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Frequently Asked Questions __________________________________________________________________________________
Q. What is the biggest difference between the branch protocol for Medicaid medical rides today and the brokerage? A. The biggest difference is who does the authorization and verification of the rides and how the management of the center is structured. In the fee-for-service system, it is up to staff at the branch to verify client eligibility, appointment eligibility, check ride resources of the client and then to authorize the appropriate transportation based on client needs using the most cost-effective provider. The staff member may be a case manager or it could be a clerical person—that structure is not standardized. Also the person may or may not have received any formal training.
In the brokerage model, the authorization and verification is managed by contract. Transportation providers are contracted through the brokerage. The brokerage has professional call takers trained specifically to perform the duties of the call center. They receive ongoing customer service training, and they use professional call center software with a manager onsite to assist. The transportation providers are contracted to the brokerage, and they go through mandatory training and screening.
The costs of the rides are reconciled through the brokerage service and billing is monitored. The brokerage produces monthly reports of the number of rides, costs, unduplicated clients, “no-shows” and complaints.
Q. Do the call takers stay with the job, or is there a lot of staff turnover? How will I know the brokerage can give my clients the same level of service as I do? A. The call center staff will be trained on customer service, DHS client orientation and transportation methods, and their entire focus will be to provide service. Call centers do not see more turnover than any other business.
Q. How many people work in a call center and how many calls do they take? A. The call center staff can, and do, take up to 100 incoming calls a day. They also have staff dedicated to scheduling rides and quality assurance and there are management staff onsite. They are focused on transportation for our clients. The number of staff is determined by the number of eligible clients in the region and the history of number of rides completed.
Q. I've heard that call centers will require that clients use the bus, even though clients don’t like the bus. Does the call center offer any choices to the clients? A. The brokerage or call center staff have to meet two main criteria: (1) Find the most appropriate ride for the client based on actual need, not want, and (2) find the ride that is the lowest cost. A client’s freedom of choice is not allowed by federal waiver and current federal law.
Q. Clients are uncomfortable with changes. What assurance is there that clients will be informed of the changes and that some flexibility will be used in sensitive cases? A. The clients receive information about the changes. Staff also receive information about the changes and they can assist clients. The clients will actually receive more efficient service with the call center. The call takers will ask a series of questions about the special needs of the client, which will be recorded in a database and also in their “client notes.” The call takers will get to know the clients and their needs quickly. Call center management onsite will assist the call takers if the client needs additional questions answered. They may also call social service staff to discuss issues.
Q. How can call takers learn all of the OMAP Medicaid transportation policies? A. All call takers will receive client sensitivity training and customer service training; they will have training manuals, policy and operation manuals; and training will be an ongoing requirement of the brokerage. Each brokerage has developed an advisory counsel that includes residents of each region and riders of the service. This advisory group will address sensitivity issues if they come up. We also have a customer complaint process in place. Brokers meet monthly to review policy issues and make recommendations to DMAP.
Q. What are the management controls in a brokerage or call center? A. Call center staff members are focused on helping our clients arrange the most appropriate, most cost-effective rides. When call center staff hit a roadblock or need help, the manager is there. Managers have access to other managers and also to state transportation managers. Call center staff have regular team meetings and training.
Q. Are there accounting controls set up in a brokerage? A. The broker uses software to manage its pool of transportation providers. At the time a ride is scheduled, software is used to determine an approximate cost of the ride based on the providers’ rate.
When the provider submits their bill, each ride must have an assigned ride number, and the system checks the rides within a range of total cost. The system will kick out rides that were billed at a significantly higher charge. If this happens, the provider must account for the additional charge or will not receive payment for that ride. In a brokerage, only authorized rides will be paid, and clients must be on-board for the provider to receive payment.
Q. Does each brokerage get to set its own policies? A. Oregon brokerages use basically the same policies (no-show policy, criminal history checks, DMV checks, etc.) that are at least as stringent as the DHS Mental Health protocols and in some cases are even more conservative toward client safety. Some brokerages have set differing policies regarding use of DHS volunteer drivers or the amount of liability insurance required for providers.
Q. How will the caseworker know the brokerage can give their clients the same level of service as they do? A. Call center staff are trained on Medicaid policy, transportation services/methods, and their entire focus will be to provide excellent customer service. They are also given the DHS client orientation to better understand this from the client’s perspective.
Q. Some of the transit people we have heard about only care about the ride, how do we know they will care about our client’s welfare? A. The call center staff will get to know the clients as well as you do. In addition, the call takers in every brokerage report that they quickly get to know the individual clients.
