Proposed Contract No. CW135340 with Verida, Inc.

MURIELBOWSERMAYOR
June 25,2026
HonorablePhilMendelson
Chairman
CounciloftheDistrictofColumbia
JohnA.WilsonBuilding
1350PennsylvaniaAvenue,NW, Suite504
Washington,DC 20004
DearChairmanMendelson:
Pursuanttosection451oftheDistrictofColumbiaHomeRuleAct(D.C.OfficialCode§ 1-204.51)andsection202oftheProcurementPracticesReformActof2010(D.C.OfficialCode§2-352.02),enclosedforconsiderationandapprovalbytheCounciloftheDistrictofColumbiaisproposedContractNo.CW135340withVerida,Inc.,inthenot-to-exceedamountof$34,010,636.‘TheperiodofperformanceisfromOctober1,2026,throughSeptember30,2027.
Undertheproposedcontract,Verida,Inc.willserveasaTransportationBrokeronbehalfoftheDistricttomanageandadministerNon-EmergencyMedicalTransportationServicesfortheMedicaidEligibleFee-For-ServiceandIntellectualandDevelopmentalDisabilitiesBeneficiaries.
My administrationisavailabletodiscussanyquestionsyoumayhaveregardingtheproposed
contract.Inordertofacilitatearesponsetoanyquestionsyoumayhave,pleasehaveyourstaffcontactMareScott,ChiefOperatingOfficer,OfficeofContractingandProcurement,at(202)724-8759.
IlookforwardtotheCouncil'sfavorableconsiderationofthiscontract.
Sincerely,
Mériel Bpwser
GOVERNMENT OF THE DISTRICT OF COLUMBIA
Office of Contracting and Procurement

Pursuant to section 202(c) of the Procurement Practices Reform Act of 2010, as amended, D.C.
Official Code § 2-352.02(c), the following contract summary is provided:

COUNCIL CONTRACT SUMMARY
(Standard)

(A) Contract Number: CW135340

Proposed Contractor: Verida, Inc. (Verida)

Proposed Contractor’s Principals: Dena Adams-McNeish
Chief Development Officer

Contract Amount: Not-to-exceed (NTE) $34,010,636

Unit and Method of Compensation: Fixed Capitated Rates

Term of Contract: October 1, 2026, through September 30, 2027

Type of Contract: Requirements Contract with a Cost Reimbursement
Component

Source Selection Method: Competitive Sealed Proposal

(B) For a contract containing option periods, the contract amount for the base period and for
each option period. If the contract amount for one or more of the option periods differs
from the amount for the base period, provide an explanation of the reason for the
difference:

Base Period Amount: NTE $34,010,636

Option Period 1 Amount: NTE $34,285,400
Explanation of difference from base period (if applicable): The amount for option period one
is higher than the base period due to inflationary factors related to the cost of operating a
business using the Consumer Price Index.

Option Period 2 Amount: NTE $34,614,176
Explanation of difference from base period (if applicable): The amount for option period two
is higher than the base period due to inflationary factors related to the cost of operating a
business using the Consumer Price Index.

Option Period 3 Amount: NTE $34,638,104
Explanation of difference from base period (if applicable): The amount for option period
three is higher than the base period due to inflationary factors related to the cost of operating a
business using the Consumer Price Index.

Option Period 4 Amount: NTE $34,974,932
Explanation of difference from base period (if applicable): The amount for option period four
is higher than the base period due to inflationary factors related to the cost of operating a
business using the Consumer Price Index.

(C) The goods or services to be provided, the methods of delivering goods or services, and any
significant program changes reflected in the proposed contract:

The contractor shall serve as a Transportation Broker on behalf of the District to manage and
administer Non-Emergency Medical Transportation Services for the Medicaid Eligible Fee-For-
Service and Intellectual and Developmental Disabilities Beneficiaries.

(D) The selection process, including the number of offerors, the evaluation criteria, and the
evaluation results, including price, technical or quality, and past performance components:

Solicitation Number Doc781928 was issued to the public on October 3, 2025, and closed on
November 19, 2025. On the closing date, the District received five timely proposals. The
Contracting Officer (CO) determined that two proposals were nonresponsive and should be
eliminated from further consideration for award based on both respective offerors failing to
submit with its proposal a compliant proposed subcontracting plan. The three remaining
proposals were evaluated in accordance with the technical evaluation factors as described in the
solicitation, which are listed below.

The evaluation factors consisted of:

− Technical Approach and Methodology;
− Technical Expertise;
− Past Performance; and
− Price

Based upon the findings of the technical evaluation panel and the contracting officer’s
independent review of the proposals in accordance with the evaluation factors, the contracting
officer determined that the proposal from Verida was the most advantageous offer to the District
and that it is in the best interest of the District that award be made to Verida.

(E) A description of any bid protest related to the award of the contract, including whether the
protest was resolved through litigation, withdrawal of the protest by the protestor, or
voluntary corrective action by the District. Include the identity of the protestor, the
grounds alleged in the protest, and any deficiencies identified by the District as a result of
the protest:

None

(F) A description of any other contracts the proposed contractor is currently seeking or holds
with the District:

None

(G) The background and qualifications of the proposed contractor, including its organization,
financial stability, personnel, and performance on past or current government or private
sector contracts with requirements similar to those of the proposed contract:

The proposed contractor has demonstrated through past performance reports that its organization
has the history, organizational and technical experience, including the key personnel, required to
successfully meet the requirements of the proposed contract. Likewise, it has been determined
that the proposed contractor maintains the financial resources, accounting and operational
controls to successfully fulfill the District’s requirement. The proposed contractor has been
determined responsible in accordance with the District’s standards of responsibility.

(H) A summary of the subcontracting plan required under section 2346 of the Small, Local,
and Disadvantaged Business Enterprise Development and Assistance Act of 2005, as
amended, D.C. Official Code § 2-218.01 et seq. (“Act”), including a certification that the
subcontracting plan meets the minimum requirements of the Act and the dollar volume of
the portion of the contract to be subcontracted, expressed both in total dollars and as a
percentage of the total contract amount:

The contractor provided a subcontracting plan with a set aside of 35% for the total dollar amount
of $11,996,910. The CO has determined that the plan meets the Department of Small and Local
Business Development requirement.

(I) Performance standards and the expected outcome of the proposed contract:

The performance standards and expected outcomes for the proposed Non-Emergency Medical
Transportation contractor include operating a centralized 24-hour call center, verifying
beneficiary eligibility, assessing transportation needs, and determining the most appropriate
mode of transport for Medicaid beneficiaries. All transportation services must comply with
applicable federal and District regulations. Additionally, the contractor is expected to execute
transportation provider service agreements, administer claims payments, and implement a quality
assurance plan to ensure consistent and safe transportation services.

(J) The amount and date of any expenditure of funds by the District pursuant to the contract
prior to its submission to the Council for approval:

None

(K) A certification that the proposed contract is within the appropriated budget authority for
the agency for the fiscal year and is consistent with the financial plan and budget adopted
in accordance with D.C. Official Code §§ 47-392.01 and 47-392.02:

The Office of the Chief Financial Officer has certified that funding is consistent with the
applicable financial plan and budget.

(L) A certification that the contract is legally sufficient, including whether the proposed
contractor has any pending legal claims against the District:

The Office of the Attorney General has certified that the proposed contract is legally sufficient.
The contractor has no legal claims pending against the District.

(M) A certification that the Citywide Clean Hands database indicates that the proposed
contractor is current with its District taxes. If the Citywide Clean Hands Database
indicates that the proposed contractor is not current with its District taxes, either: (1) a
certification that the contractor has worked out and is current with a payment schedule
approved by the District; or (2) a certification that the contractor will be current with its
District taxes after the District recovers any outstanding debt as provided under D.C.
Official Code § 2-353.01(b):

The Citywide Clean Hands database indicates the contractor is current with its District taxes.

(N) A certification from the proposed contractor that it is current with its federal taxes, or has
worked out and is current with a payment schedule approved by the federal government:

The contractor has self-certified, via the Bidder Offeror Certification form, that it is current with
its federal taxes.

(O) A certification that the proposed contractor has been determined not to violate section 334a
of the Board of Ethics and Government Accountability Establishment and Comprehensive
Ethics Reform Amendment Act of 2011, D.C. Official Code § 1-1163.34a; and (2) A
certification from the proposed contractor that it currently is not and will not be in
violation of section 334a of the Board of Ethics and Government Accountability
Establishment and Comprehensive Ethics Reform Amendment Act of 2011, D.C. Official
Code § 1-1163.34a:

The contractor has certified, via the Bidder Offeror Certification form, that it is (1) not in
violation of section 334a of the Board of Ethics and Government Accountability Establishment
and Comprehensive Ethics Reform Amendment Act of 2011, D.C. Official Code § 1-1163.34a;
and (2) currently is not and will not be in violation of section 334a of the Board of Ethics and
Government Accountability Establishment and Comprehensive Ethics Reform Amendment Act
of 2011, D.C. Official Code § 1-1163.34a.

(P) The status of the proposed contractor as a certified local, small, or disadvantaged business
enterprise as defined in the Small, Local, and Disadvantaged Business Enterprise
Development and Assistance Act of 2005, as amended, D.C. Official Code § 2-218.01 et seq.:

The contractor is not a certified local, small or disadvantaged business enterprise.

(Q) Other aspects of the proposed contract that the Chief Procurement Officer considers
significant:

None

(R) A statement indicating whether the proposed contractor is currently debarred from
providing services or goods to the District or federal government, the dates of the
debarment, and the reasons for debarment:

The contractor does not appear on the Office of Inspector General Exclusions Database, the
Federal Excluded Parties List or the District’s list of Debarred and Suspended Contractors.

(S) Any determination and findings issues relating to the contract’s formation, including any
determination and findings made under D.C. Official Code § 2-352.05 (privatization
contracts):

Determination and Findings for Competitive Sealed Proposals
Determination and Findings for Competitive Range
Determination and Findings for Contractor Responsibility
Determination and Findings for Price Reasonableness

(T) Where the contract, and any amendments or modifications, if executed, will be made
available online:

http://ocp.dc.gov

(U) Where the original solicitation, and any amendments or modifications, will be made
available online:

http://ocp.dc.gov
1101 4th Street, SW
Washington, DC 20024
Date of Notice: April 13, 2026 L0016346549Notice Number:
FEIN: **-***4845
Case ID: 18922047

Government of the District of Columbia
Office of the Chief Financial Officer
Office of Tax and Revenue
VERIDA. INC.
843 DALLAS HWY
VILLA RICA GA 30180-1237

Branch Chief, Collection and Enforcement Administration
Authorized By Melinda Jenkins
To validate this certificate, please visit MyTax.DC.gov. On the MyTax DC homepage, click the
“Validate a Certificate of Clean Hands” hyperlink under the Clean Hands section.
CERTIFICATE OF CLEAN HANDS
As reported in the Clean Hands system, the above referenced individual/entity has no outstanding
liability with the District of Columbia Office of Tax and Revenue or the Department of Employment
Services. As of the date above, the individual/entity has complied with DC Code § 47-2862, therefore
this Certificate of Clean Hands is issued.
TITLE 47. TAXATION, LICENSING, PERMITS, ASSESSMENTS, AND FEES
CHAPTER 28 GENERAL LICENSE
SUBCHAPTER II. CLEAN HANDS BEFORE RECEIVING A LICENSE OR PERMIT
D.C. CODE § 47-2862 (2006)
§ 47-2862 PROHIBITION AGAINST ISSUANCE OF LICENSE OR PERMIT
1101 4th Street SW, Suite W270, Washington, DC 20024/Phone: (202) 724-5045/MyTax.DC.gov

COPY
441 4th St. NW, Suite 900 South, Washington, D.C. 20001 (202) 442-5988 FAX (202) 478-1373
Moore GOVERNMENT OF THE DISTRICT OF COLUMBIA Department of Health Care FinanceOffice of the Chief Financial OfficerMEMORANDUM TO: Nancy Hapeman Chief Procurement Officer Office of Contracting and Procurement THRU: Delicia V. Moore Delicia V. Associate Chief Financial Officer Human Support Services Cluster Digitally signed by Delicia V. Moore Date: 2026.06.09 14:17:52 -04'00' FROM:Darrin Shaffer Agency Fiscal Officer Digitally signed by Darrin A Shaffer Date: 2026.06.08 16:57:32 -04'00' Department of Health Care Finance DATE: June 8, 2026 SUBJECT: Certification of Funding Availability for Non-Emergency Medical Transportation Services Local Budget and Financial Plan for Fiscal Year 2027 to fund the costs associated with the Verida Inc. contract that the -Emergency Transportation Provider Services. This certification supports the Verida Inc. contract during the period from 10/1/2026 through 09/30/2027. The funding allocation is as follows: Vendor: Verida, Inc. Contract: CW135340Fiscal Year 2027 Funding: 10/1/2026-09/30/2027 Agency DIFS Fund DIFS Program DIFS Account Amount HT0 1010001 700100 7141003 $10,185,251.50 HT0 4025002 700100 7141003 $23,825,384.50 FY 2027 Total: $34,010,636.00 Upon approval of the Local Budget and Financial Plan by the Council and the Mayor and completion of the thirty-day Congressional layover, funds will be sufficient to pay for fees and costs associated with the contract. There is no fiscal impact associated with the contract. Should you have any questions, please contact me at (202) 442-9079.
Darrin A Shaffer
400 6th Street NW, Suite 9100, Washington, DC 20001 (202) 727-3400

GOVERNMENT OF THE DISTRICT OF COLUMBIA
Office of the Attorney General

ATTORNEY GENERAL
BRIAN L. SCHWALB

Commercial Division

MEMORANDUM

TO: Tomás Talamante
Director
Office of Policy and Legislative Affairs

FROM: Robert Schildkraut
Section Chief
Government Contracts Section

DATE: June 10, 2026

SUBJECT: Approval of Contract for Transportation Broker for Non-Emergency
Medical Transportation Services
Contractor: Verida, Inc.
Contract No.: CW135340
Estimated Total Amount: NTE $34,010,636

This is to Certify that this Office has reviewed the above- referenced Contract and that we have
found it to be legally sufficient. If you have any questions in this regard, please do not hesitate to
call me at (202) 724-4018.

______________________________
Robert Schildkraut

AWARD/CONTRACT
1. Solicitation Number
Doc781928
Page of Pages
1 183
2. Contract Number
CW135340
3. Effective Date
October 1, 2026
4. Requisition/Purchase Request/Project No.
5. Issued By: Code
Office of Contracting and Procurement
Health Services Cluster
441 4th Street, NW; Suite 330 S
Washington, DC 20001
6. Administered by (If other than line 5)
Department of Health Care Finance
Health Care Delivery Management Administration (HCDMA)
441 4th Street, NW; Suite 900S
Washington, DC 20001
7. Name and Address of Contractor (No. street, city, county, state, and Zip Code)
Verida, Inc.
843 Dallas Hwy
Villa Rica, GA 30180
8. Delivery
FOB Origin FOB Destination
9. Discount for prompt payment:
Net 30 days
10. Submit invoices to the Address shown in Section G.2
(2 copies unless otherwise specified)
DC Vendor Portal, https://vendorportal.dc.gov
11. Ship to/Mark For Code 12. Payment will be made by Code
Department of Health Care Finance
HCDMA
441 4th Street, NW; Suite 900S
Washington, DC 20001

Department of Health Care Finance
13. Remit Address: 14. Accounting and Appropriation Data
ENCUMBRANCE CODE:
15A. Item 15B. Supplies/Services 15C. Qty. 15D. Unit 15E. Est. Unit Price 15F. Est. Amount
0001 Non-Emergency Medical Transportation (NEMT) 12 Months $2,792,553 $33,510,636
0002 Non-Emergency Air Ambulance Transportation 5 Services $100,000 NTE $500,000
Amount of Contract NTE $34,010,636
16. Table of Contents
(X) Section Description Page (X) Section Description Page
PART I – THE SCHEDULE PART II – CONTRACT CLAUSES
X A Award/Contract 1 X I Contract Clauses 164-181
X B Contract Type, Supplies/Services and
Price/Cost 2-9 PART III – LIST OF DOCUMENTS, EXHIBITS AND OTHER ATTACHMENTS
X C Specifications/Work Statement 10-127 X J Attachments 182-183
X D Packaging and Marking 128 PART IV – REPRESENTATIONS AND INSTRUCTIONS
X E Inspection and Acceptance 129 K Representations, Certifications and Other
Statements of Offerors

X F Period of Performance and Deliverables 130-138
X G Contract Administration 139-146 L Instructions, Conditions and Notices to Offerors
X H Special Contract Requirements 147-163 M Evaluation Factors
Contracting Officer will complete Item 17 or 18 as applicable
17. CONTRACTOR’S NEGOTIATED AGREEMENT 18. AWARD
(Contractor is required to sign this document and return (1) copy to the issuing office.)
Contractor agrees to furnish and deliver all items or perform all the services set forth
or otherwise identified above and on any continuation sheets, for the consideration
stated herein. The rights and obligations of the parties to this contract shall be subject
to and governed by the following documents: (a) this award/contract, (b) the
solicitation, if any, and (c) such provisions, representations, certifications, and
specifications, as are attached or incorporated by reference herein. (Attachments are
listed herein.)
Your offer on Solicitation Number Doc781928, including the additions or
changes made by you which additions or changes are set forth in full
above, is hereby accepted as to the items listed above and on any
continuation sheets. This award consummates the contract which consists
of the following documents: (a) the Government’s solicitation and your
offer, and (b) this award/contract. No further contractual document is
necessary.
19A. Name and Title of Signer (Type or print)
Dena Adams-McNeish Chief Development Officer
20A. Name of Contracting Officer
Jarad Dorsey
19B. Name of Contractor

Verida, Inc By
Chief (SDigenavtuereloof ppemrseonnatuthoOrifzefditocseigrn)
19C. Date Signed

4/28/2026
20B. District of Columbia

(Signature of Contracting Officer)
20C. Date Signed
DC OCP 201 (7-99)

Government of the District of Columbia Office of Contracting & Procurement

CW135340 Non-Emergency Medical Transportation
Page 2 of 183

SECTION B: CONTRACT TYPE, SUPPLIES OR SERVICES AND
PRICE/COST
B.1 The Government of the District of Columbia (the District), Office of Contracting and
Procurement (OCP), on behalf of the Department of Health Care Finance (DHCF), is
seeking a Transportation Broker (the Contractor), to manage and administer Non-
Emergency Medical Transportation Services (NEMT) for the District’s Medicaid Eligible
Fee-For-Service (FFS) and Intellectual and Developmental Disabilities (IDD)
Beneficiaries.

B.2 The District contemplates the award of a Requirements Contract with a Cost
Reimbursement component in accordance with Title 27 of the District of Columbia
Municipal Regulations (DCMR) Chapter 24.

B.3 REQUIREMENTS CONTRACT

B.3.1 The District will purchase its requirements of the articles or services included herein from
the Contractor. The estimated quantities stated herein reflect the best estimates available.
The estimate shall not be construed as a representation that the estimated quantity will be
required or ordered, or that conditions affecting requirements will be stable. The
estimated quantities shall not be construed to limit the quantities which may be ordered
from the Contractor by the District or to relieve the Contractor of its obligation to fill all
such orders.

B.3.2 Delivery or performance shall be made only as authorized in accordance with the
Ordering Clause, G.10. The District may issue orders requiring delivery to multiple
destinations or performance at multiple locations. If the District urgently requires
delivery before the earliest date that delivery may be specified under this contract, and if
the Contractor shall not accept an order providing for the accelerated delivery, the District
may acquire the urgently required goods or services from another source.

B.3.3 There is no limit on the number of orders that may be issued. The District may issue
orders requiring delivery to multiple destinations or performance at multiple locations.

B.3.4 Any order issued during the effective period of this contract and not completed within
that period shall be completed by the Contractor within the time specified in the order.
The contract shall govern the Contractor's and District's rights and obligations with
respect to that order to the same extent as if the order were completed during the
contract's effective period; provided that the Contractor shall not be required to make any
deliveries under this contract after April 9, 2031.
CW135340 Non-Emergency Medical Transportation
Page 3 of 183

B.4 PRICE SCHEDULE

B.4.1 BASE PERIOD
October 1, 2026, through September 30, 2027

B.4.1.1 REQUIREMENTS

Contract
Line-Item
Number
(CLIN)

Item Description

Price Per
Beneficiary
Estimated
Monthly
Beneficiaries
Total
Estimated
Monthly Price
0001: Medicaid Transportation Broker to manage and administer Non-Emergency
Medical Transportation (NEMT) services to the District’s Medicaid Eligible Fee-For-
Service (FFS) and Intellectual and Developmental Disabilities (IDD) Beneficiaries.
0001A NEMT services for
FFS Beneficiaries $38.87 50,000 $1,943,500
0001B NEMT services for
IDD Beneficiaries $446.87 1,900 $849,053
Estimated Monthly Total $2,792,553
Estimated Grand Total for B.4.1.1 $33,510,636

B.4.1.2 COST REIMBURSEMENT

CLIN Item Description Not-to-Exceed Cost
0002: Non-Emergency Air Ambulance Transportation
0002A Fixed Wing Air Ambulance $100,000 Per Member Per
Month (PMPM)
0002B Rotary Wing Air Ambulance $100,000 PMPM
NTE Total for B.4.1.2 NTE $500,000

B.4.1.3 TOTAL BASE PERIOD AMOUNT

Estimated Total Amount for B.4.1.1 – Base Period $33,510,636
NTE Total for B.4.1.2 Base Period NTE $500,000
ESTIMATED GRAND TOTAL FOR BASE PERIOD B.4.1 NTE $34,010,636
CW135340 Non-Emergency Medical Transportation
Page 4 of 183

B.4.2 OPTION PERIOD ONE
October 1, 2027, through September 30, 2028

B.4.2.1 REQUIREMENTS

CLIN

Item Description

Price Per
Beneficiary
Estimated
Monthly
Beneficiaries
Total
Estimated
Monthly Price
1001: Medicaid Transportation Broker to manage and administer NEMT services to the
FFS and IDD Beneficiaries.
1001A NEMT services for FFS
Beneficiaries $39.19 50,000 $1,959,500
1001B NEMT services for IDD
Beneficiaries $450.50 1,900 $855,950
Estimated Monthly Total $2,815,450
Estimated Grand Total for B.4.2.1 $33,785,400

B.4.2.2 COST REIMBURSEMENT

CLIN Item Description Not-to-Exceed Cost
1002: Non-Emergency Air Ambulance Transportation
1002A Fixed Wing Air Ambulance $100,000 PMPM
1002B Rotary Wing Air Ambulance $100,000 PMPM
NTE Total for B.4.2.2 NTE $500,000

B.4.2.3 TOTAL OPTION PERIOD ONE AMOUNT

Estimated Total Amount for B.4.2.1 – Option Period One

$33,785,400
NTE Total for B.4.2.2 Option Period One NTE $500,000
ESTIMATED GRAND TOTAL FOR
OPTION PERIOD ONE B.4.2 NTE $34,285,400
CW135340 Non-Emergency Medical Transportation
Page 5 of 183

B.4.3 OPTION PERIOD TWO
October 1, 2028, through September 30, 2029

B.4.3.1 REQUIREMENTS

CLIN

Item Description

Price Per
Beneficiary
Estimated
Monthly
Beneficiaries
Total
Estimated
Monthly Price
2001: Medicaid Transportation Broker to manage and administer NEMT services to
the FFS and IDD Beneficiaries.
2001A NEMT services for FFS
Beneficiaries $39.57 50,000 $1,978,500
2001B NEMT services for IDD
Beneficiaries $454.92 1,900 $864,348
Estimated Monthly Total $2,842,848
Estimated Grand Total for B.4.3.1 $34,114,176

B.4.3.2 COST REIMBURSEMENT

CLIN Item Description Not-to-Exceed Cost
2002: Non-Emergency Air Ambulance Transportation
2002A Fixed Wing Air Ambulance $100,000 PMPM
2002B Rotary Wing Air Ambulance $100,000 PMPM
NTE Total for B.4.3.2 NTE $500,000

B.4.3.3 TOTAL OPTION PERIOD TWO AMOUNT

Estimated Total Amount for B.4.3.1 – Option Period Two $34,114,176
NTE Total for B.4.3.2 Option Period Two NTE $500,000
ESTIMATED GRAND TOTAL FOR
OPTION PERIOD TWO B.4.3 NTE $34,614,176
CW135340 Non-Emergency Medical Transportation
Page 6 of 183

B.4.4 OPTION PERIOD THREE
October 1, 2029, through September 30, 2030

B.4.4.1 REQUIREMENTS

CLIN

Item Description Price Per
Beneficiary
Estimated
Monthly
Beneficiaries
Total
Estimated
Monthly Price
3001: Medicaid Transportation Broker to manage and administer NEMT services to
the FFS and IDD Beneficiaries.
3001A NEMT services for FFS
Beneficiaries $39.60 50,000 $1,980,000
3001B NEMT services for IDD
Beneficiaries $455.18 1,900 $864,842
Estimated Monthly Total $2,844,842
Estimated Grand Total for B.4.4.1 $34,138,104

B.4.4.2 COST REIMBURSEMENT

CLIN Item Description Not-to-Exceed Cost
3002: Non-Emergency Air Ambulance Transportation
3002A Fixed Wing Air Ambulance $100,000 PMPM
3002B Rotary Wing Air Ambulance $100,000 PMPM
NTE Total for B.4.4.2 NTE $500,000

B.4.4.3 TOTAL OPTION PERIOD THREE AMOUNT

Estimated Total Amount for B.4.4.1 – Option Period Three $34,138,104
NTE Total for B.4.4.2 Option Three One NTE $500,000
ESTIMATED GRAND TOTAL FOR
OPTION PERIOD THREE B.4.4 NTE $34,638,104
CW135340 Non-Emergency Medical Transportation
Page 7 of 183

B.4.5 OPTION PERIOD FOUR
October 1, 2030, through September 30, 2031

B.4.5.1 REQUIREMENTS

CLIN

Item Description

Price Per
Beneficiary
Estimated
Monthly
Beneficiaries
Total
Estimated
Monthly Price
4001: Medicaid Transportation Broker to manage and administer NEMT services to
the FFS and IDD Beneficiaries.

4001A NEMT services for FFS
Beneficiaries

$39.99

50,000

$1,999,500
4001B NEMT services for IDD
Beneficiaries $459.69 1,900 $873,411
Estimated Monthly Total $2,872,911
Estimated Grand Total for B.4.5.1 $34,474,932

B.4.5.2 COST REIMBURSEMENT

CLIN Item Description Not-to-Exceed Cost
4002: Non-Emergency Air Ambulance Transportation
4002A Fixed Wing Air Ambulance $100,000 PMPM
4002B Rotary Wing Air Ambulance $100,000 PMPM
NTE Total for B.4.5.2 NTE $500,000

B.4.5.3 TOTAL OPTION PERIOD FOUR AMOUNT

Estimated Total Amount for B.4.5.1 – Option Period Four $34,474,932
NTE Total for B.4.5.2 Option Period Four NTE $500,000
ESTIMATED GRAND TOTAL FOR
OPTION PERIOD FOUR B.4.5 NTE $34,974,932
CW135340 Non-Emergency Medical Transportation
Page 8 of 183

B.5 The Contractor shall provide and be responsible for all Implementation Phase expenses
incurred, as defined below in C.3.42.

B.6 An offeror responding to this solicitation that is required to subcontract shall be required
to submit with its proposal, any subcontracting plan required by law. Proposals
responding to this Request for Proposal (RFP) will be rejected if the Offeror fails to
submit a subcontracting plan that is required by the Small and Certified Business
Enterprise Development and Assistance Act.

B.7 For contracts in excess of $250,000, at least 35% of the dollar volume of the contract
shall be subcontracted in accordance with section H.9 and the Small and Certified
Business Enterprise Development and Assistance Act. A Subcontracting Plan form is
available at https://ocp.dc.gov/page/solicitation-documents.

B.7.1 Please note, the Subcontracting Plan form shall show proposed subcontracts for a total
amount of at least 35% of the Offeror’s proposed Estimated Grand Total for B.4.1.1 the
base period only . Do NOT include the Cost Reimbursement Amount of NTE
$500,000

B.7.2 Small Business Enterprises (SBEs) or Certified Business Enterprises (CBEs) responding
to this solicitation MUST also complete the Subcontracting Plan form, see Attachment J.8
Section 1C. SBEs/CBEs must attest to completing 100% of the work with their own
organization and resources or attest to subcontracting a portion of the contract with
SBEs/CBEs by completing Attachment J.8 in its entirety. Failure to submit a complete
Subcontracting Plan form showing compliance with the Small and Certified Business
Enterprise Development and Assistance Act will disqualify a proposal in accordance with
the Act and Sections B.6, B.7 and H.9.2.

B.8 SPECIAL PROVISION RELATED TO THE NONPROFIT FAIR
COMPENSATION ACT

B.8.1 Nonprofit Fair Compensation Act of 2020, D.C. Code § 2-222.01 et seq.

Nonprofit organizations, as defined in the Act, shall include in their rates the indirect
costs incurred in provision of goods or performance of services under this contract
pursuant to the nonprofit organization's unexpired Negotiated Indirect Cost Rate
Agreement (NICRA). If a nonprofit organization does not have an unexpired NICRA, the
nonprofit organization may elect to instead include in its rates its indirect costs:
(1) As calculated using a de minimis rate of 10% of all direct costs under this contract;
(2) By negotiating a new percentage indirect cost rate with the awarding agency;
(3) As calculated with the same percentage indirect cost rate as the nonprofit
organization negotiated with any District agency within the past 2 years; however, a
nonprofit organization may request to renegotiate indirect costs rates in accordance
with B.8.2; or
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(4) As calculated with a percentage rate and base amount, determined by a certified
public accountant, as defined in the Act, using the nonprofit organization's audited
financial statements from the immediately preceding fiscal year, pursuant to the
OMB Uniform Guidance, and certified in writing by the certified public accountant.

B.8.2 If this contract is funded by a federal agency, indirect costs shall be consistent with the
requirements for pass-through entities in 2 C.F.R. § 200.331, or any successor
regulations.

B.8.3 The Contractor shall pay its subcontractors, which are nonprofit organizations, the same
indirect cost rates as the nonprofit organization subcontractors would have received as a
prime contractor.
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SECTION C: SPECIFICATIONS/WORK STATEMENT
C.1 SCOPE

C.1.1 DHCF is seeking a Contractor to perform the duties of a transportation broker to manage
and administer NEMT services to FFS and IDD Beneficiaries.

C.1.2 The Contractor is responsible for the comprehensive administration, oversight, and
delivery of NEMT services to Medicaid-eligible beneficiaries within the District. This
includes the development and maintenance of a provider network composed of active
NEMT Providers currently enrolled in the District’s Medicaid program. The Contractor
must operate a centralized 24-hour call center, verify eligibility, assess transportation
needs, determine the most appropriate mode of transport—including public transportation
such as Washington Metropolitan Area Transit Authority (WMATA) and schedule trips
accordingly.

C.1.3 In addition, the Contractor must ensure continuous monitoring of service quality,
maintain all required documentation and reports, and respond promptly to any complaints
or grievances. All transportation services must comply with applicable federal and
District regulations. The Subcontractors are prohibited from using vehicles they own to
perform any portion of their contractual responsibilities as defined in sections C.5.24.3.
The Subcontractors are prohibited from subcontracting any portion of their contractual
responsibilities as defined in sections C.5.24.3.

C.1.4 The Contractor must also solicit and execute Transportation Provider Service Agreements
(TPSAs), administer claims payments, and implement a quality assurance plan to ensure
consistent and safe transport services. Monitoring includes vehicle inspections, driver and
attendant compliance, and routine site visits by the District. The Contractor must
immediately report in writing suspected fraud or abuse and maintain an auditable trail of
all service-related data.

C.1.5 By serving as the gatekeeper to NEMT access, the Contractor plays a vital role in
ensuring timely, safe, and medically necessary transportation for vulnerable populations
across the District. Furthermore, the Contractor must obtain prior written approval from
the District before issuing any training materials or public communications.

C.2 APPLICABLE DOCUMENTS

C.2.1 The following documents are applicable to this procurement and are hereby incorporated
by this reference:
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Item
No.
Document
Type Title Date

01

Federal Law
42 U.S.C 1396 et. Seq.
Title XIX of the Social Security Act Grants to States
for Medical Assistance Program Conditions of
participation applicable to providers of services
described in Section 1903(m) and 1932 of the Social
Security Act, 42 U.S.C. §1396b(m);
http://www.ssa.gov/OP_Home/ssact/title19/1900.ht
m

Most
Recent

02

Federal Law
42 U.S.C 1397 et. Seq.
Title XXI of the Social Security Act
State Children’s Health Insurance Program
http://www.ssa.gov/OP_Home/ssact/title21/2100.htm
Most
Recent

03

Federal
Regulation
42 CFR, 42 CFR 431.53 and 431.54
Assurance of Transportation and Exceptions to State
Plan Requirements
eCFR :: 42 CFR 431.53 -- Assurance of
transportation.

Most
Recent

04

Federal Law
Social Security Act
Section 1903 (m) Payments to States
http://www.ssa.gov/OP_Home/ssact/title19/1903.htm
and Section 1932 Payments to Managed Care
Organizations
http://www.ssa.gov/OP_Home/ssact/title19/1932.htm

Most
Recent

05

Federal Law
42 USC §12101 et seq and 29 USC § 794 Section
504 of the Rehabilitation Act of 1973, and
Title II of the Americans with Disabilities Act of
1990 Rehabilitation Act of 1973 | U.S. Equal
Employment Opportunity Commission

Most
Recent

06 Federal
Regulation
42 CFR Part 434 Subparts A and F
General Requirements - Contracts and Subcontracts -
Federal Financial Participation
Available at: https://ecfr.io/Title-42/pt42.4.434
Most
Recent
07 Federal
Regulation
45 CFR Part 160 and 164, HIPAA Regulations
Privacy Rule Introduction | HHS.gov
Most
Recent

08

Federal Law
Title 49 Transportation, Subtitle A – Office of the
Secretary Part 37 Transportation Services for
Individuals With Disabilities
http://www.fta.dot.gov/12876_3906.html
Most
Recent
09 Federal
Guidelines
Center for Medicare and Medicaid Services Manuals
http://www.cms.hhs.gov/Manuals/
Most
Recent

10 Federal (CMS)
Waiver
Terms and provisions of the waiver granted to the
District by the Secretary of Health and Human
Services under §1915(b) of the Social Security Act
42 U.S.C.
Most
Recent
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Item
No.
Document
Type Title Date
§1396n (b);
https://www.law.cornell.edu/uscode/text/42/1396n

11 Federal
Regulation
42 CFR Part 438.2 Definitions
https://www.ecfr.gov/cgi-bin/text-
idx?rgn=div5&node=42:4.0.1.1.8#se42.4.438_12
Most
Recent

12

Federal
Regulation
42 CFR Part 455 Subparts B and E
Disclosure of Information by Providers and Fiscal
Agents Provider Screening and Enrollment
Available at: eCFR :: 42 CFR Part 455 Subpart B --
Disclosure of Information by Providers and Fiscal
Agents & eCFR :: 42 CFR Part 455 Subpart E --
Provider Screening and Enrollment

Most
Recent

13

District of
Columbia Law
D.C. Official Code § 2-1931 et seq
Language Access Act
Available at: Subchapter II. Language Access. |
D.C. Law Library

Most
Recent

14

District of
Columbia Law
D.C. Official Code Title 50 Motor and Non-Motor
Vehicles and Traffic
Subtitle IV Motorized Vehicle Registration,
Inspection, Licensing
Chapter 6 Inspection
Chapter 11 Inspection
Chapter 15 Registration of Motor Vehicles Subtitle
VI Safety
Available at:
https://code.dccouncil.us/dc/council/code/titles/50/

Most
Recent

15

District of
Columbia Law
DC Official Code Title 2 Chapter 3A Government
Procurement
Subchapter II Procurement Organization
Privatization Contracts and Procedures
Requirements
Subchapter III Contractor Standards Subchapter IV
Source Selection and Contract Information
Available at: Chapter 3A. Government
Procurement. | D.C. Law Library

Most
Recent

16
District of
Columbia
Policy and
Guidelines
DDS Policy and Guidelines
Policies and Procedures - DDA | dds
Most
Recent

17
District of
Columbia
Municipal
Regulations
Title 29. Chapter 29-5: Emergency Medical Services
Chapter 29-5. Emergency Medical Services, Title
29. Public Welfare, D.C. Municipal Regulations
Most
Recent
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Item
No.
Document
Type Title Date

18
District of
Columbia
Municipal
Regulations
Title 29. Public Welfare
Chapter 29-13: Medicaid Program Administrative
Procedures
https://dcregs.dc.gov/Common/DCMR/SectionList.a
spx?SectionNumber=29-1300

Most
Recent

C.3 DEFINITIONS/ACRONYMS

The following terms are incorporated into the solicitation and resulting contract with the
following meanings:

C.3.1 Accompanying Member – Individuals who are authorized to travel with an eligible
beneficiary to and from an appointment.

C.3.2 Aged, Blind, and Disabled (ABD) – are adults 65 and older, blind or disabled according
to the Social Security Administration

C.3.3 Americans with Disability Act (ADA) – Federal law that provides protection from
discrimination against individuals with disabilities, as defined in 42 U.S. Code § 12101 et
seq.

C.3.4 ADA Para-transit – Transportation Services defined by the ADA which mandate that
public transportation agencies provide door-to-door services for disabled Beneficiaries as
stated in 42 U.S. Code § 12141 et seq. and 49 CFR 37

C.3.5 Agent – an entity authorized to act on behalf of another.
C.3.6 Air Ambulance – An air ambulance is a specially outfitted helicopter or fixed-wing
aircraft that transports injured or sick people in a medical emergency or over distances or
terrain impractical for a conventional ground ambulance.
C.3.7 Ambulance – (or Emergency Medical Services (EMS) vehicle) as defined by Chapter 5
(Ambulance Service) of Title 29 (Public Welfare) of the DCMR, means any vehicle,
vessel or craft that holds a valid permit issued by the District of Columbia Department of
Health, and that is specially constructed, equipped, maintained and operated, and
intended to be used for emergency medical care and the transportation of patients who are
sick, injured, wounded, or otherwise incapacitated or helpless. The word "ambulance"
may not appear on any vehicle, vessel or aircraft that does not hold a valid EMS vehicle
permit. This RFP and Contract cover only non- emergency ambulance
transportation services such as neonatal and other ambulance services as defined in
42 Code of Federal Regulations (CFR) 414.605.

C.3.8 Appropriate Mode of Transportation – The most cost-efficient type of transportation that
best meets the physical, medical or behavioral circumstances of a Beneficiary requiring
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transportation to a medical care provider or service including ambulatory vehicles,
wheelchair vehicles, stretcher vehicles, private providers such as taxis, and public
transportation.

C.3.9 Attendant – A person paid by the transportation service provider to accompany the
Beneficiary in the vehicle in addition to the driver, who assists in transporting a
Beneficiary to ensure his or her safety.

C.3.10 Bariatric Transport – transport provided by a qualified ambulatory van or stretcher van
operator to individuals who have a body mass index of greater than 40 or weigh at least
100 pounds over ideal weight.

C.3.11 Beneficiary – A person who receives a Medicaid service while eligible for the Medicaid
program, whether a Fee-For-Service (FFS) Beneficiary or an Intellectual and
Developmental Disabilities (IDD). People may be Medicaid Eligible without being
Medicaid Beneficiaries.

C.3.12 Beneficiary File – A record of the transportation services requested and provided by a
Beneficiary and any other transportation related matters such as Grievances or
complaints; the Beneficiary File is maintained by the Contractor.

C.3.13 Broker (Contractor) – An entity or company which assists Medicaid clients obtain
transportation service options by matching Beneficiaries with appropriate transportation
providers through a central trip request and administrative facility. The entity also recruits
and Contracts with transportation providers, performs payment administration, gate
keeping, trip assignments, quality assurance, administrative oversight and reporting. The
entity the District has a contract with for the provision of required tasks.

C.3.14 Brokerage – A method of providing transportation where beneficiaries are matched with
appropriate transportation providers through a central trip request and administrative
facility. Actual trips are provided by several different transportation providers.

C.3.15 Capitated Rate/Capitation – A prospective payment method that pays the provider of
service a uniform amount for each person covered, usually monthly.

C.3.16 CMS – Centers for Medicare and Medicaid Services is the agency within the U.S.
Department of Health and Human Services (HHS) that provides health coverage through
Medicare, Medicaid, and other federal programs as explained at
https://www.cms.gov/about-cms.
C.3.17 Centralized Call Center – The Contractor provided customer service support 24 hours per
day equipped to receive, assign, and schedule transportation requests.

C.3.18 Conceptual Plan – plans developed by the Contractor to demonstrate a knowledgeable
understanding of the elements of the scope and the objective of the health plan and how
they are related and managed to successfully contribute to the Contract requirements.
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C.3.19 Contract Administrator (CA) – an individual responsible for contract administration as
defined by District regulations.

