parties to the Grievance/Appeal.

i. The STP shall maintain, monitor, and review a record/log of all Complaints,
Grievances, and Appeals in accordance with the terms of this Contract and to
fulfill the reporting requirements as set forth in this Contract.

j. The STP shall work with the Commission’s Grievance/Appeals Coordinator to
resolve all grievance related issues.

k. Notice of Action

(1) The STP shall notify the Medicaid Beneficiary, in writing, using
language at, or below the fourth (4th) grade reading level, of any
Action taken by the STP to deny a Transportation Service request, or limit Transportation Services in an amount, duration, or scope
that is less than requested.

(2) The STP shall provide notice to the Medicaid Beneficiary as set forth
below (see 42 CFR 438.404(a) and (c) and 42 CFR 438.210(b) and (c)):

(a) The Action the Recipient has taken or intends to take;

(b) The reasons for the Action, customized for the circumstances of
the Medicaid Beneficiary;

(c) The Medicaid Beneficiary’s or the Health Care Professional’s (with
written permission of the Medicaid Beneficiary) right to file an Appeal;

(d) The procedures for filing an Appeal;

(e) The circumstances under which expedited resolution is available
and how to request it; and,

(f) The Medicaid Beneficiary’s rights to request that Transportation
Service