Q. Caseworkers are concerned that their clients’ needs will go unmet because the broker will care more about cost than service. How do you reply to this? A. The brokerage or call center staff has to meet two main criteria: (1) Find the most appropriate ride for the client, and (2) Find the ride that is the lowest cost. There are also provisions in the contract for client complaints if the client doesn’t receive an appropriate ride
Q. How will you transition our clients to the call center? We know them and they trust us; they may not like the brokerage. A. The clients will receive information about the changes. Staff will also receive information about the changes so they can assist their clients. The clients will actually receive more efficient service with the call center. Rarely will a client have their call answered by the phone system; the lines will be answered by real people. The call takers will ask a series of questions about the special needs of the client, which will be recorded in their client notes. The call takers will get to know the clients quickly. This is their only job.
Q. We are worried that the mental health clients will be treated rudely, with no understanding of their special needs. How can you assure us this is not a problem? A. All call takers will receive client sensitivity training and customer service training; they will have training manuals, policy and operation manuals; and training will be an ongoing requirement of the brokerage.
Each brokerage has developed an advisory counsel that includes residents of each region and riders of the service. This advisory group will address sensitivity issues if they come up. We also have a customer complaint process in place. Brokers meet monthly to review policy issues and make recommendations to DMAP.
Q. How do we know the call center will be safe for our clients? A. Safety issues will be part of the DHS orientation for call center staff covering:
Clients do not go to the call center; they connect only by phone.
Q. We have heard clients don’t like to be questioned by the call takers. What’s that about? A. The questions are the same that the caseworker would normally ask:
The call takers will check the eligibility of the person and if the ride is a Medicaid-covered service. These questions are all contract requirements that meet Medicaid standards. The answers are recorded in the call-center database for future reference.
Q. Clients at residential facilities expect to be helped (from their room, into the van, into the doctor’s office, etc.). Can we expect this level of service to continue in the brokerage environment? A. The brokerage has a contract that clearly identifies the roles and responsibilities of the transportation provider. The drivers are there to drive. If a client needs a care attendant, it is the facility’s or the client’s responsibility to provide one. This is a risk management issue for the brokerage and the transportation providers. The brokerage contract will not allow drivers to enter clients’ rooms or escort clients to their appointments. Training will provided for facilities and clients. Clients will need to be ready at the front door of the pick-up address.
Q. Some clients have limited mobility; will the driver assist them with getting onto the van? A. Yes, client ride requests should identify their special needs, so the drivers will know to provide assistance boarding and de-boarding the vehicle.
Q. Mental Health clients sometimes forget they have an appointment or they just don’t feel like going to their appointment. What will you do about that? A. The transportation providers are not paid for their services if a client does not ride. They can’t afford to provide service without payment. Keeping that in mind, the client is held accountable, and there is a policy. If they have three no-shows within a rolling 30-day period, they may receive a sanction (no service for 30 days).
Q. If the client has been referred to attend special meetings or appointments by their parole officer (or someone in the court system), but they do not have a letter from the court, will the brokerage still consider these court-ordered rides? A. Yes, the OMAP contract manager has determined the rides to be court-ordered.
Q. Will you transport children six years or younger unescorted? In addition, is this negotiable? A. No, the brokerage will not transport children six years and younger unescorted. This is non-negotiable, primarily due to protocols established by the DHS Child Welfare program and to liability issues.
Q. What would happen if the hospital needs to discharge a patient at 9:30 p.m.? A. Brokerages have their own processes and protocols for after-hours transportation that allow for the transport to take place with authorization to follow.
Q. Can non-OMAP clients ride along free for appointments at the same destination? A. The answer is “yes” or “no” depending on whether the transportation provider agrees to allow it at no additional cost. In addition, this must be negotiated with the call center.
Q. Will the call center arrange a pharmacy ride out of town for specialty medications? (As an example, from McMinnville to Portland.) A. The ride will only be allowed if services of the same type cannot be found locally.
Q. Does the Medicaid brokerage have a time limit on how long a client must wait if they are in a grouped ride? A. Wait times on shared rides are reviewed individually. Client needs are always factored in.
Q. What would happen if all of the transportation providers refused to give a client a ride due to scheduling conflicts? A. Could this appointment be re-scheduled or delayed without doing harm to the client? If not, a provider from a different service level could be secured to provide the ride or a provider from outside the region could be secured. The client will be given options.