C.3.20 Clinician, Pharmacy, and Acute Provider Services (CPAPS) – A division within the
DHCF that develops, implements, and oversees the programming for primary and
specialty providers, hospitals, and other acute and preventive care services.

C.3.21 Covered Transportation Services – non-emergency medical transportation services
provided to Eligible Beneficiaries to go to and from health care appointments at medical
service locations, including doctor offices, clinics, day treatment centers, and
rehabilitation facilities within the District, Maryland, and Virginia.

C.3.22 Deliverables – Contractor furnished documents, records and reports required to be
provided to the CA for review or approval pursuant to the terms of the Contract.

C.3.23 Department on Disability Services (DDS) – is the District of Columbia agency that
provides the residents of the District of Columbia with information, oversight and
coordination of services for people with disabilities and those who support them, such as
service providers and employers, as explained at https://dds.dc.gov/.

C.3.24 Department of Health Care Finance (DHCF) is the agency responsible for the oversight
of the Contractor’s performance.

C.3.25 Department of Human Services (DHS) is the District of Columbia agency that provides
Medicaid, Food stamps, and other public assistance program for eligible District of
Columbia residents, as explained at https://dhs.dc.gov/.

C.3.26 Developmental Disability – Mental retardation or a related condition; a severe, chronic
disability manifested during the developmental period before age 22, which results in
impaired intellectual functioning or deficiencies in essential skills as defined in 42 CFR
435.1010.

C.3.27 District Holidays – Legal Public Holidays observed by the District of Columbia as listed
by the Department of Human Resources, https://dchr.dc.gov/page/holiday-
schedules#gsc.tab=0, including New Year’s Day, Inauguration Day, Dr. Martin Luther
King, Jr’s Birthday, Washington’s Birthday, DC Emancipation Day, Memorial Day,
Juneteenth National Independence Day, Independence Day, Labor Day, Indigenous
Peoples’ Day, Veterans day, Thanksgiving Day, and Christmas Day.
C.3.28 Diversion - refers to the practice of reassigning or utilizing personnel who are funded,
designated, or assigned to perform specific contract-related functions for tasks unrelated
to their contractually defined roles, or for purposes not approved by DHCF. Diversion
does not include the resignation, death, disablement, or dismissal for cause of Key
Personnel which is beyond the control of the Contractor.
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C.3.29 Economic Security Administration (ESA) – The District of Columbia office within the
Department of Human Services (DHS) responsible for determining eligibility for
Medicaid through Temporary Assistance for Needy Families (TANF) and (TANF-related
categories), and for administering determinations for Social Security Insurance (SSI)
eligibility made by the Social Security Administration, as explained at
https://dhs.dc.gov/page/about-dhs.

C.3.30 Eligible Beneficiary – An individual who has been designated by the District’s DHS ESA
as eligible for Medicaid medical and meets the criteria in Section C.5.3 Eligible
Beneficiary and is not a Non-Covered Beneficiary as defined in Section C.5.4.

C.3.31 Eligibility Verification System – The information system maintained by the District of
Columbia ESA providing Medicaid Providers the ability to verify eligibility status of
Medicaid Beneficiaries.

C.3.32 Encounter Data – Information derived from a contact, or a service delivered by a health
care provider for any capitated service provided to a Beneficiary.

C.3.33 Escort – A person permitted to accompany an Eligible Beneficiary or groups of Eligible
Beneficiaries during the delivery of transportation services at no cost to the person.

C.3.34 Exceptional Transportation Services – NEMT service necessary under extraordinary
medical circumstances that require travel out-of-area, and other ground travel, for health
care treatment not normally provided through District health care providers.

C.3.35 Fair Hearing – The process adopted and implemented by DC Health in compliance with
Federal regulations and State rules relating to Medicaid Fair Hearings found at 42 CFR
Part 431, Subpart E.

C.3.36 Fiscal Agent – The District contractor that operates the District’s Medicaid Management
Information Systems (MMIS), including payment of claims for Eligible Beneficiaries for
covered Medicaid services.

C.3.37 Fixed Wing Air Ambulance – is air transportation other than by helicopter for the purpose
of interfacility transportation to access a higher level of care not available at the
transferring Facility or for returning a Beneficiary to Washington DC from an Out of-
State Facility that is more than 150 miles from the borders of Washington DC.
Furthermore, Beneficiaries who would be eligible for a ROTARY WING transport, but
for whom it is contraindicated due to clinical conditions, may be considered for FIXED
WING transport.

C.3.38 Full Trip – To transport clients to and back from a Health Care Service Facility.
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C.3.39 Gatekeeper – A process used to determine the services to be provided to a Beneficiary,
including coordinating the provision of appropriate care.

C.3.40 Grievance – A complaint, which cannot be resolved to the Beneficiary’s satisfaction or an
issue presented by the Beneficiary to the Contractor or the District in writing for formal
consideration.

C.3.41 Health Care Service Facility – a place that provides healthcare to patients such as clinics,
hospitals, medical and dental offices, and outpatient care centers.

C.3.42 Implementation Phase – The phase of the Contract beginning from date of award through
twelve months thereafter to provide the Contractor the time to properly equip the
Contractor’s operations to successfully begin to receive and process transportation
requests and the execution of the day-to-day operations of the NEMT program.

C.3.43 Intellectual and Developmental Disabilities – (IDD) are severe, chronic conditions that
are due to mental and/or physical impairments.

C.3.44 Managed Care – A system in which the overall care of a patient is overseen by a single
provider or organization..

C.3.45 Managed Care Organization (MCO) – An entity which provides or contracts for Managed
Care.

C.3.46 Medicaid – A joint federal-state entitlement program that pays for medical services for
qualified people. As explained at https://dhcf.dc.gov/service/medicaid, Medicaid helps
pay for medical services for low-income and disabled people. For those eligible for full
Medicaid services, Medicaid pays healthcare providers. Providers are doctors, hospitals
and pharmacies who are enrolled with DC Medicaid.

C.3.47 Medicaid Beneficiary – A Medicaid Eligible Beneficiary that has received a service paid
for with Medicaid program funds.

C.3.48 Medicaid Eligible –This term is used in reference to persons who, after going through a
certification process, become eligible to receive services and other assistance under the
auspices of the Medicaid program. The term does not include persons who could be
eligible for Medicaid (e.g., meet all income and asset criteria tied to eligibility) that are
not enrolled in the program.
C.3.49 Medicaid Management Information System (MMIS) – An integrated group of procedures
and computer processing operations (subsystems) developed at the general design level to
meet principal objectives. For title XIX purposes, "systems mechanization" and "
mechanized claims processing and information retrieval systems" are identified in section
1903(a)(3) of the Social Security Act and defined in regulation at 42 CFR 433.111. The
objectives of this system and its enhancements include the title XIX program control and
administrative costs; service to Beneficiaries, providers and inquiries; operations of
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claims control and computer capabilities; and management reporting for planning and
control. These systems are grouped into the following seven functional areas:
beneficiaries; providers; claims processing; reference files; surveillance and utilization
review; management and administration reporting; and third- party liability.

C.3.50 Medicaid Provider – An entity, person, group, or company, approved by DHCF to
provide a covered Medicaid service to a District of Columbia Medicaid Beneficiary.

C.3.51 Multi-Passenger Van – A vehicle with the capacity to seat a driver and up to 14
passengers that is often built on a truck platform or a minivan, a vehicle designed to carry
10 people or less and generally built on a car platform, that meet the vehicle
requirements, safety requirements, licensing and insurance requirements.

C.3.52 My Health GPS – DHCF’s care coordination benefit for Medicaid beneficiaries with
three or more chronic conditions.

C.3.53 Network – All Transportation Providers in the Contractor’s system providing Covered
Transportation Services to Beneficiaries. The Contractor’s Network development staff
handles the recruitment of Transportation Providers that make up the Network.

C.3.54 Non-Covered Transportation Services – NEMT services not covered under this Contract,
which include transportation to any service not covered through the DHCF Fee-for-
Service (FFS) Medicaid program or Emergency Ambulance Transportation.

C.3.55 Non-Emergency Medical Transportation (NEMT) Services – are medically necessary,
cost-effective transportation services for any Eligible Beneficiary (and Escort, if required)
with no other means of transportation available to any Medicaid covered service.

C.3.56 Nurse Triage Line – Under the Right Care, Right Now program, callers to 911 with non-
emergency injuries or illnesses are transferred to a nurse, either by the 911 center or by a
Fire and Emergency Medical Services (FEMS) first responder. The nurse asks the caller
questions and assesses his or her symptoms so that the nurse can refer the caller to the
most appropriate non-emergency medical care available, most likely a community clinic
or urgent care clinic in the caller’s neighborhood. https://ouc.dc.gov/page/right-care-right-
now1

C.3.57 Ombudsman – An ombudsman is an individual who assists enrollees in resolving
problems they may have with their health plan. An ombudsman is a neutral party who
works with the enrollee, the health plan, and the provider (as appropriate) to resolve the
individual enrollee’s problems.

C.3.58 On-Demand – Is when the Beneficiary’s trips are generated by calls from the Beneficiary
or their agents to the Contractor, who then coordinates the dispatchment of a vehicle to
pick the Beneficiary up and transport them to their destination.
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C.3.59 Operational Phase – The phase of the Contract beginning after the Implementation Phase
and when, after review and approval of the CA, the Contractor shall begin to receive
transportation requests from Beneficiaries and provide the services required under the
Contract, including performing day-to-day operations of the NEMT program.

C.3.60 Outreach – Activities performed by the Contractor to contact Eligible Beneficiaries and
Medicaid Eligible persons and their families and to communicate information about
Medicaid resources and provide education.

C.3.61 Para-transit – Type of passenger transportation that is more flexible than conventional
fixed route transit. Para transit includes demand-response transportation services,
subscription bus services, and shared-ride taxis. Most often refers to wheelchair-
accessible, demand-response van service.

C.3.62 Per-Member-Per-Month (PMPM) – Amount paid for each Eligible Beneficiary each
month.

C.3.63 Portion of Trip – transportation of Eligible Beneficiaries to or from a health care service
facility.

C.3.64 Pre-Paid Ambulatory Health Plan (PAHP) – is an entity that provides services to Eligible
Beneficiaries under contract with the District, and based on capitation payments, or other
payment arrangements that do not use District plan payment rates. Does not provide or
arrange for and is not otherwise responsible for the provision of any inpatient hospital or
institutional services for its Eligible Beneficiaries; and does not have a comprehensive
risk contract.

C.3.65 Prior Authorization – A required authorization to be obtained by the Eligible Beneficiary
from the Contractor prior to the delivery of Non-Emergency Transportation Services.

C.3.66 Public Transportation – Transportation available to the general public in exchange for a
rider fee such as METRO Bus/Rail service, and taxicabs.

C.3.67 Rotary Wing Air Ambulance – Rotary-wing aircraft are those that are powered by
rotating blades, such as helicopters. These types of air ambulances are most used during
emergencies, when someone needs to be transported a shorter distance as quickly as
possible.
C.3.68 Round Trip – A trip to a place and back usually over the same route.
C.3.69 Surety Bond – A bond issued by a party legally liable for the debt, default, or failure of a
principal to satisfy a Contractual obligation.

C.3.70 Temporary Assistance for Needy Families (TANF) –The program provides cash
assistance to families in need, along with a suite of services to facilitate their path to
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success, as explain at https://dhs.dc.gov/service/tanf-district-families.

C.3.71 Transportation Provider – A business entity under Contract with the Contractor to provide
NEMT Services for the District of Columbia Eligible Beneficiaries.

C.3.72 Transportation Provider Service Agreement (TPSA) – A signed, written, enforceable
agreement between the Contractor and the Transportation Provider detailing the roles and
responsibilities of each.

C.3.73 Transportation Services – The appropriate mode of transportation that can suitably meet
the Eligible Beneficiary’s medical needs.

C.3.74 Unlinked Passenger Trip – The one-way movement of a person or vehicle between two
points. A person who leaves home on one vehicle, transfers to a second vehicle to arrive
at a destination, leaves the destination and has to transfer to yet another vehicle to
complete the journey home has made three Unlinked Passenger Trips.

C.3.75 Urgent Care – An unscheduled, episodic clinical event with or without a diagnosis, when
a Beneficiary has a reasonable belief that delaying care beyond 72 hours will result in a
worsening of the condition or prolonged pain or discomfort. Urgent Care also includes a
Beneficiary’s discharge from hospital or nursing home.

C.3.76 Waiver 1915(b) – A statutory provision of Medicaid that allows a state to partially limit
the freedom of choice by consumers of Medicaid Eligible services or that waives the
requirements under Title XIX, the Medicaid Act, for uniform applicability statewide of a
plan or comparability of benefits. A section of the Social Security Act, which allows
states to waive a Beneficiary’s freedom of choice and require that beneficiaries enroll in
Prepaid Ambulatory Health Plan programs to obtain Non-Emergency Transportation
Services. Waivers must be approved by CMS.

C.3.77 Washington DC Metropolitan Area – the metropolitan area consisting of the city of
Washington DC, the counties of Montgomery and Prince Georges, St. Charles and the
City of Baltimore in Maryland and the Northern Virginia counties of Fairfax, Arlington
and the City of Alexandria.

C.3.78 Washington Metropolitan Statistical Area – Area which includes the District of Columbia;
the Virginia Cities of Alexandria, Falls Church, Manassas, Manassas Park, Fairfax, and
Fredericksburg, the Virginia Counties of Fairfax, Arlington, Prince William, Loudoun,
Stafford, Clarke, Warren, Fauquier, Culpepper, Spotsylvania, and King George; the
Maryland Counties of Montgomery, Prince Georges, Charles, Frederick, and Calvert; and
the West Virginia Counties of Berkeley and Jefferson.

C.3.79 Washington Metropolitan Area Transit Commission (WMATC) – The agency created in
1960 pursuant to the Washington Metropolitan Area Transit Regulation Compact, an
interstate compacts among Maryland, Virginia and the District of Columbia providing for
regional regulation of private sector motor carriers transporting passengers for hire in the
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Washington Metropolitan Area, as explained at https://www.wmatc.gov/. The
Commission issues operating authority to van and bus operators and some sedan and
limousine operators. Carriers holding authority from the Commission must file fixed rates
and fares with the Commission and comply with Commission-prescribed insurance,
safety and vehicle- marking regulations. The Commission also prescribes rates and
charges for transportation by taxicab between one compact signatory and another, where
both points are within the Metropolitan District.

C.4 BACKGROUND

C.4.1 The DHCF is the single District agency responsible for the administration of the District’s
Medical Assistance Program authorized under Title XIX of the Social Security Act and
the District’s State Children’s Health Insurance Program (CHIP) authorized under Title
XXI of the Social Security Act (C.2.1 Applicable Documents #1 and #2). Through these
programs, approximately 250,000 income-eligible, persons, disabled, and elderly
residents receive medical coverage, https://dhs.dc.gov/service/medical-assistance.
Approximately 220,000 of these Beneficiaries are enrolled in an MCO. Those 220,000
Beneficiaries receive Transportation Services from the MCO and shall not be eligible to
receive NEMT services under this Contract and therefore shall not be the responsibility of
the Contractor. Specifically, the Contractor shall not provide or approve transportation
requests for Medicaid Eligible residents who are:

Enrolled in a MCO or assigned to an MCO;
Eligible for Medicaid as a Qualified Medicare Beneficiary (QMB); or
Eligible for services as children through the District’s CHIP program, (C.2.1 Applicable
Document #2).

C.4.2 The estimated total number of the District’s FFS Eligible Beneficiaries ranges each
month between approximately 40,000 and 50,000. The estimated total number of the
District’s IDD Eligible Beneficiaries each month is approximately 1,900. Annually, no
more than five non-emergency air ambulance transportation services are provided to FFS
and IDD Eligible Beneficiaries.

C.4.3 The actual utilization in FY17 through FY23 is provided below for the eligible population
groups:

Fiscal Year IDD *Washington, DC
2017 1,117 9,213
2018 1,062 9,579
2019 933 10,021
2020 1,767 37,076
2021 1,437 35,228
2022 1,473 29,784
2023 1,517 25,546
*WDC are the Beneficiaries who are not enrolled in the IDD waiver.
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C.4.4 Historical claims or service request history for NEMT during FY17 through FY23 is
provided below by type of van:

Fiscal Year Trip Legs
Stretcher Van
Trip Legs
Wheelchair Van
Trip Legs
Ambulatory Van
Beneficiary
Cancellations
2017 2,071 79,346 761,764 25,426
2018 1,552 82,145 737,710 24,975
2019 3,546 78,995 652,370 26,609
2020 3008 51232 353,743 44,359
2021 5085 41180 181,634 54,708
2022 6708 39503 232,148 81,804
2023 5940 34375 208,291 74,173

C.4.5 Historical claims information for fare cards, Metro Access, and gas mileage
reimbursement for FY17 through FY23 is provided below:

Fiscal Year Fare Cards Metro Access Gas Mileage
Reimbursement
2017 95,911 39,761 7,290
2018 76,825 42,639 7,376
2019 45,745 43,049 7,340
2020 43,229 30,194 8,019
2021 12,065 47,117 7,538
2022 15,070 39,752 8,332
2023 9,774 25,420 8,622

C.4.6 Historical claims information for Taxicabs, Lyft, and My Health GPS for FY18 through
FY23 is provided below:

Fiscal Year

Taxicabs

Lyft

My Health GPS* Nurse Triage
Line**
2018 589 16 871 71
2019 9,220 17,911 702 234
2020 246 15,842 225 544
2021 1,720 8,718 135 240
2022 1,076 19,803 419 134
2023 665 24,274 381 66
*My Health GPS launched on 7/1/2017
**Nurse Triage Line launched on 4/9/2018

C.4.7 The incumbent contractor maintains provider agreements with 19 active Transportation
Providers that provide Transportation Services to this FFS population. Requests for
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NEMT calls and authorization requests may exceed 300 per day. The contractor’s Call
Center staff respond to transportation requests and calls on a real-time basis.

C.4.8 Currently the CPAPS Division within DHCF oversees the operations of the incumbent
contractor.

C.4.9 The provision and administration of NEMT is critical to the District’s Medicaid program.
This Contract is intended to ensure that Medicaid Eligible FFS and IDD Beneficiaries
have access to medical care via NEMT, including ambulatory van vehicles, wheelchair
van vehicles, and stretcher van vehicles, as required by the CMS. The Contractor is also
responsible for ensuring support services, such as claims administration and processing,
customer support, oversight, and monitoring, are provided in accordance with Federal
and District guidelines.

C.4.10 DHCF is concerned about the District’s rising expenses for health care programs but
remains committed to the delivery of quality services. In response to this on-going
challenge, DHCF recognizes the transportation broker system represents the best solution
for the District to effectively and efficiently administer the NEMT services. This
conclusion has been reached based on several references including the U.S. HHS, Office
of Inspector General (OIG) study (OEI-04-95-00140). The OIG, the federal agency is
charged with oversight of state Medicaid expenditures, recommends in the study that
states consider using transportation brokers as an effective means of controlling Medicaid
non-emergency transportation costs. This recommendation came from an OIG prompted
by significant increases in non-emergency Medicaid transportation costs during the
1990’s. The OIG study concluded that, in addition to controlling costs, transportation
brokerage firms have been effective in reducing fraud and abuse by Providers and
Beneficiaries, and in increasing utilization of low-cost modes of transportation, such as
publicly funded transit systems.

C.4.11 In addition, the Community Transportation Association of America recognized
transportation brokers as “the most successful approach to managing Medicaid
transportation” in its 2001 publication entitled, “Medicaid Transportation: Assuring
Access to Health Care.” This study concluded that brokers provide a high level of
expertise in the medical transportation field, utilize state-of-the art telecommunications
and software technologies, and employ innovative cost and utilization monitoring
techniques.

C.4.12 In 2016, Kaiser Family Foundation article reported that a majority of states have adopted
the best practice of utilizing transportation brokers in some capacity to manage Medicaid
NEMT services. Many more states are looking into transportation Brokerages as a means
of controlling human service transportation costs.

C.4.13 The implementation of the transportation broker program is to deliver NEMT services in
a culmination of DHCF’s cost containment and improvement of the strategy for the
NEMT services. The management and oversight NEMT services to result from this
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Contract are intended to control program expenditures, providing quality, efficient and
effective services for all covered Medicaid FFS Beneficiaries.

C.4.14 A total of 274 transportation complaints were filed in FY 2023 and 275 in FY 2024.
These totals included complaints involving the transportation provider, driver, vehicle
and the Broker’s processes for scheduling trips.

C.4.15 The IDD Waiver is a 1915 Waiver approved by CMS. Typically, home and community-
based service waivers afford the states the flexibility to develop and implement creative
alternatives to placing Medicaid-eligible individuals in medical facilities such as nursing
homes, Community Residential Facilities, and Intermediate Care Facilities for the
Mentally Retarded. The IDD Waiver is a home and community-based waiver program
that recognizes that many individuals who are at risk of being placed in a medical facility
can be cared for in their natural homes and communities, thus preserving their
independence and ties to families and friends at a cost no higher than the institutional
care.

C.4.16 The IDD Waiver provides 25 services to individuals who qualify for Medicaid, and meet
the criteria as set forth for the waiver program. These include individuals with IDD. The
IDD Waiver was implemented in the District of Columbia in September of 1998.

C.5 REQUIREMENTS

PART I: QUALIFYING FOR MEDICAID NEMT SERVICES

C.5.1 Covered Transportation Services
C.5.1.1 The Contractor shall provide NEMT services for medically necessary transportation
for any Eligible Beneficiary and an Escort, if required. These services ensure access
to medical evaluations, treatments, prescription drugs, and medical equipment.
Additionally, NEMT services shall be provided for medical services reimbursed under
the District Medicaid program, even if provided by non-participating health
practitioners or entities.

C.5.1.2 The Contractor shall provide NEMT services with applicable service limitations for
the following covered Medicaid services:
1. Ambulatory services;
2. Podiatry, Optometry, and Dental services;
3. Physical Therapy and Occupational Therapy (Home Health Agency or medical
rehabilitation facility);
4. Private Duty Nursing;
5. Clinic services;
6. Speech, hearing, and language disorder services (supervised);
7. Prescription Drugs and Prosthetic devices;
8. Eyeglasses and Diagnostic services;
9. Preventive and Rehabilitative services;
10. Inpatient Psychiatric Hospital services (65+ years);
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11. Skilled Nursing and Intermediate Care Facility services (including non-Mental
Disease facilities);
12. Distinct part unit services for Developmental Disability;
13. Inpatient psychiatric services (Under 22 years);
14. Hospice Care;
15. Targeted Case Management and Tuberculosis-related services;
16. Pregnancy-related and postpartum services, including complications;
17. Gastric bypass;
18. Emergency hospital services (non-Medicare participating hospitals); and
19. Personal Care services (in-home, under treatment plan and supervision).

C.5.1.3 In accordance with 42 CFR 440.170, the Contractor shall be responsible for
providing, at its own expense, an Attendant to accompany an Eligible Beneficiary
when such assistance is determined necessary to ensure the Eligible Beneficiary’s
safe transportation and participation in medical services. The Contractor shall also
bear all costs associated with the Attendant’s transportation, meals, and lodging. If the
Attendant is not a member of the Eligible Beneficiary’s family, the Contractor shall
additionally be responsible for payment of the Attendant’s salary. These costs shall
not be separately reimbursable by the District and are deemed included in the
Contractor’s rate. The Contractor is solely responsible for ensuring that all Attendants
meet the qualifications and service standards required under this Contract and
applicable law.

C.5.1.4 The Contractor shall modify applicable systems to capture and report Beneficiary
utilization among these categories listed in C.5.1.2. Policies and procedures,
including reasonable trip limits for therapeutic services, shall be developed in
coordination with the District.

C.5.1.5 The Contractor shall provide transportation to and from District points of origin and
Medicaid-reimbursable service locations at the request of the Eligible Beneficiary or
an authorized representative. No co-payments shall be collected for these services.

C.5.1.6 The Contractor shall provide transportation outside the Washington, DC Metropolitan
Area only when adequate medical resources are unavailable locally or when a
healthcare provider refers the Eligible Beneficiary to necessary medical care outside
the area. Out-of-boundary trips must originate within the District and be deemed
medically necessary. A written referral from a healthcare provider shall be required.

C.5.1.7 Urgent Care Transportation
The Contractor shall arrange for NEMT services for Urgent Care when a Beneficiary
lacks other appropriate transportation options. Coordination includes:
1. Verifying the need for Urgent Care due to hospital discharge or a time-sensitive
medical appointment;
2. Receiving transportation requests from the Nurse Triage Line or My Health GPS
coordinator;
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3. Confirming that the Beneficiary lacks access to alternative transportation;
4. Identifying and dispatching a Transportation Provider;
5. Referring the Beneficiary to emergency ambulance services via 911 when
necessary;
6. Providing Urgent Care transportation via non-shared, sedan-type vehicles (e.g.,
taxicab, Uber, Lyft); and
7. Completing Urgent Care requests within one hour unless otherwise arranged.

C.5.1.8 Backup Service

C.5.1.8.1 The Contractor shall arrange for backup vehicles and personnel when scheduled
transportation is disrupted due to:
1. Vehicle delays exceeding 20 minutes;
2. Mechanical issues, accidents, or other operational disruptions; and
3. A Beneficiary’s condition preventing continued transport.

C.5.1.8.2 The Contractor shall ensure backup vehicles (e.g., taxicab, Lyft) are arranged within
30 minutes of determining unavailability.

C.5.1.9 Additional Covered Transportation Services

The Contractor shall provide transportation for:
1. A parent, foster parent, or guardian visiting a minor child hospitalized as an
inpatient, regardless of their Medicaid eligibility;
2. Eligible Beneficiaries traveling out-of-state for necessary medical care, including
return trips via TPSAs with out-of-state Transportation Providers;
3. Eligible Beneficiaries residing outside the District but within the Washington, DC
Metropolitan Area due to:
a) Temporary recuperation at a family member’s home;
b) Foster care placement;
c) Nursing home or supervised residence status; and
d) Hospital discharge.
4. One-way transport for a discharged Eligible Beneficiary who requires an
ambulatory or wheelchair-accessible vehicle, including one Attendant; and
5. Eligible Beneficiaries, their representatives, and witnesses traveling to and from
Fair Hearings for appeals of adverse DHCF decisions.
C.5.2 Non-Covered Transportation Services
C.5.2.1 The Contractor shall ensure that Medicaid Covered Transportation Services are used
solely for the services described in the Contract. Unauthorized use of Medicaid
Covered Transportation Services constitutes fraudulent activity and is subject to
criminal prosecution.

C.5.2.2 The Contractor shall not provide NEMT services for the following non-covered
transportation purposes:
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1. Visits for services provided by a relative or household member;
2. Cosmetic surgery;
3. Abortions, unless the person's life is at risk or in cases of reported rape or incest;
4. Disposable or over-the-counter medical supplies (e.g., bandages, adult diapers,
rubbing alcohol, cotton);
5. Chiropractic services unless the individual is covered by Medicare;
6. Experimental items or services;
7. Vocational training, except for IDD waiver Beneficiaries;
8. Attendance at amusement parks, sporting events, and other social functions,
except community outings for the Developmental Disabilities Administration
(DDA)-served Beneficiaries as described in C.5.6.3.2; and
9. Alcoholics Anonymous (AA) and Narcotics Anonymous (NA) meetings.

C.5.2.3 Additionally, the Contractor shall not provide NEMT services to healthcare providers
located outside the Washington, DC Metropolitan Area. Services to the County of
Baltimore and City of Baltimore, Maryland, are also excluded unless for medical
specialty care not available within the Washington, DC Metropolitan Statistical Area.

C.5.2.4 The Contractor shall not arrange NEMT services for Medicaid Beneficiaries residing
outside the District without prior approval from the District. In such cases, the
Contractor shall refer Eligible Beneficiaries to the appropriate Transportation
Provider covering their area, as applicable, except as outlined in C.5.1.9.

C.5.2.5 The Contractor shall not provide emergency ambulance services. The Contractor shall
provide Eligible Beneficiaries requesting emergency ambulance services with
instructions to access those services via 911 or connect the Eligible Beneficiary or
caller to a licensed emergency service.

C.5.2.6 The Contractor shall not provide NEMT services to get to or from:
1. Academic programs;
2. Respite;
3. Residential habilitation; or
4. Supported living facilities with transportation services.

C.5.2.7 The Contractor shall ensure that all Exceptional Transportation Services are
coordinated through the CA. This transportation is limited to out-of-area ground
travel. Exceptional Transportation does not include travel to direct service providers
within or outside of the District’s borders or to the facilities listed in the Contract
which have been designated as Exceptional Transportation Services and utilized for
routine care.

C.5.3 Eligible Beneficiaries

The Contractor shall ensure that NEMT services are provided to District Medicaid
Beneficiaries residing within the District who require medically necessary services and
have no other means of transportation. Eligible Beneficiaries include:
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1. ABD;
2. ABD and Dual Eligible with Medicare and Medicaid;
3. FFS beneficiaries and Dual Eligible with Medicare and Medicaid;
4. FFS;
5. IDD Waiver; and
6. Parents, guardians, companions, Escorts, or other individuals accompanying IDD
Waiver Beneficiaries

C.5.4 Non-Covered Beneficiaries

The Contractor shall not provide NEMT services to the following individuals:

1. DC Medicaid Beneficiaries residing outside the District without DHCF approval;
2. Beneficiaries enrolled in a MCO or assigned to an MCO;
3. Beneficiaries eligible for Medicaid as Qualified Medicare Beneficiaries (QMB);
4. Children eligible for services through the Title XXI Children’s Health Program
(CHIP), as these Beneficiaries are enrolled in an MCO;
5. Beneficiaries in residential habilitation; and
6. Beneficiaries in supported living facilities with transportation.

C.5.5 Modes of Covered Transportation

C.5.5.1 The Contractor shall classify and utilize Transportation Providers’ vehicles based on
their initial inspection to establish vehicle capacity and determine the appropriate
mode of transportation per vehicle requirements.

C.5.5.2 Covered transportation modes include:

1. Ambulatory Vans: A multi-passenger van meeting all stated requirements, capable
of transporting patients in a comfortable and safe manner. (C.5.24.1.1);

2. Wheelchair Vans: A van equipped with a power (electric or hydraulic) lift, secure
floor mounts, shoulder strap capabilities, and four floor straps (two front and two
rear) for wheelchair security. The power lift must also have manual capabilities as
a backup. (C.5.24.1.2);

3. Bariatric and Stretcher Vans: A non-emergency van designed to accommodate a
gurney, with a secure floor mount for transport. This service requires two stretcher
staff to assist Beneficiaries who are unable to ambulate and require assistance.
(C.5.24.1.3);

4. Non-Emergency Ambulance: An ambulance or air ambulance used to transport
Beneficiaries requiring transportation in a recumbent position or needing life
support equipment, such as oxygen, administered by trained medical personnel.
(C.5.25.1.4);
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5. Air Ambulance: air ambulance used to transport Beneficiaries requiring
transportation in a recumbent position or needing life support equipment, such as
oxygen, administered by trained medical personnel (C.5.24.1.5);

6. Public Transportation:
(WMATA), commonly referred to as Metro, is a tri-jurisdictional public transit
agency that operates transit services in the Washington metropolitan area.
WMATA provides rapid transit service under the Metrorail name, fixed-route bus
service under the Metrobus brand, and paratransit service under
the MetroAccess brand. (C.5.24.1.6); and

7. Ridesharing or Ridehailing Service:
An arrangement in which drivers of usually privately owned vehicles who wish to
offer rides and passengers who wish to obtain rides use a network (such as one
accessed through an app or a website) to coordinate the sharing of individual
automobile trips for which the passengers pay a fare. (C.5.24.1.7).

C.5.6 Gatekeeper Services

C.5.6.1 Screening Protocol

The Contractor shall serve as the Gatekeeper and oversee the screening process
designed to determine and validate three key elements: (1) Covered and Non-Covered
Transportation Services; (2) Eligible and Non-Covered Beneficiaries; and (3) the
Type of Transportation required to meet the Eligible Beneficiary’s need. This process
ensures appropriate use of transportation resources based on eligibility and medical
necessity.

The screening protocol is initiated when either a Provider or a Beneficiary identifies a
transportation need. The Provider first assesses and determines the type of vehicle
required. This identified need is then referred to the Nurse Triage Line (NTL) or My
Health GPS (which is linked to the Nurse Triage Line) to access the Beneficiary’s
information from the MMIS. MMIS is used to confirm the Beneficiary’s coverage
status.

Following verification that the Beneficiary is an Eligible Beneficiary through MMIS,
the NTL connects with the Contractor’s centralized call center. At this point, a
Registered Nurse (RN) affiliated with the Contractor conducts the Prior Authorization
Process. The RN reviews the Provider’s assessment of the transportation need and
determines whether the service qualifies as urgent (requiring same-day transport) or
standard (requiring transport within 24 to 48 hours).

C.5.6.2 Determination and Verification of Transportation Services

C.5.6.2.1 The Contractor shall conduct an assessment to determine the level or mode of
Transportation Services required or requested by or for an Eligible Beneficiary. The
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Contractor shall structure the determination of need for service to meet the following
basic requirements:

C.5.6.2.1.1 Transportation Services shall not be provided until:
1. The Contractor has verified that the Beneficiary is an Eligible Beneficiary;
2. The Beneficiary has declared to the Contractor during the intake process that
he or she is a current resident of the District;
3. The Contractor has recorded the Beneficiary’s Medicaid identification number
and address for reporting purposes;
4. The Beneficiary has declared to the Contractor during the intake process that
he or she needs NEMT; and
5. The Contractor has determined the Beneficiary to have a valid service need for
NEMT.

C.5.6.2.1.2 The Contractor shall advise the Beneficiary:
1. That, under the penalty of law, a Beneficiary shall provide the Contractor with
accurate and complete information to determine the need for NEMT services;
2. That the Beneficiary is required to provide the Contractor documentation and
a picture ID, when requested, to validate Medicaid eligibility, at the time of
pick-up;
3. When requested, the Beneficiary must provide information related to the need
for services to the Contractor, as a condition for receiving service and being
determined eligible for the service;
4. That the NEMT program only covers transportation to or from a health care
service provider for Medicaid covered services, approved in advance through
Prior Authorization;
5. If an Escort is necessary to ride during the trip, the Escort is required to
provide the Contractor with the name, relationship and reason for the Escort;
and
6. If the Beneficiary’s transportation service request is a one-way trip, the
Contractor shall not be responsible for transporting the Escort back to the
original pickup point.

C.5.6.3 Determination and Verification of Beneficiary Eligibility
C.5.6.3.1 The Contractor shall determine if special needs exist for an Eligible Beneficiary
requesting Transportation Services, including the use of an Attendant or Escort.
C.5.6.3.1.1 Attendant Services - The Contractor shall arrange with the Transportation
Provider for the provision of one Attendant during transport when, in the
judgment of the Contractor and in consideration of all known factors or as
required by the licensed health care provider, it is necessary to have an adult
helper on a trip to assure the safety of all passengers. The Attendant shall remain
with the vehicle after the Eligible Beneficiary has left the vehicle at its
destination. The Contractor shall provide Attendant Services as part of the
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Capitated Rate to be received by the Contractor.

C.5.6.3.1.2 Escort Services - The Contractor shall allow, without charge to the Escort or
Eligible Beneficiary, one Escort to accompany an Eligible Beneficiary or group of
Eligible Beneficiaries who are residents of a nursing facility, blind, deaf, mentally
disabled, or under the age of 21, when the Eligible Beneficiaries are transported to
receive Medicaid covered services. The Contractor is not responsible for
arranging or compensating an Escort for services rendered except, upon request,
for the cost of Public Transportation.

C.5.6.3.2 The Contractor shall provide a system to deliver NEMT services for the District’s IDD
waiver population, including the following additional needs and considerations to
overcome specific barriers and issues faced by this population:

C.5.6.3.2.1 Provision of an Attendant on board the vehicle only when required and verified by
the Contractor in accordance with applicable policies and procedures to be
developed by the Contractor and provided to the District before the Contractor
starts providing services;
C.5.6.3.2.2 Provision of increased driver training in accordance with DDS rules and
regulations to properly provide for IDD waiver Beneficiaries’ needs;
C.5.6.3.2.3 Selection of a preferred provider, where appropriate, in accordance with
applicable policies and procedures to be developed by the District together with
the Contractor;
C.5.6.3.2.4 Provision of services for travel for socialization needs in accordance with
applicable policies and procedures to be developed by the District together with
the Contractor;
C.5.6.3.2.5 Beneficiary behavior documentation and management and propensity to no-show
for assigned trips;
C.5.6.3.2.6 Provision of services to IDD waiver beneficiaries residing outside of the District
of Columbia in a supervised apartment;
C.5.6.3.2.7 Acceptance of an Eligible Beneficiary’s group provider as a sole source provider
and reimbursable through the Contractor;
C.5.6.3.2.8 Acknowledgement that the DDS Service Coordinator must certify the medical
necessity form for individuals served by DDS; and
C.5.6.3.2.9 Provision of Metro Access services for Eligible Beneficiaries requiring ADA level
service due to mobility or low-level cognitive issues. The Eligible Beneficiary
must obtain the appropriate ADA needs certification.
C.5.6.4 Mode and Level of Transportation Determination
C.5.6.4.1 The Contractor shall determine the most Appropriate Mode of Transportation based
on the Eligible Beneficiary’s need, considering the Eligible Beneficiary’s current
level of mobility and functional independence based on information provided by the
Eligible Beneficiary.
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C.5.6.4.2 The Contractor shall use the basis for identifying the appropriate mode of public
transportation based on the following factors:
a) Distance from scheduled stops;
b) Age of Eligible Beneficiary;
c) Disabilities, if any, of Eligible Beneficiary;
d) Any physical or mental impairment of Eligible Beneficiary which would preclude
use of Public Transportation;
e) Availability of funds of Eligible Beneficiary to pay for transportation;
f) Date of request;
g) Date of trip; and
h) The Contractor shall provide Public Transportation NEMT services for ABD
beneficiaries, except when the Eligible Beneficiary is receiving dialysis,
chemotherapy, radiation therapy, or utilizes a mobility device, or where the
Contractor determines Public Transportation would be inappropriate.

C.5.6.4.3 Modes other than Public Transportation shall be used when the Eligible Beneficiary
is:
1. Able to travel independently but, due to permanent or temporary debilitating
physical or mental conditions, cannot use Public Transportation;
2. Unable to be accommodated by the public Para-transit system; or
3. Traveling to and from a location which is inaccessible by Public Transportation
(inaccessibility is within more than ½ mile of scheduled stop).

C.5.6.4.4 Air Ambulance Determination of Medical Necessity

The Contractor shall review and approve or deny Air Ambulance Service requests for
FFS Beneficiaries being transported to an enrolled Washington DC Medicaid
Provider rendering a covered service by determining the following for Medical
Necessity:
a) Air Ambulance Service does not occur from an incident or accident scene where
there was an immediate threat to life, health, or disability such that a real-time
response is/was needed by an entity providing EMS;
b) Eligible Beneficiary requires covered services that the transferring hospital is
unable to provide;
c) Documented attempts to secure Clinically Appropriate Ground Transportation;
d) Documented and verified time and distance to the Closest Appropriate Provider
of care not available at the transferring Facility is either greater than 10 Miles or
confirmed at more than 30 minutes by ground as per the contractor’s preferred
GPS;
e) Person to be transported is an DC Medicaid Eligible Beneficiary;
f) Receiving hospital is the closest that can provide Medicaid covered services
required for treatment and agrees to accept the Eligible Beneficiary;
g) Transfer is not primarily for the preference or convenience of the Eligible
Beneficiary or Physician; and
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h) Eligible Beneficiary’s medical condition is such that using Ground
Transportation is absolutely contraindicated.

C.5.6.5 Nurse Triage Line Determination and Validity

C.5.6.5.1 The Contractor shall receive notification of transportation needs by the NTL. The
Contractor shall connect with the Beneficiary after receiving initial notification from
the NTL.

C.5.6.5.2 The Contractor shall identify the appropriate mode of transportation for the
Beneficiary and notify the Beneficiary. The Contractor’s notification shall include the
color, make and model of vehicle, time of the expected arrival and name of the
company (i.e. Lyft, Uber, or Taxicab).

C.5.6.5.3 The NTL shall utilize the DC MMIS, and if necessary, the Interactive Voice Response
System (IVR) to obtain the following to determine and verify that the Beneficiary is
an Eligible Beneficiary:
1. Caller’s first and last name and relationship to the Beneficiary;
2. Beneficiary’s first and last name;
3. Beneficiary’s complete address, including apartment number;
4. Beneficiary’s Medicaid number; and
5. Beneficiary’s or caller’s telephone number, if available.

C.5.6.5.4 The Contractor shall submit secure e-mail requests within two hours for eligibility
verification to the CA only in the event that the DC MMIS is not functioning or the
IVR is down or non-operational.

C.5.6.5.5 The Contractor shall schedule requests for Transportation Services pending
verification of the Beneficiary’s eligibility. The Contractor’s electronic requests shall
include:
1. Beneficiary’s full name;
2. Beneficiary’s Social Security Number, if available;
3. Beneficiary’s Medicaid number, if available;
4. Beneficiary’s home address;
5. Date of birth;
6. Sex of the Beneficiary; and
7. Date(s) when transportation verification was requested or sought.
C.5.6.5.6 Except for the information contained on the Medicaid eligibility certification, the
Contractor shall accept the information provided verbally by the Beneficiary, or
person speaking on behalf of the Beneficiary, as valid when determining the need for
NEMT services, unless the Contractor has cause to doubt the validity of information
provided. If the Contractor has cause to doubt the validity of the information provided
by or on behalf of the Beneficiary, in accordance with the approved District NEMT
Gatekeeping protocols, the Contractor shall request additional documentation of a
Beneficiary’s information. The Contractor shall request a copy of a written referral
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signed by the referring healthcare provider attesting to the need for travel outside the
District. The Contractor shall give Beneficiaries who are denied NEMT services
written notice or a letter indicating the reason for denial and an explanation of their
appeal rights within three business days of receipt of a denial notice.

C.5.6.6 My Health GPS Determination and Validation
The Contractor shall arrange NEMT services for DC Medicaid Beneficiaries eligible
for the My Health GPS program. The Contractor shall provide or perform the
following to coordinate transportation for the My Health GPS eligible Beneficiary to
and from healthcare appointments:
1. Receive requests for Transportation Services from My Health GPS coordinators;
2. Determine and verify the Beneficiary DC Medicaid and My Health GPS
eligibility;
3. Determine any special transport needs;
4. Determine Appropriate Mode of Transportation; and
5. Schedule and arrange service with an On-demand Transportation Provider.

C.5.6.7 RN Prior Authorization Process

C.5.6.7.1 The Contractor shall not provide service for requests that are outside the scope of
Covered Transportation Services (C.5.1). The Contractor shall refer to all requests to
the Contractor’s Registered Nurse Triage Line for review and approval or denial. For
urgent requests, the review must be reviewed immediately. For non-urgent requests
the Contractor’s RN shall provide the review results within 24 to 48 Hours of receipt.

C.5.6.7.2 The Contractor is required to collect the information as described in section C.5.6.8.2
for each request and as follows:
C.5.6.7.2.1 The Contractor shall develop and propose a model or prototype Beneficiary intake
worksheet for NEMT services; and
C.5.6.7.2.2 The Contractor shall develop and propose a transportation authorization/request
form to be used at the time the Contractor receives a request for transportation
that out of the Washington DC region.

C.5.6.7.3 If the request involves the provision of healthcare services outside of the metropolitan
area (Washington DC, Maryland, and Virginia), the Contractor shall submit these
requests to the CA for review and approval. The Contractor shall inquire and collect
the following details in addition to the details described in section C.5.6.8.2 before
submitting the request to the CA:
1. Reason that the services are not being performed within the metropolitan area;
and
2. Potential Appointment Frequency.
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C.5.6.7.4 If the request involves arranging for the pickup of an Eligible Beneficiary at a
residence located outside of the District of Columbia, the Contractor shall inquire and
provide the following to the Contractor’s RN, the following details in addition to the
details described in section C.5.6.8.2:
1. The purpose for the pick-up outside of the District of Columbia;
2. The District of Columbia address on file; and
3. If there is a temporary address outside of the District of Columbia, then provide
the potential length of time for the stay.

C.5.6.7.5 The Standing prior authorizations will expire after six months. The Contractor’s RN
shall reassess the standing order and can extend the standing order for no more than
six additional months for the following reasons:
1. Surgery recovery, expected to take a longer time with an expected recovery date;
2. Long term care facility resident ordered by Physician for hospice, rehabilitation,
and displacement as a result of health matters with a plan to return to the District;
and
3. Diagnosed with a terminal illness/ condition in which is residing with family for
end-of-life care.

C.5.6.7.6 If more time is needed following the reassessment, then the Contractor shall escalate
the case to the CA for further investigation, review and approval via the transportation
prior authorization form. If the CA determines that the Eligible Beneficiary will
benefit from services in the current state of residence, the CA will provide the
Contractor with the denial on the transportation prior authorization form provided by
the contractor.

C.5.6.7.7 Preauthorization of interfacility transfer via Air Ambulance Services
The Contractor shall maintain and provide twenty-four-hour telephone coverage for
the purpose of preauthorizing interfacility transfers 24/7/365. Unless otherwise
specified in this section, reviews shall be conducted under the supervision of, and
Authorization shall be granted by any of the following, who may make a final
medical necessity determination including a Denial: Registered Nurses (preferably
with Transport Experience); Paramedics with Critical Care Transport Experience;
Physicians; and Nurse Practitioners or Physician Assistants.

C.5.6.8 Centralized Call Center Determination and Validation

C.5.6.8.1 The Contractor shall develop and complete an electronic computerized Beneficiary
Reservation Intake Form and Process at the time of the incoming call or contact for
each request made by a Beneficiary. The Contractor’s Beneficiary Reservation form
shall serve as the electronic document to guide the Contractor through the
authorization and scheduling process. The Beneficiary Reservation and Intake Form
shall include the Transportation Authorization Request Form.
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C.5.6.8.2 The Contractor shall develop the Transportation Authorization Request Form to be
used at the time the Contractor receives a request for transportation out of the
Washington DC region. The Contractor’s transportation authorization request form
shall be automated, completed, and maintained by the Contractor and shall include at
a minimum the following:
1. Date and time of the call;
2. Contractor Customer Service Representative’s (CSR) name;
3. Identification Number assigned to the CSR who recorded the request;
4. Caller’s first and last name and relationship to the Beneficiary;
5. Beneficiary’s first and last name;
6. Beneficiary’s complete address, including apartment number;
7. Beneficiary’s Medicaid number;
8. Beneficiary’s or caller’s telephone number, if available, transport type (e.g.
ambulatory, stretcher, wheelchair);
9. If caller is not beneficiary, then caller’s Name, title, and organization or
relationship to beneficiary;
10. Caller’s telephone number;
11. Standing or one-time request; Standing requests are only valid for six months;
12. Authorization number;
13. Unique transaction identification number;
14. The type of request (e.g. urgent, three days’ notice);
15. Assistance needed (Yes/No);
16. Name of the Medicaid Beneficiary requiring transportation;
17. Address of Medicaid Beneficiary;
18. Medicaid identification number;
19. Point of origin if different from Beneficiary’s address;
20. Point of destination;
21. Date and time of medical appointment;
22. Disposition of request;
23. The mode of transportation to be provided (Public Transportation, ambulatory
van, wheelchair van, non-emergency ambulance, or stretcher van);
24. Scheduled date and time of pickup;
25. Provider name and identification code of Transportation Provider to which the trip
was assigned;
26. Any special needs of the Beneficiary or instructions to the driver; and
27. General comments.

PART II: BENEFICIARY SERVICES

C.5.7 The Contractor shall develop and distribute notifications to Beneficiaries to announce and
introduce the availability of NEMT services. These notifications and outreach materials
shall be submitted to the CA for review and approval within 30 days of the kick-off
meeting.
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C.5.7.1 The Contractor shall prepare Beneficiary Notification materials informing
Beneficiaries about the availability of District NEMT services and the requirement for
advance scheduling, prior to assuming responsibility for transportation service
provision. This initial notification shall be distributed at least 45 days before the start
of service. The content shall be written at approximately a seventh grade reading
level, be easy to understand, and made available in English and any additional
languages requested by DHCF. It shall also be accessible in alternative formats for
Beneficiaries with special needs, such as those with visual impairments.

C.5.7.2 The Beneficiary Initial Notification shall include:
1. The availability and description of NEMT services;
2. The Contractor’s name, central office location and hours, phone and fax numbers,
and website; and
3. The procedure for requesting services.

C.5.7.3 The Contractor shall develop, print, and mail the notification (with labels and
postage) to approximately 50,000 FFS Beneficiaries and 1,900 IDD Beneficiaries,
pending District approval.

C.5.8 The Contractor shall prepare a Beneficiary Training and Education Plan, Presentation
and Training Materials, to be submitted within 30 days of the kick-off meeting for CA
approval. These materials shall meet the same accessibility and readability standards
as the Beneficiary Education Plan.

C.5.8.1 For Newly Eligible Beneficiaries, the ESA will provide notice of NEMT services
upon Medicaid eligibility determination to Beneficiaries. The Contractor shall review
enrollment records and send a notification to each newly Eligible Beneficiary within
10 days. This notice shall include the same information outlined in the initial
notification requirements.

C.5.8.2 The Contractor shall create and provide educational materials to be distributed by
ESA during the eligibility process. These materials, including brochures, shall be
distributed to each ESA office and contain all the information detailed in the initial
Beneficiary notification. The Contractor shall submit these materials for review and
approval by the CA within 30 days of the kick-off meeting.

C.5.8.3 The Contractor is required to develop a Beneficiary Training and Education Plan to
inform Beneficiaries of their rights, responsibilities, and Health Insurance Portability
and Accountability Act (HIPAA) requirements related to NEMT services. This plan
shall be submitted to the CA for approval within 30 days of the kick-off meeting.
Educational content shall be written at a seventh grade reading level, be easy to
understand, and accessible in both English and other DHCF-required languages, as
well as in alternative formats for those with visual impairments.

C.5.8.3.1 The Contractor’s Beneficiary Education Plan shall include information about:
1. The availability and description of NEMT services;
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2. The Contractor’s business information; and
3. How to request transportation services?

C.5.9 NEMT Services Advisory Committee
C.5.9.1 The Contractor shall establish a NEMT Services Advisory Committee. The NEMT
Services Advisory Committee shall meet each quarter of the calendar year at the
Contractor’s central business office. The Contractor shall schedule the NEMT
Services Advisory Committee meetings, document and record attendance at each
meeting, provide food and refreshments, and develop meeting minutes to describe the
events of the meeting and any follow-up activities resulting from the meeting. The
meeting minutes shall be submitted to the CA for approval within five business days
of the meeting for approval. The Contractor shall distribute the approved meeting
minutes to all meeting attendees and NEMT Services Advisory Committee members
not in attendance within five business days of receipt of approval from the CA. In
addition, the Contractor shall ensure transportation and parking validation is provided
for DHCF Staff and Advisory Committee members.
C.5.9.2 The Contractor shall establish an Advisory Committee in the District. The Committee
shall consist of representatives from a nursing home, dialysis center, hospital,
Transportation Provider(s), Beneficiary(s); the Contractor’s account manager and a
quality assurance representative, at a minimum. The Committee’s purpose shall be to
discuss and provide consultations on service delivery and provide support to the
Contractor. Their functions shall consist of, but are not limited to:
C.5.9.2.1 Assist in monitoring and evaluating the Transportation Providers pursuant to the
Contract;
C.5.9.2.2 Advise the Contractor and DHCF on priorities for policy and program improvements;
C.5.9.2.3 Identify service issues; and
C.5.9.2.4 Review and Track complaints.

C.5.10 DHCF Medical Care Advisory Board
The Contractor shall assure representation and participation at the DHCF Medical
Care Advisory Committee (MCAC) monthly meeting. This committee’s purpose and
function is to provide input to the Contractor and discuss policy changes as needed in
relation to the NEMT services and Contractor responsibilities.

PART III: IMPLEMENTATION PHASE

C.5.11 During the Transition, the Contractor shall work closely with DHCF to support a
coordinated and seamless handoff from the incumbent contractor. The Contractor
shall finalize the implementation plan, inclusive of all transition activities, and submit
it to DHCF for approval in accordance with Section C.5.16.

C.5.12 The Contractor is responsible for integrating its information system with the MMIS
and ensuring its capacity to receive all necessary downloads and data extracts
required to manage transportation services effectively. Additionally, the Contractor
shall utilize the DC MMIS and, if applicable, the current IVR system to establish a
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direct, online eligibility verification process for all Beneficiaries transported within
the District in accordance with Section C.5.16.

C.5.13 The Contractor shall actively participate in biweekly meetings with DHCF to address
and resolve any transition-related issues, establish communication protocols, and
promote transparency and coordination among all stakeholders, including the
incumbent Contractor and MMIS Contractor.

C.5.14 The Contractor shall collaborate with DHCF to develop and adhere to project
management and reporting standards, submit biweekly written status reports detailing
progress against the approved project plan, and conduct regular status meetings to
ensure alignment and accountability.

C.5.15 The Contractor shall contribute to work group activities, support the development of
procedures and operational protocols, and maintain open communication to facilitate
a successful transition.

C.5.16 The Contractor shall provide a Preliminary Implementation Plan to the CA within
five days of contract award. During the kickoff meeting the Contactor and the District
will discuss the approval and suggested changes to the Preliminary Implementation
Plan. The Final Implementation Plan is due within 20 business days after the kickoff
meeting. The Contractor shall not begin the Implementation Phase without an
approved Implementation Plan.

C.5.16.1 The Final Implementation Plan shall incorporate all elements and provisions that the
Contractor included in its proposal as well as DHCF suggested changes. The
Contractor shall complete the Implementation plan in 90 days.

C.5.16.2 The Contractor shall provide and be responsible for all Implementation Phase
expenses incurred for facilities, furniture, computer equipment, telecommunication
equipment, postage for mailings, distribution of mailings, all printed materials, and
any other costs and expenses required to implement the required services. The
Contractor will not be compensated by DHCF for implementation expenses.

C.5.16.3 The Implementation Phase includes the following:
1. Implementation Plan (C.5.17);
2. Implementation Meetings (C.5.18);
3. Implementation Reports (C.5.19); and
4. Readiness Testing (C.5.20).
C.5.17 Implementation Plan

C.5.17.1 The Contractor shall utilize the software program Microsoft Project to develop and
monitor the Implementation Plan.

C.5.17.2 The Implementation Plan shall include at minimum:
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C.5.17.2.1 Gatekeeper Procedures and Protocols

C.5.17.2.1.1 The types of activities required to be included in the Gatekeeper Protocols and
Procedures comprise of, but are not limited to the following:
1. Verify Beneficiary’s current eligibility for Medicaid via DC MMIS or IVR;
2. Develop and maintain a system of conditional edits to determine whether a
Beneficiary is eligible for the NEMT services requested, based upon
eligibility information to be provided by DHCF;
3. Assess the Beneficiary’s needs for NEMT services;
4. Select the most economical and appropriate transportation to meet the
Beneficiary’s need, including any special transport requirements for medically
fragile or physical/mentally challenged Beneficiaries;
5. Educate Beneficiaries in the use of NEMT services and educate
Transportation Providers in the NEMT program; and
6. Document and track inquiries, requests and other information in an automated
call tracking system.

C.5.17.2.2 Quality Assurance Plan
The Contractor shall develop, propose, and maintain an ongoing quality assurance
plan to support the provision of high-quality Transportation Services to the
Beneficiary community. At a minimum, the quality assurance plan shall include
the following elements:
1. Key indicators of quality related to scheduling and delivery of Transportation
Services;
2. A description of how the Contractor plans to monitor these key indicators;
3. A description of how the Contractor shall develop, implement, and evaluate
corrective actions or modifications to overall operations as necessary to
address quality concerns;
4. A description of how the Contractor shall monitor the quality of the
Transportation Providers;
5. A description of the staffing resources responsible for the quality assurance
plan and quality assurance activities;
6. Samples of all reports related to quality assurance and performance
monitoring, along with descriptions of their use and who is responsible for
reviewing them; and
7. Conduct oversight and provide assurance that Transportation Providers meet
health and safety standards for vehicle maintenance, operation, and inspection;
driver qualifications and defensive driver training; Beneficiary
problem/complaint resolution; and the delivery of courteous, safe, and timely
Transportation Services.

C.5.17.2.2.1 Quality Assurance Plan Updates

1. The Contractor shall review and update the Quality Assurance Plan whenever
changes in the operation of the NEMT services are made and at a minimum
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yearly. Annual reports shall be submitted within 90 days prior to the (12th) of
the month after the effective date of the Contract.

2. Updates to the plan shall be approved by the CA before distribution. The
District reserves the right to require modifications to the Quality Assurance
Plan throughout the life of the Contract. Required updates shall be submitted
to DHCF for approval within 30 business days prior to implementation of the
update.

3. The Quality Assurance Plan developed as part of the Contract shall become
the property of DHCF, which reserves the right to share selected text with
other Medicaid agencies for the purpose of improving related District
government manuals.

C.5.17.2.3 Project Plans
The types of activities required to be included in the Project Plans comprise of,
but are not limited to, the following:

1. Office and Infrastructure Setup (C.5.23)
a) Acquisition of office space, furniture, telecommunications and computer
equipment. (C.5.23.1)
b) Establish disaster recovery protocols for the Central Business Office.
(C.5.23.2)
c) Develop and maintain a Telecommunication System. (C.5.23.3)
d) Develop and maintain an Internet Website. (C.5.23.4)
e) Develop and maintain Call Center Nurse Triage Line Operations
(C.5.23.5)
f) Develop and maintain a Centralized Call Center. (C.5.23.6)

2. Network Development and Compliance (C.5.24)
a) Criteria for Covered Transportation (C.5.24.1)
b) Recruitment of Transportation Providers. (C.5.24.2)
c) Transportation Provider and Driver Performance Incentive Program
(C.5.24.4)
d) Reporting Attestations (C.5.24.5)
e) Record Retention (C.5.24.6)
f) Ensure the Transportation Providers submit proof of compliance prior to
providing NEMT services. (C.5.24.7)
g) Confidentiality of Information (C.5.24.8)
h) Independent Audit (C.5.24.9)
i) Completion of all TPSA (C.5.24.10)
j) Verification that Transportation Provider vehicles meet DHCF standards.
Verification that drivers meet DHCF standards. Ensure all NEMT
providers selected maintain an active valid license, registration, and
WMATC certificate throughout the term of the TPSA with the Contractor.
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(C.5.24.11)

3. Operational Documentation, and Deliverables (C.5.25)
a) Operational Meetings (C.5.25.1)
b) Operational Reports (C.5.25.2)
c) Operational Manuals and Policies and Procedures (C.5.25.3)

4. Staffing, Training, and Education (C.5.26)
a) Hiring and training of central office, call center, and drivers (Key
Personnel, C.5.26.1)
b) Hiring and training of central office, call center, and drivers (Other Staff,
C.5.26.2)
c) Staff training plan and installation calendar for trip scheduling and
reservations systems (C.5.26.3)
d) Staff Training and Education Plan (C.5.26.4)
e) Provider education and staff training, as well as Beneficiary education
(C.5.26.5)

C.5.17.3 The Implementation Plan shall include the milestone schedule utilizing Microsoft
Project to implement the NEMT program in 90 days. The Implementation Plan will
include testing the program with Transportation Providers, as well as external
education and training programs. The Contractor shall clearly define the description
and purpose of the task, the person responsible for the task, the location or department
of the activity, a scheduled start date, and when the task is to be accomplished.

C.5.17.4 The Implementation Plan shall include all tasks required to begin operations
successfully, including transition efforts. The Implementation Plan shall enable
DHCF to successfully transition and implement NEMT services in a logical sequence,
in a timely manner, and with efficient use of resources. The Contractor shall update
the Implementation Plan as necessary.

C.5.18 Implementation Meetings

C.5.18.1 The Contractor shall meet with DHCF, at a minimum, bi-weekly during the
Implementation Phase to account for the progress of the Project Plan tasks identified
above.
C.5.18.2 The Contractor shall be responsible for preparing and submitting the meetings notes
to the CA within two days after the meeting, to include action items, from each
meeting, the agenda for the meeting and preparing and distributing minutes.
C.5.19 Implementation Reports

C.5.19.1 The Contractor shall develop and submit a comprehensive written Implementation
Plan Status Report to the CA no later than one business day prior to the
implementation meeting. The status report will provide a detailed overview of the
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project’s progress and will include, at minimum, a milestone schedule for all
implementation tasks. These tasks will include but are not limited to 1) Gatekeeper
Procedures and Protocols, 2) Quality Assurance Plan, and 3) the Project Plan.

C.5.19.2 The Contractor shall ensure that all information provided is accurate, up-to-date, and
reflective of the status of the implementation process.

C.5.20 Readiness Testing

C.5.20.1 The Contractor shall provide operational readiness testing of daily operational
requirements to see that they are all functioning adequately.

C.5.20.1.1 The CA shall conduct a readiness assessment of the Contractor to ensure that the
Contractor has all processes in place to meet the scope of work outlined in the
Contract. The Contractor shall demonstrate evidence of readiness relative to each
requirement and function in the scope of work prior to undertaking any of the services
or functions of the Contract. Readiness assessments shall begin immediately after the
Contract is executed but not-to-exceed 90 days from the date of award and prior to
the start of services.

C.5.20.1.2 The readiness assessment shall include site visits and review of documentation and
deliverables.

C.5.20.1.3 Approximately five weeks before the Operational Start Date of the contract as defined
in Section C.3.58, the Contractor shall complete and pass the operational readiness
testing. The Contractor shall meet with all District agencies that provide or coordinate
Medicaid services for Beneficiaries, 45 days prior to the Contractor’s assumption of
the daily operations of the NEMT services.

C.5.20.1.4 Representatives from the District and its Agent shall go to the Contractor’s facility
and test or determine whether all systems are operational and ready for full-time
service.

C.5.20.1.5 During this test, the Contractor shall demonstrate that the following items are
available, operational and ready for service:
C.5.20.1.6.1 Transportation Provider Network;
a) TPSA;
b) Vehicles;
c) Drivers; and
d) Attendants.
C.5.20.1.6.2 Transportation Provider Training and Education Plan;
C.5.20.1.6.3 Beneficiary Notifications;
C.5.20.1.6.4 Beneficiary Training and Education Plan;
C.5.20.1.6.5 Centralized Call Center;
C.5.20.1.6.6 Central Business Office;
C.5.20.1.6.7 Key Personnel;
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C.5.20.1.6.8 Staff Training and Education Plan;
C.5.20.1.6.9 Record Keeping Processes and Procedures;
C.5.20.1.6.10 Vehicle Inspection and Monitoring Process;
C.5.20.1.6.11 Telecommunications and Software Technologies;
a) Mobile Line Access;
b) Automated Call Distribution (ACD) System;
c) Telephone Line Requirements;
d) Scheduling Software (C.5.23.3.5); and
e) Videoconferencing System.
C.5.20.1.6.12 Management Information System;
C.5.20.1.6.13 High-speed internet connects to interfaces with MMIS (C.5.12);
C.5.20.1.6.14 Implementation Phase Documentation and Deliverables;
C.5.20.1.6.15 All documentation and Deliverables required during the Implementation Phase of
the Contract are available for review and approval;
C.5.20.1.6.16 After-hour coverage arrangements;
C.5.20.1.6.17 Gatekeeping procedures;
C.5.20.1.6.18 Beneficiary appeal/denial process;
C.5.20.1.6.19 Quality assurance;
C.5.20.1.6.20 TPSA signed;
C.5.20.1.6.21 Required data submission procedure;
C.5.20.1.6.22 Reporting procedures are in place; and
C.5.20.1.6.23 Any other items or functions as deemed necessary by DHCF.

C.5.20.1.6 The Contractor shall not provide NEMT services until the readiness testing is 100%
complete and the Contractor is fully capable, and the District has determined the
Contractor is ready to provide service.

C.5.20.2 Corrective Action Plan

C.5.20.2.1 The Contractor shall have an opportunity to make corrections and shall be
required to submit a corrective action plan (CAP) to DHCF within 10 days of
notification if there are any identified deficiencies. The Contractor is required to
submit proof to DHCF that corrections were made once all concerns and
deficiencies have been resolved.

C.5.20.2.2 If the CA determines that the Contractor has not met the criteria for readiness,
DHCF will notify the Contractor, and the Contractor shall be required to develop a
CAP acceptable to the CA. Following the Contractor’s implementation of the
CAP, the CA has the right to conduct a site visit to the Contractor’s office to
verify implementation of the corrective actions. The CA will approve the
Contractor to begin providing the services, once the CA verifies that the CAP has
been implemented satisfactorily.

PART IV: OPERATIONAL PHASE
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C.5.21 The Contractor shall not begin the Operational Phase without an approved Final
Implementation Plan.

C.5.22 The Contractor shall provide and be responsible for all Operational Phase expenses
incurred for facilities, furniture, computer equipment, telecommunication equipment,
postage for mailings, distribution of mailings, all printed materials, and any other
costs and expenses required to operate and provide NEMT services. The Contractor
will not be compensated by DHCF for operational expenses. The Contractor shall be
responsible for any damage to the building interior, or their approaches in delivering
equipment covered by this Contract.

C.5.23 The Contractor shall provide operational tasks for Office and Infrastructure Setup.

C.5.23.1 Central Business Office

C.5.23.1.1 Establishment and Location
1. The Contractor shall establish and maintain a non-residential central business
office (CBO) located within the District.
2. The CBO will serve as the primary administrative hub for the NEMT services
program.
3. The CBO will operate Monday through Friday, from 8:00 a.m. to 6:00 p.m.
Eastern Time.

C.5.23.1.2 Operational Functions
The Contractor shall conduct general administrative functions at the CBO,
including but not limited to:
1. Accommodating walk-in Beneficiaries;
2. Conducting business with DHCF and other District agencies;
3. Distributing Public Transportation fare cards;
4. Sending and receiving facsimiles;
5. Reproducing documents ;
6. Managing Information Systems;
7. Operating a Telecommunication System, including:
a) ACD System;
b) Video Conferencing System;
c) Dedicated telephone line for direct access to the Program Director;
d) Toll-free and local (202) numbers for Beneficiaries to request
transportation services;
e) Multilingual telephone line support and;
f) TTY relay service;
8. Performing Call Center operations.

C.5.23.1.3 Licensing and Compliance
1. The Contractor’s shall maintain in the CBO all necessary licenses and
approvals from the District’s Department of Licensing and Consumer
Protection (DLCP).
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2. The Contractor shall possess and maintain a valid Certificate of Occupancy
for the CBO.
3. The CBO address will appear on all official documentation, correspondence,
and printed materials related to the Contractor and NEMT services.

C.5.23.1.4 Central Business Office Location List
1. The Contractor shall submit a list of the NEMT service area to the CA within
30 days from the acceptance of the final implementation plan.
2. The list will clearly identify the location/addresses of:
a) The Contractor’s CBO;
b) Satellite offices;
c) DHCF offices; and
d) Key medical providers, hospitals, and other relevant sites used by
Transportation Providers, Beneficiaries, and medical care providers.

C.5.23.1.5 Satellite Offices and Contingency Planning
1. The Contractor shall establish and maintain satellite offices capable of
receiving Beneficiary calls and scheduling transportation services.
2. The Contractor shall ensure that satellite offices will be operational in the
event of a disaster affecting the CBO or a failure of the Contractor’s telephone
and scheduling system.

C.5.23.1.6 Office Equipment and Facilities
1. The Contractor shall furnish all necessary supplies, office furniture,
equipment, video teleconferencing systems, computer equipment, and
peripherals required for operations of the CBO, satellite offices, and other
operational facilities.
2. The Contractor shall provide, at a minimum, two workstations at the CBO
equipped with:
a) Telephones;
b) Computers;
c) Required connectivity; and
d) Office furniture.
3. The workstations shall be accessible to DHCF staff for reviewing the
Contractor’s information system and the MMIS.
C.5.23.1.7 Parking and Access
1. The Contractor shall provide a minimum of two parking passes for NEMT
meetings held at the CBO.
2. The Contractor shall issue at least two access badges to DHCF representatives
for entry into the CBO.

C.5.23.1.8 Cost Recordkeeping and Transparency
1. The Contractor shall maintain detailed records of all costs associated with the
performance of required services under the Contract.
2. Cost records shall include, but are not limited to:
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a) Fees;
b) Expenses;
c) Charges;
d) Insurance premiums; and
e) Any other expenditures related to Contract performance.
3. The Contractor shall provide these records for District review upon request.

C.5.23.2 Disaster Recovery Plan

C.5.23.2.1 The Contractor shall develop and maintain a comprehensive Disaster Recovery
Plan to minimize disruptions to transportation services caused by a disaster
affecting the CBO or other operational facilities.

C.5.23.2.2 The Contractor shall be solely responsible for maintaining adequate backup
systems to ensure uninterrupted scheduling and transportation services.

C.5.23.2.3 The Disaster Recovery Plan shall be submitted to the CA for review and approval
60 days after the approval of the Final Implementation Plan.

C.5.23.2.4 The Disaster Recovery Plan shall include, at minimum:
1. Risk Mitigation Measures: steps taken to minimize disaster risks, including
physical security protocols, fire detection, and prevention measures;
2. Continuity of Operations: Procedures for handling Beneficiary calls and
scheduling transportation services in the event of system failures or CBO,
satellite office or other operational facility inaccessibility;
3. Data Protection and Recovery: Methods to prevent data loss and recover
required records in case of fire, flood, or other disasters; and
4. Off-Site Storage: Secure off-site storage solutions for critical data and records.

C.5.23.2.5 The Contractor shall update the Disaster Recovery Plan annually and submit the
revised version to the CA within 15 business days after the contract performance
period ends.

C.5.23.3 Telecommunications and Software Technologies
C.5.23.3.1 Telecommunication System

The Contractor shall develop and maintain a telecommunications system,
including a Mobile Line Access, ACD System, Telephone Land Line
Requirements, and Scheduling Software, within 30 days from the approved Final
implementation plan.

C.5.23.3.2 After-Hours Contact System

The Contractor shall establish a system allowing District officials to contact Key
Staff after hours and during District holidays.
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C.5.23.3.3 Automated Call Distribution System

1. The Contractor shall maintain an Automated Call Distribution (ACD) system
to support the Centralized Call Center, ensuring 24/7 operational capacity.

2. The ACD system will provide:
a) Automated Attendant for inbound calls;
b) At least 10 menu choices;
c) Voice mail functionality;
d) Call transfer capability;
e) Toll-free helpline for Beneficiaries (24/7);
f) IVR in English and Spanish;
g) Touch-tone access for disabled Eligible Beneficiaries to confirm scheduled
trips; and
h) Online and phone-based transportation requests from hospitals and
facilities.
3. The ACD system shall include an automated reporting system to generate
monthly reports detailing:
a) Number of calls received, answered, abandoned, and on hold;
b) Average hold times; and
c) Call center representative availability.
4. The Contractor shall ensure calls are answered within five rings, with average
hold times not exceeding two minutes.
5. The Contractor shall implement a CAP (C.5.23.9.6) for busy signals, subject
to CA approval.
6. The ACD system shall be fully operational within 30 days from the
acceptance of the approved Final Implementation Plan.

C.5.23.3.4 Telephone Line

1. The Contractor shall maintain the following telephone lines:
a) Local and toll-free numbers for Beneficiary and provider inquiries;
b) Toll-free number for reporting late or missed transportation;
c) TTY capability for hearing-impaired access;
d) Multilingual line in compliance with the DC Language Access Act of
2004, D.C. Code § 2-1931 et seq.; and
e) Direct administrative line for DHCF staff to reach the Project Director.
2. The Contractor shall release and transfer toll-free numbers to DHCF upon
contract termination.
3. The Contractor shall implement a backup telephone system for uninterrupted
service during power failures or emergencies, subject to DHCF approval.
4. The Contractor shall notify DHCF immediately if the phone system is down
or operating on backup.
5. The Contractor shall maintain a manual backup process for processing
requests during system outages.
6. The Contractor shall maintain mobile access to all key personnel.
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C.5.23.3.5 Scheduling Software

1. The Contractor shall provide scheduling software to fairly and efficiently
assign transportation requests among service providers.
2. The software shall:
a) Maintain a provider database with trip assignment information;
b) Validate addresses, calculate distances, and determine pricing;
c) Support standing order and on-demand trip reservations;
d) Assess availability of public and federally funded transportation options;
e) Capture required data elements for trip processing; and
f) Be commercially available or operational at an existing site for District
demonstration within 20 days of Contract award.
3. The Contractor shall maintain software support agreements to ensure system
upgrades, enhancements, and bug fixes throughout the contract term.
4. The scheduling software shall be fully operational for the Readiness Test
(C.5.20)

C.5.23.3.6 Management Information System (MIS)

1. The Contractor’s MIS shall:
a) Interface with the District’s MMIS and if necessary, the IVR systems;
b) Comply with HIPAA security and privacy regulations; and
c) Accept and process Medicaid provider files quarterly.
2. The Contractor’s MIS shall be fully operational for the Readiness Test
(C.5.20).

C.5.23.3.7 System Interface and Computer Equipment

1. The Contractor shall maintain computer hardware and software sufficient to
support ACD, eligibility verification, trip reservations, and reporting.
2. The system shall:
a) Include adequate software licensing agreements;
b) Be compatible with and exchange data with the DC MMIS;
c) Maintain a dedicated high-speed internet connection (minimum 768 Kbps
symmetrical speeds); and
d) Perform daily electronic backups with off-site storage.
C.5.23.3.8 Confidentiality and Security
1. The Contractor shall ensure compliance with HIPAA and District privacy
policies for all retrieved, shared, and reproduced information.
2. Staff handling confidential information shall sign confidentiality agreements,
and Transportation Service Providers (TPSA) shall adhere to the same
confidentiality requirements.
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3. Unauthorized disclosure of confidential information shall be considered a
breach of contract and grounds for termination.
4. The Contractor shall safeguard data from unauthorized alteration, loss, theft,
or breach.

C.5.23.4 Internet Website

C.5.23.4.1 The Contractor shall develop and maintain a website dedicated to the District’s
NEMT services program. The website shall include the following:
1. Contractor Information
a) CBO address, phone, and fax number;
b) Office hours and directions; and
c) Staff contact names, phone numbers, and emails.
2. Information for Transportation Providers
a) FAQs, operational policies, and provider manuals;
b) Policy updates, revisions, and meeting schedules; and
c) Reporting requirements, templates, and training updates.
3. Information for Beneficiaries
a) Toll-free 24/7 help line;
b) Transportation Provider Network (updated monthly);
c) How to access NEMT services, file complaints, and understand
beneficiary responsibilities;
d) Links to relevant websites (e.g., DC Medicaid, https://www.dc-
medicaid.com/dcwebportal/home, DHCF, https://dhcf.dc.gov/ , CMS,
https://www.cms.gov/ and Health Care Ombudsman,
https://healthcareombudsman.dc.gov/); and
e) Public meeting information and NEMT Advisory Committee information
with sign-up options to join the committee.

C.5.23.4.2 The Contractor shall submit a test version of the website to the CA within 30 days
after the Final Implementation Plan approval. Updates shall be made as needed
but at least annually, with CA approval before posting.

C.5.23.4.3 The website shall be fully developed, populated, and accessible to the public
within 30 days of the CA’s approval.
C.5.23.4.4 The Contractor shall provide monthly electronic records of website activities after
the launch of the website. Monthly reports shall be submitted by the 15th day of
the following month.
C.5.23.5 Call Center Nurse Triage Line (NTL) Operations
C.5.23.5.1 Hours of operation for the NTL are from seven a.m. through 11 p.m. daily.

C.5.23.5.2 During the hours of operation of the NTL, it is imperative that the NTL be staffed
consistently without interruption, due to the urgent nature of these trips. Operators
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that leave the NTL station will need to be immediately relieved by another
operator capable of staffing the NTL station.

C.5.23.5.3 A dedicated connection between the Contractor and the NTL shall be operational
at all times.

C.5.23.5.4 The Contractor shall initiate contact with the Beneficiary after receiving
Beneficiary information electronically via the web portal or another electronic
means from the NTL. The initial notification from the NTL to the Contractor will
entail an alert which will contain the Beneficiary’s name and phone number,
DOB, destination health care provider office and telephone number.

C.5.23.5.5 The Contractor shall notify the NTL within 60 seconds of completion of
scheduling transportation.

C.5.23.5.6 The Contractor shall dispatch a Transportation Provider to pick up the Eligible
Beneficiary.

C.5.23.5.7 The Contractor shall ensure the Eligible Beneficiary is picked up within 30
minutes of the completion of the transportation arrangement.

C.5.23.5.8 The Contractor shall transmit the Time of Dispatch, expected Eligible Beneficiary
pick up time, Transportation Provider information to the NTL within five minutes
of scheduling transportation.

C.5.23.5.9 The Transportation Provider shall transport the Eligible Beneficiary to the office of
the health care provider designated by the NTL.

C.5.23.5.10 The Contractor shall transmit actual pick-up time, time of arrival, and destination
site to the NTL within five minutes of the scheduling transportation.

C.5.23.5.11 The Contractor shall ensure the Transportation Provider transports the Eligible
Beneficiary to and from their scheduled destination.

C.5.23.5.12 The Contractor shall provide daily reports to the NTL that includes all current data
points for each trip leg.
C.5.23.5.13 The Contractor shall confirm wheelchair accessibility by phone and/or web portal
within 45 minutes of the request from the NTL.
C.5.23.6 Centralized Call Center
C.5.23.6.1 The Contractor shall operate the call center and maintain a complaint line that is
accessible 24 hours per day, 365 days per year, from the Contractor’s District of
Columbia CBO. The call center shall schedule transportation services for routine
appointments, weekdays, Monday through Friday, from 8:00 a.m. to 6:00 p.m.
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(Eastern Standard Time). The call center will also schedule Urgent Care
transportation requests and hospital discharge trips 24 hours a day, 7 days a week,
weekdays after-hours (6:01 p.m. to 7:59 a.m.) and on weekends (6:01 p.m. Friday
through 7:59 a.m. Monday).

C.5.23.6.2 The Contractor shall operate the call center to schedule all authorized
transportation requests, including those requiring an Attendant, Escort, or other
accommodations for special needs. The Contractor shall use approved scheduling
software to assign trips fairly, equitably, and cost-effectively.

C.5.23.6.3 The Contractor shall ensure that all call center staff, whether based in the DC
onsite CBO or working remotely, possess a basic knowledge of healthcare
provider office locations, hospitals, and clinics within the District of Columbia.
The Contractor’s call center staff shall also be able to effectively navigate the
Washington, DC metropolitan area and demonstrate the ability to research and
retrieve relevant location information online as needed to support Beneficiaries.

C.5.23.6.4 The Contractor’s call center functions and 70% of the customer service
representatives staff shall be located in the Contractor’s CBO on weekdays,
Monday through Friday, from 8:00 am to 6:00 pm (Eastern Standard Time).

C.5.23.6.5 The Contractor shall operate the call center to notify Transportation Providers of
trip assignments at least 48 hours in advance, when possible. The Contractor shall
timely reassign trips when necessary.

C.5.23.6.6 The Contractor shall operate the call center to ensure that Transportation
Providers are contacted so that Eligible Beneficiaries are picked up within one
hour of hospital or nursing home discharge notification.
C.5.23.6.7 The Contractor shall operate the call center to manage recurring trip requests so
that Eligible Beneficiaries are not required to make separate arrangements for
each instance. This includes implementing procedures to recertify standing orders
with the medical provider every 90 days.

C.5.23.6.8 The Contractor shall operate the call center as a duly licensed, centralized facility
in the District of Columbia that is accessible to DHCF.

C.5.23.6.9 The Contractor shall operate the call center in a manner that ensures all incoming
telephone inquiries regarding NEMT services are processed in a timely,
responsive, and courteous manner.

C.5.23.6.10 The Contractor shall operate the call center with staff who treat all callers with
dignity and respect the caller’s right to privacy and confidentiality.

C.5.23.6.11 The Contractor shall operate the call center with staff who greet callers
professionally, identifying both the Contractor and themselves by name.
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C.5.23.6.12 The Contractor shall operate the call center in a manner that ensures oral
communication is conducted in a language the caller understands. The Contractor
shall operate the call center with English-speaking staff and shall provide
interpretive services when a caller speaks a language other than English. If a
caller requests an interpreter from among their family or acquaintances, the
Contractor shall not permit interpretation by anyone under the age of 18.

C.5.23.6.13 The Contractor shall operate the call center with procedures in place to transfer
emergency transportation requests directly to the 911 system.

C.5.23.6.14 The Contractor shall operate the call center in accordance with policies that
prohibit the assignment of trips for minors (under 18) unless accompanied by a
parent, foster parent, guardian, caretaker, or Escort. If such a request is received
without the required accompaniment, the Contractor shall deny the request in
writing and notify the Beneficiary of alternative transportation options.

C.5.23.6.15 The Contractor shall operate the call center to escalate calls from dissatisfied
Beneficiaries to a supervisor, and further to a manager, if the issue remains
unresolved.

C.5.23.6.16 The Contractor shall operate the call center to establish and maintain a
Beneficiary File for each complaint or appeal filed by or on behalf of a
Beneficiary. These files shall be made available to the CA upon request.