Q. What happens to the gentleman’s agreement a branch or facility has with a favorite transportation provider? Can we still use them exclusively? A. The brokerage contract specifically requires the rides to be authorized and assigned to contracted providers that meet the client needs most appropriately and are the lowest cost. Previous agreements are not valid after the brokerage opens. If a facility or branch arranges transportation without the broker’s authorization, the transportation provider will not be paid through Medicaid. The provider could try to recover payment from the branch or facility that contacted them.
Q. If I call a provider directly for a ride, will they get paid for the ride? A. No, you do not have the authority to do that. All Medicaid rides require authorization. All medical ride requests must go through the brokerage.
Q. What is a client “no-show”? A. If a client has a scheduled ride and they are not at the pick-up location as arranged, the driver will report a “no-show” to the brokerage. Client no-shows will be tracked and clients may lose their ride privileges if they have more than three no-shows in a rolling 30-day period. Clients cannot be billed, and the brokerage cannot pay providers for rides provided without a client on board. If you need to cancel your ride, call the brokerage.
Q. How will I know the person at my door is my driver? Do providers have to use picture ID? A. Yes, all drivers should have picture ID that identifies them as a brokerage driver.
Q. Should I tip the driver? A. No, tips are not to be given or received.
Q. If the brokerage tells me I have to ride the bus, what can I do? I don’t know how to do that. A. Ask for travel training.
Q. Will the providers have to call clients to confirm their rides? A. No, they are not required by contract to confirm rides; however, it is good customer service and it may reduce the number of client no-shows.
Q. I always ride with a particular taxi; can I still have them drive me? A. Not necessarily. The call center will screen the caller for eligibility, then check for the lowest cost and most appropriate provider for the client. If Provider A has lower rates than the others, this provider will get the rides. If there are more calls than Provider A can handle, and two other providers (B & C) cost the same, then Provider B will get the first call and Provider C will get the next call.
Q. Will the broker be able to provide me with same-day rides? Sometimes my doctor wants to see me immediately when I’m not feeling well. A. The broker will try to arrange for same-day rides; however, it will depend on whether there is a provider available. They may already be booked with other people’s appointments.
Q. What happens if my drivers are always late to pick me up for my doctor appointments? A. All concerns and complaints need to be turned into the brokerage. That is the process that will make the corrections. After the complaint is researched, a provider may be sanctioned or possibly terminated of the contract if they are unable to provide on-time, safe services.
Q. Will I still need to tell my case manager I need a ride to a health care provider? A. No, you will just call the toll-free transportation brokerage call center to ask for a ride.
Q. Will I have to answer a bunch of questions every time I call for a ride? A. You will have to answer a few questions to ensure that you are eligible for the Medicaid service, that you are going to a Medicaid-covered service, and that you have no other transportation resources available to you. These things are required and monitored by Medicaid rules.
Q. If a provider gets a call after hours directly from a client asking for a ride, how do we know we’ll get paid if we provide the ride? A. You take a risk when you accept this type of ride. You can ask to see the client’s medical card or call the toll-free number for AIS to see if the person is eligible for services.
Q. What does a provider do about client no-shows, and can we get paid? A. A provider should always let the broker know the client was a no-show, and record it. Also you can leave a card or “door hanger” to let the client know you were there. Clients will be tracked and may lose their ride privileges if they have more than three no-shows in a rolling 30-day period. Clients cannot be billed, and the brokerage cannot pay providers for rides provided without a client on board.
Q. Do providers have to use picture ID? A. Yes, all drivers should have picture ID.
Q. How often will the brokerage pay transportation providers? A. The broker will make payments net 30 (as often as weekly may be possible).
Q. How often can providers change their rates? A. Providers can change their rates on the first of each month, if necessary.
Q. Do providers have to call clients to confirm their rides? A. No, they are not required by contract to confirm rides; however, it is good customer service and it may reduce the number of client no-shows.
Q. How will the call center assign rides? A. The call center will screen the caller for eligibility, then check for the lowest cost, most appropriate provider for this client. If provider A has lower rates than the others, this provider will get the ride. If there are more calls than Provider A can handle, and two other providers (B and C) cost the same, then Provider B will get the first call and Provider C will get the next call.
Q. Will the broker restrict the number of contracts so we can all make money? A. No, the broker will not restrict the number of contracts.
Q. What happens if a provider fails to fulfill the contractual obligations such as safety? A. A provider may be sanctioned or possibly lose its contract.
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