C.5.24 The Contractor shall provide operational tasks for Network Development and
Compliance.

C.5.24.1 Criteria for Covered Transportation

C.5.24.1.1 The Contractor shall classify each vehicle for service in one of the following
covered modes of transportation:

C.5.24.1.1.1 Ambulatory Vans
The Contractor shall utilize the Contractor’s initial inspection of Transportation
Providers’ vehicles to establish the capacity of each vehicle and determine the
type of transportation each vehicle is capable of providing based on the vehicle
requirements.
C.5.24.1.1.2 Wheelchair Vans
1. The Contractor shall provide NEMT Services, other than van or Public
Transportation, when one of the following conditions is present:
a) The Eligible Beneficiary requires a wheelchair and is unable to use Public
Transportation;
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b) The Eligible Beneficiary has a disabling physical condition, which requires
the use of a walker, cane, crutches or brace and is unable to use a minibus,
commercial taxi or Public Transportation;
c) When an ambulatory Eligible Beneficiary requires radiation therapy,
chemotherapy or dialysis treatment, which results in a disabling physical
condition after treatment, causing the Eligible Beneficiary to be unable to
access transportation without physical assistance; and
d) The Eligible Beneficiary is unable to ambulate without personal assistance
of the driver in entering or exiting the Eligible Beneficiary’s residence and
medical facility; or the Eligible Beneficiary has a severe, debilitating
weakness or is mentally disoriented as a result of illness or health care
treatment and requires personal assistance.

2. The Contractor is not precluded from using more intensive modes of
transportation if the Contractor determines the use to be appropriate. One of
the above limiting conditions may exist before more intensive modes, other
than van or Public Transportation is considered; however, the existence of a
limiting condition does not necessarily mean that a more intensive mode of
transportation is required.

3. The Contractor shall also consider the functional ability and independence of
the Eligible Beneficiary in determining the need for wheelchair or stretcher
services. The Contractor shall ensure that the NEMT services are adequate to
meet the health needs of the Eligible Beneficiary.

C.5.24.1.1.3 Bariatric and Stretcher Vans

The Contractor shall provide stretcher services for nursing home facilities and
other providers in need of stretcher services, as requested by the health care
provider. The Contractor shall verify the facility’s closing hours during the
reservation process to ensure that Eligible Beneficiaries arrive back to their point
of origination before the facility closes.

C.5.24.1.1.4 Non-Emergency Ambulance

1. The Contractor shall coordinate transportation when the Eligible Beneficiary is
in need of healthcare services and only can be transported by a non-
emergency ambulance service. The ordering physician shall submit supporting
documentation that the Eligible Beneficiary's medical condition qualifies the
use of a non-emergency ambulance service.

2. The Contractor shall coordinate NEMT for the purpose of obtaining necessary
medical care or services for an Eligible Beneficiary whose medical condition
requires transportation in a recumbent position where the Eligible Beneficiary
shall be transported on a stretcher or requires the administration of life support
equipment, such as oxygen, by trained medical personnel. NEMT is of a pre-
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planned nature and is generally provided to and from a healthcare
appointment.

3. The Contractor shall have contracts with qualified ambulatory van providers
or ambulances who have the equipment and the training to transport Eligible
Beneficiaries whose weight may be 500 pounds or more.

4. The Contractor’s Non-Emergency ambulance shall be compliant with DC
Department of Health rules and regulations and requirements.

C.5.24.1.1.5 Air Ambulance

1. The Contractor shall provide Covered Air Ambulance Transportation Services
to all eligible Medicaid Beneficiaries to and from a District point of origin or
to and from specific Medicaid approved destinations. These services will
include all necessary medical equipment and personnel required to ensure safe
and effective transportation.

2. The Contractor is responsible for ensuring that all services meet the standards
set forth by the DHCF regulations and any applicable state and federal laws.

3. The Contractor shall coordinate with Medicaid providers to confirm eligibility
and coverage for each Eligible Beneficiary prior to the provision of services.

4. The Contractor will be provided a minimum of five days advance notice of
when it shall assume the responsibility for reviewing and authorizing or
denying interfacility Air Ambulance Services.

5. The Contractor shall receive Air Ambulance Services requests from Acute
Care Hospitals, Medical care facilities or Air Ambulance Services Providers
and shall evaluate the appropriateness of a request for Air Ambulance Services
based on the following factors listed in order of consideration:
a) Medical Necessity;
b) Medicaid Eligibility;
c) Absolute contraindication of ground transport due to time and distance;
d) Transport to the closest DC Medicaid enrolled Appropriate Provider;
e) If the requesting entity is an Air Ambulance Service, it is a Washington
DC Medicaid Provider; and
f) If the request is for Fixed Wing transport, after satisfying the above
circumstances, the Contractor shall refer the request to the Rotary wing for
final approval. (As per Section C.5.24.1.5.8 (a), the CA must approve all
fixed wing transports.)

6. When conducting any Air Ambulance Service review for Authorization, the
Contractor shall receive, store, and review all the following documents and
determine Medical Necessity:
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a) Statewide Certification for Medicaid Air Ambulance Services Form;
b) Demographic Face Sheet from the sending hospital;
c) The specialty needed at the tertiary care Facility that is not available at the
sending Facility;
d) History and Physical or Emergency Department Diagnosis and Treatment
Plan. Any other supporting medical documentation from the sending or
receiving hospital; and
e) Written documentation that the receiving facility will accept the
beneficiary.

7. The Contractor shall provide Ground Transportation as a default Mode of
Transportation between rendering facilities, at minimum for the following
purposes:
a) Emergency Room Physicians may inappropriately request Air Ambulance
Services for the transfer of patients for whom their Facility does not have
the appropriate services, without the knowledge that rotary wing transport
may increase the time between their decision to transfer the patient, and
the definitive care they are seeking at a tertiary care center. For this
reason, there are parameters that must be evaluated to weigh the risks vs.
benefits of the Air Ambulance Service request.
b) Air Ambulance Services shall also be inappropriately requested for
convenience or Physician preference, which is not permitted.

8. Based upon all the above-described guidelines and factors, the Contractor
shall issue an Authorization Number or a Denial.
a) If the request is for fixed wing transport, the Contractor cannot make an
approval determination on its own. The CA must first approve the request
before the Contractor informs the requester of the approval.
b) If the request is approved, the Contractor shall inform or remind the
requesting Air Ambulance Services Provider or Acute Hospital that the
issuance of an Authorization Number does not guarantee
payment/reimbursement to the Air Ambulance Service Provider. The
Contractor shall emphasize that Air Ambulance Services Providers will be
reimbursed only when contemporaneous, complete, acceptable, verifiable
records are submitted in a timely manner in accordance with the
instructions and Provider Agreement with DHCF.
c) If the request is denied, including if the CA denies a fixed wing transport
request, the Denial shall be provided both verbally and in writing.
d) Denial is considered an Adverse Determination and shall be accompanied
by a description of appeal rights (see Section C.5.28.4). The Appeal rights
will be described in a script (written and verbal) that will be provided to
the Contractor.

9. The Contractor shall ensure that all Transportation Providers submit and
maintain evidence of compliance with States Licensing, regulations, insurance
requirements and certification requirements including the following:
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a) At least have a valid pilot license to operate an Air Ambulance service in
one state; and
b) Be an FAA-certified Aircraft Operator under 14 CFR Part 135,
https://www.faa.gov/about/officeorg/headquartersoffices/avs/faa-
certificated-aircraft-operators-legal-part-135-holders.

10. The Contractor shall ensure that the Air Ambulance providing transport
be staffed by at least two emergency medical (EMT) technicians, who meet
the requirements of state and local laws where the services are being
performed and where at least one of whom shall (1) meet the vehicle staff
requirements above for BLS vehicles and (2) be certified as an EMT-
Intermediate or an EMT-Paramedic by the state or local authority where the
services are being furnished to perform one or more ALS services.

11. The Contractor shall ensure that Air Ambulance Providers maintain all
Airplane and medical aviation equipment adequately to comply with or
exceed the Airplane manufacturers’ operating and maintenance standards as
well as any District, and federal, safety and mechanical requirements.

12. The Contractor shall ensure that all Airplanes operating within the Network
maintain compliance with the following features in a functional, operational,
clean, and accessible manner, as applicable:

a. Air ambulances are equipped with medical supplies, monitoring devices,
and life-saving equipment to stabilize and care for beneficiaries during
transit.

13. The Contractor shall develop and submit a template of the Contractor’s Air
Ambulance Service Agreement (AASA). The Contractor’s AASA template
shall serve as the foundation for each AASA and serve as the primary source
of information for the NEMT services program. The Contractor shall submit
the AASA for the review and approval of the CA within 10 business days after
the kickoff meeting.

14. For Rotary Wing Air Ambulance services, the Contractor shall:
a) Receive a request from a Washington DC Medicaid Provider for
Authorization. A request for rotary wing transportation to a higher level of
care is urgent and of a time sensitive nature. Review and verbal
Authorization or Denial shall be made within 15 minutes of receipt of
necessary supporting documentation for such a request;
b) Issue, when appropriate, a Unique Authorization Number to the requesting
Provider for each Preauthorized rotary wing transport;
c) Transmit to the CA in the manner specified by the Rotary wing,
Authorization and Unique Authorization Number granted to include
Provider, points of origin and destination, Beneficiary Medicaid ID,
transferring and Receiving Facility, and date of service;
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d) Inform the requester that the issuance of an Authorization Number to the
requesting Provider does not guarantee reimbursement to the Air
Ambulance Service Provider;
e) Upon determining Air Ambulance Services are not Medically Necessary,
issue a Denial, and provide the appropriate contact information for the
NEMT Ground Transportation based on the closest Washington DC
jurisdiction to the transferring Facility;
f) Provide a Retrospective Review to Authorize or deny reimbursement
under the conditions listed in Section C.5.24.1.5.17 below;
g) If the entity requesting rotary Authorization is a Facility, either the
transferring or receiving Facility shall contact and arrange transport with
an Air Ambulance Service Provider. The Contractor is not required to
make transportation arrangements with any Air Ambulance Service
Provider; and
h) If the entity requesting rotary wing Authorization is an Air Ambulance
Service, the Contractor shall verify that the Air Ambulance Service is an
eligible Washington DC Medicaid Provider via MMIS. Air Ambulance
Service Providers shall only be issued an Authorization Number if they are
active Washington DC Medicaid Providers.

15. For Fixed Wing Air Ambulance , the Contractor shall:
a) Receive requests from the receiving or transferring Facility. Requestors
shall be informed the review process will take a minimum of three
business days;
b) Obtain documentation from the transferring Facility;
c) Contact at least two Washington DC Medicaid Fixed-Wing Providers to
determine if they are willing to provide the requested transport and, if so,
obtain a price quote to perform the described transport;
d) Provide Rotary wing provider with the responses of the contacted Fixed-
Wing Providers, including the price quotes if provided;
e) In the event that there are not two Providers willing or able to provide this
service, the single quote shall be sufficient with documentation of all
Providers who were contacted;
f) The Rotary wing provider will inform the Contractor whether the request
is approved, in which case the Contractor shall issue a Unique
Authorization Number directly to the approved Fixed- Wing Provider and
finalize the arrangements for the transport; and
g) If the request is denied by the Rotary wing provider, the Contractor shall
inform the requesting entity and issue a Denial Letter – Notice of Adverse
Determination (see Section C.5.28).

16. Reconsideration Reviews
The Contractor shall provide reconsideration reviews, at a minimum based on
the following:
a) Upon being notified that a request for Air Ambulance Transportation is
denied, the requestor shall ask the Contractor to revisit that determination.
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A Provider shall request a Reconsideration Review in real-time when there
is an Adverse Determination which the Provider feels is not in the best
interest of their patient;
b) Being requested any time prior to service delivery if additional
documentation is supplied by the Provider for consideration by the
Contractor;
c) When Adverse Determinations are requested by the Provider with further
clarification, when new/missing medical information is provided or when
so requested by the Rotary wing; and
d) Within seven business days after receiving the request.

17. Retrospective Reviews
The Contractor shall provide retrospective reviews, at minimum based on the
following:
a) In certain situations, an individual shall not be Medicaid Eligible on the
date of service and is provided retroactive Medicaid. For those granted
retroactive Medicaid, a review of the Air Ambulance Service shall be
submitted for retroactive review and payments;
b) The Air Ambulance Service Provider shall be a Provider at the time the
Service is provided;
c) Though Preauthorization is preferable, there are times when post-transport
review is the only viable method of providing Authorization. These
situations shall include:
i. The Beneficiary was not Medicaid pending or Eligible at the time of
service, as evidenced by the EVS verification prior to service being
provided;
ii. The sending Facility is not located in Washington DC and not aware of
the Preauthorization requirement; and
iii. Beneficiary Medicaid status was unknown to the sending Facility,
receiving Facility, or rendering Air Ambulance Service Provider due to
the Beneficiary’s clinical inability to communicate.
d) In performing Retrospective Reviews of Air Ambulance Services, the
Contractor shall, at a minimum not review:
i. Any requests for payment that does not contain all the required
documentation, including patient care report and flight information;
ii. Any initial requests for payment received beyond one year of the date
of services rendered; and
iii. Any requests for payment of services rendered to an individual whose
Medicaid eligibility has not yet been determined. To ensure payment
for this task, the Contractor shall verify active eligibility on the date of
service prior to performance of the review.

18. Commercial Flights, Accompanying Members, Meals and Lodging
The Contractor shall provide commercial flights, Accompanying Members,
meals and lodging, at minimum based on the following:
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a) Lodging and meal expenses are permissible for Accompanying Members.
All requests for meals and lodging shall be submitted to the Contractor
before transportation. Accompanying Members can be an immediate
family member (parent, spouse, guardian, child or foster parent) to
accompany and/or stay with the Beneficiary at a medical facility when the
need to stay is based on medical necessity and documented by the
physician. Meals and lodging of the Accompanying Members are covered.
Unlimited round trips per hospitalization (for visits, admittance and for
discharge) when the parent or Accompanying Member chooses not to stay
with the Eligible Beneficiary. A parent, guardian, or Accompanying
Member must accompany a child under the age of 16 unless the child is an
emancipated minor. A child aged 16 and up may travel unaccompanied
with written consent from the parent guardian, or foster parent;
b) When an overnight stay or longer is necessary for the Eligible Beneficiary,
lodging and meal expenses shall be covered for three Accompanying
Members. If there is a need for more than three Accompanying Members,
the request shall be approved by the CA;
c) Lodging accommodation shall be secured at the most economical facility
available. If the accompanying member chooses lodging other than the
most economical facility selected by the Contractor, reimbursement will
be capped at a maximum of $80 per night;
d) The U.S. General Services Administration (GSA) will determine the
funding amount for the Accompanying Members' travel allowance. The
per diem rate will be used to determine both meals and lodging amounts.
The GSA's Office of Personnel Management per diem rate scale varies by
the state where the Eligible Beneficiary is located; and
e) The determination of which meals and hotels to include is based on the
departure time and return time of the accompanying member. Per diem
rates | GSA

C.5.24.1.1.6 Public Transportation
C.5.24.1.6.1 The Contractor shall utilize Public Transportation Providers to compliment the
private Transportation Provider Network selected from the District’s list of current
and active providers to ensure the availability of adequate transportation services
to meet the needs of the Eligible Beneficiaries.

C.5.24.1.6.2 The Contractor shall, to the extent practical and efficient, enter into Public
Transportation Provider Service Agreements with Public Transportation providers
to ensure the development of a varied Transportation Provider Network to deliver
NEMT services.

C.5.24.1.6.3 The Contractor shall use Public Transportation to provide the most cost-effective
service to the Eligible Beneficiary, if such transportation is appropriate to meet the
needs of the Beneficiary.
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C.5.24.1.6.4 The Contractor shall utilize the following covered modes of Public Transportation
as appropriate:

C.5.24.1.6.4.1 Fare Card Reimbursed Trips

1. The Contractor shall procure and enter into agreements with local Public
Transportation Providers (METRO) to provide services including
Metrorail, Metro Bus, or Metro Paratransit services for Medicaid
Beneficiaries. The Contractor shall reimburse or provide fare cards for
Eligible Beneficiaries.

2. The Contractor shall provide fare cards for Eligible Beneficiaries. The
Contractor shall make available at the Contractor’s Central Business
Office, via courier and U.S. mail, bus or Metrorail fare passes to Eligible
Beneficiaries and Escorts, if applicable, for use in traveling to or from
scheduled health care appointments by Public Transportation in cases
where the Eligible Beneficiary or Escorts cannot afford to purchase them.

3. The Contractor shall also utilize other regional Public Transportation
systems that integrate with the METRO to provide NEMT services outside
the District.

4. After Hours: The Contractor shall ensure that services are offered through
the cab system outside of the daily core business hours.

C.5.24.1.6.4.2 Gas Mileage Reimbursement

1. The Contractor and Medicaid Beneficiary shall agree to gas mileage
reimbursement for non-emergency transportation to Medicaid covered
services using the Eligible Beneficiary’s own vehicle or transportation
provided by a friend or relative.

2. The Contractor shall ensure the Eligible Beneficiary will be
reimbursed for trips taken. The Contractor’s gas mileage
reimbursement program shall include the following but not limited to:
a) Prior authorization;
b) Eligibility verification;
c) Verification of the trip taken;
d) Verification of trip mileage; and
e) Parking Fee Receipts.

C.5.24.1.6.5 Public Transportation Policies and Procedures

1. The Contractor shall develop and implement procedures to determine the
appropriateness and accessibility of Public Transportation for Eligible
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Beneficiaries.

2. The Contractor shall submit their Public Transportation Policies and
Procedures.

C.5.24.2 Transportation Provider Network Development

C.5.24.2.1 The Contractor shall develop a transportation network containing the capacity to
deliver NEMT services and meet the needs of Eligible Beneficiaries effectively
and efficiently. The Contractor is encouraged to develop innovative and creative
strategies to reduce trip costs. The Contractor shall ensure the transportation
network contains an adequate number, variety of resources, and contingency plans
for unexpected peak transportation demands including the following:

1. Transportation Providers
a) Number of Transportation Provider;
b) Number and type of each mode of transportation (ambulatory vans,
wheelchair vans, non-emergency ambulances, bariatric and stretcher van
vehicles);
c) Number of Transportation Providers to provide service for IDD Waiver
Beneficiaries; and
d) Drivers and Attendants.

2. Public Transportation Providers
a) METRO SmarTrip Cards;
b) METRO Rail Pass;
c) Taxicabs and other vehicles-for-hire regulated by DC’s Department of For
Hire Vehicles; and
d) On-Demand NEMT vehicles, such as Uber and Lyft.

C.5.24.2.2 Transportation Providers - Solicitation and Selection
The Contractor shall utilize at a minimum the following to develop a
Transportation Provider Network:

1. The Contractor shall recruit, solicit, and select Transportation Providers that
have been licensed and certified by WMATC to provide a sufficient number
and the required type of providers to deliver timely and high quality NEMT
services.
2. The Contractor shall enter into TPSAs with Transportation Providers currently
enrolled as active in the District’s Medicaid NEMT Transportation program
(see list in Attachment J.19) that shall be based in the Washington DC
Metropolitan Area to provide return trips in cases where an Eligible
Beneficiary shall travel outside of the District of Columbia to obtain
appropriate health care services.
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3. The Contractor shall submit a Transportation Provider Selection Plan for the
review and approval of the CA within 10 business days after the kick off
meeting. The Plan shall document a systematic, objective selection process
that promotes free and open competition among the full pool of active
Transportation Providers (as listed in Attachment J.19).
a) The Contractor shall ensure responses received from Transportation
Providers address the following:
i. General requirements;
ii. Technical Approach;
iii. Cost/ Price; and
iv. Other pertinent information defined by the Contractor.

4. Transportation Provider Service Agreement Template
The Contractor shall provide a template of the written agreement to be
executed with each Transportation Provider. This template shall include:
a) Roles and responsibilities of both the Contractor and the Transportation
Provider; and
b) Contractual terms in compliance with TPSA requirements.

C.5.24.3 The Contractor shall not prohibit their subcontractors to subcontract any portion of
the requirements of the contract.

C.5.24.4 Transportation Provider and Driver Performance Incentive Program

C.5.24.4.1 The Contractor shall develop a Transportation Provider and Driver Performance
Report to award monetary incentives on a quarterly basis to Transportation
Providers and drivers who demonstrate exceptional performances during the
respective quarter. The Contractor shall submit the proposed report quarterly to the
District listing Transportation Providers receiving incentives. Quarterly reports
shall be submitted within 30 days following the end of the preceding quarter.

C.5.24.4.2 The Contractor shall submit a monthly report to the District of the liquidated
damages assessed to Transportation Providers. Monthly reports shall be submitted
by the 15th day of the following month. The report shall include the following:
1. Name of the Transportation Provider;
2. Reason for the liquidated damage;
3. Date of the non-compliance; and
4. Amount of the liquidated damage assessed.
C.5.24.4.3 The Contractor shall provide annually to the District the Contractor’s audited
financial statements examined and verified by an independent certified public
accountant (CPA) which shall include provide trip-level and administrative cost
data that can be independently verified. Annual reports shall be submitted within
90 days prior to the (12th) of the month after the effective date of the Contract.

C.5.24.5 Reporting Attestations
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C.5.24.5.1 The Contractor shall provide reposting attestations for daily and weekly reporting
of their subcontractors mandated reports. By submitting a Deliverable, the
Contractor represents that, to the best of its knowledge, it has performed the
associated tasks in a manner that shall, in contrast with other tasks, meet the
objectives stated or referred to in the Contract.

C.5.24.5.2 In accordance with 42 C.F.R. § 438.606, the Contractor shall, provide an
attestation/certification to DHCF, based on best information, knowledge, and
belief that the data, documentation, and information are accurate. The
Contractor’s program director or an individual who reports directly to the program
director with delegated authority to sign for the program director (the program
director is ultimately responsible for the certification), shall certify the data,
documentation, or information submitted by the Contractor to the District.

C.5.24.6 Record Retention

C.5.24.6.1 The Contractor shall ensure that each Transportation Provider maintains all
required records and documentation including Transportation Providers’
information, vehicle information, driver and Attendant information, and any other
records the Contractor shall need to access.

C.5.24.6.2 The Contractor shall ensure that the following record retention requirements are
maintained:
C.5.24.6.2.1 All records, including training records, pertaining to the Contract shall be readily
retrievable within three business days for review at the request of the District;
C.5.24.6.2.2 All records shall be maintained and available for review by authorized federal and
District personnel during the entire term of the Contract and for the period of three
years thereafter, unless an audit is in progress; and
C.5.24.6.2.3 Records involving an audit in progress or previous unresolved audit findings shall
be kept for a period of six years or until all issues are resolved, whichever is
greater. The Contractor shall retrieve the records at the District’s request during the
six years.

C.5.24.6.3 The Contractor shall maintain records that are necessary to fully disclose the
extent of services provided and to furnish DHCF with information regarding
District services, as requested. Such required records include completed vehicle
manifests and Encounter Data reports from the Transportation Providers that
delivered the service.
C.5.24.6.4 The Contractor shall make all records related to the services provided under the
Contract available for such reviews by DHCF. DHCF will monitor the
Contractor’s performance under the Contract by telephone contact, face-to-face
contact, record reviews, customer service satisfaction surveys and any other
means deemed necessary. DHCF reserves the right to audit the Contractor’s
records to validate service delivery reports and other information.
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C.5.24.7 Transportation Provider Records
The Contractor shall establish, maintain and provide upon District request, the
following records and related information in its files for each Transportation Provider
with a TPSA:

C.5.24.7.1 Copy of Contractor’s executed TPSA for each Transportation Provider; and Copy
of Transportation Provider’s registration with the District Public Service
Commission.

C.5.24.7.2 Vehicle Records
The Contractor shall ensure that, at a minimum, the following records and
documentation are maintained for vehicles providing service under the TPSA:
1. Manufacturer and model;
2. Model year;
3. Current vehicle registration;
4. Vehicle Identification Number (VIN);
5. Shows Active within the WMATC database system and the Provider has a
WMATC Certificate of compliance;
6. Type of vehicle (van, wheelchair van or stretcher van);
7. Capacity of vehicle;
8. License tag number and state of vehicle registration;
9. Declaration page or certificate of insurance policy coverage;
10. Registration permit and vehicle stamp;
11. Special equipment such as wheelchair lifts; and
12. Date, odometer reading, and inspection results pass/fail, verification that
vehicle meets the Contract’s vehicle requirements (C.5.2.3.2), inspection of
equipment such as brakes, tire tread, turn signals, horn, seat belts, air
conditioning/heating.

C.5.24.7.3 Driver Records
The Contractor shall ensure that, at a minimum, the following records and
documentation are maintained for Driver and Attendants providing service under
the TPSA as applicable:
1. Driver’s full name, date of birth and social security number; and any alias;
2. Copy of the Driver’s District, Virginia, or Maryland driver’s license;
3. Driver’s driving record for the previous three years obtained from District,
Virginia and Maryland Police;
4. Criminal background checks in accordance with the Social Security Act
Section 1902(a)(87), 42 CFR 455.450, and the 17 DCMR Chapter 85;
5. First aid training and CPR certificates;
6. Driver training course certificate;
7. Documentation of any complaints or accommodation received about the
Driver;
8. Driver’s accident, moving violations, and incident reports and any outcomes of
each; and
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9. Criminal charges and outcomes once the Contract commences.
10. Parking, photo enforcement or minor moving violation tickets and outcomes
once the Contract starts.

C.5.24.8 Confidentiality of Information

C.5.24.8.1 The Contractor shall ensure that all information retrieved, obtained, shared within
the Contractor’s organization, produced, reproduced, and given to Transportation
Providers is in full compliance with all confidentiality and HIPAA privacy
policies and laws. The Contractor shall not exchange any information deemed
confidential with any organization outside of the scope of services provided by
the Contractor, DHCF, or the District, without prior written approval from the
District.

C.5.24.8.2 The Contractor shall ensure that Transportation Providers maintain the
confidentiality of information regarding Beneficiaries during the delivery of
NEMT services.

C.5.24.9 Independent Audit

C.5.24.9.1 The Contractor shall obtain the services of an independent audit firm to assess the
Contractor’s internal accounting controls and procedures to perform the services
under the Contract. The independent audit firm shall determine whether the audit
revealed any conditions that presented a material weakness in the overall
administration of the NEMT services program and whether the Contractor’s
accounting and financial practices are consistent with sound business principles
and generally accepted accounting procedures.

C.5.24.9.2 The Contractor shall provide the initial Independent Audit Findings to the CA
within 60 days after the kickoff meeting. The Independent Audit Findings shall
include at a minimum detail of the independent auditor’s assessment of the
Contractor’s internal accounting controls and procedures. The Independent Audit
Findings shall also include statements from the auditor confirming that no
material weaknesses in the Contractor’s internal controls and procedures exist and
that the Contractor’s accounting and financial practices are consistent with sound
business principles and generally accepted accounting procedures. The
Contractor shall submit subsequent annual Independent Audit Findings for the
review and approval of the CA each year by September 15th.

C.5.24.9.3 The Contractor shall develop an audit compliance plan and submit the plan for the
District’s review and approval within 30 days from the Operational start date of
the Contract. The plan shall ensure that Transportation Providers maintain proper
and current licenses, permits, certifications and insurance coverage as required by
the District and the WMATC.

C.5.24.10 Transportation Provider Service Agreements
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C.5.24.10.1 The Contractor shall ensure that a TPSA is executed with each Transportation
Provider selected by the Contractor as a member of the Contractor’s
transportation network prior to the delivery of services.

C.5.24.10.2 The Contractor shall not establish or maintain a TPSA with any transportation
provider that:

C.5.24.10.2.1 Has been debarred, suspended, or otherwise excluded from participating in federal
or District of Columbia government procurements or programs, including but not
limited to the System for Award Management (SAM) and the District’s Excluded
Parties List;

C.5.24.10.2.2 Has been convicted of or is under investigation for offenses related to fraud,
abuse, misrepresentation, or any other conduct that would pose a risk to Eligible
Beneficiaries or to the integrity of the Medicaid program; and

C.5.24.10.2.3 Fails to maintain valid licensure, certifications, or required background checks in
accordance with federal and District regulations, including but not limited to
driver qualifications, criminal background checks, and exclusion from federal
health care programs under 42 U.S.C. § 1320a–7.

C.5.24.10.3 The Contractor shall verify each provider’s eligibility and compliance prior to
execution of a TPSA and shall continually monitor providers for changes in
status. The Contractor shall immediately terminate any TPSA with a provider that
becomes ineligible under this Section.

C.5.24.10.4 The Contractor shall ensure that copies of the executed TPSA and other relevant
documents are maintained in the Contractor’s Transportation Provider files.

C.5.24.10.5 The Contractor shall ensure that each TPSA includes, at a minimum, the
following requirements to be specified in the TPSA:
1. Vehicle requirements, insurance coverage, licenses, permits, and required
certifications;
2. Drivers and Attendants qualifications, responsibilities, and conduct;
3. Pick-up and delivery standards;
4. Eligible Beneficiaries;
5. Non-covered Beneficiaries;
6. Covered Transportation Services;
7. Medicaid Non-covered Transportation Services;
8. Modes of covered transportation;
9. Network Support Services and Systems;
10. Telecommunication System;
11. Management Information System;
12. Network program Policies and Procedures and Manuals;
13. Network Advisory Committee;
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14. DHCF Medical Care Advisory Board;
15. Reporting Requirements;
16. Record Retention;
17. Meetings;
18. Confidentiality of Beneficiary information;
19. Provider Rates, Payment and Payment Administration;
20. Procedures for obtaining reimbursement for authorized trips;
21. Non-compliance with standards and consequences;
22. Passing of TPSA specific provision containing language in each TPSA that in
the instance of default by the Contractor, each executed TPSA shall pass from
the Contractor to the District to provide for continued provision of NEMT
services. All TPSA terms, conditions, and rates contained in the TPSA shall
remain in effect until or unless the District renegotiates with the
Transportation Provider;
23. Indemnification language to protect the District; and
24. Provisions prohibiting the Transportation Provider from subcontracting direct
Transportation Services.

C.5.24.10.6 Transportation Provider Service Agreement Template

The Contractor shall develop and submit a template of the Contractor’s TPSA.
The Contractor’s TPSA template shall serve as the basic foundation for each
TPSA and serve as the primary source of information for the NEMT services
program. The Contractor shall submit the proposed TPSA Template with the
Implementation Plan in accordance with Section C.5.16.

C.5.24.10.7 Non-Compliance with Standards

C.5.24.10.7.1 The Contractor shall ensure Transportation Providers include vehicles identified
in each TPSA, and that drivers and Attendants maintain compliance with the
terms, conditions, and requirements of the TPSA.

C.5.24.10.7.2 The Contractor’s failure to maintain compliance and potential consequences shall
include, but is not limited, to the following:
1. The Contractor shall ensure that any vehicle in the NEMT Contractor program
found not in compliance with the vehicle licensing, registration, District or
federal requirements, or any requirements contained in the TPSA shall be
removed from service immediately until the Contractor confirms and verifies
in writing that successful corrective action has been completed and the
deficiencies corrected. The Contractor shall notify the CA in writing and
maintain all corrective actions and resulting actions in the Transportation
Provider files and the vehicle file;

2. The Contractor shall conduct an on-site visit of Transportation Providers with
a TPSA that receives two or more complaints from passengers concerning
vehicle cleanliness, heating, air conditioning, vehicle equipment failure, or
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other deficiencies identified in C.5.2.3 within a five-day period. The
Contractor shall complete an on-site inspection within 48 hours of notification
of the 5th complaint. The Contractor shall identify orally and in writing the
required corrective action to be taken by the Transportation Provider to
continue to provide NEMT services. The Contractor shall notify the CA and
maintain all corrective actions and resulting actions in the Transportation
Provider files and the vehicle file;

3. The Contractor shall terminate a TPSA when it identifies what it considers
sub-standard performance or when the Transportation Provider has failed to
take satisfactory corrective action within the designated time period requested
by the Contractor. The Contractor shall notify the CA in writing and maintain
all corrective actions and resulting actions in the Transportation Provider files
and the vehicle file. The District shall have the right to direct the Contractor to
terminate any TPSA with a Transportation Provider when the District
determines it to be in the best interest of the District;

4. The Contractor shall remove from service any Transportation Provider that has
been documented as more than 5% of the Transportation Provider’s scheduled
trips are late 20 minutes or more off delivery or pick-up schedule); the
Transportation Provider shall remain removed from service until the
Contractor confirms and verifies in writing that successful corrective action
has been completed and deficiencies corrected. The Contractor shall notify the
CA in writing and maintain all corrective actions and resulting actions in the
Transportation Provider files;

5. The Contractor shall ensure that any driver without a valid driver’s license
shall be immediately removed from service. The Contractor shall notify the CA
in writing and maintain all corrective actions and resulting actions in the
Transportation Provider files;

6. The Contractor shall ensure that any driver who fails a random drug screening
shall be removed from service. The Contractor shall notify the CA in writing
and maintain all corrective actions and resulting actions in the Transportation
Provider files;

7. The Contractor shall ensure that any drivers who, within a twelve (12) month
period, receives a citation or is convicted of two moving violations, or is
involved in an accident where the driver is determined to be wholly or
partially negligent, shall be immediately removed from service. The
Contractor shall notify the CA in writing and maintain all corrective actions
and resulting actions in the Transportation Provider files;

8. The Contractor shall ensure that any driver failing to maintain the conduct and
service delivery requirements contained in the TPSA shall be removed from
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service. The Contractor shall notify the CA in writing and maintain all
corrective actions and resulting actions in the Transportation Provider files;

9. The District shall have the right at any time to require the Contractor to
reassign or terminate any person’s involvement in providing service under this
Contract, including, but not limited to, any Transportation Provider, driver, or
Attendant, that the District determines is unacceptable; and

10. Subject to the CA’s prior written approval, the Contractor may allow
reinstatement of any person removed from service if the Contractor confirms
and verifies that the person has successfully completed corrective action and
corrected all deficiencies. The District’s shall have no responsibility or
liability regarding such reinstatement and the Contractor shall remain
responsible and liable.

C.5.24.11 Transportation Provider Requirements

C.5.24.11.1 WMATC Certificate of Insurance, Policy Endorsement, and Certificate of
Authority

1. The Contractor shall ensure that all Transportation Providers submit and
maintain evidence of compliance with WMATC including the following:
a) A valid certificate of insurance throughout the term of the TPSA with the
Contractor;
b) A Policy Declarations page naming the Contractor as a secondary insured
and evidence that the policy limits meet the TPSA minimum insurance
requirements including $1.5 million in general liability coverage; and
c) A Certificate of Authority indicating the Transportation Provider has
registered the provider’s insurance carrier with WMATC.
C.5.24.11.2 Vehicle Requirements
1. The Contractor shall ensure that all vehicles to be used in the delivery of
NEMT services shall comply with ADA regulations applicable to the services
provided, District Department of Motor Vehicles (DMV) licensing and
inspection requirements, District safety standards D.C. Official Code Title 50
Registration of Motorized Vehicles (C.2.1 Applicable Document # 14), and
the requirements described in the TPSA.

2. The Contractor shall ensure that each vehicle identified in a TPSA to provide
NEMT services shall comply with or maintain the following:
a) Vehicle Inspections: The Contractor shall ensure that each Transportation
Provider vehicle to provide service under a TPSA has a current vehicle
inspection and complies with the inspection requirements for the state the
vehicle is registered in and the D.C. Code Title 50, Inspection of
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Motorized Vehicles (C.2.1 Applicable Document # 14) prior to the start of
service and a copy of the vehicle inspections made available to the CA.
i. Vehicle Inspection Final Plan: The Contractor shall submit to the
District the Vehicle Inspection Final Plan at least 30 days prior to the
Operation Start date.
b) Vehicle Registration: The Contractor shall ensure that each Transportation
Provider vehicle to provide service under a TPSA has a valid vehicle
registration in compliance with D.C. Code Title 50 Registration of
Motorized Vehicles (C.2.1 Applicable Document # 14) prior to the start of
service and a copy of the vehicle registration made available to the CA.
The Contractor shall ensure that each vehicle maintains a current vehicle
registration for the duration of the period the vehicle provides services
under the TPSA.
c) Insurance Requirements: The Contractor shall ensure each Transportation
Provider vehicle to provide service under a TPSA meets the insurance
requirements (Section I.8) prior to the start of service and copy of proof of
required insurance made available to the CA. The Contractor shall ensure
that each vehicle maintains the required insurance coverage for the
duration of the period the vehicle is used to provide services under the
TPSA.
i. The Contractor shall ensure that all Transportation Providers that
employ two or more persons as full-time employees have the required
Workers’ Compensation Insurance Coverage.
ii. The Contractor shall ensure that the Contractor is listed as an
additional insured on all Transportation Providers’ insurance policies.
All expenses for insurance coverage are at the expense of the
Transportation Provider.
iii. The Contractor shall remove from service immediately any
Transportation Provider who has either a lapse in coverage, changes in
coverage limits to an amount that does not meet the minimum
insurance requirements or fails to renew its policy. The Contractor
shall verify that the Transportation Provider has obtained proper
coverage before re-instatement into the Transportation Provider
program.
d) Maintenance: The Contractor shall ensure that Transportation Providers
maintain all vehicles and vehicle equipment adequately to comply with or
exceed the vehicle manufacturers’ operating and maintenance standards as
well as any, District, WMATC and federal, safety and mechanical
requirements.
e) General Vehicle Requirements: The Contractor shall ensure that all
vehicles operating within the Network maintain compliance with the
following vehicle features or vehicle related items in a functional,
operational, clean, and accessible manner, as applicable:
i. The number of people in the vehicle, including the driver, shall not
exceed the vehicle manufacturer’s approved seating capacity;
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ii. All vehicles shall be operated within the manufacturer’s safe operating
standards at all times;
iii. Age Limit: Vehicles to be utilized in the delivery of NEMT services
shall not exceed 10 years in age as determined by the release date of the
vehicle; vehicles exceeding 10 years in age shall not be utilized;
iv. Two-Way Communication Systems: Every vehicle shall have a real-time
link phone or two-way radio. Vehicles shall maintain a two-way
communication system, such as radio or cellular phone, linking all
vehicles used in delivering the services contemplated under the Contract
with the Transportation Provider’s major place of business. Pagers are
not an acceptable substitute. The two-way communication system shall
be used in such a manner as to facilitate communication and to minimize
the time in which out-of-service vehicles can be replaced or repaired. A
vehicle with an inoperative two-way communication system shall be
placed out-of-service until the system is repaired or replaced. In the
event a Driver uses a cellular telephone, the Driver shall adhere to
District and surrounding area (i.e. VA, MD) laws regarding cell phones
(i.e., hand free only);
v. Air Conditioner and Heating Systems: Vehicles shall be equipped with
adequate heating and air conditioning for driver and passengers and shall
maintain a temperature at all times that is comfortable to the passengers.
Any vehicle with a non-functioning heating and air conditioning system
shall be placed out-of-service until appropriate corrective action is taken;
vi. Seat Belts: Vehicles shall have functioning, clean and accessible seat
belts for each passenger seat position and shall be stored off the floor
when not in use; All such vehicles shall have an easily visible interior
sign that states: “ALL PASSENGERS SHALL USE SEAT BELTS”;
vii. Child Safety Seats: Vehicles shall utilize child safety seats when
transporting children under age five. The Contractor shall ensure that
child safety seats are provided as operating equipment;
viii. Seat Belt Extensions: Vehicles shall have at least two seat belt
extensions stored in the vehicle at all times;
ix. Seat Belt Cutter: Vehicles shall be equipped with seat belt cutter(s),
mounted above the driver’s door, for use in emergency situations;
x. Odometer, Speedometer, and Clock: Vehicles shall have a functioning
and accurate speedometer, odometer and clock;
xi. Exterior Lighting: Vehicles’ exterior lights shall have lenses that are
secured and intact. Partial or broken lenses are not acceptable. All
vehicles shall have the following functional lighting equipment:
1. Headlights operational in low and high beam;
2. Brake lights;
3. Hazard lights;
4. Turn Signals (front and rear); and
5. License plate lights.
xii. Interior Lighting: Vehicles shall have functional interior light(s) within
the passenger compartment;
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xiii. Sidewalls and Ceiling Coverings: Vehicles shall have adequate sidewall
padding and ceiling covering. In the event a van ceiling is uncovered, no
objects can be exposed or hanging;
xiv. Horn: Vehicles shall have an operating horn;
xv. Windshield Wipers: Vehicles’ windshield wipers shall have operating
wipers. If there is a rear wiper in place, it shall be functional;
xvi. Windshield: Vehicles’ windshield shall be clear, properly sealed and not
contain any cracks;
xvii. Windows: Vehicles’ windows shall not contain any cracks, damage, or
unauthorized tinting. Each window shall be operational as it pertains to
the vehicle manufacturer specifications; broken windows shall be
replaced before the vehicle is used to transport Beneficiaries;
xviii. Door Locks: Vehicles’ doors shall have operating locks at all times;
xix. Vehicle Tires: Vehicles’ tires shall meet the vehicle manufacturer
specifications and shall not have thread wears less than 3/32” of an inch.
Spare or temporary tires are not acceptable as normal operating
equipment;
xx. Spare Tire and Tire Replacement Equipment: Vehicles shall maintain a
spare tire and the manufacturers’ required replacement equipment;
xxi. License Plates and Authorized Decals: Vehicles shall have secured
license plates that shall be visible at all times of the day. All license
plate lights shall be operational. The dates on the licenses shall be
current and not expired;
xxii. Passenger Comfort: Vehicles shall be adequate in operation so as not to
create passenger discomfort due to vehicle vibration and or noise;
xxiii. Rear View Mirrors: Vehicles shall have an interior and two exterior rear
view mirrors, one on each side of the vehicle. All mirrors shall be free of
cracks and securely mounted without any obstructions;
xxiv. Interior Mirror: 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;
xxv. Exterior Condition: Vehicles’ interior and exterior shall be clean and
have exteriors free of broken mirrors or windows, excessive grime, rust,
chipped paint or major dents, which detract from the overall appearance
of the vehicles;
xxvi. Interior Condition: Vehicles shall have passenger compartments that are
clean, free from torn upholstery floor or ceiling covering, damaged or
broken seats, and protruding sharp edges and shall also be free of dirt,
oil, grease, litter, hazardous debris, and unsecured items. The vehicle
shall also be odor free, including the use of offensive air fresheners or
cleaners. 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;
xxvii. Vehicle Exterior Signage: Vehicles shall have the Transportation
Provider’s name, telephone number and vehicle number displayed on the
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outside of the vehicle located on the front driver and passenger doors.
The business name and local telephone number must appear in lettering
that is a minimum of three inches in height and of a color that contrasts
with its surrounding background. WMATC certificate information shall
also be displayed on the exterior. Each vehicle shall have a “How’s My
Driving call 1-800 “(Contractor’s toll free telephone number) sign or
vehicle sticker placed on the rear at all times;
1. To comply with confidentiality requirements, no words shall be
displayed on the vehicle that implies that Medicaid Participants are
being transported. The name of the Transportation Provider’s
business shall not imply that Medicaid Participants are being
transported;
2. The vehicle license number, Contractor’s toll-free and local
telephone number shall be prominently displayed on the interior of
each vehicle. This information and the complaint procedures shall
be clearly visible and available in written format in each vehicle for
distribution to passenger’s upon request;
xxviii. Vehicle Interior Signage: Vehicles’ interior signage shall include the
Contractor’s company name; the Contractor’s phone number and address
shall be prominently displayed within the interior of each vehicle. This
information shall also be available in writing and placed or located in the
vehicles for distribution to passengers on request. A photo driver and
Attendant’s I.D., on duty shall be displayed in the vehicle on the
sidewall at all times in clear view of Beneficiaries being transported. All
vehicles shall have the following signs posted in all vehicle interiors,
easily visible to the passengers:
1. No Smoking, Eating or Drinking;
2. No music, radios, Walkman’s, etc.; and
3. All passengers shall be secured in seat belts at all times.
xxix. Fire Extinguishers: Vehicles shall be equipped with two functional fire
extinguishers at 2.5 pounds each in pressure, with a combined capacity
totaling 5.0 pounds in size, ABC, Halon type, or equal and shall display
a current inspection tag or sticker. The fire extinguisher shall be secured
within reach of the driver and visible to passengers for use in
emergencies when the driver is incapacitated;
xxx. Step Tools: Vehicles, except stretcher vans, that require a step up for
entry, shall include a retractable step, or a step stool as approved by the
CA to aid in passenger boarding. The step stool shall be used to
minimize ground-to-first-step height, shall have four legs with anti-skid
tips, sturdy metal with non-skid tread, with a height of 8 and 1/4", a
width of 15" and a depth of 14" or an equally suitable replacement.
Under no condition shall any alternative substitutes be considered a
viable alternative for a step stool and shall not be permitted on any
vehicle; Step stools must be secured away from aisles and doorways
while the vehicle is in motion in order to avoid obstructing the paths of
passengers in the event of an emergency evacuation;
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xxxi. Distress Tools: Vehicles shall have on board three portable triangular
reflectors mounted on stands. Use of flares is prohibited;
xxxii. Vehicle Documents: Vehicles shall include a vehicle information packet
to be stored in the glove compartment, or securely store on or in the
driver’s visor. This packet shall include:
1. Vehicle registration;
2. Insurance card;
3. Accident procedures and forms; and
4. Public Safety Certificate or sticker.
xxxiii. First Aid Spill Kits: Vehicles shall be equipped with two fully stocked
First Aid Kits. The First Aid Kit shall be stocked with antiseptic
cleansing wipes, triple antibiotic ointment, assorted sizes of adhesive and
gauze bandages, tape, scissors, latex or other impermeable gloves and
sterile eyewash. One kit is required to be mounted. A Spill Kit shall be
mounted and include the following required items: liquid spill absorbent
latex gloves, hazardous waste disposal bags, scrub brush, disinfectant
and deodorizer;
xxxiv. Sanitary Gloves: Vehicles shall maintain a supply of latex gloves to be
used during the sterilization of the vehicle, to remove or discard any
items that may contain bodily fluids, and in the event the passenger
needs assistance with his/her mobility needs and has a sensitive area that
is exposed;
xxxv. Winter Driving Equipment: Vehicles shall have tire chains for all tires
for use in inclement weather conditions. This item shall be included in
the vehicle inspection process and shall meet all safety standards of the
District;
xxxvi. Vehicle GPS System: All vehicles shall contain a Global Positioning
System (GPS) of the District and surrounding service areas of Maryland
and Virginia, with sufficient detail to locate Beneficiaries’ addresses and
medical destinations. The GPS shall be approved by the CA; and
xxxvii. Inspection Sticker and Emission Testing: Vehicles shall have a current
inspection sticker displayed on the windshield and an emissions testing
document indicating PASS, in the vehicle at all times. Each vehicle shall
be tested annually or according to the state registration inspection
schedule and passed.
1. If a vehicle has failed inspection and emissions testing, the
Contractor shall remove the vehicle from service immediately.
2. The Contractor shall remove a vehicle from service when the
vehicle’s manufacturer malfunction indicator light is active,
including but not limited to the check engine light, oil light or
brake light.

C.5.24.11.3 Wheelchair Van Requirements

1. The Contractor shall ensure that all vehicles classified to transport wheelchair
passengers shall comply with the ADA requirements, WMATC requirements,
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and the General Vehicle Requirements.

2. The Contractor shall ensure that wheelchair vehicles used to transport
wheelchair passengers shall, at a minimum, meet the following ADA
requirements:
a) The Contractor shall ensure that all wheelchair van vehicles operating
within the NEMT system are not older than eight years;
b) Maintain a floor-to-ceiling height clearance of at least 56 inches in the
passenger compartment;
c) Maintain an engine-wheelchair lift interlock system which:
i. Requires that the vehicle’s transmission is placed in park and the
emergency brake is engaged; and
ii. While in park with the emergency brake engaged, the vehicle engine
shall either shut down or become inoperable to place in any gear once
the wheelchair lift ramp is deployed. This prevents the vehicle from
moving when the lift is deployed.
d) Maintain a Wheelchair lift, either a hydraulically or electro-mechanically
powered, mounted so as not to impair the structural integrity of the vehicle
that meets the following specifications:
i. The lift platform 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 inch. The platform deflection shall not be more than
three degrees under 600-pound load. The lift platform shall be at least
30 inches wide and 48 inches long;
ii. The lift platform shall not have a platform surface and the roll-off
barrier greater than 5/8 of an inch. When raised, the area between the
platform and the vehicle floor shall not exceed ½ inch horizontally and
5/8 inch vertically;
iii. The lift controls shall be operable and accessible from inside and
outside the vehicle and shall be secure from accidental or unauthorized
operation;
iv. The lift shall be powered from the vehicle’s electric system. In the
event of a power failure, the lift platform shall be able to be
raised/lowered manually with passengers and shall provide a method
to slow free-fall in the event of power or component failure;
v. The lift operation shall be smooth without any jerking motion.
Movement shall be less than six inches per second during lift cycle and
less than or equal to 12 inches per second during stowage cycle;
vi. When the lift platform is in storage in the passenger compartment, it
shall not be capable of falling out of or into the vehicle, even if the
power should fail;
vii. All sharp edges of the lift structure, which might be hazardous to
passengers, shall be ground smooth;
viii. The lift platform shall have a properly functioning, automatically
engaging anti-roll-off barrier, with a minimum of 1" on the outbound
end, to prevent ride over;
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ix. It is preferable but not required, that the platform, when not in a
storage position, not intrude into the body of the vehicle more than 12
inches and shall be equipped with permanent vertical side plates to a
height of at least two inches above the platform surface;
x. The lift platform surface shall be of a non-skid expanded metal mesh or
equivalent, to allow for vision through the platform;
xi. The lift shall be clearly marked with reflector tape on each side except
the side adjacent to the vehicle and on the edge of all steps, thresholds
and the boarding edge of lift platform;
xii. 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;
1. Maximum height ranges (30-38) inches;
2. Knuckle clearance handhold, 1 and ½ inch (1-1/2") minimum
3. Shall be able to withstand force of 100 pounds; and
4. The handrail shall not reduce the lift platform width of at least 30
inches.
e) Maintain a Wheelchair Restraint System for each wheelchair position
including a wheelchair-securing device or “tie-down” that complies with
applicable ADA standards. The device shall be:
i. Placed as near to the accessible entrance as practical, providing clear
floor area of 30 inches by 48 inches. Up to six inches may be under
another seat if there is nine inches height clearance from floor. All
wheelchairs shall be forward facing;
ii. Tested to meet a 30 m.p.h./20 gm standard;
iii. Able to securely restrain the wheelchair during transport from
movement forward, backward, lateral and overturning movements in
excess of two inches;
iv. Adjustable to accommodate all wheel bases, tires (including
pneumatic) and motorized wheelchairs;
v. A locked system, belt system or both. 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 security 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;
vi. Equipped with seat belts and/or a shoulder harness that is attached to
the floor or to the sidewall of the vehicle, which shall be capable of
securing both the passenger and wheelchair; and
vii. The system utilized shall accommodate scooter-type wheelchairs.
However, passengers utilizing these devices shall be requested to
dismount from the device and be seated in a passenger seat.
f) The wheelchair entrance door shall:
i. Maintain a minimum vertical clearance of 56 inches and a minimum
clear door opening of 30 inches wide;
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ii. Have no lip or protrusion at the door threshold of more than ½ inch;
iii. Be equipped with straps or locking devices to hold the door open when
the lift is in use; and
iv. Be located in the rear or on the side of the vehicle. It is preferable, but
not required, that the side door be the wheelchair entrance, as opposed
to the rear door.

C.5.24.11.4 Stretcher Vehicle Requirements

1. The Contractor shall ensure all vehicles classified as stretcher vans or vehicles
used to transport passengers shall comply with the ADA and WMATC
requirements, and the General Vehicle Requirements.
2. The Contractor shall ensure that stretcher vehicles used to transport stretcher
patients shall, at a minimum meet the following equipment requirements at all
times:
a) Stretcher van vehicles operating within the NEMT system are not older
than eight years;
b) The vehicle shall have a gurney with a weight capacity of at least 500
pounds;
c) The gurney and vehicle shall have the proper floor mounts to secure and
stabilize the gurney when lowered; and
d) The gurney shall have three body straps. One to be placed at the
Beneficiary’s feet, one at the Beneficiary’s upper thigh area, and one
across the Beneficiary’s chest area. In the event a Beneficiary has an injury
to any of the areas, the Attendant is required to make the proper and
necessary adjustments to the strap locations.

C.5.24.11.5 Vehicle Inspection and Monitoring Process

1. The Contractor shall develop an internal inspection process and monitoring
system to ensure that all Transportation Provider vehicles comply with the
TPSA vehicle requirements (C.5.24.11.2) throughout the term of the TPSA
with the Contractor.
2. The Contractor shall at a minimum conduct the following inspections:
a) Initial inspection of each Transportation Provider vehicle prior to the
beginning of service delivery; the Contractor shall ensure that NEMT
Providers maintain all vehicles to meet or exceed local, State, and federal
requirements, and manufacturer’s safety, mechanical, operating, and
maintenance standards;
i. In addition, the Contractor shall test all communication equipment
during regularly scheduled vehicle inspections.
b) Annual inspections of each Transportation Provider vehicle within 12
months of the initial inspection; and
c) Vehicle Specific inspection, as needed, to respond to complaints or other
inquiries.
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3. The Contractor shall develop and submit the Vehicle Inspection and
Monitoring Process for the review and approval of the CA within 10 business
days after the kickoff meeting. The Contractor shall retain records of all
vehicle inspections described in C.5.25.10.5 above.
4. The Contractor shall submit the final plan for vehicle inspection, forms, and a
list of trained inspectors to CA at least 30 days prior to the Operations start
date. The plan shall include the names of all employees or subcontractors who
are authorized to inspect the vehicles for Contractor. Inspection forms must
have a checklist that includes all the appropriate vehicle inspection
requirements of the Contract and of District, State and federal law.
5. The Contractor shall take the following corrective action if the Transportation
Provider is not in compliance:
a) The Contractor shall immediately remove from service any vehicle or
driver found to be out of compliance with the requirements listed in
C.5.24, or with any State or federal regulations, or posing health or
safety hazard for the vehicle occupants. The vehicle or driver shall be
returned to service only after the Contractor verifies that the
deficiencies have been corrected. Any deficiencies, and actions taken
to remedy deficiencies, shall be documented and become a part of the
vehicle’s and the driver’s permanent records; and
b) Any vehicle receiving two or more legitimate complaints from
passengers concerning cleanliness, temperature deficiencies, or other
deficiencies within a five day period shall be removed from service
until the vehicle is inspected and appropriate corrective action is taken.
Legitimate complaints are determined by the CA based on, at a
minimum, an investigation of the complaint and the Tracking Log.
Such actions shall be documented and become part of the Contractor’s
records for CA review (upon request).
i. Legitimate Complaints are valid, or substantiated.

C.5.24.11.6 Transportation Providers’ Drivers and Attendants Requirements

1. The Contractor shall ensure that all drivers and Attendants employed by
Transportation Providers to provide services under a TPSA shall maintain or
fulfill the following minimum requirements:
a) All drivers, at all times during their employment, shall be at least 21 years
of age and have a current valid driver’s license to operate the
transportation vehicle to which they are assigned;
b) Valid driver’s license from the District, Virginia or Maryland that is not
presently or in the past five years been revoked or suspended;
c) No prior convictions of murder, attempted murder, manslaughter, arson,
assault, battery, assault and battery, assault with a dangerous weapon,
mayhem or threats to do bodily harm, burglary, robbery, kidnapping, theft,
fraud, forgery, extortion or blackmail, illegal use or possession of a
firearm, rape, sexual assault, sexual battery, or sexual abuse, child abuse or
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cruelty to children, or unlawful distribution or possession with intent to
distribute, a controlled substance, during the last 7 years;
d) Shall not have any felony convictions during the Contract period;
e) Fluent in the English language; and
f) Ability to read and comprehend driving instructions.
2. The Contractor shall ensure that all drivers and Attendants employed by
Transportation Providers to provide services under a TPSA:
a) Have not received treatment within the past five years for controlled
substances in accordance with DC Code 48-901;
b) Have not received a positive drug screening, from drugs defined in DC
Code 48-901 Subchapter II, Standards and Schedules, resulting from a
urine analysis or other drug screening within the past five years; and
c) Have not been cited for three or more moving violations or accidents
within the last seven years.
3. The Contractor shall ensure that all drivers that may endanger the safety of
Beneficiaries are removed from service, including but not limited to the
following:
a) If the Transportation Provider suspects that the driver is using
drugs/medications/alcohol that would endanger the safety of Beneficiaries,
the Transportation Provider shall immediately remove the driver from
providing service to Beneficiaries; and
b) Drivers who receive citations and are convicted of two moving violations
or accidents within a 12 month period, where the driver was wholly or
partially negligent, shall be removed from service.
4. The Contractor shall ensure that each driver and Attendant adheres to and
maintain compliance with each of the following:
a) Criminal Background and Transportation Record Checks: The Contractor
shall provide FBI and background checks for the drivers and Attendants
and ensure that all drivers and Attendants shall have and maintain Federal
and FBI background checks free of felony convictions. The Contractor
shall ensure current copies of criminal background checks and
transportation record checks for all drivers and Attendants are provided
prior to starting service with updates provided annually. The Contractor
shall retain copies of criminal background and transportation record
checks for review by the CA;
b) Driver’s Licenses: All drivers employed by each Transportation Provider
shall be licensed by the District or licensed by a jurisdiction in the
metropolitan area to operate the transportation vehicle to which they are
assigned by the Transportation Provider. The Contractor shall ensure that
copies of all current Transportation Providers’ vehicle drivers’ operator
licenses shall be submitted to the Contractor prior to starting service. The
Contractor shall retain copies of each driver’s license for review by the
CA;
c) First Aid and CPR Certificates: All drivers and Attendants shall maintain
current First Aid and CPR training certificates. Drivers and Attendants are
responsible for securing First Aid and CPR training, as the Contractor is
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not required to offer these courses or pay for them. The Contractor shall
ensure that First Aid and CPR certificates are provided for each driver and
Attendant prior to their starting service. The Contractor shall include the
First Aid and CPR certifications in the annual inspection of driver records.
Certificates shall be maintained for review by the CA;
d) Drug Screenings: The Contractor shall provide and pay for drug screening
tests for drivers and Attendants and ensure that all drivers and Attendants
undergo drug screenings and obtain a negative result prior to starting
service. The Contractor shall ensure that drivers and Attendants receiving
a positive screening shall not be allowed to provide service or shall be
removed from service delivery. The Contractor shall ensure that each
driver and Attendant has passed a random drug screening at least a
minimum quarterly with the results available for review by the CA;
e) Training and Education: The Contractor shall ensure that each driver and
Attendant complete the required Contractor sponsored training and
education (C.5.26.5.3) prior to providing service to ensure a Driver’s
competence in driving habits, and understand the importance of customer
focused service delivery with an emphasis on safety;
f) Uniforms: The Contractor shall ensure that drivers and Attendants wear
company-authorized uniforms (shirt and pants required) in an approved
manner, including shirts worn tucked inside the pants with no other logos
than those approved by the Contractor. Headgear, if worn, shall be part of
the general uniform with logos consistent with other uniform pieces; and
g) No Smoking Policy: The Contractor shall ensure that drivers and
Attendants uphold the No Smoking Policy, including that smoking of any
kind is prohibited in and around the vehicles while performing
transportation service. “No Smoking” signs shall be visible to all
passengers. The Contractor shall require drivers and Attendants to contact
the Contractor immediately if passengers fail to comply with this
prohibition.

5. Driver Conduct
The Contractor shall ensure that drivers and Attendants employed by
Transportation Providers to provide services under the TPSA adhere to the
following required standards of conduct:
a) All drivers shall be courteous, patient, and helpful to all passengers and be
neat and clean in appearance;
b) No driver or Attendant within MD, DC, or VA shall use or be under the
influence of alcohol, narcotics, illegal drugs, or any drugs that impairs
their ability to safely perform duties on or off work duty.;
c) No driver or Attendant shall physically, mentally, or verbally abuse any
passenger, including Beneficiaries ;
d) No driver shall touch any passenger, including Beneficiaries, except as
appropriate and necessary to assist the passenger into or out of the vehicle,
into a seat and to secure the seatbelt, or as necessary to render first aid or
assistance for which the driver or Attendant has been trained;
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e) All drivers and Attendants shall wear or have easily visible an official
company I.D. badge that is easily readable and identifies the employee and
the employer;
f) At no time shall drivers or Attendants smoke, eat or consume any
beverage, with the exception of water, while in the vehicle or while
assisting passengers, including Beneficiaries, entering or exiting the
vehicle or while in the presence of any Beneficiary. The driver shall advise
all passengers, including Beneficiaries, that they are not allowed to smoke,
eat or consume any beverage while in the vehicle. The driver shall report
any incidents of this nature to the Contractor;
g) Drivers and Attendants shall not wear any type of headphones or
earphones at any time while on duty. while operating a moving motor
vehicle in the District of Columbia unless the telephone or device is
equipped with a hands-free accessory;
h) Drivers shall not text while driving;
i) Drivers and Attendants shall ensure that passengers are not left in the
vehicle unattended;
j) Drivers or Attendants shall exit the vehicle to open and close vehicle doors
when passengers enter or exit the vehicle and provide assistance, as
necessary, to or from the main door of the place of destination. The driver
shall wait until the Beneficiary has safely entered the destination building
before departing the location;
k) Driver and Attendants shall properly identify and announce their presence
at the entrance of the building and at the specified pick-up location if the
Beneficiary is not at the curbside for pick-up.;
l) Drivers and Attendants shall present their company I.D. badge when
entering a facility, during pickups, and whenever requested by the District;
m) The driver’s and Attendant’s picture shall be placed in the vehicle on the
interior sidewall in view of the Beneficiaries being transported;
n) Drivers, or Attendants shall assist the passenger in the process of being
seated, including the fastening of the seatbelts and securing of infants and
children under age 5 in properly installed child safety seats. Drivers shall
confirm, prior to allowing any vehicle to proceed, that wheelchairs and
wheelchair passengers are properly secured and that all passengers are
properly belted in their seat belts;
o) Drivers, or Attendants, shall assist passengers in the process of exiting the
vehicle and in moving to access the building of the passenger’s destination;
p) Upon arrival at the destination, the driver shall park the vehicle so that the
passenger does not have to cross streets to reach the entrance of the
destination;
q) Drivers or Attendants shall confirm, prior to vehicle departure that the
delivered passenger is safely inside the assigned destination building;
r) Drivers and Attendants shall provide support and oral directions to
passengers. Such assistance shall also apply to the movement of
wheelchairs and mobility-limited persons as they enter or exit the vehicle
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using the wheelchair lift. Such assistance shall also include stowage by
the driver of mobility aids and folding wheelchair;
s) If a Beneficiary’s or other passenger’s behavior or any other condition
impedes the safe operation of the vehicle, the driver shall park the vehicle
in a safe location out of traffic, notify the dispatcher, and request
assistance;
t) Drivers shall maintain a temperature that is considered comfortable to the
Beneficiary at all times while the vehicle is occupied by a Beneficiary,
Escort, or Attendant;
u) Drivers or Attendants shall not be responsible for the
Beneficiary’s/passenger’s personal items. Interior signage
(C.5.24.11.2.2.e.xxviii) shall be displayed inside the vehicle making this
known and visible to riders, passengers, and Beneficiaries;
v) Neither drivers nor Attendants are allowed to use two-way radios or
mobile telephones while on duty, except if it pertains to the transportation
needs of the Beneficiaries. Personal phone calls are not allowed while on
duty, whether driving or while parked;
w) Drivers and Attendants shall be required to pass periodic and random drug
testing, provided by the Contractor, at a minimum of one time during each
quarter per calendar year;
x) Drivers shall be subject to immediate post-accident alcohol and drug
testing. Refusal to comply shall be grounds for immediate dismissal of the
driver. If the Transportation Provider refuses to comply, the Contractor
shall terminate the Transportation Provider’s TPSA immediately;
y) Any driver receiving two or more complaints from passengers concerning
standards in C.5.24.10.7 within a five business day period shall not be
utilized until corrective action is taken by the NEMT Provider. All
complaints shall be documented and become part of the driver’s
permanent record/file and forwarded to the Contractor. The Contractor
shall provide this documentation to the District; and
z) Drivers and Attendants shall always be present in the vehicle while
Beneficiaries in the vehicle. Beneficiaries shall not be left unattended.

6. Driver and Attendant Inspection and Monitoring Process
a) The Contractor shall develop an inspection process and monitoring system
to ensure that all drivers and Attendants comply with the requirements
contained in the TPSA throughout the term of the TPSA with the
Contractor. The Contractor shall ensure, at a minimum:
i. Driver’s Licenses for all drivers remain current;
ii. Each driver has an updated criminal background and transportation
record check;
iii. All drivers and Attendants complete at least four random drug
screenings during a calendar year;
iv. All drivers and Attendants maintain current First Aid and CPR
certifications;
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v. Driver and Attendant complete the required training and education
sessions; and
vi. That the NEMT Provider removes drivers with more than one
confirmed incident of failure to properly secure a passenger’s
wheelchair from providing services until such time as the NEMT
Provider submits documentation to the Contractor to support that the
driver has been properly trained in the use of securement devices.

7. Pick Up and Delivery Standards
The Contractor shall ensure that NEMT Providers comply with the following
pickup and delivery standards:
a) On-time arrivals and pick-up shall be standard; arrival before the
scheduled pick-up time is permitted; however, an Eligible Beneficiary
shall not be required to board the vehicle before the scheduled pick-up
time and Transportation Providers shall wait up to a minimum of 15
minutes beyond the scheduled pick-up time. If the Eligible Beneficiary is
not present for pick up, the driver shall notify the NEMT Provider’s
dispatcher before departing from the pick-up location. NEMT Providers
cannot change the assigned pickup time without permission from the
Contractor. If the NEMT Provider cannot arrive on time to the pick-up
location, the NEMT Provider or Contractor shall contact the Eligible
Beneficiary or the Eligible Beneficiary’s representative and the Provider to
inform of the late arrival. The Contractor shall utilize a taxicab or On-
Demand NEMT vehicle to pick- up the Eligible Beneficiary if the provider
vehicle originally scheduled is no longer available. No more than two
percent (2%) of the scheduled trips shall be late or missed per day;
b) The Contractor shall ensure that Medicaid Beneficiaries are transported to
and from appointments on time. Medicaid FFS Beneficiaries are to be
advised of pickup time for transportation to appointments when requests
are made with the Contractor. Any deviation in time of actual pick-up
more than 15 minutes is not acceptable as timely service. For the return
pick-up from an appointment, the vehicle shall arrive within 60 minutes
from the time of notification by the Beneficiary or facility;
c) In multiple-load situations, ensure that no Eligible Beneficiary is forced to
remain in the vehicle more than 60 minutes longer than the average travel
time for that Eligible Beneficiary’s direct transport from point of pickup to
destination;
d) Drivers shall transport Eligible Beneficiaries to their destinations on time
for their scheduled appointments. The Transportation Provider’s driver
shall wait until the Eligible Beneficiary has safely entered his or her
building or dwelling before departing the location;
e) Drivers shall report all late arrivals to the Transportation
Provider/dispatcher for the purpose of notifying the direct Medicaid
Provider of the Eligible Beneficiary’s late arrival;
f) Contractor shall monitor trips to ensure Eligible Beneficiaries are
transported to and from their homes and appointments in a timely manner;
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g) Transportation Providers are required to report all late arrivals to the
Contractor. The Contractor shall monitor all late arrivals (i.e. physician,
hospital, family) and submit a cumulative on-time report to the CA
quarterly. Quarterly reports shall be submitted within 30 days following
the end of the preceding quarter;
h) Adverse Weather Plan. The Contractor shall have a written plan for
transporting Eligible Beneficiaries who need critical medical care during
adverse weather conditions. “Adverse weather conditions” includes but is
not limited to, extreme heat, extreme cold, hurricane, tropical storms,
flooding, tornado warnings and heavy snowfall. The Contractor shall
submit the proposed plan and thereafter upon the CA’s request;
i) Public Emergency. The Contractor shall have a written plan for
transporting Eligible Beneficiaries who need critical medical care during a
District of Columbia public emergency. The Contractor shall submit the
proposed plan and thereafter on an annual basis. Annual reports shall be
submitted within 90 days prior to the (12th) of the month after the effective
date of the Contract; and
j) The Transportation Provider/dispatcher shall contact proposed passengers/
Eligible Beneficiaries (via telephone) at their pickup points to inform them
of the delay in arrival of vehicle. The Transportation Provider shall advise
scheduled Eligible Beneficiaries of alternative transportation
arrangements when necessary.

8. Electronic Tracking System
The Contractor shall provide an electronic tracking system to track vehicles in
real-time that are delivering NEMT services under this Contract. The
Contractor’s electronic tracking system shall be capable of the following:
a) Capturing the actual pick-up time and location for each assigned trip;
b) Capturing the actual drop-off time and location for each assigned trip;
c) Monitoring the timeliness and success of assigned trips; and
d) Monthly data reporting that monitors unsuccessful and late trips.

C.5.24.11.7 The Contractor shall ensure that direct Transportation Providers maintain the
necessary computer and management information system capabilities to produce
accurate and timely encounter reports and maintain records and other NEMT
services information, as requested by the Contractor and the District.

C.5.24.11.8 Driver Qualifications & Background Checks
C.5.24.11.8.1 The Contractor shall ensure that all drivers, whether employees or independent
contractors, undergo comprehensive background screening prior to engagement,
in compliance with:

C.5.24.11.8.1.1 The Fair Credit Reporting Act (FCRA), including obtaining prior written
consent, providing pre- and post-adverse action notices if employment is
denied or terminated based on the background check, and enabling candidates
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to dispute findings;

C.5.24.11.8.1.2 Department of Transportation (DOT) and Federal Motor Carrier Safety
Administration (FMCSA) regulations, including:
(a) Motor Vehicle Record (MVR) checks;
(b) DOT-compliant drug and alcohol testing; and
(c) DOT physical examinations for drivers of commercial vehicles or those
transporting passengers.

C.5.24.11.8.2 In addition, the Contractor shall conduct criminal history checks (national and
local) and federal exclusion list screenings (e.g., OIG exclusion lists) to ensure
drivers are not barred from federal healthcare programs.

C.5.24.11.8.3 The Contractor shall re-conduct background checks periodically, at intervals
compliant with federal and applicable state standards (e.g., annual MVR reviews,
re-screening every 5 years for criminal history, and monthly checks against the
federal exclusion list).

C.5.24.11.8.4 The Contractor shall maintain a policy that clearly defines disqualifying criteria
(e.g., certain criminal convictions, unsafe driving records) consistent with federal
law and applicable state standards and apply them uniformly. Documentation of
this policy must be available and provided to the CA at the CA’s request.

C.5.24.11.8.5 The Contractor shall immediately notify the CA in writing within 24 hours, if:

(a) A driver fails any required background screening;
(b) A driver becomes subject to a disqualifying offense; or
(c) A driver is listed on the federal exclusion list during their employment or
engagement.

C.5.24.11.8.6 The Contractor shall securely maintain for at least 3 years and provide upon
request:

(a) Background check consents;
(b) Screening results;
(c) Notices sent;
(d) Disqualification decisions; and
(e) Documentation of corrective actions.
C.5.24.11.8.7 The Contractor shall manage all personal and medical data collected in
accordance with HIPAA, ensuring confidentiality and secure storage.

C.5.24.11.8.8 The Contractor shall certify and periodically reaffirm that all background checks
comply with FCRA, DOT, FMCSA, HIPAA, and any applicable state or local
regulations. The Contractor shall allow periodic audits by the Contract
Administrator and DHCF’s Department of Program Integrity to verify
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compliance.

C.5.24.11.8.9 Drug and Alcohol

C.5.24.11.8.8.1 The Contractor shall ensure that all transportation providers, including
subcontractors, comply with all applicable District of Columbia drug laws, as
well as federal laws and regulations, including but not limited to 49 CFR Part
40 (Procedures for Transportation Workplace Drug and Alcohol Testing
Programs) and 49 CFR Part 382 (Controlled Substances and Alcohol Use and
Testing), at all times during the performance of this Contract.

C.5.24.11.8.8.2 The Contractor shall develop, implement, and maintain a written policy and
procedure to address any violation of a District or federal drug law by any
transportation provider. At a minimum, this process shall include:
a) The Contractor shall notify the CA in writing within two days of becoming
aware of any actual or alleged violation of a District or federal drug law by
any provider;
b) The Contractor shall conduct an internal investigation of the violation and
submit a Corrective Action Plan to the CA within five days of the
notification. The CAP shall detail the nature of the violation, investigative
findings, and the corrective measures to prevent recurrence;
c) The Contractor shall immediately remove personnel involved in a
confirmed drug law violation from providing services under this Contract,
pending investigation and determination of continued eligibility;
d) All actions taken in response to a violation shall be documented and
maintained for the duration of the Contract. Documentation must be
available to the District upon request; and
e) The Contractor shall ensure that all drivers providing NEMT services are
subject to drug and alcohol testing programs in accordance with 49 CFR
Part 40 and Part 382, including pre-employment, random, reasonable
suspicion, and post-accident testing.

C.5.24.11.9 Safety Requirements for IDD Beneficiaries and Vehicle Monitoring

C.5.24.11.9.1 In-Vehicle Camera Systems
a) The Contractor shall ensure that all vehicles used to transport eligible
beneficiaries are equipped with in-vehicle video cameras. Cameras shall
record video only and must capture both the driver and passenger
compartments.
b) Recorded footage shall be encrypted, securely stored, and retained on record
for a period of 12 months.
c) Access to recorded footage shall be restricted to authorized Contractor and
DHCF staff for the purposes of safety review, grievance investigation, or
quality assurance.
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d) The Contractor shall ensure all camera equipment and data management
practices comply with HIPAA and applicable privacy and data security laws.
e) The Contractor shall provide DHCF access to footage within three (3)
business days of a written request or within twenty-four (24) hours in cases
involving safety or abuse allegations.

C.5.24.11.9.2 Attendant Requirements for IDD Waiver Beneficiaries

a) The Contractor shall ensure that every ride involving an IDD Waiver
beneficiary includes a designated attendant. The attendant may be:
i. An attendant provided by the Contractor or its transportation provider, or
ii. An attendant designated by the eligible beneficiary’s family or caregiver,
if preferred and authorized by the beneficiary’s support team.
b) Attendants provided by the Contractor shall meet all background check, abuse
registry clearance, and training requirements applicable to personnel
interacting with vulnerable populations.
c) The attendant’s role is to ensure the beneficiary’s safety, assist with boarding
and exiting, and support communication or behavioral needs during transport.
d) The Contractor shall maintain documentation verifying attendant assignment
and compliance for each IDD Waiver transport.

C.5.24.11.9.3 Compliance and Monitoring

The Contractor shall incorporate these requirements into all subcontractor
TPSA’s and ensure subcontractor compliance.

C.5.25 The Contractor shall provide operational tasks for Operational Documentation, and
Deliverables.

C.5.25.1 Operational Meetings

C.5.25.1.1 The Contractor shall meet with DHCF in person or by video conference, at a
minimum, monthly during the Operational Phase to account for status updates of
the Operational Reports.

C.5.25.1.2 The Contractor shall be responsible for preparing the meeting notes to include
action items, from each meeting, the agenda for the meeting and preparing and
distributing minutes. The Contractor shall develop and submit the meeting notes
to the CA for approval 48 hours after each meeting is held.
C.5.25.1.3 Transportation Provider Meetings
The Contractor, at a minimum, shall meet with all Transportation Providers on a
quarterly basis at an established location in the District to give Transportation
Providers an opportunity to discuss current operational issues, receive updated
information from the Contractor, and submit any reports or documents needed.
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C.5.25.2 Operational Reports

The Contractor shall ensure that each Transportation Provider prepares and provides
report information needed to meet the Contractor’s reporting requirements. In
addition, the Contractor shall ensure that each Transportation Provider understands
the reporting requirements and how the different formats shall be prepared. The
Contractor shall provide at a minimum the following reports or information from the
Transportation Providers and provide these reports to the District:

C.5.25.2.1 Daily Manifests and Driver Daily Log Reports

1. The Contractor shall ensure that the Transportation Provider completes the
manifest reports daily. Daily reports shall be submitted by 10:00 a.m. on the
next business day following the day of report.

2. Vehicle manifest reports shall be completed by each vehicle driver daily and
shall contain the following information:
a) Transportation Provider name;
b) Driver and Attendant names;
c) Vehicle number;
d) Vehicle driver name;
e) Beneficiary’s name;
f) Beneficiary’s Medicaid number;
g) Time of medical appointment (if applicable);
h) Pick up point;
i) Destination;
j) Scheduled pick up time;
k) Actual arrival time at pick-up point;
l) Odometer reading at point of pick-up;
m) Odometer reading at point of drop-off;
n) Name of Escort or companion, if any, and relationship to Beneficiary;
o) Date of service;
p) Name of Contractor-provided Attendant (if applicable); and
q) Attendant and/or companion name

C.5.25.2.2 Client Satisfaction Survey Report

The Contractor shall propose and conduct a client satisfaction survey annually to
assess the quality of services rendered under this Contract. The survey shall be
distributed to the Beneficiary population. The Contractor shall compile the results
and submit a comprehensive Client Satisfaction Survey Report to the District within
30 days of survey completion. This report shall include, at a minimum: an executive
summary, methodology, response data, analysis of key satisfaction indicators, client
feedback, and actionable recommendations for service improvement.
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C.5.25.2.3 Encounter Data Reports

The Contractor shall ensure that all contracted Medicaid Transportation Providers
submit Encounter Data to the Contractor in an electronic format using HIPAA
compliant transactions, such as the HIPAA X12 837 transaction. The Contractor
shall be held accountable for obtaining Encounter Data from all of its contracted
providers for rate development purposes and in order for the Contractor to receive
capitation payments from DHCF. The Contractor shall submit properly
completed Encounter Data to the CA and DHCF on a quarterly basis. The
Contractor shall submit all Encounter Data reports within 30 days following the
last day of the quarter of service in the standard format of the HIPAA X12 837.

C.5.25.2.4 Accident & Moving Violations Report

The Contractor shall notify CA of the following:
a) Any accident which occurs during performance of services under the Contract
in which a driver, Attendant, Escort, or Beneficiary or other passenger is
injured or killed. The Contractor shall file a written accident report with the
CA within two business days of the accident and shall cooperate with DHCF
during any ensuing investigation by the District and or its Agent. The
Contractor shall ensure that the Transportation Provider files an accident
report with the police and insurance company within 48 hours after the
incident. The Contractor shall provide a copy of the police report to the CA
within 10 business days of the moving violation; and the Contractor shall
include a police report as supporting documentation;
b) Any and all moving violations that occur while performing services under the
Contract The Contractor shall provide a copy of the police report to the CA
within 10 business days of the moving violation; and
c) The Contractor shall maintain copies of each accident report in its files and
the Transportation Provider’s files, and the files of the vehicle and driver
involved in the accident. Police reports associated with moving violations
shall be maintained in the file of the responsible driver and Transportation
Provider.

C.5.25.2.5 Transportation Services – Summary Report
a) The Contractor shall develop and provide a monthly Transportation Services
summary report to the CA. Monthly reports shall be submitted by the 15th day
of the following month. The Contractor shall include at a minimum the
following information in the Transportation Services summary report:
i. Number of trips;
ii. Number of unduplicated Beneficiaries, and the total number of miles,
sorted by mode of transportation service provided; and
iii. Number of requests denied, sorted by the level of transportation, the type
of service and the reason for denial.
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b) The monthly Transportation Services summary report shall contain, at a
minimum, the level of detail described in C.5.25.2.15. The Contractor shall
correct the monthly Transportation Services summary report within five days
of notification of errors by the CA.

C.5.25.2.6 Beneficiary No-Show Report

a) The Contractor shall generate a Beneficiary no-show report and submit it
to the CA monthly.

b) The report, at a minimum, shall contain the following:
i. The total number of Beneficiary no-shows for the period;
ii. The total number of no-shows per provider;
iii. The Beneficiary’s name;
iv. The no-show date; and
v. The scheduled pick-up time, and scheduled appointment time.

c) The Contractor shall submit the Beneficiary No-Show Report for the
review and approval of the CA by the 15th of each month.

C.5.25.2.7 Non-Compliance Activity Report - Transportation Providers, Vehicles, Drivers,
and Attendants

1. The Contractor shall prepare and submit a Non-Compliance Activity Report
detailing those Transportation Providers, vehicles, drivers, and Attendants that
have been removed from service delivery.

2. The Non-Compliance Activity Report shall also indicate those Transportation
Providers, vehicles, drivers and Attendants that have been returned to service
delivery after having satisfied or corrected the issue(s) that originally resulted
in removal from service.

3. The Contractor shall submit the Non-Compliance Activity Report for the
review and approval of the CA monthly. Monthly reports shall be submitted
by the 15th day of the following month.

C.5.25.2.8 Transportation Provider and Driver Reports
1. The Contractor shall develop and submit to the CA using software
applications Microsoft Word or Excel, a listing of Transportation Providers
and the drivers and Attendants for each Transportation Provider at the
Operation start date. The roster shall indicate, at a minimum, the driver’s
name, District, Virginia or Maryland driver’s license number, and social
security number. The report will also show the total number of drivers in
service.
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2. The Contractor shall provide updates to the listing of Transportation Providers
and the drivers and Attendants to reflect additions and deletions in
Transportation Providers and personnel each month. Monthly reports shall be
submitted by the 15th day of the following month.

C.5.25.2.9 Vehicle Reports

1. The Contractor shall develop and provide to the CA a listing of all vehicles
placed in service for the performance of the NEMT program in the District
under the Contract 30 days before Operational start date of the Contract. The
list shall include each vehicle:
a) Name of Transportation Provider;
b) Manufacturer and model of vehicle;
c) Model year;
d) Vehicle Identification Number;
e) Type of vehicle (minibus, wheelchair van, non-emergency ambulance or
stretcher van); and
f) Vehicle registration number assigned by DMV.

2. The Contractor shall provide updates to the listing of vehicles to reflect
additions and deletions in Transportation Providers and personnel each month.
Monthly reports shall be submitted by the 15th day of the following month.

C.5.25.2.10 Ad Hoc Reports

The Contractor shall provide the CA ad hoc reports, as requested, regarding the
Transportation Services and information to be specified by the CA. Ad Hoc
Reports shall be submitted within three business days after the date of request,
unless otherwise specified by the CA.

C.5.25.2.11 IDD Waiver Transportation Services Reports

1. The Contractor shall develop and maintain an automated system that tracks
and generates special reports regarding Beneficiaries in the Intellectually
Disabilities and Developmental Disabilities (IDD) Waiver program.

2. The Contractor shall submit the IDD encounter data reports to the CA
quarterly to ensure the District can complete the required CMS cost and
encounter reports that are submitted to CMS on a quarterly basis for the
District’s IDD waiver program. The IDD Transportation Services reports shall
document Encounter Data as described in C.5.25.2.3.

3. The Contractor shall submit an IDD monthly report (Monthly reports shall be
submitted by the 15th day of the following month) for each individual
transported through the IDD waiver program in a form and manner specified
by the CA to include the following:
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a) Destination;
b) Type of destination;
c) Categorize trips as one of the following:
d) Medically necessary services covered in the DC Medicaid State Plan;
e) Vocational services, activities, and resources;
f) Day habilitation, prevocational habilitation, or supported employment; and
g) Waiver and other community services, activities, and resources.

C.5.25.2.12 Incident Reports

1. The Contractor shall develop a formal incident report template form and train
Transportation Providers on the use of the form. The Contractor shall submit
the format of the incident report to the CA for approval within 20 days after
the kickoff meeting.

2. The Transportation Provider is responsible for notifying the Contractor of any
incident. The Contractor shall notify the CA of an incident, via a formal
Incident Report, within 48 hours of an incident.

3. The Contractor shall document any Beneficiary incidents reported by the
Transportation Provider. The Transportation Provider shall document and
report any Beneficiary incidents to the Contractor within 24 hours of an
incident.

4. The Contractor shall review all documentation regarding an incident and
conduct an investigation of an incident and take appropriate action. The
completed incident reports forms shall be sent to the CA via email.

5. If a Beneficiary has been injured, the Transportation Provider is required to
report the incident to the Contractor immediately. If a Beneficiary has been
injured, the Contractor is required to report the incident to the CA
immediately.

6. The Contractor shall provide a summary report of all incidents to the CA
monthly. Monthly reports shall be submitted by the 15th day of the following
month. This is a separate form and in addition to individual incident reports.
7. Serious events include all incidents in which a Beneficiary sustains an injury
or the risk thereof, this is synonymous with what the Joint Commission on
Accreditation of Healthcare Organization call “Sentinel Events”. Serious
events include:
a) An incident that has resulted in an unanticipated death or major permanent
loss of function, not related to the natural course of the Beneficiary’s
illness.
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8. The Contractor shall report all serious events to the CA immediately, even if
the Beneficiary outcome was not death or major permanent loss of function.

9. The Contractor shall notify the CA and the Department on Disability Services
within 48 hours of any incident involving an Intellectual and Developmental
Disabilities Waiver beneficiary. The notification shall include all known
details of the incident at the time of reporting.

10. The Contractor shall provide the CA and DDS with written documentation of
the incident closure for all incidents involving IDD Waiver beneficiaries. The
closure report shall include the outcome of the investigation, corrective
actions taken, and verification that the incident has been resolved in
accordance with applicable policies and procedures.

C.5.25.2.13 Telecommunications System Reports

On a monthly basis, the Contractor shall provide reports produced by the ACD
telephone system used in receiving and scheduling appointments to the CA or its
Agent. Monthly reports shall be submitted by the 15th day of the following month.
The following information shall be included in this report:
1. Number of calls received;
2. Type of inquiries or calls received;
3. Number of calls placed on hold;
4. Average hold time for calls placed on hold;
5. Number of abandoned calls;
6. Abandon calls as a percentage of total calls received;
7. Average hold time prior to abandonment;
8. Average talk time;
9. Average number of rings for initial answer;
10. Number of customer services/call center request;
11. Number of position vacancies for CSR/call center representatives; and
12. Number of telephone operators by time of day/day of week.

C.5.25.2.14 Annual Financial Reports
The Contractor shall submit an annual certified financial audit/report through the
close of each District fiscal year, calendar year or tax-reporting year within six
months of the close of the year just ended, as described in (C.5.24.9).
C.5.25.2.15 Invoice Report
1. The Contractor shall develop and submit to the CA a monthly invoice report
that identifies all Transportation Providers reimbursed for services by the
Contractor within 30, 45, and 60-day period. Monthly reports shall be
submitted by the 15th day of the following month. The monthly Invoice report
shall provide the following:
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a) Date of the invoice submission;
b) Payment method; and
c) Date of payment.

2. The Contractor shall maintain monthly billing files per provider to justify the
number of transports and for audit purposes. The Invoice Report shall provide
pertinent data to successfully perform a cross reference to actual and specific
clients transported by each transportation service provider.

C.5.25.2.16 Provider No-show Report

1. The Contractor shall generate a Transportation Provider no-show report and
submit it to the CA by the 15th of each month. The report, at a minimum, shall
contain the following:
a) The total number of Transportation Provider no-shows for the period;
b) The Transportation Provider’s name;
c) Beneficiary’s name;
d) The no-show date; and
e) The scheduled pick-up time, and scheduled appointment time.

C.5.25.2.17 Exclusion Report

1. The Contractor shall examine the exclusion report on a monthly basis, in
accordance with Federal Regulation 42 CFR 455.436 using the General
Services Administration’s Excluded Parties List System (EPLS) and the U.S
HHS, Office of the Inspector General’s (HHS-OIG’s) List of Excluded
Individual and Entities (LEIE) to determine if any of its owners, officers,
principals, agent or employees whether paid or voluntary, have been
suspended or excluded or terminated from the Medicare or Medicaid
programs.

2. The Contractor shall submit a monthly report. Monthly reports shall be
submitted by the 15th day of the following month to the CA of the results of
the exclusion searches with a minimum of the following:
a) Name (e.g. Attendant, driver, subcontractor);
b) Job title (e.g. Attendant, driver, subcontractor);
c) Transportation Provider Name;
d) The date the Contractor performed the exclusion search;
e) Name of the excluded party database (e.g. OIG, EPLS);
f) Status of exclusion if applicable;
g) Exclusion type if applicable; and
h) The date of the exclusion

C.5.25.2.18 Transportation Provider Expiring Insurance Report

The Contractor shall notify the Transportation Provider in writing within 90 days
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in advance of the expiration date of applicable insurance policy(s). The
Contractor shall provide the CA with a copy of the insurance policy expiration
report monthly.

C.5.25.2.19 Vehicle Inspection and Monitoring Process Report

The Contractor shall develop a vehicle inspection and monitoring process that
ensures all Transportation Provider vehicles comply with the TPSA standards.
This report shall include:
1. An internal inspection and monitoring system;
2. Initial inspections prior to service launch;
3. Annual inspections within 12 months of the previous inspection;
4. Complaint-triggered or incident-based specific inspections;
5. Verification of ongoing compliance with local, state, federal, and
manufacturer safety and maintenance standards; and
6. Testing of communication equipment during inspections.

C.5.25.2.20 Driver and Attendant Inspection and Monitoring Process Report

The Contractor shall develop a monitoring process for all drivers and Attendants
under the TPSA. This report shall include:
1. Verification of current driver’s licenses;
2. Updated criminal background and driving record checks;
3. Results and procedures for random drug screenings;
4. Current First Aid and CPR certifications; and
5. Completion of all required training and education.

C.5.25.2.21 Adverse Weather Plan

The Contractor shall submit a written plan for transporting Beneficiaries who
require critical medical care during adverse weather conditions. The report shall:
1. Define procedures for extreme heat, cold, hurricanes, tropical storms,
flooding, tornado warnings, and heavy snowfall; and
2. Detail protocols to ensure uninterrupted transportation for critical needs.
C.5.25.2.22 Independent Audit Report
The Contractor shall retain an independent audit firm to assess the internal
accounting controls and administration procedures for the District’s NEMT
services. This report shall:
1. Identify any material weaknesses in administration;
2. Evaluate compliance with generally accepted accounting principles; and
3. Assess alignment with sound business practices.
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C.5.25.3 Operational Manuals and Policies and Procedures

C.5.25.3.1 The Contractor shall develop and provide Operational Manuals and Policies and
Procedures to describe the delivery of NEMT services.

C.5.25.3.2 The Contractor shall ensure that each Transportation Provider maintains
compliance with the established policies and procedures, as well any revisions or
updates that the Contractor may issue.

C.5.25.3.3 The Contractor shall at a minimum maintain the following manuals and policies
and procedures to be used in the training and education:
1. Transportation Providers, Drivers, and Attendants;
2. Beneficiary education plans; and
3. The Contractor’s staff, and as reference documents for Transportation
Providers and their staff, the Contractor’s staff, medical care providers, and
any other related party requesting information regarding the NEMT program:
a) Operating Policies and Procedures Manual;
b) Transportation Provider Manual;
c) Systems Manual;
d) Users Documentation Manual; and
e) Quality Assurance Plan.

C.5.25.3.4 The Contractor shall submit the NEMT Services Operating Policies and
Procedures Manuals for the review and approval of the CA within 10 business
days after the kickoff meeting.

C.5.25.3.5 Policies and Procedures and Manuals
1. The Contractor shall develop and provide all operations, provider and training
manuals, plans and materials to be used for Beneficiary, provider and staff
training and on-going education to the CA. The Contractor shall coordinate
with the CA to ensure that the content, developed by the Contractor, for each of
the NEMT program’s policies and procedures, manuals, and plans is accurate,
complete, and current.

2. The Contractor shall receive the written approval of the CA prior to the
issuance and distribution of forms, informational and educational materials,
manuals, training documents and equipment, and any other printed material
and equipment used to perform services under the Contract.

3. The Contractor shall submit all training materials to the CA for approval at
least 60 days prior to the training session. DHCF shall have 10 business days to
review and request changes, if necessary. If changes are requested, the
Contractor shall resubmit the training material within 10 business days of
receipt of the CA’s comments. The Contractor shall provide documentation of
all formal training activities and individualized corrective action assistance to
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the CA on a quarterly basis. Quarterly reports shall be submitted within 30
days following the end of the preceding quarter.

C.5.25.3.6 Operating Policies and Procedures Manual
C.5.25.3.6.1 The Contractor shall develop an Operations Procedure Manual detailing
procedure to be used in the scheduling and delivery of Transportation Services.
The Operations Procedures Manual shall be submitted to the CA for review and
approval 30 days after the kickoff meeting. The Contractor shall incorporate
modifications required by DHCF within 10 business days of notification into the
manual. The Contractor shall obtain written approval from the CA for the
Contractor’s Operations Procedures Manual prior to beginning the Operational
Phase of the Contract.

C.5.25.3.6.2 The Contractor’s Operations Procedure Manual shall be incorporated into all
training programs for the Contractor’s current staff and new hires, the
Contractor’s orientations for Transportation Providers and Transportation Provider
orientations. The manual shall also be provided to all Transportation Providers
with whom the Contractor has entered a TPSA. The manual shall be utilized in a
Transportation Provider orientation program to be provided by the Contractor to
Transportation Providers prior to starting service.
C.5.25.3.6.3 Operations Procedure Manual Updates
The Contractor shall review and update the Operations Procedure Manual
whenever changes in the operation of the NEMT services are made or at a
minimum yearly. Updates to the manual shall be approved in writing by the CA
before distribution. The District reserves the right to require modifications to the
Operations Procedure Manual throughout the life of the Contract. Required
updates shall be submitted to the CA for approval within 10 business days of the
request. The Operations Procedure Manual developed under the Contract shall
become the property of the District, which reserves the right to share selected text
with other Medicaid agencies for the purpose of improving related District
government manuals.

C.5.25.3.7 Transportation Provider Manual
C.5.25.3.7.1 The Contractor shall provide a copy of the Transportation Provider Manual to the
CA at least 40 days prior to the Operation Start date.

C.5.25.3.7.2 The Contractor shall ensure that each Transportation Provider under a TPSA is
provided an approved Transportation Provider Manual.
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C.5.25.3.7.3 Transportation Provider Manual Updates
The Contractor shall review and update the Transportation Provider Manual
whenever changes in the operation of the NEMT services are made or at a
minimum yearly. Updates to the manual shall be approved by the CA before
distribution. The District reserves the right to require modifications to the manual
throughout the life of the Contract. Required updates shall be submitted to DHCF
for approval within 10 business days of the request. The Transportation Provider
Manual developed as part of the Contract shall become the property of DHCF,
which reserves the right to share selected text with other Medicaid agencies for
the purpose of improving related District government manuals.

C.5.25.3.8 Systems Design Manual

C.5.25.3.8.1 The Contractor shall provide the Systems Design Manual to the CA within 30
days after the kickoff meeting.

C.5.25.3.8.2 Systems Design Manual Updates
The Contractor shall review and update the Systems Design Manual whenever
changes in the operation of the NEMT services are made or at a minimum yearly.
Annual reports shall be submitted within 90 days prior to the (12th) of the month
after the effective date of the Contract. Updates to the manual shall be approved in
writing by the CA before distribution. The District reserves the right to require
modifications to the Systems Design Manual throughout the life of the Contract.
Required updates shall be submitted to the CA for approval within 10 business
days of the request. The Systems Design Manual developed as part of the
Contract shall become the property of DHCF, which reserves the right to share
selected text with other Medicaid agencies for the purpose of improving related
District government manuals.

C.5.25.3.9 Users Documentation Manual

C.5.25.3.9.1 The Contractor shall develop a comprehensive document that provides users with
details on how to schedule and assign trips using the automated system. This User
Documentation Manual shall include detailed instruction on the specific use of the
Contractor’s automated systems used to authorize services, schedule and assign
trips. The Contractor shall provide the User Documentation Manual to the CA at
least 40 days prior to the Operational start date of the Contract.

C.5.25.3.9.2 Users Documentation Manual Updates

The Contractor shall review and update the User Documentation Manual
whenever changes in the operation of the NEMT services are made or at a
minimum yearly. Updates to the manual shall be approved in writing by the CA
before distribution. The District reserves the right to make modifications to the
Systems Design Manual throughout the life of the Contract. Required updates
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shall be submitted to the CA for approval within 10 business days of the request.
The User Documentation Manual developed as part of the Contract shall become
the property of DHCF, which reserves the right to share selected text with other
Medicaid agencies for the purpose of improving related District government
manuals.

C.5.26 The Contractor shall provide operational tasks for Staffing, Training, and Education.

The Contractor shall provide adequate staffing with the variety and required skill sets,
organization, and supervision to successfully manage and administer the NEMT services
program.

C.5.26.1 The Contractor shall provide full-time on-site, local Key Personnel, each of whom is
an employee of Contractor, meeting the following requirements:

C.5.26.1.1 Program Director

Position Title Program Director Minimum Years of
Experience 5
Functional Responsibilities:
The Program Director holds overall responsibility for all DC NEMT Contractor functions and
possess the authority to allocate resources to meet Contract requirements without service
interruption to Beneficiaries. This individual serves as the District’s single point of contact, is
required to be on-site full-time. The Program Director shall demonstrate leadership, project
management skills, and knowledge of healthcare, Managed Care, Medicaid, and service
delivery to low-income populations.
Minimum Experience:
Relevant professional experience in transportation provider network management, NEMT, and
logistics coordination.
Minimum Education:
A Bachelor’s degree from an accredited institution in either of the following: Public
Administration, Health Administration, Social Work, Education, or related fields.
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C.5.26.1.2 Senior Manager, Call Center Operations

Position Title Senior Manager Call Center
Operations
Minimum Years of
Experience 5
Functional Responsibilities:
Responsible for the overall performance of the call center operations, including the enrollment of
Beneficiaries and management of the Customer Service Hotline. This manager has authority over
all staff, activities related to Beneficiary service operations and fiduciary responsibilities.
Minimum Experience:
Proven experience implementing call center performance metrics (e.g., ASA, abandonment rate,
FCR), Experience with healthcare regulations (e.g., HIPAA) and handling Protected Health
Information (PHI), and experience with the following areas in Communications, Management,
Health Administration, Social Work, Business Administration. Project management skills,
knowledge of healthcare, Medicaid programs; experience with low-income populations; and
leadership experience.
Minimum Education:
A Bachelor’s degree from an accredited institution in either of the following: Communications,
Management, Health Administration, Social Work, Business Administration, or related fields.

C.5.26.1.3 Call Center Supervisor

Position Title Call Center Supervisor Minimum Years of
Experience 3
Functional Responsibilities:
Responsible for training and motivating call center representatives, supporting them in handling
inquiries, complaints, and general support to Beneficiaries. This role includes monitoring
performance, assisting in hiring and training, and coaching staff to ensure service excellence.
Minimum Experience:
Knowledge of call center technologies (e.g., ACD, CRM systems), at least 3 years of experience
providing coaching and quality assurance monitoring for frontline agents, with at least 3 years of
experience in a leadership role in a call center or customer service environment overseeing staff
performance, quality assurance, and daily operations.
Minimum Education:
An associate’s degree from an accredited institution in either of the following: Communications,
Management, Health Administration, or related fields.
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C.5.26.1.4 Senior Manager, Transportation Provider Network

Position Title
Senior Manager of
Transportation Provider
Network
Minimum Years of
Experience

5
Functional Responsibilities:
Manages daily operations of the Transportation Provider Network and ensures compliance with all
federal, state, and contractual requirements. This individual is responsible for coordinating all
network-related activities, maintaining provider readiness, and fiduciary responsibilities.
Minimum Experience:
Relevant professional experience in transportation provider network management, NEMT, and
logistics coordination. Project management skills, knowledge of healthcare, Medicaid programs,
experience with low-income populations; and leadership experience.
Minimum Education:
A Bachelor’s degree from an accredited institution in either of the following: business
administration, logistics, transportation management, public administration, or related fields.

C.5.26.1.5 Senior Manager, Complaints and Grievances

Position Title Senior Manager of
Complaints and Grievances
Minimum Years of
Experience 5
Functional Responsibilities:
Oversees the complaint, grievance, and appeals processes, including managing the dedicated
telephone line, all related staff and operations, and fiduciary responsibilities. This individual
ensures timely and compliant resolution of beneficiary issues.
Minimum Experience:
Experience with root cause analysis, case tracking, reporting, and regulatory compliance,
Knowledge of Medicaid grievance and appeal processes and relevant federal/state regulations. As
well as experience in complaints, grievances management, appeals, and member services within
healthcare, managed care or regulatory environment. Project management skills, knowledge of
healthcare, Medicaid programs, experience with low-income populations; and leadership
experience.
Minimum Education:
A Bachelor’s degree from an accredited institution in either of the following: Healthcare
administration, public health, business administration, social work or a related field.
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C.5.26.1.6 Senior Manager, Education and Training (Transportation Providers and
Beneficiaries)

Position Title
Senior Manager Education and
Training (Transportation
Providers and Beneficiaries)
Minimum Years of
Experience

5
Functional Responsibilities:
Leads all educational, training, and outreach initiatives targeted at Transportation Providers and
Beneficiaries. Responsible for developing, coordinating, and evaluating program awareness and
training materials, and fiduciary responsibilities.
Minimum Experience:
Experience creating culturally competent training for diverse populations, including individuals with
disabilities, Knowledge of adult learning principles, curriculum development, and learning
management systems (LMS). Experience collaborating with both internal staff and external vendors
to ensure compliance and consistent service standards, additionally experience in education training
of transportation program delivery. Project management skills, knowledge of healthcare, Medicaid
programs, experience with low-income populations; and leadership experience.
Minimum Education:
A Bachelor’s degree from an accredited institution in either of the following: Education, Public
Health, Communications, Transportation Management or a related field.

C.5.26.1.7 Senior Manager, Information System (IS)

Position Title Senior Manager IS Minimum Years of
Experience 5
Functional Responsibilities:
Oversees internal IT systems and manages interfaces with MMIS, IVR, ESA, and future data
warehouses. Ensures data collection, analysis, reporting systems support contract operations, and
fiduciary responsibilities. This position shall be based in the corporate office.
Minimum Experience:
Experience managing system integrations, data security protocols (including HIPAA
compliance), and transportation scheduling or dispatch platforms, Demonstrated ability to
oversee database administration, cybersecurity, and reporting solutions, additionally experience
in information systems or IT management. Project management skills, knowledge of healthcare,
Medicaid programs, experience with low-income populations; and leadership experience.
Minimum Education:
A Bachelor’s degree from an accredited institution in either of the following: information
technology, computer science, information systems, or a closely related field.
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C.5.26.1.8 Data and Reporting Manager

Position Title Data and Reporting Manager Minimum Years of
Experience 5
Functional Responsibilities:
Dedicated to collecting and analyzing transportation utilization data. Responsible for preparing
the required contract and ad hoc reports to support program performance evaluation.
Minimum Experience:
Relevant experience in data management, analysis, reporting, including demonstrated proficiency
with data visualization tools (Tableu, Power BI), SQL and statistical analysis.
Minimum Education:
A Bachelor’s degree from an accredited institution in either of the following: data analytics,
statistics, computer science, information systems, public health, business administration or a
closely related field.

C.5.26.1.9 Transportation Ombudsman

Position Title Transportation Ombudsman Minimum Years of
Experience 3
Functional Responsibilities:
A full-time position dedicated to acting as an independent advocate for Beneficiaries to
investigate and resolve issues related to NEMT services. Works collaboratively with stakeholders
and the District to adjudicate complaints. Shall be free from conflicts of interest and any undue
influence by the Contractor.
Minimum Experience:
Relevant experience in customer advocacy, complaint resolution, and transportation program
services.
Minimum Education:
A Bachelor’s degree from an accredited institution in either of the following: social work, public
administration, transportation management, communications, conflict resolution or a closely
related field.
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C.5.26.1.10 Field Monitor

Position Title Field Monitor Minimum Years of
Experience 3
Functional Responsibilities:
Field staff responsible for monitoring Transportation Providers' service delivery, including
vehicle condition, driver performance, and contract compliance. Ensures quality control in field
operations. Possession of a valid driver’s license and a clean driving record.
Willingness and ability to travel extensively within assigned service areas, including regular
fieldwork at provider locations. Familiarity with transportation regulations, ADA requirements,
and Department of Transportation (DOT) standards.
Minimum Experience:
Knowledge of vehicle safety standards, ADA compliance, and NEMT regulations. Experience in
conducting on-site inspections, driver/vehicle audits, adherence to safety protocols, and
preparation of written reports. Familiarity with NEMT or public transportation programs.
Minimum Education:
A high school diploma or equivalent with verifiable experience in transportation operations, field
inspections, logistics, and compliance monitoring.

C.5.26.1.11 Staff Assistant

Position Title Staff Assistant Minimum Years of
Experience 3
Functional Responsibilities:
Provides administrative support to the Program Director and key staff. Responsible for assisting
with daily operational tasks and facilitating internal office coordination and communication.
Minimum Experience:
Relevant experience using office software, data entry, document preparation and basic filing, and
record keeping. Familiarity with scheduling, correspondence management and support for
program staff.
Minimum Education:
A high school diploma or equivalent with experience in administrative support, clerical duties,
and customer service in an office or program setting.

C.5.26.1.12 The Contractor shall provide each Key Personnel with a mobile telephone.
C.5.26.1.13 The Key Personnel shall directly report to the Program Director.
C.5.26.1.14 The Key Personnel shall work in the Washington, DC office.
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C.5.26.1.15 The Contractor shall provide the District with mobile telephone numbers for Key
Personnel and with an administrative phone number to directly contact
Contractor’s other staff without having to go through the Call Center. In case of
an urgent situation, the Contractor shall ensure that staff are available to answer
the administrative phone number 24 hours a day and seven days per week.

C.5.26.1.16 Kery Personnel shall be available to the Contractor’s staff in person or by
telephone within a 60-minute response time during the CBO hours of operation.

C.5.26.1.17 The Contractor shall provide all staff with training pre-approved by the CA in
writing, annually that includes, but is not limited to, NEMT policy, call center
procedures, HIPAA, Protected Health Information, cultural sensitivity training,
customer service skills, and training for handling difficult callers.

C.5.26.1.18 The Contractor shall not divert Key Personnel for any period except in accordance
with the procedure identified in this section. For purposes of this solicitation,
Diversion is defined in Section C.3.28.

C.5.26.1.19 The Contractor shall provide a written notice of proposed Diversion of Key
Personnel to the CA at least 60 days in advance of a proposed date of change,
together with the name and qualifications of the person(s) who will replace the
diverted Key Personnel. At least 30 days before the proposed Diversion, the CA
will notify the Contractor in writing whether the proposed Diversion is approved
or rejected. The Contractor shall ensure replacement staff approved by the CA is
on-site at least two weeks prior to the departure date of the diverted Key
Personnel member.

C.5.26.1.20 The Contractor shall replace Key Personnel, who have left employment for
reasons other than Diversion, with people of equal ability and qualifications. The
CA shall have the right to conduct separate interviews for proposed replacements
for Key Personnel. The CA has the right to approve, in writing, the replacement of
Key Personnel. If the replacement of a Key Personnel is not accepted by the CA
and there is no replacement accepted and beginning work by a date previously
determined by the CA, the Contractor shall be subject to liquidated damages in
the same manner as provided in the event of unapproved Diversion of Key
Personnel.

C.5.26.1.21 The Contractor shall remove any Key Personnel that is reasonably determined by
the CA to be non-cooperative, inept, incompetent, unethical, or otherwise
unacceptable, after the CA gives the Contract or written notice of such
problematic behavior, and the Contractor has been given 30 days to remedy the
problems identified with the Key Personnel and has failed to do so. In the event
that a Key Personnel is removed pursuant to instruction by the CA, the Contractor
shall fill the vacancy within 30 days with a newly hired candidate with acceptable
experience and skills subject to the prior written approval of the CA.
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C.5.26.2 Other Staff
In addition to the Key Personnel, the Contractor shall maintain sufficient clinical
staff, including the following positions, to oversee clinical determinations, and
reviewing the Level of Need (LON) forms submitted to the Contractor:

C.5.26.2.1 Registered Professional Nurse (“RN”): Currently licensed, registered and is in
good standing within District of Columbia, Maryland, and Virginia. The RN will
make overall decisions for prior authorizations for services, will investigate each
prior authorization request, will assist with implementation of education training
material and help facilitate trainings for the transportation providers as well as all
Contractor staff, will oversee the LON process and help make determinations of
best mode of transportation needed, Oversee the IDD requests, will work
diligently with Department of Disability Services directly and will implement a
system to monitor the travel training for the Beneficiaries;

C.5.26.2.2 The Contractor shall maintain sufficient levels of supervisory and support staff
with appropriate training and work experience to perform all Contract
requirements on an on- going basis, ensure that its staff responds to the CA’s
requests for documents and information and CA’s questions and requests within
one business day. The Contractor shall maintain at a minimum the following:

1. Supervisory Staff shall be readily available to the Contractor’s staff in person
or by telephone during CBO hours of operation;
2. Support Staff
a) Network Development- Staff shall handle the negotiation and enforcement
of TPSA with the Transportation Providers and monitor insurance
certificates daily to ensure all insurance policies are current;
b) Readiness Review Staff - The Contractor shall provide sufficient staff
devoted to the readiness review process;
c) Customer Service Representatives – The Contractor shall provide customer
service representatives for the call center to receive, schedule, and assign
NEMT services; and
d) Complaints and Grievances Staff - The Contractor shall maintain the
necessary staff and resources needed to expeditiously resolve, complaints
and issues identified by the advisory group, surveys and or complaints
filed.
C.5.26.2.3 The Contractor shall remove any of the Contractor’s staff that is reasonably
determined by the CA to be non-cooperative, inept, incompetent, unethical, or
otherwise unacceptable, after the CA from the District gives the Contract written
notice of such problematic behavior, and the Contractor has been given 30 days to
remedy the problems identified with the staff and has failed to do so. In the event
that a staff person is removed pursuant to instruction by the CA, the Contractor
shall fill the vacancy within 30 days with a newly hired candidate with acceptable
experience and skills subject to the prior written approval of the CA.
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C.5.26.3 The Contractor shall provide a finalized Staffing Plan, within thirty business days of
award, that includes an Organizational Chart and supporting documentation. The
Staffing Plan shall, at a minimum, identify the Contractor’s Key Personnel, other
staff, and define the duties of staff within the Contractor’s CBO. The Organizational
Chart shall clearly depict the total number of staff by position, reporting lines,
supervisory levels, and any vacant positions. It shall also include position descriptions
that outline the minimum qualifications, training, and education requirements for each
position. Additionally, the Staffing Plan shall provide a roadmap detailing how the
Contractor will recruit and retain Key Personnel.

C.5.26.4 Staff Training and Education Plan

The Contractor shall develop and implement a staff training and education plan to
serve as a comprehensive training manual and reference for the Contractor’s staff.
The Staff Training and Education Plan shall be developed and submitted for the
review and approval of the CA within 60 days after the kickoff meeting. The Staff
Training and Education Plan shall describe at a minimum the following:

C.5.26.4.1 Staff Orientation
The Contractor shall ensure that all staff receive an onboarding orientation to
include at a minimum the following prior to providing service:

1. Overview of NEMT Program and division of responsibilities between the
Contractor and Transportation Providers;
2. Intake Procedures;
3. Eligibility determination and verification;
4. Necessity of Services;
5. Appropriate Mode of Transportation;
6. Scheduling of Transportation Services;
7. Procedures for notifying Beneficiaries when services are denied or terminated
by the Contractor;
8. Criteria and procedures for documenting and notifying Beneficiaries when
services are denied or terminated by the Transportation Provider;
9. Vehicle requirements, insurance coverage, licenses, permits, and certifications;
10. Drivers and Attendants qualifications, responsibilities, and conduct;
11. Pick-up and delivery standards;
12. Covered and non-covered Beneficiaries;
13. Covered Transportation Services and Non-covered Transportation Services;
14. Support Services:
a) Telephone and Communication;
b) Computer;
c) NEMT program Operating Manuals;
i. Operational Procedures;
ii. Transportation Provider Manual;
iii. Systems Manual;
iv. User Manual;
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v. Quality Assurance Plans;
vi. Monitoring and Oversight;
vii. Complaint and Grievance Policy;
viii. Accidents, Unusual Incidents;
ix. Moving violations and Vehicle breakdowns; and
x. In-climate Weather.
15. Reporting Requirements:
a) Client Satisfaction Survey Report;
b) Complaint Log;
c) Responses;
d) Encounter Data Reports;
e) Accident & Moving Violations Report;
f) Transportation Services – Summary Report;
g) IDD Waiver Reports;
h) Beneficiary No-Show Report;
i) Driver Reports; and
j) Daily Manifests.
16. Record Maintenance and Retention:
a) Transportation Provider records;
b) Vehicle records; and
c) Drivers and Attendants records.
17. Confidentiality of Beneficiary information;
18. Payment and Payment Administration;
a) Procedures for obtaining reimbursement for authorized trips;
19. Non-compliance with standards;
20. Customer Service;
21. DDS Training;
22. Cultural Competency; and
23. Diversity LGBTQ, Pronouns and Inclusive Language Training.

C.5.26.4.2 Customer Service Training Manual
The Contractor shall develop and implement a customer service education and
training course for all staff having direct contact with Beneficiaries,
Transportation Providers, or health care providers prior to permitting any
personnel to have public contact or answer call center lines.

C.5.26.4.2.1 The Contractor’s Customer Service Training Manual shall be developed and
submitted for the review and approval of the CA within 60 days after the kickoff
meeting.

C.5.26.4.2.2 The Contractor’s Customer Service Training Manual shall include the following:
1. Sensitivity components dealing with aged and disabled persons;
2. Multicultural contacts;
3. Handling hostile callers;
4. Public contact;
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5. Communicating with hearing or speech impaired individuals through a service
such as the District’s Relay Center;
6. Intake process and procedures including eligibility verification, determining
the necessity of services, Appropriate Mode of Transportation, and scheduling
of services;
7. Cultural Competency;
8. Diversity LGBTQ, Pronouns & Inclusive Language Training; and
9. DDS Training
a) Most Integrated Settings;
b) Behavior Support Plan (BSP)/Restricted Controls;
c) Basic Assurances/Quality Enhancement;
d) Individual Support Plan (ISP) policy;
e) Psychotropic Medications;
f) Adaptive Equipment;
g) Medical/Dental;
h) Incident Management; and
i) DDS policies pertaining to transportation for Medicaid FFS or IDD waiver
Beneficiaries.

C.5.26.4.3 Continuing Staff Training and Education Plan
The Contractor shall develop and implement continuing staff training and
education sessions to be provided to the Contractor’s staff at a minimum
quarterly.

C.5.26.4.3.1 The Contractor’s Continuing Staff Training and Education Plan shall provide the
opportunity to update staff on policy changes, procedure changes, and other
NEMT services program updates.
C.5.26.4.3.2 The Contractor’s Continuing Staff Training and Education Plan shall be submitted
for the review and approval of the CA within 90 days after the kickoff meeting.
C.5.26.4.4 Training and Education Plan Presentation and Training Materials
The Contractor shall develop and provide all curriculums, presentation and
training materials to be utilized in training and education of the Contractor’s staff
including:
a) Staff Orientation (C.5.25.5.1);
b) Customer Service Training Manual (C.5.25.5.2); and
c) Continuing Staff Training and Education Plan (C.5.25.5.3).

C.5.26.4.4.1 The Contractor shall develop and submit presentation and training materials for
the Staff Orientation and Customer Service Manual for the review and approval of
the CA within 60 days after the kickoff meeting, and within 90 days after the
kickoff meeting for the Continuing Staff Training and Education Plan.
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C.5.26.4.5 Training and Education Evaluation Tool

The Contractor shall develop and administer an evaluation tool for each of the
Contractor’s training and education sessions to assess the overall effectiveness
and perception of the Contractor’s training and provide training and education
attendees the opportunity to assess all aspects of the training, providing the
Contractor with data to consider changes and modifications to improve the
training and education sessions the Contractor provides. The Contractor shall
develop and submit the evaluation tool for the review and approval of the CA
within 60 days after the kickoff meeting.

C.5.26.5 Provider Education & Staff Training

C.5.26.5.1 Transportation Provider Relations and Education
The Contractor shall maintain provider relations that foster and encourage a
positive constructive working relationship between the Contractor and the
Transportation Provider intending to produce effective, efficient, quality service
delivery of NEMT services.

C.5.26.5.2 Transportation Provider Training and Education Plan
The Contractor shall develop and implement a training and education plan for
Transportation Providers and their drivers and Attendants.

C.5.26.5.2.1 The Contractor shall provide an adequately equipped facility to accommodate the
appropriate number of attendees in an environment that facilitates and supports
the training initiative. The Contractor shall utilize the Contractor’s facility, the
Transportation Provider’s facility, or other appropriate facilities.

C.5.26.5.2.2 The Transportation Provider’s Training and Education Plan shall be developed
and implemented to provide the Transportation Providers a thorough
understanding of the NEMT services and the knowledge to make maximum
contributions to the success of the program.

C.5.26.5.2.3 The Transportation Provider Training and Education Plan shall be submitted to
the CA for review and approval within 30 days after the kickoff meeting. The plan
shall include at a minimum the following:
C.5.26.5.2.3.1 Transportation Provider Orientation
The Contractor shall develop and provide an orientation of NEMT services
and the key program features for each Transportation Provider selected as part
of the Contractor’s Network that has entered into a TPSA with the Contractor.

C.5.26.5.2.3.1.1 The orientation shall be conducted 30 days prior to the Operation Start date of
Contract and shall consist of, at a minimum, the following topics, areas, and
subjects:
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1. Overview of the NEMT Program and division of responsibilities between
the Contractor and Transportation Providers;
2. Prior Authorization procedures;
3. Covered and non-covered Beneficiaries;
4. Eligible Beneficiaries verification;
5. Covered Transportation Services and Non-covered Transportation
Services;
6. Necessity of Services;
7. Appropriate Mode of Transportation;
8. Scheduling of Transportation Services;
9. Procedures for notifying Beneficiaries when services are denied or
terminated by the Contractor;
10. Criteria and procedures for documenting and notifying Beneficiaries when
services are denied or terminated by the Transportation Provider;
11. Vehicle requirements, insurance coverage, licenses, permits, and
certifications;
12. Drivers’ and Attendants’ qualifications, responsibilities, and conduct;
13. Pick-up and delivery standards;
14. Modes of transportation;
15. Support Services
a) Telephone and Communication;
b) Computer;
c) NEMT program Operating Manuals;
i. Operational Procedures;
ii. Transportation Provider Manual;
iii. Systems Manual;
iv. User Manual;
v. Quality Assurance Plans;
1. Quality Assurance Plans;
2. Monitoring and Oversight;
3. Complaint and Grievance Policy;
4. Accidents, Unusual Incidents, Moving violations and Vehicle
breakdowns; and
5. In-climate Weather
d) Reporting Requirements
i. Client Satisfaction Survey Report;
ii. Complaint Log;
iii. Responses;
iv. Encounter Data Reports;
v. Accident & Moving Violations Report;
vi. Transportation Services – Summary Report;
vii. Beneficiary No-Show Report;
viii. Provider No-Show Report;
ix. Driver Reports; and
x. Daily Manifests.
e) Record Maintenance and Retention
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i. Transportation Provider records;
ii. Vehicle records; and
iii. Drivers and Attendants records.
f) Confidentiality of Beneficiary or patient information;
g) Payment and Payment Administration;
h) Procedures for obtaining reimbursement for authorized trips;
i) Non-compliance with standards; and
j) Federal False Claims Act

C.5.26.5.2.3.1.2 Comprehensive Training and Education Sessions
The Contractor shall provide comprehensive education and training to each
NEMT Transportation Provider prior to the startup of services and continue, at
a minimum, quarterly through the life of the Contract.

C.5.26.5.2.3.1.2.1 The Contractor shall also provide any updates, policy changes, and
Contracts addendums, operational or organizational structural changes to
Transportation Providers at least 30 days, prior to implementation.

C.5.26.5.2.3.1.2.2 The Contractor’s training shall include, but not be limited to, training in
the following related areas:
1. Trip documentation and signature authorization;
2. Defensive driving techniques;
3. On-time performance criteria;
4. Proper wheelchair tie-down procedures;
5. Correct wheelchair lift procedure (electric and manual);
6. Beneficiary assistance while boarding;
7. Vehicle rules for Beneficiaries;
8. Proper stretcher mounting procedures;
9. Uniform requirements;
10. Driver and Attendant Identification;
11. Driver conduct;
12. Emergency evacuation procedure for vehicles;
13. Emergency vehicle roadside safety;
14. Proper cellular phone/two-way radio etiquette;
15. Trip reimbursement process and Encounter Data submission;
16. Invoice due dates;
17. Required documentation needed prior to service;
18. Monthly, quarterly, annual reports due to Contractor, if applicable;
19. Basic first aid and CPR;
20. Emergency Procedures;
21. Safety procedures; and
22. Assisting Passengers with Developmental Disabilities (DDS guidelines
and courses).
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C.5.26.5.3 Driver and Attendant Training and Education

C.5.26.5.3.1 The Contractor shall establish and implement driver and Attendant training and
education. The Contractor shall establish and implement driver and Attendant
training standards in lieu of the standards established below subject to advance
review and written approval of the CA.

C.5.26.5.3.2 The Contractor shall ensure that all Drivers and Attendants providing service under
a TPSA successfully complete, at a minimum, the following training and
education prior to providing NEMT services to Beneficiaries:

1. Driver training, including defensive Driving training;
2. First aid and CPR training;
3. Spill kit training;
4. Removal of biohazards training;
5. A passenger assistance orientation program;
6. Driver reporting requirements training;
7. A safety and sensitivity program to ensure a safe operating environment;
8. Emergency and accident procedures;
9. Customer service training; and
10. DDS Training courses.

C.5.26.5.3.3 The Contractor shall provide documentation at the Operation Start date that
Drivers have completed training and education requirements.

C.5.26.5.4 IDD Waiver Beneficiaries Training

C.5.26.5.4.1 The Contractor shall develop a training course for direct Transportation Providers
and Air Ambulance Service provider that deliver services to IDD waiver
Beneficiaries with a Developmental Disability. The Contractor shall ensure that
the training course shall incorporate the requirements of DDS transportation
policies and procedures (C.2.1 Applicable Document #15) prior to providing
service.

C.5.26.5.4.2 The Contractor shall ensure that Transportation Providers transporting IDD
Waiver Beneficiaries attend and successfully complete the IDD waiver training
courses prior to providing NEMT services.
C.5.26.5.4.3 The Contractor’s IDD waiver training course shall include at a minimum the
following DDS specific areas as they relate to Medicaid FFS or IDD waiver
Beneficiaries. The IDD waiver training courses shall include the following:

1. Most Integrated Settings;
2. Behavior Support Plan (BSP)/Restricted Controls;
3. Basic Assurances/Quality Enhancement;
4. Individual Support Plan (ISP) policy;
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5. Psychotropic Medications;
6. Adaptive Equipment;
7. Medical/Dental;
8. Incident Management;
9. DDS policies pertaining to transportation for Medicaid FFS or IDD waiver
Beneficiaries; and
10. American with Disabilities Act (ADA) (C.2.1 Applicable document #5).

C.5.26.5.4.4 The Contractor shall provide documentation at the Operation Start date that
Drivers have completed the IDD Waiver training and education requirements.

C.5.26.5.5 Provider/Driver Specific Individualized Training and Education
The Contractor shall provide individual training and education as needed and as
requested by providers. The Contractor’s Transportation Provider, driver, or
Attendant specific training shall address policy, procedure, and other pertinent
provisions of the NEMT program to address issues to facilitate improved
performance.

C.5.26.5.6 Training and Education Plan Attendance, Presentation, and Training Materials

C.5.26.5.6.1 The Contractor shall maintain records of attendance and provide all curriculums,
presentation and training materials to be utilized in Transportation Provider’s
Training and Education Plan including the following:

1. Transportation Provider Orientations (C.5.25.6.2.3.1);
2. Comprehensive Training and Education (C.5.25.6.2.3.1.2);
3. Driver and Attendant Training and Education (C.5.25.6.3);
4. IDD Waiver Beneficiaries Training (C.5.25.6.4); and
5. Provider/Driver Specific Individualized Training and Education (C.5.25.6.5).

C.5.26.5.6.2 The Contractor shall submit training materials to the CA for written approval at
least 60 days prior to the training session.

C.5.26.5.7 Training and Education Evaluation Tool
The Contractor shall develop and administer an evaluation tool for each of the
Contractor’s training and education sessions to assess the overall effectiveness
and perception of the Contractor’s training and provide training and education
attendees the opportunity to assess and provide feedback on all aspects of the
training. The Contractor shall submit the Training and Education Evaluation Tool
for the review and written approval of the CA within 60 days after the kickoff
meeting.

C.5.26.5.8 Stakeholder Outreach, Training and Education
The Contractor shall develop and implement a comprehensive Stakeholder
Communication Plan to train and educate health care providers, facilities (e.g.
hospitals, long-term care facilities, dialysis centers, health care clinics, day
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programs), and community-based organizations about NEMT services. The
Contractor shall schedule and coordinate a monthly outreach event and provide a
copy of the Stakeholder Communication Plan to the District. Monthly reports
shall be submitted by the 15th day of the following month to the CA.

C.5.26.5.9 Federal False Claims Act
The Contractor shall develop, implement, and maintain a comprehensive training
program for all employees, subcontractors, and any personnel engaged in the
provision of Non-Emergency Medical Transportation (NEMT) services. This
training shall include, at a minimum:

C.5.26.5.9.1 Education on the Federal False Claims Act (31 U.S.C. §§ 3729–3733), the District
of Columbia False Claims Act (D.C. Code §§ 2–381.01 et seq.), and any other
applicable fraud, waste, and abuse prevention requirements. Training shall cover
prohibited conduct, penalties for violations, whistleblower protections, and
reporting mechanisms.

C.5.26.5.10 Security Requirements

The Contractor’s employees when performing services under this Contract shall
not be in possession of any form of weapons or contraband; shall be subject to
search; shall conduct themselves in a professional manner at all times; shall not
cause any disturbance in a facility; and shall be subject to all other rules and
regulations of a facility and DHCF. The Contractor shall provide a copy of all
applicable rules and regulations to the employees. The Contractor shall ascertain
that each employee is issued a copy of said rules and signs a statement
acknowledging the receipt of said rules. The Contractor shall maintain the
acknowledgement of receipt in the individual employee’s personnel folder.

PART V: PERFORMANCE STANDARDS

C.5.27 Quantifiable Performance Standards
Performance standards are used to measure the quality of the delivered service and to
target corrective activities to achieve overall quality goals and are essential element of the
NEMT program. The Contractor shall ensure that the NEMT network is adequate to meet
the standards defined herein:
C.5.27.1 On-time Performance
1. Ninety percent (90%) of Transportation Providers are on-time per day;
2. No more than one-quarter of one percent (0.25%) of the trips are missed (provider
no-show) per day;
3. No more than ten percent (10%) of trips are late for Beneficiary pick up per day;
4. No more than five percent (5%) of trips are late for Beneficiary drop off to their
appointment per day; and
5. No more than 1.99% of cancellations are short-notice cancellations by
Transportation Provider per day.
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C.5.27.2 Complaint and Grievances
1. No more than 1.9 complaints per 1,000 trip legs; and
2. Ninety percent (90%) of all complaints shall be resolved per Contract guidelines.

C.5.27.3 Call Center
1. Monthly abandon rate is five percent (5%) or less for all of the Contractor’s call
centers; and
2. The monthly average for answering the call by a non-recorded voice is eighty-five
percent (85%) within 30 seconds.

C.5.27.4 Satisfaction Survey
1. No less than ninety-five percent (95%) Beneficiary satisfaction with Contractor’s
call center’s performance on a monthly independent survey;
2. No less than ninety-five percent (95%) Beneficiary satisfaction with network
Transportation Provider performance on a monthly independent survey; and
3. No less than ninety percent (90%) Beneficiary satisfaction with Transportation
Providers on an annual independent survey.

C.5.28 Denial of Service
C.5.28.1 The Contractor shall deny a request for Transportation Services or immediately
discontinue a trip for any Eligible Beneficiary for the following reasons:
C.5.28.1.1 Beneficiary refusal to cooperate in determining Beneficiary’s status of Medicaid
eligibility;
C.5.28.1.2 Beneficiary refusal to provide the documentation requested to determine need for
NEMT services;
C.5.28.1.3 Beneficiary is found to be ineligible for NEMT services on the basis of the
documented information that cannot be otherwise confirmed;
C.5.28.1.4 Beneficiary refuses the Appropriate Mode of Transportation determined by the
Contractor;
C.5.28.1.5 Beneficiary exhibits uncooperative or disruptive behavior, misuses/abuses NEMT
services, or abuses employees of the Contractor or provider(s), and such behavior
is not the result of a beneficiary’s special needs (except when the beneficiary’s
continued use of the service seriously impairs the contractor’s/provider’s ability to
furnish services to the beneficiary or other beneficiaries);
C.5.28.1.6 Beneficiary is not ready to board NEMT transport 10 minutes after the scheduled
pick-up time; or
C.5.28.1.7 Beneficiary fails to request a reservation three days in advance of appointment
without good cause. For purposes of this section “Good Cause” is created by
factors such as, but not limited to any of the following:
1. Urgent Care;
2. Post-surgical or medical follow-up care specified by a health care provider to
occur in fewer than three days;
3. Imminent availability of an appointment with a specialist when the next
available appointment would require a delay of two weeks or more; or
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4. Administrative or technical delays caused by the Contractor requiring that an
appointment be rescheduled.

C.5.28.2 The Contractor shall establish an immediate second level of review with a supervisory
level employee.

C.5.28.3 The Contractor shall send the Beneficiary a denial, and within 72 hours of the denial a
written explanation regarding the Beneficiary that was denied or terminated from
NEMT services, citing the specific reason for the denial or termination and the
Beneficiary’s right to appeal (see notice requirements) as well as Appeal procedures.
All costs of generating and sending denial notices shall be paid by the Contractor.

C.5.28.4 The Contractor shall consider reinstatement of denied services under certain
circumstances consistent with the 42 CFR 438.210.

C.5.29 Complaints and Resolutions
C.5.29.1 The Contractor shall record and respond to all complaints received related to the
NEMT services, including complaints by Beneficiaries or providers, the District, or
other individuals or groups, that contact the Contractor. The Contractor shall record
and respond to all complaints it receives. Resolution of complaints by the Contractor
is subject to the discretionary review and approval of the CA. The Contractor shall be
required to implement and submit proof of any corrective policies or procedures as a
result of the CA’s review.
C.5.29.2 The Contractor shall provide a written response when there is evidence of
professional misconduct, breach of Contract, regulatory or statutory violation, moral
turpitude or other unacceptable acts that will negatively affect the wellbeing of a
Beneficiary. The Contractor shall consider reported conduct or behavior having an
adverse effect on the health, safety, well-being or condition of a Beneficiary or
passenger associated with a Beneficiary while being transported a complaint.

C.5.29.3 The Contractor shall provide a verbal response to each complaint received within
three business days of the Contractor’s receipt of the complaint. The Contractor shall
provide a written response to the person filing the complaint within five business days
of the Contractor’s receipt of the complaint. Upon request, the Contractor shall
provide the CA with a written record of the complaint and resolution, including any
corrective action, within three business days the complaint. The CA will have three
business days to review the contractor’s proposed response for approval, or rejection.
The contractor should establish and maintain formal standardized written procedures
for handling all complaints, including documentation requirements. The Contractor’s
Policies and Procedures for Complaints shall be submitted for the review and
approval of the CA within 10 business days after the kickoff meeting.

C.5.29.4 The Contractor shall remove from public contact or provide a retraining program for
service personnel who receive two complaints determined by the Contractor to be
substantiated within a 90-day period. The Contractor shall remove from public
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contact any service personnel who is determined by the Contractor to be in violation
of the company’s rules determined through complaints that are substantiated within a
12 consecutive month period.

C.5.29.5 The Contractor shall ensure that a Transportation Provider removes from direct
contact with Beneficiaries or provide a retraining program for drivers who receive two
complaints determined by the Contractor to be valid within a 90-day period. The
Contractor shall ensure that a Transportation Provider removes from direct contact
with Beneficiaries any driver who has received 4 complaints determined by the
Contractor to be valid within a consecutive 12-month period.

C.5.29.6 The Contractor shall designate an individual within the Contractor’s organization to
act as liaison with the CA and DHCF to ensure prompt action is taken in regard to
complaints received regarding NEMT services. The Contractor shall remove a
Transportation Provider at the request of the District. The Contractor shall investigate
complaints received and if determined by the CA, remove from public contact or
require retraining for any personnel.

C.5.29.7 The Contractor shall compile an appropriate summary report and analyze complaints
on file monthly to determine the quality of services provided to Beneficiaries,
particularly noting patterns or trends of the complaints received. The original report
shall be sent to the CA monthly and shall include a description of corrective actions
the Contractor has taken to assure service delivery conforms to the requirements of
the Contract. The summary report shall be in accordance with the specifications and
format approved by the CA. Monthly reports shall be submitted by the 15th day of the
following month.

C.5.30 Beneficiary Complaint Process
C.5.30.1 The Contractor shall notify Beneficiaries of their right to file a complaint for
unsatisfactory services provided by a Transportation Provider. In the event a
Beneficiary wants to file a complaint, the Contractor shall provide the following: The
proper form, if requested in person, or process the Beneficiaries call through call
center or Quality Assurance unit established by the Contractor. Once the Contractor
documents all the pertinent information, the Contractor shall conduct a thorough
investigation of all parties involved.

C.5.30.2 The Contractor has three business days from the date a complaint is filed to complete
the investigation and provide the Beneficiary with a written response. The
Contractor’s response shall include, at a minimum, the specific reason for the service
failure, an explanation from the Transportation Provider, the Contractor’s corrective
action plan with a follow-up date, and the Beneficiary’s appeal rights as to the
corrective action. The Contractor shall mail or hand the original response letter to the
Beneficiary and maintain a copy in the Contractor’s file that is available for the CA’s
review.
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C.5.31 Beneficiary Complaint Appeals Process
The Contractor shall, at a minimum, perform the following if the Beneficiary elects to
file an appeal to the Contractor’s corrective action; the Beneficiary has 30 days from
the date of the receipt of the initial complaint.

C.5.31.1 The Contractor shall make available to the Beneficiary the Notice of Appeals Letter
developed by the Contractor for complaints.

C.5.31.2 The Contractor shall make available the appeals letter and any related documents that
are not classified as confidential to the Beneficiary. The Contractor shall provide a
written response to the Beneficiary’s appeal letter within three business days of the
day the request for appeal was received. The Contractor’s written response shall
include in detail, the specific reason for the initial decision being upheld or any
corrective action the Contractor shall take based on the appeal. The Contractor shall
certify mail or hand the response to the appeal to the Beneficiary and the Contractor
shall maintain a copy in its file available for audit, if needed.

C.5.31.3 The Contractor shall allow the Beneficiary 30 days from the date of the appeal
response to appeal to DHCF. The Beneficiary’s failure to file an appeal with DHCF
within 30 days of the Beneficiary’s receipt of the appeal response waives the
Beneficiary’s rights to further appeal. The Contractor shall inform or ensure that the
CA is informed of the Eligible Beneficiary’s appeal filing.

C.5.32 Beneficiary Denial Appeal Process
The Contractor shall provide the following in the event a Beneficiary appeals the
Contractor’s decision concerning a denial of service:
C.5.32.1 Provide written notice to the Beneficiary within three business days of the day the trip
was denied, suspended, or terminated. The notice shall include in detail, the specific
reason for denial, suspension or termination and an explanation of the Beneficiary’s
appeal rights. The Contractor shall mail or hand the Beneficiary the original notice
and the Contractor shall maintain a copy in its file available for audit, if needed. The
Contractor shall use the Notice of Appeals Letter developed by DHCF;

C.5.32.2 Provide the Beneficiary with a minimum of 30 days from the date of the notice to
appeal the initial decision. The Beneficiary’s failure to file an appeal within 30 days
from the Beneficiary’s receipt of the notice waives the Beneficiary’s right to further
appeal;

C.5.32.3 Upon receipt of a timely appeal, the Contractor has 30 days to complete the appeals
process. The Contractor shall provide the Beneficiary information regarding having
an opportunity to file an appeal at the Office of Administrative Hearings in the event
they are not satisfied with the Contractor’s complaints and grievance process; and

C.5.32.4 If the Beneficiary appeals to the Office of Administrative Hearings, the Contractor
shall defend its decision, if necessary, at the time of any administrative hearing.
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C.5.33 Grievances/Complaints

C.5.33.1 The Contractor shall develop a Grievance/Complaints process with formal policies
and procedures. The Contractor shall educate annually Transportation Providers and
Beneficiaries of their right to file a Grievance with the Contractor for denied services
provided by either the Contractor or the Transportation Provider.

C.5.33.2 The Contractor shall establish a Grievance process that adheres to the following
requirements:
C.5.33.2.1 The Contractor shall inform Beneficiaries of their right to file a Grievance with the
Office of Administrative Hearing at any time during the Grievance process;

C.5.33.2.2 The Contractor shall offer to assist the Beneficiary with the filing of a complaint
with the Office of Administrative Hearing;

C.5.33.2.3 The Contractor shall allow Beneficiaries 90 days from the date the Contractor
mails a notice of action to file a Grievance/complaint or request a Fair Hearing to
the Beneficiary;
C.5.33.2.4 Within 90 days after the Contractor mails the notice of action to file a complaint,
Grievance, or request a Fair Hearing to the Beneficiary, a Beneficiary or the
Beneficiary’s designees shall have the right to file a Grievance with “good cause;”
C.5.33.2.5 The Contractor shall in no way penalize any Beneficiary who files a complaint or
Grievance or requests a Fair Hearing;

C.5.33.2.6 The Contractor shall make its Grievance process available for disputes between
the Contractor and the Beneficiary concerning, among other things, denial,
reduction, delay, suspension, or termination of services; requests for services that
are not acted upon in a timely manner; dissatisfaction with providers;
appropriateness of services rendered; availability of services; the inability to
obtain culturally and linguistically appropriate care; or verbal disputes with the
Transportation Provider. A denial includes any instance in which a request for a
transportation service has been made in which a Beneficiary has been told "no"
for all or part of the transportation service;

C.5.33.2.7 The Contractor shall maintain adequate staff to receive Beneficiary complaints
submitted by phone or in writing and to meet by phone or in person with
Beneficiaries to answer questions and attempt to resolve complaints. If the
complaint cannot be resolved at this level, the Contractor’s staff shall submit
complaints to the formal complaints and Grievance process. The Contractor shall
document all communications, written and verbal, with Beneficiaries and shall
maintain written policies and procedures for the receipt and prompt resolution of
complaints and Grievances. The Contractor’s policies and procedures shall
comply with the requirements of 42 CFR 438.406. All of the Contractor’s reports
and documentation shall be subject to review by the District as deemed necessary;
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and

C.5.33.2.8 The Contractor shall reconsider a decision to deny, reduce, terminate, or delay
authorization of a requested service or payment denial in response to a Grievance
submitted by a Beneficiary or a provider on behalf of a Beneficiary. Should the
Beneficiary disagree with the Contractor’s response to a Grievance, the
Beneficiary or a provider on behalf of the Beneficiary may appeal the
Contractor’s decision.

C.5.33.2.9 Levels of Reconsideration.

1. Immediate Reconsideration (Informal Review) – The Contractor shall
establish a process for immediate reconsideration of the denial, reduction
suspension, or stoppage of services when there is a dispute about whether the
Beneficiary has an urgent medical condition or there is a delay in the
furnishing of an urgent service. The Contractor shall have a representative not
involved in the original decision perform the review and reconsider the matter
and issue a decision within one hour of the Contractor’s receipt of the
immediate reconsideration. The Contractor shall utilize the immediate
reconsideration process under the following circumstances:
a) A Beneficiary submits a Grievance and the Contractor’s timeframe for a
standard resolution could jeopardize the Beneficiary’s life or health; and
b) A Beneficiary submits a Grievance while accessing services for urgent or
emergency care.
2. Expedited Grievance (First Level Review) – The Contractor shall establish an
expedited Grievance process for making a first level reconsideration
determination of a Transportation Service denial within 72 hours of the
Contractor’s receipt of the grievance. The Contractor shall have a reviewer
that is an appropriate representative who was not involved in the initial
coverage determination. Aggrieved individuals shall have the right to submit
additional data and meet with the Contractor’s representative prior to the
Contractor making a final determination. The Contractor shall ensure that, at a
minimum, the expedited Grievance process is utilized for Beneficiaries
dissatisfied with the response to a request for Transportation Services.
3. Standard Grievance (First Level Review) – The Contractor shall establish and
maintain a standard Grievance process for first level reconsideration of
authorization decisions that resulted in the denial, termination, delay or
reduction of a Covered Transportation Service. This process may also serve as
a first level reconsideration of an unresolved complaint. The Contractor shall
be responsible for the following activities regarding the Grievance process:
a) The Contractor shall inform providers and Beneficiaries of procedures for
grieving denials or reductions of requested services;
b) The Contractor shall inform Beneficiaries of their rights in the Grievance
process, including the right to appear in person before the Contractor’s
personnel responsible for resolving the Grievance, the timing in which the
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review shall be completed, and their rights to Fair Hearings at any point in
the process;
c) The Contractor shall appoint a Grievance Committee to review all
standard Grievances. At a minimum, the Grievance Committee shall
include a Director or his/her designee, a transportation supervisor, and any
other coordinator. Other Contractor staff shall participate to substitute for
a staff member involved in the matter being grieved, or to provide needed
specialty expertise; and
d) The Contractor shall resolve the Grievance and notify the Beneficiary or
the Beneficiary’s designee in writing of the decision no later than 30
business days from the date the Grievance was received by the Contractor,
except in cases involving an expedited Grievance. The Contractor shall
extend the 30-business day timeframe by up to 14 days if the Beneficiary
or the Beneficiary’s representative requests the extension.
4. Appeals (Second Level Review) – The Contractor shall establish and maintain
an appeals process to review and resolve disputes involving adverse decisions
resulting from the standard Grievance process. The Contractor shall be
responsible for ensuring:
a) The same resolution and notification timeframes described above for the
standard Grievance process are adhered to throughout the appeals process;
and
b) The appeals committee responsible for the review and reconsideration of
the dispute includes a representative who was not involved in any previous
decision regarding the dispute.

C.5.33.3 The Contractor shall submit the Grievance Policy and Procedures for the review and
approval of the CA within 10 business days after the kickoff meeting.

C.5.33.4 Grievance Process Policy Updates

The Contractor shall update the Grievance Process Policy as needed, at a minimum
annually. Annual reports shall be submitted within 90 days prior to the (12th) of the
month after the effective date of the Contract.

C.5.33.5 Complaints and Grievances - Requirements for Notice of Action
The Contractor shall notify Beneficiaries in writing within 72 hours of any intention
to deny, limit, reduce, delay or terminate a service or deny payment. This notice shall
clearly explain the following:
C.5.33.5.1 The action the Contractor intends to take and the supporting reasons, laws or rules
for the action;
C.5.33.5.2 The Beneficiary’s right to file a complaint or Grievance with the Contractor and
the right to request a Fair Hearing at any time;
C.5.33.5.3 The Beneficiary’s right to appear in person in front of the Contractor’s personnel
if the Beneficiary files a Grievance;
C.5.33.5.4 The Beneficiary’s right to have a representative involved in the process;
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C.5.33.5.5 The assistance that the Health Care Ombudsman’s Office can provide and how to
contact the Health Care Ombudsman;
C.5.33.5.6 The Beneficiary’s right to obtain free copies of the documents, including the
Beneficiary’s records, the Contractor used to make the decision and the necessity
criteria referenced in the decision; and
C.5.33.5.7 The circumstances under which benefits shall continue pending resolution of the
Grievance or issuance of a District Fair Hearing decision.

C.5.33.6 Written Notification of Receipt

The Contractor shall, within two business days of receipt of the Beneficiary’s
Grievance, send to the Beneficiary a letter of notification of receipt of the complaint
or Grievance.

C.5.33.7 Continuation of Coverage
C.5.33.7.1 The Contractor shall continue to furnish Transportation Services at the level and
in the amount, scope, and duration that the Transportation Services were provided
to the Beneficiary prior to notification of the Contractor’s determination pending
resolution of the Grievance or appeal. This provision for continued coverage
applies only to a Beneficiary who filed a standard Grievance within 10 days of the
date on which the Beneficiary was notified of the Contractor’s determination to
terminate or reduce a service. The Contractor shall provide continued coverage
until the date that:
1. The Grievance is resolved; or
2. The Beneficiary has not requested a Fair Hearing within the required
timeframe.

C.5.33.7.2 The Contractor shall issue an authorization for any Transportation Services
authorized as a result of the Grievance or Fair Hearing process within two
business days of a Grievance or notice of a Fair Hearing decision.

C.5.33.8 Fair Hearings

C.5.33.8.1 The Contractor shall notify the Beneficiary or the Beneficiary’s designee about
the right to a Fair Hearing with the DC Office of Administrative Hearings each
time the Contractor sends an adverse decision on a request for Medicaid Covered
Services, including on a complaint, Grievance, or appeal, to the Beneficiary.

C.5.33.8.2 The Contractor shall submit all documents regarding the Contractor’s action and
the Beneficiary’s dispute to the CA no later than five business days from the date
the Contractor receives notice from the District that a Fair Hearing request has
been filed if a Beneficiary requests a Fair Hearing.

C.5.33.8.3 The Contractor shall allow a Beneficiary to request a Fair Hearing before, during,
or after a Contractor’s Grievance process. However, a Beneficiary is allowed no
more than 90 days from the date the Contractor mails notice of action to a
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Beneficiary to request a hearing in accordance with 42 CFR 431.200.

C.5.33.8.4 Pending the decision from the Fair Hearing, the Contractor shall continue to
furnish Transportation Services at the level and in the amount, scope, and duration
that the Contractor provided Transportation Services to the Beneficiary prior to
notification of the Contractor’s determination.

C.5.33.8.5 The Contractor shall assist the Beneficiary with filing of any request for a Fair
Hearing and the Contractor shall send a copy of the filed request to the
Beneficiary’s home address.

C.5.33.8.6 The Contractor shall notify the Beneficiary that the Health Care Ombudsman can
assist with filing a request for a Fair Hearing and provide information for how to
contact the Health Care Ombudsman.

C.5.33.8.7 The Contractor shall provide transportation for the Beneficiary, the Beneficiary’s
representative and witnesses to and from the Office of Administrative Hearing to
appeal an adverse decision regarding a request for Medicaid Covered Services.

C.5.33.9 Grievance and Fair Hearing Resolutions

If the Contractor reverses or modifies an authorized decision through the Grievance
resolution process or is notified of OAH Fair Hearing decision to reverse a decision,
the Contractor shall authorize or provide the Transportation Services no later than two
business days after OAH reverses or notifies the Contractor of its decision to reverse
the Contractor’s determination. In the case of an expedited Grievance, the Contractor
shall begin providing services within 24 hours of the OAH Fair Hearing reversal
decision.

C.5.33.10 Tracking Log

The Contractor shall maintain a log to document all complaints and Grievances to
include at a minimum the following:
C.5.33.10.1 The log shall document the type and nature of each dispute, the Transportation
Provider that is the subject of the complaint, how the matter was addressed and
what, if any, corrective action was taken; and

C.5.33.10.2 The Contractor shall use the information described in this subsection for quality
improvement and shall be provided to the District’s Medical Care Advisory
Board, MCAC on a quarterly basis.

PART VI: CONTRACT TRANSITION/TURNOVER
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C.5.34 The Contractor shall provide assistance in turning over the Contractor’s functions to
the District prior to the conclusion or non-renewal of the Contract, or prior to
termination for any reason, as specified below:

C.5.34.1 Turnover Plan
The Contractor shall develop and provide to the CA a turnover plan within six months
from the date of award and update the plan annually thereafter. S ubs e qu e nt
annual turnover reports shall be submitted within nine months from date of the
exercise of a 12-month option period. The Contractor’s turnover plan shall include, at
a minimum, the following:
C.5.34.1.1 Proposed approach to turnover, in paragraph form, along with a work plan,
including the tasks and sub-task timeline schedule for the turnover;
C.5.34.1.2 An estimate of the number of Full-Time Equivalent (FTE's) and type personnel
needed to operate all functions of the turnover plan. The alignment shall be
separated by the service area and by the type of activity of the personnel;
C.5.34.1.3 A flow chart of all facilities and resources currently required to continue
Contractor functions, including, but not limited to:
1. Data processing equipment;
2. Reservation/scheduling software;
3. System and special software (database management system and
telecommunications);
4. Other equipment, ACD telephone, computer equipment; and
5. Office space.
C.5.34.1.4 Transport and service provider Network;
C.5.34.1.5 A documented agreement indicating that the Contractor shall allow the District to
utilize the Contractor’s software until a new Contractor can be selected and
transitioned to deliver NEMT services.
C.5.34.1.6 The Turnover Plan shall include a production plan and all documented procedures,
manuals, files, and encrypted hard drives;
C.5.34.1.7 The outline of resource requirements shall be based on the Contractor’s
experience in the operation of the Contractor’s functions and shall include actual
Contractor resources devoted to the operation of all tasks required by the Contract;
C.5.34.1.8 The Contractor shall submit the turnover plan to the CA for approval six months
after contract award and thereafter within 30 days of the CA’s request.
C.5.34.1.9 Upon the expiration or termination of the Contract, the Contractor shall take all
steps necessary to facilitate the assignment of all software transferred to the
District;
C.5.34.1.10 The Contractor shall provide to the CA the turnover plan and all current, updated
and accurate reference files, and all other records, when requested by the District;
1. The status of any ongoing negotiations with Transportation Providers;
2. Payment administration;
3. Gatekeeping and Prior Authorization;
4. Reservation and trip assignments;
5. Quality assurance, and
6. Administrative oversight and management reporting.
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C.5.34.1.11 Turnover – Training Manuals, Operational Policies and Procedures, Brochures,
Pamphlets and other Contract Related Documents

The Contractor shall submit to the CA annually copies of training manuals,
operational procedures manuals, brochures, pamphlets, and all other written
materials developed in support of the Contract in hard copy and electronic media.

C.5.34.1.12 Turnover – DHCF Staff Training

Upon request by the CA, the Contractor shall conduct training for the staff of
DHCF or its designated Agent in the required Contractor’s operation. Such
training shall be completed at least one month prior to the expiration or
termination of the Contract or upon a date specified by the CA.

C.5.34.1.13 Turnover Plan Updates

The Contractor shall submit to the CA Turnover Plan Updates as applicable and
annually. Annual reports shall be submitted within 90 days prior to the (12th) of
the month after the effective date of the Contract.
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SECTION D: PACKAGING AND MARKING

D.1 The packaging and marking requirements for this contract shall be governed by clause
number two, Shipping Instructions-Consignment, of the Government of the District of
Columbia's Standard Contract Provisions for use with Supplies and Services Contracts,
dated July 2010. (Attachment J.1)
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SECTION E: INSPECTION AND ACCEPTANCE

E.1 The inspection and acceptance requirements for this contract shall be governed by clause
number clause number six, Inspection of Services of the Government of the District of
Columbia's Standard Contract Provisions for use with Supplies and Services Contracts,
dated July 2010. (Attachment J.1)
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SECTION F: PERIOD OF PERFORMANCE AND DELIVERABLES

F.1 TERM OF CONTRACT

The term of the contract shall be for a period of one year from the date of award.

F.2 OPTION TO EXTEND THE TERM OF THE CONTRACT

F.2.1 The District may extend the term of this contract for a period of four (4) one-year option
periods, or successive fractions thereof, by written notice to the Contractor before the
expiration of the contract; provided that the District will give the Contractor preliminary
written notice of its intent to extend at least 30 days before the contract expires. The
preliminary notice does not commit the District to an extension. The exercise of option
years is subject to the availability of funds at the time of the exercise of the option. The
Contractor may waive the 30-day preliminary notice requirement by providing a written
waiver to the Contracting Officer prior to expiration of the contract.

F.2.2 If the District exercises this option, the extended contract shall be considered to include
this option provision.

F.2.3 The total duration of this contract, including the exercising of any options under this
clause, shall not exceed five years.

F.3 DELIVERABLES

F.3.1 The Contractor shall perform the activities required to successfully complete the
District’s requirements and submit each deliverable to the CA or designee identified in
section G.9.

CLIN Deliverable Format/Method
of Delivery Due Dates
0001 NTL Non-Operational
Request (C.5.6.5.4)
Electronically.
Word Document or
Excel or PDF
Within two hours if DC
MMIS is not functioning,
when needed
0001
RN Prior Authorization
Outside Metropolitan Area
Request (C.5.6.7.3)
Electronically.
Word Document or
Excel or PDF
As needed
0001 RN Triage Line
Reassessment (C.5.6.7.6)
Electronically.
Word Document or
Excel or PDF
As needed
0001
Notifications to Beneficiaries
of the Introduction of NEMT
Services (C.5.7.1)
Electronically.
Word Document or
Excel or PDF
45 days before the start of
operations
0001
Notifications to Beneficiaries
of the Availability of NEMT
Services (C.5.7)
Electronically.
Word Document or
Excel or PDF
Within 30 days of the
kick-off meeting
CW135340 Non-Emergency Medical Transportation
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CLIN Deliverable Format/Method
of Delivery Due Dates

0001
Beneficiary Training and
Education Plan, Presentation,
and Training Materials
(C.5.8)
Electronically.
Word Document or
Excel or PDF
Within 30 days of the
kick-off meeting
0001
Newly Eligible Beneficiaries
Notification of NEMT
(C.5.8.1)
Electronically.
Word Document or
Excel or PDF
Within 10 days of ESA
Notification

0001 ESA Educational Materials
(C.5.8.2)
Electronically.
Word Document or
Excel or PDF
Within 30 days of the
kick-off meeting
0001 Beneficiary Education Plan
(C.5.8.3)
Electronically.
Word Document or
Excel or PDF
Within 30 days of the
kick-off meeting
0001
NEMT Services Advisory
Committee Meeting Minutes
(C.5.9.1)
Electronically.
Word Document or
Excel or PDF
Within five business days
of the kick-off meeting
0001 Preliminary Implementation
Plan (C.5.16)
Electronically.
Word Document or
Excel or PDF
Within 5 days after the
contract award
0001 Implementation Plan Status
Report (C.5.14, C.5.19.1)
Electronically.
Word Document or
Excel or PDF
One day following the bi-
weekly Implementation
Meeting
0001 Final Implementation Plan
(C.5.11, C.5.16)
Electronically.
Word Document or
Excel or PDF
Within 20 business days
after the kickoff meeting

0001

Quality Assurance Plan
Updates (C.5.17.2.2.1)
Electronically.
Word Document or
Excel or PDF
Annually. Annual reports
shall be submitted within
90 days prior to the
effective date of the
Contract.
0001 Implementation Meeting
Notes (C.5.18.2)
Electronically.
Word Document or
Excel or PDF
Within two days following
the bi-weekly
Implementation Meeting

0001 Readiness Testing Corrective
Action Plan (C.5.20.2)
Electronically.
Word Document or
Excel or PDF
Within 10 business days of
notification there are any
identified deficiencies
0001 List of the NEMT Service
Area (C.5.23.1.4)
Electronically.
Word Document or
Excel or PDF
Within 30 days from the
acceptance of the final
implementation plan.
0001 Cost Records (C.5.23.1.8)
Electronically.
Word Document or
Excel or PDF
Upon Request
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CLIN Deliverable Format/Method
of Delivery Due Dates
0001 Disaster Recovery Plan
(C.5.23.2.3)
Electronically.
Word Document or
Excel or PDF
Within 60 days after the
approval of the Final
Implementation Plan

0001 Updated Disaster Recovery
Plan (C.5.23.2.5)
Electronically.
Word Document or
Excel or PDF
Annually. To be submitted
15 business days before
the contract performance
period ends

0001 Test Version of the Internet
Website (C.5.23.4.2)
Electronically.
Word Document or
Excel or PDF
Within 30 days after the
Final Implementation Plan
approval

0001

Record of Website Activities
(C.5.23.4.4)
Electronically.
Word Document or
Excel or PDF
Monthly after the launch
of the website. Monthly
reports shall be submitted by
the 15th day of the following
month.
0001
Call Center Beneficiary
Complaint or Appeal Files
(C.5.23.6.16)
Electronically.
Word Document or
Excel or PDF
Upon Request
0002
Denial of Fixed Wing
Transport Request
(C.5.24.1.5(8)(c), C.5.28)
Electronically.
Word Document or
Excel or PDF
Upon request
0002
Air Ambulance Service
Agreement Template
(C.5.24.1.5(13)
Electronically.
Word Document or
Excel or PDF
Within 10 business days of
the kickoff meeting
0001 Transportation Provider
Selection Plan (C.5.24.2.2(3)
Electronically.
Word Document or
Excel or PDF
Within 10 business days of
the kickoff meeting

0001

Transportation Provider and
Driver Performance Incentive
Program Report (C.5.24.4.1)

Electronically.
Word Document or
Excel or PDF
Quarterly. Quarterly
reports shall be submitted
within 30 days following
the end of the preceding
quarter.

0001
Transportation Provider and
Driver Performance Incentive
Program Liquidated Damages
Report (C.5.24.4.2)
Electronically.
Word Document or
Excel or PDF
Monthly. Monthly reports
shall be submitted by the 15th
day of the following month.

0001
Transportation Provider and
Driver Performance Incentive
Program Financial
Statements (C.5.24.4.3)

Electronically.
Word Document or
Excel or PDF
Annually. Annual reports
shall be submitted within
90 days prior to the (12th)
of the month after the
effective date of the
Contract.
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CLIN Deliverable Format/Method
of Delivery Due Dates
0001 Attestation/Certificate
(C.5.24.5.2)
Electronically.
Word Document or
Excel or PDF
Upon request
0001 Record Retention (C.5.24.6)
Electronically.
Word Document or
Excel or PDF
Within three business days
for review at the request of
the District

0001 Initial Independent Audit
Findings (C.5.24.9.2)
Electronically.
Word Document or
Excel or PDF
Within 60 days of the
kickoff meeting
0001 Independent Audit Findings
(C.5.24.9.2, C.5.25.2.22)
Electronically.
Word Document or
Excel or PDF
Annually. Due September
15th
0001 Audit Compliance Plan
(C.5.24.9.3)
Electronically.
Word Document or
Excel or PDF
Within 30 days from the
Operational start date

0001
Non-Compliance with
Standards Corrective Action
for Transportation Provider
Complaints (C.5.24.10.7.2,
C.5.24.11.6(5)(y)
Electronically.
Word Document or
Excel or PDF

Upon request
0001 Vehicle Inspection Final Plan
(C.5.24.11.2.2.a.i)
Electronically.
Word Document or
Excel or PDF
Within 30 days prior to the
Operation start date
0001
Vehicle Inspection and
Monitoring Process
(C.5.24.11.5(3)
Electronically.
Word Document or
Excel or PDF
Within 10 days of the
kickoff meeting
0001
Final Vehicle Inspection and
Monitoring Process
(C.5.24.11.5(4)
Electronically.
Word Document or
Excel or PDF
Within 30 days prior to the
Operations start date
0001
Vehicle Inspection and
Monitoring Process Report
(C.5.25.2.19)
Electronically.
Word Document or
Excel or PDF
Annually. Within 12
months of the previous
inspection

0001

Cumulative on-time Report
(C.5.24.11.6.7.g)
Electronically.
Word Document or
Excel or PDF
Quarterly. Quarterly
reports shall be submitted
within 30 days following
the end of the preceding
quarter.
0001
Adverse Weather Plan
(C.5.24.11.6.7.h,
(C.5.25.2.21)
Electronically.
Word Document or
Excel or PDF
Upon request
0001
Transporting During a Public
Emergency Plan
(C.5.24.11.6.7.i)
Electronically.
Word Document or
Excel or PDF
Annually. Annual reports
shall be submitted within
90 days prior to the
CW135340 Non-Emergency Medical Transportation
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CLIN Deliverable Format/Method
of Delivery Due Dates
effective date of the
Contract.
0001 Operational Meetings Agenda
and Minutes (C.5.25.1.2)
Electronically.
Word Document or
Excel or PDF
Within 2 days after each
meeting is held

0001
Daily Manifests and Driver
Daily Log Reports
(C.5.25.2.1)
Electronically.
Word Document or
Excel or PDF
Daily. Submitted by 10:00
a.m. on the next business
day
0001 Client Satisfaction Survey
Report (C.5.25.2.2)
Electronically.
Word Document or
Excel or PDF
Within 30 days of annual
survey completion

0001

Encounter Data Report
(C.5.25.2.3)
Electronically.
Word Document or
Excel or PDF
Quarterly. Quarterly
reports shall be submitted
within 30 days following
the end of the preceding
quarter.

0001

IDD Encounter Data Report
(C.5.25.2.11(2)
Electronically.
Word Document or
Excel or PDF
Quarterly. Quarterly
reports shall be submitted
within 30 days following
the end of the preceding
quarter.
0001
Accident & Moving
Violations Report
(C.5.25.2.4.a)
Electronically.
Word Document or
Excel or PDF
Within two business days
of the accident
0001 Police Report (C.5.25.2.4.b)
Electronically.
Word Document or
Excel or PDF
Within 10 business days of
the moving violation
0001 Transportation Services
Summary Report (C.5.25.2.5)
Electronically.
Word Document or
Excel or PDF
Monthly. Monthly reports
shall be submitted by the 15th
day of the following month.
0001
Corrections to the
Transportation Services
Summary Report (C.5.25.2.5)
Electronically.
Word Document or
Excel or PDF
Within 5 days of
notification of errors

0001 Beneficiary No-Show Report
(C.5.25.2.6)
Electronically.
Word Document or
Excel or PDF
Monthly. Monthly reports
shall be submitted by the 15th
day of the following month.
0001 Non-Compliance Activity
Report (C.5.25.2.7)
Electronically.
Word Document or
Excel or PDF
Monthly. Monthly reports
shall be submitted by the 15th
day of the following month.
0001 Transportation Provider and
Driver Reports (C.5.25.2.8(1)
Electronically.
Word Document or
Excel or PDF
At the Operation start date
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CLIN Deliverable Format/Method
of Delivery Due Dates
0001
Updates to the Transportation
Provider and Driver Reports
(C.5.25.2.8(2)
Electronically.
Word Document or
Excel or PDF
Monthly. Monthly reports
shall be submitted by the 15th
day of the following month.
0001 Vehicle Reports
(C.5.25.2.9(1)
Electronically.
Word Document or
Excel or PDF
30 days before
Operational start date

0001 Updates to the Vehicle
Reports (C.5.25.2.9(2)
Electronically.
Word Document or
Excel or PDF
Monthly. Monthly reports
shall be submitted by the 15th
day of the following month.

0001 Ad Hoc Reports
(C.5.25.2.10)
Electronically.
Word Document or
Excel or PDF
within three business days
after the date of request,
unless otherwise specified
by the CA.
0001
IDD Waiver Transportation
Services Reports
(C.5.25.2.11(3)
Electronically.
Word Document or
Excel or PDF
Monthly. Monthly reports
shall be submitted by the 15th
day of the following month.
0001 Format of Incident Reports
(C.5.25.2.12(1)
Electronically.
Word Document or
Excel or PDF
Within 20 days of the
kickoff meeting
0001 Summary Report on Incidents
(C.5.25.2.12(6)
Electronically.
Word Document or
Excel or PDF
Monthly. Monthly reports
shall be submitted by the 15th
day of the following month.
0001 Telecommunications System
Reports (C.5.25.2.13)
Electronically.
Word Document or
Excel or PDF
Monthly. Monthly reports
shall be submitted by the 15th
day of the following month.
0001 Certified Financial Reports
(C.5.25.2.14)
Electronically.
Word Document or
Excel or PDF
Annually. Within six
months after the close of
the ended year
0001 Invoice Report (C.5.25.2.15)
Electronically.
Word Document or
Excel or PDF
Monthly. Monthly reports
shall be submitted by the 15th
day of the following month.
0001 Provider No-Show Report
(C.5.25.2.16)
Electronically.
Word Document or
Excel or PDF
Monthly. Monthly reports
shall be submitted by the 15th
day of the following month.
0001 Exclusion Report
(C.5.25.2.17)
Electronically.
Word Document or
Excel or PDF
Monthly. Monthly reports
shall be submitted by the 15th
day of the following month.

0001
Transportation Provider
Expiring Insurance Report
(C.5.25.2.18)
Electronically.
Word Document or
Excel or PDF
Within 90 days of the
expiration date of
applicable insurance
policy(s)
0001
NEMT Services Operating
Policies and Procedures
Manual (C.5.25.3.4)
Electronically.
Word Document or
Excel or PDF
Within 10 business days of
the kickoff meeting
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CLIN Deliverable Format/Method
of Delivery Due Dates
0001
Policies and Procedures
Training Manual
(C.5.25.3.5(3)
Electronically.
Word Document or
Excel or PDF
Within 60 days prior to the
training session
0001
Revisions to the Policies and
Procedures Training Manual
(C.5.25.3.5.3)
Electronically.
Word Document or
Excel or PDF
Within 10 business days of
receipt of comments

0001

Training Activities and
Individualized Corrective
Action (C.5.25.3.5.3)

Electronically.
Word Document or
Excel or PDF
Quarterly. Quarterly
reports shall be submitted
within 30 days following
the end of the preceding
quarter.
0001 Operations Procedure Manual
(C.5.25.3.6.1)
Electronically.
Word Document or
Excel or PDF
Within 30 days of the
kickoff meeting
0001
Revisions to the Operations
Procedure Manual
(C.5.25.3.6.3)
Electronically.
Word Document or
Excel or PDF
Within 10 business days of
receipt of comments
0001 Transportation Provider
Manual (C.5.25.3.7)
Electronically.
Word Document or
Excel or PDF
Within 40 days prior to the
Operation start date
0001
Revisions to the
Transportation Provider
Manual (C.5.25.3.7.3)
Electronically.
Word Document or
Excel or PDF
Within 10 business days of
receipt of comments
0001 Systems Design Manual
(C.5.25.3.8.1)
Electronically.
Word Document or
Excel or PDF
Within 30 days of the
kickoff meeting

0001

Revisions to the Systems
Design Manual (C.5.25.3.8.2)

Electronically.
Word Document or
Excel or PDF
Ongoing within 10
business days of receipt of
comments. At minimum,
annually. Annual reports
shall be submitted within
90 days prior to the
effective date of the
Contract.
0001 Users Documentation Manual
(C.5.25.3.9.1)
Electronically.
Word Document or
Excel or PDF
Within 40 days prior to the
Operation start date

0001
Revisions to the Users
Documentation Manual
(C.5.25.3.9.2)
Electronically.
Word Document or
Excel or PDF
Within 10 business days of
receipt of comments
0001 Staff Training and Education
Plan (C.5.26.4)
Electronically.
Word Document or
Excel or PDF
Within 60 days of the
kickoff meeting
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CLIN Deliverable Format/Method
of Delivery Due Dates
0001 Customer Service Training
Manual (C.5.26.4.2.1)
Electronically.
Word Document or
Excel or PDF
Within 60 days of the
kickoff meeting
0001 Staffing Plan (C.5.26.3)
Electronically.
Word Document or
Excel or PDF
Within 30 business days of
contract award

0001 Continuing Staff Training and
Education Plan (C.5.26.4.3.2)
Electronically.
Word Document or
Excel or PDF
Within 90 days of the
kickoff meeting

0001

Presentation and Education
Materials (C.5.26.4.4.1)
Electronically.
Word Document or
Excel or PDF
Within 60 days of the
kickoff meeting. Within 90
days of the Continuing
Staff Training and
Education Plan
0001 Evaluation Tool (C.5.26.4.5)
Electronically.
Word Document or
Excel or PDF
Within 60 days of the
kickoff meeting
0001
Transportation Provider
Training and Education Plan
(C.5.26.5.2.3)
Electronically.
Word Document or
Excel or PDF
Within 30 days of the
kickoff meeting
0001
Confirmation of Completed
Driver & Attendant Training
and Education (C.5.26.5.3.3)
Electronically.
Word Document or
Excel or PDF
Prior to Operation Start
date

0001
Confirmation of Completed
Driver IDD Waiver
Beneficiary Training and
Education (C.5.26.5.4.4)
Electronically.
Word Document or
Excel or PDF
Prior to Operation Start
date
0001
Transportation Provider
Training Materials
(C.5.26.5.6.2)
Electronically.
Word Document or
Excel or PDF
Within 60 days prior to the
training session
0001 Training and Education
Evaluation Tool (C.5.26.5.7)
Electronically.
Word Document or
Excel or PDF
Within 60 days of the
kickoff meeting

0001

Stakeholder Communication
Plan (C.5.26.5.8)
Electronically.
Word Document or
Excel or PDF
After the monthly
outreach event. Monthly
reports shall be submitted by
the 15th day of the following
month.
0001 Record of Complaint and
Resolution (C.5.29.3)
Electronically.
Word Document or
Excel or PDF
Upon request
0001 Policies and Procedures for
Complaints (C.5.29.3)
Electronically.
Word Document or
Excel or PDF
Within 10 days of the
kickoff meeting
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CLIN Deliverable Format/Method
of Delivery Due Dates
0001 Compliant and Resolution
Summary Report (C.5.29.7)
Electronically.
Word Document or
Excel or PDF
Monthly. Monthly reports
shall be submitted by the 15th
day of the following month.
0001 Grievance Policy and
Procedures (C.5.33.3)
Electronically.
Word Document or
Excel or PDF
Within 10 days of the
kickoff meeting

0001

Updated Grievance Policy
and Procedures (C.5.33.4)

Electronically.
Word Document or
Excel or PDF
Annually. Annual reports
shall be submitted within
90 days prior to the
effective date of the
Contract.
0001 Fair Hearing – Action and
Disputes (C.5.33.8.2)
Electronically.
Word Document or
Excel or PDF
Within five business days
from the date of notice

0001 Turnover Plan (C.5.34.1,
C.5.34.1.8)
Electronically.
Word Document or
Excel or PDF
Within six months from
the date of the award.
Within 30 days of a
request

0001

Updated Turnover Plan
(C.5.34.1, C.34.1.13)
Electronically.
Word Document or
Excel or PDF
Annually. Annual reports
shall be submitted within
90 days prior to the
effective date of the
Contract.

0001
Training Manuals,
Operational Policies and
Procedures, Brochures,
Pamphlets and other Contract
Related Documents
(C.5.34.1.11)

Electronically.
Word Document or
Excel or PDF
Annually. Annual reports
shall be submitted within
90 days prior to the
effective date of the
Contract.

F.3.2 The Contractor shall submit to the District, as a deliverable, the report described in
section H.5.5 that is required by the 51% District Residents New Hires Requirements and
First Source Employment Agreement. If the Contractor does not submit the report as part
of the deliverables, final payment to the Contractor shall not be paid pursuant to section
G.3.2.
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SECTION G: CONTRACT ADMINISTRATION
G.1 INVOICE PAYMENT

G.1.1 The District will make payments to the Contractor, upon the submission of proper
invoices at the prices stipulated in this contract, for supplies delivered and accepted or
services performed and accepted, less any discounts, allowances or adjustments provided
for in this contract.

G.1.2 The District will pay the Contractor on or before the 30th day after receiving a proper
invoice from the Contractor.
G.2 INVOICE SUBMITTAL
G.2.1 The Contractor shall create and submit payment requests in an electronic format through
the DC Vendor Portal, https://vendorportal.dc.gov.
G.2.2 The Contractor shall submit proper invoices monthly or as otherwise specified in G.4.

G.2.3 To constitute a proper invoice, the Contractor shall enter all required information into the
Portal after selecting the applicable purchase order number which is listed on the
Contractor’s profile.

G.3 FIRST SOURCE AGREEMENT REQUEST FOR FINAL PAYMENT

G.3.1 For contracts subject to the 51% District Residents New Hires Requirements and First
Source Employment Agreement requirements, final request for payment must be
accompanied by the report or a waiver of compliance discussed in section H.5.5.

G.3.2 The District shall not make final payment to the Contractor until the agency CFO has
received the CO’s final determination or approval of waiver of the Contractor’s
compliance with 51% District Residents New Hires Requirements and First Source
Employment Agreement requirements.

G.4 PAYMENT

G.4.1 The District shall make monthly capitated payments to the Contractor as compensation
for Covered Transportation Services provided to Eligible Beneficiaries. The District shall
finalize the monthly enrollment for each month by the 15th of the prior month and a final
enrollment list for the designated month shall begin on the first of that month. The
monthly capitation payment shall be based on the final enrollment list and the applicable
Per Beneficiary Member Per Month rate described in B.4. The Contractor shall reconcile
each month’s final enrollment list submitted by the CA with its own records and report
any discrepancies to the CA within 30 days of receipt.

G.4.1.1 The Contractor shall accept the monthly per capitated rate payments for CLIN 0001
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and CLIN 0002 as payment in full, inclusive of all administrative costs, transportation
costs, overhead, and profit for all services required under the Contract.

G.4.1.2 The District shall disburse Capitated Rate payments prospectively on the first of each
month in which services are to be delivered to Beneficiaries. Disbursement dates that
fall on a weekend or holiday are moved to the next business day.

G.4.1.3 The Contractor shall be paid on the first day of each month, of the current operating
month of services.

G.4.1.4 The Contractor and the Transportation Providers shall not accept, collect or receive
fares fees from Beneficiaries for Transportation Services.

G.4.2 MONTHLY ELIGIBILITY RECONCILIATION

G.4.2.1 The Contractor shall receive a bi-weekly eligibility file report via electronic file
transfer, twice per month by the close of business on Thursday, allowing the
Contractor one business day to retrieve the eligibility file report and process the data
in time for Beneficiary requests for Transportation Services on Monday of the
forthcoming week.

G.4.2.2 The bi-weekly eligibility file report shall contain the total number of Eligible
Beneficiaries for that week of service, ensuring that the Contractor is operating with a
current list of Eligible Beneficiaries. The Contractor shall use the DC MMIS to verify
enrollment is consistent on both the enrollment roster/report and the MMIS.

G.4.2.3 DHCF will produce the bi-weekly NEMT eligibility file report each Thursday before
the closure of business and transmit it to the Contractor. The eligibility file report
contains the information to be used by DHCF to produce the monthly capitation
payment for the next month based on the number of Eligible Beneficiaries. DHCF
will reconcile the monthly NEMT Beneficiary Extract Summary with the
aforementioned report to reimburse the Contractor for trips provided to pending
eligible individuals.

G.4.2.4 The Contractor shall pay Transportation Providers in accordance with the terms of the
TPSA between the Contractor and each Transportation Provider from the capitation
payments made to the Contractor by DHCF. The Contractor shall make full payment
of undisputed invoices for all authorized trips to the Transportation Providers, as
agreed to between the Contractor and the Transportation Providers, in their TPSAs;
otherwise, the Contractor’s payment to Transportation Providers shall be made within
30 business days of the Contractor’s receipt of an undisputed invoice. The Contractor
shall:
(1) Validate that all Transportation Services paid for were properly authorized and
actually rendered.
(2) Submit to the CA verified data for all trips made by Eligible Beneficiaries in
accordance with the terms and conditions of the Contractor’s TPSA with each
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Transportation Provider;
(3) Develop safeguards to report fraudulent activity by the Transportation Providers
and Beneficiaries.
(4) Fulfill DHCF reporting requirements for the District regarding such activity;
(5) Indemnify and defend the District against any causes of actions or claims of
payment brought by the Transportation Provider or Beneficiary; and
(6) Provide the monthly invoice report to the CA in accordance with Section
C.5.25.2.15.

G.4.2.5 Payments made by the District to the Contractor are conditioned upon receipt by the
District of applicable, accurate and complete reports, documentation, and any other
information due from the Contractor, unless written approval waiving such
requirement(s) is obtained from the Contracting Officer.

G.4.3 PROVISION OF ADJUSTMENT OF RATE

In the event the District, pursuant to the Changes Clause of the Standard Contract
Provisions, adds, deletes or changes any services to be covered by the Contractor, the
District shall review the effect of the change and equitably adjust the capitation rate
(either upwards or downwards) if appropriate. In the event a capitation rate adjustment
needs to be made prospectively, an actuarial calculation shall be made by the District to
determine the increase or decrease in the total cost from the instituted change. If
substantiated, the District shall apply the adjusted rate.

G.5 ASSIGNMENT OF CONTRACT PAYMENTS

G.5.1 In accordance with 27 DCMR 3250, the Contractor may assign to a bank, trust company,
or other financing institution funds due or to become due as a result of the performance of
this contract.

G.5.2 Any assignment shall cover all unpaid amounts payable under this contract and shall not
be made to more than one party.

G.5.3 Notwithstanding an assignment of contract payments, the Contractor, not the assignee, is
required to prepare invoices. Where such an assignment has been made, the original
copy of the invoice must refer to the assignment and must show that payment of the
invoice is to be made directly to the assignee as follows:
“Pursuant to the instrument of assignment dated , make payment of this
invoice to (name and address of assignee).”
G.6 THE QUICK PAYMENT ACT

G.6.1 Interest Penalties to Contractors
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G.6.1.1 The District will pay interest penalties on amounts due to the Contractor under the
Quick Payment Act, D.C. Official Code § 2-221.01 et seq., as amended, for the period
beginning on the day after the required payment date and ending on the date on which
payment of the amount is made. Interest shall be calculated at the rate of at least 1%
per month. No interest penalty shall be paid if payment for the completed delivery of
the item of property or service is made on or before the required payment date. The
required payment date shall be:
G.6.1.1.1 The date on which payment is due under the terms of this contract;
G.6.1.1.2 Not later than 7 days, excluding legal holidays, after the date of delivery of meat
or meat food products;
G.6.1.1.3 Not later than 10 days, excluding legal holidays, after the date of delivery of a
perishable agricultural commodity; or
G.6.1.1.4 30 days, excluding legal holidays, after receipt of a proper invoice for the amount
of the payment due.

G.6.1.2 No interest penalty shall be due to the Contractor if payment for the completed
delivery of goods or services is made on or before:
G.6.1.2.1 3rd day after the required payment date for meat or a meat product;
G.6.1.2.2 5th day after the required payment date for an agricultural commodity; or
G.6.1.2.3 15th day after any other required payment date.

G.6.1.3 Any amount of an interest penalty which remains unpaid at the end of any 30-day
period shall be added to the principal amount of the debt and thereafter interest
penalties shall accrue on the added amount.

G.6.2 Payments to Subcontractors

G.6.2.1 The Contractor shall take one of the following actions within seven (7) days of receipt
of any amount paid to the Contractor by the District for work performed by any
subcontractor under the contract:
G.6.2.1.1 Pay the subcontractor(s) for the proportionate share of the total payment received
from the District that is attributable to the subcontractor(s) for work performed
under the contract; or
G.6.2.1.2 Notify the CO and the subcontractor(s), in writing, of the Contractor’s intention to
withhold all or part of the subcontractor’s payment and state the reason for the
nonpayment.
G.6.2.2 The Contractor shall pay subcontractors or suppliers interest penalties on amounts
due to the subcontractor or supplier beginning on the day after the payment is due and
ending on the date on which the payment is made. Interest shall be calculated at the
rate of at least 1% per month. No interest penalty shall be paid on the following if
payment for the completed delivery of the item of property or service is made on or
before the:
G.6.2.2.1 3rd day after the required payment date for meat or a meat product;
G.6.2.2.2 5th day after the required payment date for an agricultural commodity; or
G.6.2.2.3 15th day after any other required payment date.
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G.6.2.3 Any amount of an interest penalty which remains unpaid by the Contractor at the end
of any 30-day period shall be added to the principal amount of the debt to the
subcontractor and thereafter interest penalties shall accrue on the added amount.

G.6.2.4 A dispute between the Contractor and subcontractor relating to the amounts or
entitlement of a subcontractor to a payment or a late payment interest penalty under
the Quick Payment Act does not constitute a dispute to which the District is a party.
The District may not be interpleaded in any judicial or administrative proceeding
involving such a dispute.

G.6.3 Subcontract requirements

G.6.3.1 The Contractor shall include in each subcontract under this contract a provision
requiring the subcontractor to include in its contract with any lower-tier subcontractor
or supplier the payment and interest clauses required under paragraphs (1) and (2) of
D.C. Official Code § 2-221.02(d).

G.6.3.2 The Contractor shall include in each subcontract under this contract a provision that
obligates the Contractor, at the election of the subcontractor, to participate in
negotiation or mediation as an alternative to administrative or judicial resolution of a
dispute between them.

G.7 CONTRACTING OFFICER

G.7.1 Contracts will be entered into and signed on behalf of the District only by Contracting
Officers. The contact information for the Contracting Officer is:

Jarad Dorsey
Office of Contracting and Procurement
441 4th Street, NW, Suite 330 South
Washington, DC 20001
202-478-2436
Jarad.dorsey4@dc.gov
G.8 AUTHORIZED CHANGES BY THE CONTRACTING OFFICER
G.8.1 The CO is the only person authorized to approve changes in any of the requirements of
this Contract.
G.8.2 The Contractor shall not comply with any order, directive or request that changes or
modifies the requirements of this Contract, unless issued in writing and signed by the CO.
G.8.3 In the event the Contractor effects any change at the instruction or request of any person
other than the CO, the change will be considered to have been made without authority
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and no adjustment will be made in the Contract price to cover any cost increase incurred
as a result thereof.

G.9 CONTRACT ADMINISTRATOR

G.9.1 The CA is responsible for general administration of the Contract and advising the CO as
to the Contractor’s compliance or noncompliance with the Contract. The CA has the
responsibility of ensuring the work conforms to the requirements of the Contract and
such other responsibilities and authorities as may be specified in the Contract.
These include:
G.9.1.1 Keeping the CO fully informed of any technical or contractual difficulties
encountered during the performance period and advising the CO of any potential
problem areas under the Contract;
G.9.1.2 Coordinating site entry for Contractor personnel, if applicable;
G.9.1.3 Reviewing invoices for completed work and recommending approval by the CO if the
Contractor’s costs are consistent with the negotiated amounts and progress is
satisfactory and commensurate with the rate of expenditure;
G.9.1.4 Reviewing and approving invoices for deliverables to ensure receipt of goods and
services. This includes the timely processing of invoices and vouchers in accordance
with the District’s payment provisions; and
G.9.1.5 Maintaining a file that includes all Contract correspondence, modifications, records of
inspections (site, data, equipment) and invoice or vouchers.
G.9.2 The address and telephone number of the CA is:
Tiffany Aziz
Department of Health Care Finance
Clinicians, Pharmacy & Acute Provider Services (CPAPS)
441 4th St., NW, Suite 900s
Washington, DC 20001
202-724-5382
tiffany.aziz@dc.gov

G.9.3 The CA shall NOT have the authority to:

G.9.3.1 Award, agree to, or sign any Contract, delivery order or task order. Only the CO shall
make contractual agreements, commitments, or modifications;
G.9.3.2 Grant deviations from or waive any of the terms and conditions of the Contract;
G.9.3.3 Increase the dollar limit of the Contract or authorize work beyond the dollar limit of
the Contract,
G.9.3.4 Authorize the expenditure of funds by the Contractor;
G.9.3.5 Change the period of performance; or
G.9.3.6 Authorize the use of District property, except as specified under the Contract.
G.9.4 The Contractor will be fully responsible for any changes not authorized in advance, in
writing, by the CO; may be denied compensation or other relief for any additional work
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performed that is not so authorized; and may also be required, at no additional cost to the
District, to take all corrective action necessitated by reason of the unauthorized changes.

G.10 ORDERING CLAUSE

G.10.1 Any supplies and services to be furnished under this contract must be ordered by issuance
of delivery orders or task orders by the CO. Such orders may be issued during the term of
this contract.

G.10.2 All delivery orders or task orders are subject to the terms and conditions of this contract.
In the event of a conflict between a delivery order or task order and this contract, the
contract shall control.

G.10.3 If mailed, a delivery order or task order is considered "issued" when the District deposits
the order in the mail. Orders may be issued by facsimile or by electronic commerce
methods.

G.11 COST REIMBURSEMENT CEILING

G.11.1 The cost reimbursement ceiling for this contract is set forth in Section B, CLIN 0002.

G.11.2 The costs for performing this contract shall not exceed the cost reimbursement ceiling
specified in Section B, CLIN 0002.

G.11.3 The Contractor agrees to use its best efforts to perform the work specified in this
contract and to meet all obligations under this contract within the cost reimbursement
ceiling.

G.11.4 The Contractor must notify the CO, in writing, whenever it has reason to believe that
the total cost for the performance of this contract will be either greater or substantially
less than the cost reimbursement ceiling.

G.11.5 As part of the notification, the Contractor must provide the CO a revised estimate of
the total cost of performing this contract.

G.11.6 The District is not obligated to reimburse the Contractor for costs incurred in excess
of the cost reimbursement ceiling specified in Section B, CLIN 0002, and the
Contractor is not obligated to continue performance under this contract (including
actions under the Termination clauses of this contract), or otherwise incur costs in
excess of the cost reimbursement ceiling specified in Section B, CLIN 0002, until the
CO notifies the Contractor, in writing, that the estimated cost has been increased and
provides revised cost reimbursement ceiling for performing this contract.

G.11.7 No notice, communication, or representation in any form from any person other than
the CO shall change the cost reimbursement ceiling. In the absence of the specified
notice, the District is not obligated to reimburse the Contractor for any costs in excess
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of the costs reimbursement ceiling, whether such costs were incurred during the
course of contract performance or as a result of termination.

G.11.8 If any cost reimbursement ceiling specified in Section B, CLIN 0002 is increased, any
costs the Contractor incurs before the increase that are in excess of the previous cost
reimbursement ceiling shall be allowable to the same extent as if incurred afterward,
unless the CO issues a termination or other notice directing that the increase is solely
to cover termination or other specified expenses.

G.11.9 A change order shall not be considered an authorization to exceed the applicable cost
reimbursement ceiling specified in Section B, CLIN 0002, unless the change order
specifically increases the cost reimbursement ceiling.

G.11.10 Only costs determined in writing to be reimbursable in accordance with the cost
principles set forth in rules issued pursuant to Title V of the D.C. Procurement
Practices Reform Act of 2010 shall be reimbursable.

G.12 INDEMNIFICATION
In accordance with clause 9 of the SCP:

The Contractor agrees to defend, indemnify and hold harmless the District, its officers,
agencies, departments, agents, and employees (collective the “District”) from and against
any and all claims, losses, liabilities, penalties, fines, forfeitures, demands, cause of
action, suits, costs, and expenses incidental thereto (including cost of defense and
attorneys’ fees), resulting from, arising out of, or in any way connected to activities or
work performed by the Contractor, Contractor’s officers, employees, agents, servants,
subcontractors, or any other person acting for or by permission of the Contractor in
performance of this Contract. The Contractor assumes all risks for direct and indirect
damage or injury to the property or persons used or employed in performance of this
Contract. The Contractor shall also repair or replace any District property that is damaged
by the Contractor, Contractor’s officers, employees, agents, servants, subcontractors, or
any other person acting for or by permission of the Contractor while performing work
hereunder.

The indemnification obligation under this section shall not be limited by the existence of
any insurance policy or by any limitation on the amount or type of damages,
compensation or benefits payable by or for Contractor or any subcontractor, and shall
survive the termination of this Contract. The District agrees to give Contractor written
notice of any claim of indemnity under this section. Additionally, Contractor shall have
the right and sole authority to control the defense or settlement of such claim, provided
that no contribution or action by the District is required in connection with the settlement.
Monies due or to become due to the Contractor under this contract may be retained by the
District as necessary to satisfy any outstanding claim which the District may have against
the Contractor.
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SECTION H: SPECIAL CONTRACT REQUIREMENTS
H.1 HIRING OF DISTRICT RESIDENTS AS APPRENTICES AND TRAINEES

H.1.1 For all new employment resulting from this contract or subcontracts hereto, as defined in
Mayor’s Order 83-265 and implementing instructions, the Contractor shall use its best
efforts to comply with the following basic goal and objectives for utilization of bona fide
residents of the District of Columbia in each project’s labor force:

H.1.1.1 At least fifty-one (51) percent of apprentices and trainees employed shall be residents
of the District of Columbia registered in programs approved by the District of
Columbia Apprenticeship Council.
H.1.2 The Contractor shall negotiate an Employment Agreement with the Department of
Employment Services (DOES) for jobs created as a result of this contract. The DOES
shall be the Contractor’s first source of referral for qualified apprentices and trainees in
the implementation of employment goals contained in this clause.

H.2 DEPARTMENT OF LABOR WAGE DETERMINATIONS

The Contractor shall be bound by the Wage Determination No. 2015-4281, Rev. 35, dated
December 3, 2025, issued by the U.S. Department of Labor in accordance with the
Service Contract Act, 41 U.S.C. § 351 et seq., and incorporated herein as Section J.2. The
Contractor shall be bound by the wage rates for the term of the contract subject to
revision as stated herein and in accordance with clause 24 of the SCP. If an option is
exercised, the Contractor shall be bound by the applicable wage rates at the time of the
exercise of the option. If the option is exercised and the CO obtains a revised wage
determination, the revised wage determination is applicable for the option periods and the
Contractor may be entitled to an equitable adjustment.

H.3 PREGNANT WORKERS FAIRNESS

H.3.1 The contractor shall comply with the Protecting Pregnant Workers Fairness Act of 2016,
D.C. Official Code § 32-1231.01 et seq. (PPWF Act).

H.3.2 The contractor shall not:
(a) Refuse to make reasonable accommodations to the known limitations related to
pregnancy, childbirth, related medical conditions, or breastfeeding for an employee,
unless the contractor can demonstrate that the accommodation would impose an undue
hardship;
(b) Take an adverse action against an employee who requests or uses a reasonable
accommodation in regard to the employee's conditions or privileges of employment,
including failing to reinstate the employee when the need for reasonable accommodations
ceases to the employee's original job or to an equivalent position with equivalent:
(1) Pay;
(2) Accumulated seniority and retirement;
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(3) Benefits; and
(4) Other applicable service credits.
(c) Deny employment opportunities to an employee, or a job applicant, if the denial is based
on the need of the employer to make reasonable accommodations to the known
limitations related to pregnancy, childbirth, related medical conditions, or breastfeeding;
(d) Require an employee affected by pregnancy, childbirth, related medical conditions, or
breastfeeding to accept an accommodation that the employee chooses not to accept if the
employee does not have a known limitation related to pregnancy, childbirth, related
medical conditions, or breastfeeding or the accommodation is not necessary for the
employee to perform her duties;
(e) Require an employee to take leave if a reasonable accommodation can be provided; or
(f) Take adverse action against an employee who has been absent from work as a result of a
pregnancy-related condition, including a pre-birth complication.

H.3.3 The contractor shall post and maintain in a conspicuous place a notice of rights in both
English and Spanish and provide written notice of an employee's right to a needed
reasonable accommodation related to pregnancy, childbirth, related medical conditions,
or breastfeeding pursuant to the PPWF Act to:
(a) New employees at the commencement of employment;
(b) Existing employees; and
(c) An employee who notifies the employer of her pregnancy, or other condition covered
by the PPWF Act, within 10 days of the notification.

H.3.4 The contractor shall provide an accurate written translation of the notice of rights to any
non-English or non-Spanish speaking employee.

H.3.5 Violations of the PPWF Act shall be subject to civil penalties as described in the Act.

H.4 UNEMPLOYED ANTI-DISCRIMINATION

H.4.1 The Contractor shall comply with the Unemployed Anti-Discrimination Act of 2012,
D.C. Official Code § 32-1361 et seq.

H.4.2 The Contractor shall not:
(a) Fail or refuse to consider for employment, or fail or refuse to hire, an individual as an
employee because of the individual's status as unemployed; or
(b) Publish, in print, on the Internet, or in any other medium, an advertisement or
announcement for any vacancy in a job for employment that includes:
(1) Any provision stating or indicating that an individual's status as unemployed
disqualifies the individual for the job; or
(2) Any provision stating or indicating that an employment agency will not consider
or hire an individual for employment based on that individual's status as
unemployed.
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H.4.3 Violations of the Unemployed Anti-Discrimination Act shall be subject to civil penalties
as described in the Act.

H.5 51% DISTRICT RESIDENTS NEW HIRES REQUIREMENTS AND FIRST
SOURCE EMPLOYMENT AGREEMENT

H.5.1 For contracts for services in the amount of $300,000 or more, the Contractor shall comply
with the First Source Employment Agreement Act of 1984, as amended, D.C. Official
Code § 2-219.01 et seq. (First Source Act).

H.5.2 The Contractor shall enter into and maintain during the term of the contract, a First
Source Employment Agreement (Employment Agreement) with the District of Columbia
Department of Employment Service’s (DOES), in which the Contractor shall agree that:
(a) The first source for finding employees to fill all jobs created in order to perform the
contract shall be the First Source Register; and
(b) The first source for finding employees to fill any vacancy occurring in all jobs
covered by the Employment Agreement shall be the First Source Register.

H.5.3 The Contractor shall not begin performance of the contract until its Employment
Agreement has been accepted by DOES. Once approved, the Employment Agreement
shall not be amended except with the approval of DOES.

H.5.4 The Contractor agrees that at least 51% of the new employees hired to perform the
contract shall be District residents.

H.5.5 The Contractor’s hiring and reporting requirements under the First Source Act and any
rules promulgated thereunder shall continue for the term of the contract.

H.5.6 The CO may impose penalties, including monetary fines of 5% of the total amount of the
direct and indirect labor costs of the contract, for a willful breach of the Employment
Agreement, failure to submit the required hiring compliance reports, or deliberate
submission of falsified data.

H.5.7 If the Contractor does not receive a good faith waiver, the CO may also impose an
additional penalty equal to 1/8 of 1% of the total amount of the direct and indirect labor
costs of the contract for each percentage by which the Contractor fails to meet its hiring
requirements.
H.5.8 Any contractor which violates, more than once within a 10-year timeframe, the hiring or
reporting requirements of the First Source Act shall be referred for debarment for not
more than five (5) years.

H.5.9 The contractor may appeal any decision of the CO pursuant to this clause to the D.C.
Contract Appeals Board as provided in clause 14 of the SCP, Disputes.
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H.5.10 The provisions of the First Source Act do not apply to nonprofit organizations which
employ 50 employees or less.

H.6 RESERVED

H.7 RESERVED

H.8 RESERVED

H.9 SUBCONTRACTING REQUIREMENTS

H.9.1 Mandatory Subcontracting Requirements

H.9.1.1 For all contracts in excess of $250,000, at least 35% of the dollar volume of the
contract shall be subcontracted to qualified small business enterprises (SBEs).

H.9.1.2 If there are insufficient SBEs to completely fulfill the requirement of paragraph
H.9.1.1, then the subcontracting may be satisfied by subcontracting 35% of the dollar
volume to any qualified certified business enterprises (CBEs); provided, however,
that all reasonable efforts shall be made to ensure that SBEs are significant
participants in the overall subcontracting work.

H.9.1.3 A prime contractor that is certified by DSLBD as a small, local or disadvantaged
business enterprise shall not be required to comply with the provisions of sections
H.9.1.1 and H.9.1.2.

H.9.1.4 Except as provided in H.9.1.5 and H.9.1.7, a prime contractor that is a CBE and has
been granted a proposal preference pursuant to D.C. Official Code § 2-218.43, or is
selected through a set-aside program, shall perform at least 35% of the contracting
effort with its own organization and resources and, if it subcontracts, 35% of the
subcontracting effort shall be with CBEs. A CBE prime contractor that performs less
than 35% of the contracting effort shall be subject to enforcement actions under D.C.
Official Code § 2-218.63.

H.9.1.5 If the prime contractor is a certified joint venture and has been granted a bid
preference pursuant to D.C. Official Code § 2-218.43, or is selected through a set-
aside program, the CBE member of the certified joint venture shall perform at least
50% of the contracting effort with its own organization and resources and, if it
subcontracts, 35% of the subcontracting effort shall be with CBEs. If the CBE
member of the certified joint venture prime contractor performs less than 50% of the
contracting effort, the certified joint venture shall be subject to enforcement actions
under D.C. Official Code § 2-218.63.

H.9.1.6 Each CBE utilized to meet these subcontracting requirements shall perform at least
35% of its contracting effort with its own organization and resources.
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H.9.1.7 A prime contractor that is a CBE and has been granted a proposal preference pursuant
to D.C. Official Code § 2-218.43, or is selected through a set-aside program, shall
perform at least 50% of the on-site work with its own organization and resources if
the contract is $1 million or less.

H.9.2 Subcontracting Plan

H.9.2.1 If the prime contractor is required to subcontract under this contract, it shall submit a
subcontracting plan as part of the proposal and it may only be amended after award
with the prior written approval of the CO and Director of DSLBD. The
Subcontracting Plan form shall show proposed subcontracts for a total amount
of at least 35% of the Offeror’s proposed Estimated Grand Total for B.4.1.1
price for the base period year only. Do NOT include the Cost Reimbursement
Amount of NTE $500,000.

Small Business Enterprises (SBEs) or Certified Business Enterprises (CBEs)
responding to this solicitation MUST also complete the Subcontracting Plan
form, see Attachment J.8, section 1C. SBEs/CBEs must attest to completing
100% of the work with its own organization and resources or attest to
subcontracting a portion of the contract with SBEs/CBEs by completing
Attachment J.8 in its entirety. Failure to complete and submit the
Subcontracting Plan form, will disqualify your proposal in accordance with
Sections B.6, B.7, and H.9.2. Any reduction in the dollar volume of the
subcontracted portion resulting from an amendment of the plan after award shall inure
to the benefit of the District.

H.9.2.2 Each subcontracting plan shall include the following:
(1) The name and address of each subcontractor;
(2) A current certification number of the small or certified business enterprise;
(3) The scope of work to be performed by each subcontractor; and
(4) The price that the prime contractor will pay each subcontractor.

H.9.3 Copies of Subcontracts

Within twenty-one (21) days of the date of award, the Contractor shall provide fully
executed copies of all subcontracts identified in the subcontracting plan to the CO, CA,
District of Columbia Auditor and the Director of DSLBD.
H.9.4 Subcontracting Plan Compliance Reporting
H.9.4.1 If the Contractor has a subcontracting plan required by law for this contract, the
Contractor shall submit a quarterly report to the CO, CA, District of Columbia
Auditor and the Director of DSLBD. The quarterly report shall include the following
information for each subcontract identified in the subcontracting plan:
(a) The price that the prime contractor will pay each subcontractor under the
subcontract;
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(b) A description of the goods procured, or the services subcontracted for;
(c) The amount paid by the prime contractor under the subcontract; and
(d) A copy of the fully executed subcontract, if it was not provided with an earlier
quarterly report.

H.9.4.2 If the fully executed subcontract is not provided with the quarterly report, the prime
contractor will not receive credit toward its subcontracting requirements for that
subcontract.

H.9.5 Annual Meetings

Upon at least 30-days written notice provided by DSLBD, the Contractor shall meet
annually with the CO, CA, District of Columbia Auditor and the Director of DSLBD to
provide an update on its subcontracting plan.

H.9.6 Notices

The Contractor shall provide written notice to the DSLBD and the District of Columbia
Auditor upon commencement of the contract and when the contract is completed.

H.9.7 Enforcement and Penalties for Breach of Subcontracting Plan

H.9.7.1 A contractor shall be deemed to have breached a subcontracting plan required by law,
if the contractor (i) fails to submit subcontracting plan monitoring or compliance
reports or other required subcontracting information in a reasonably timely manner;
(ii) submits a monitoring or compliance report or other required subcontracting
information containing a materially false statement; or (iii) fails to meet its
subcontracting requirements.

H.9.7.2 A contractor that is found to have breached its subcontracting plan for utilization of
CBEs in the performance of a contract shall be subject to the imposition of penalties,
including monetary fines in accordance with D.C. Official Code § 2-218.63.

H.9.7.3 If the CO determines the Contractor’s failure to be a material breach of the contract,
the CO shall have cause to terminate the contract under the default provisions in
clause 8 of the SCP, Default.
H.10 FAIR CRIMINAL RECORD SCREENING
H.10.1 The Contractor shall comply with the provisions of the Fair Criminal Record Screening
Amendment Act of 2014, effective December 17, 2014 (D.C. Law 20-152) (the “Act” as
used in this section). This section applies to any employment, including employment on
a temporary or contractual basis, where the physical location of the employment is in
whole or substantial part within the District of Columbia.
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H.10.2 Prior to making a conditional offer of employment, the Contractor shall not require an
applicant for employment, or a person who has requested consideration for employment
by the Contractor, to reveal or disclose an arrest or criminal accusation that is not then
pending or did not result in a criminal conviction.

H.10.3 After making a conditional offer of employment, the Contractor may require an applicant
to disclose or reveal a criminal conviction.

H.10.4 The Contractor may only withdraw a conditional offer of employment, or take adverse
action against an applicant, for a legitimate business reason as described in the Act.

H.10.5 This section and the provisions of the Act shall not apply:

(a) Where federal or District law or regulation requires the consideration of an
applicant’s criminal history for the purposes of employment;
(b) To a position designated by the employer as part of a federal or District government
program or obligation that is designed to encourage the employment of those with
criminal histories;
(c) To any facility or employer that provides programs, services, or direct care to,
children, youth, or vulnerable adults; or
(d) To employers that employ less than 11 employees.

H.10.6 A person claiming to be aggrieved by a violation of the Act may file an administrative
complaint with the District of Columbia Office of Human Rights, and the Commission on
Human Rights may impose monetary penalties against the Contractor.

H.11 DISTRICT RESPONSIBILITIES

The Government of the District of Columbia will provide the following:

H.11.1 Orientation (kickoff meeting) for the Contractor relative to the terms of the contract
and program mandates;

H.11.2 Assistance with transition activities and NEMT integration;
H.11.3 Continuous contract performance evaluations and program monitoring;
H.11.4 Preparing any response or request for additional information or clarification from the
Contractor as it pertains to the Contractor’s compliance or noncompliance of
submission of deliverables;
H.11.5 Monitor and evaluate Contractor compliance with the requirements of this Contract;
H.11.6 Conduct a timely review of all materials submitted to DHCF by the Contractor as
required;
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H.11.7 Maintain adequate liaison and cooperation with the Contractor, including providing
timely management decisions and approvals of forms and procedures to enable the
Contractor to properly perform contractual duties;

H.11.8 Attend required meetings with the Contractor to discuss issues, changes, deliverables’
status, and specific agenda items proposed by the District or the Contractor. The
Contractor shall be the default chair of the meetings; however, the CA shall have
discretion to chair the meetings upon request;

H.11.9 DHCF reserves the right to inspect the Contractor’s physical facilities, including any
located outside of Washington DC, prior to award to satisfy questions regarding the
Contractor’s ability to perform the requirements of the NEMT contract; and

H.11.10 In accordance with 42 C.F.R. § 440.170 (a)(4), DHCF, its designee, may perform
reviews and audits of the Contractor’s day-to-day operations as needed or every 6
months to ensure the Contractor is compliant with the requirements set forth in this
Contract. The reviews and audits may include, but not be limited to the following:
Desktop; on-site visits; staff and Enrollee interviews; transportation provider record
reviews (paper or electronic); Claims payment systems; care/case management
software systems; customer relations system; review of CQI policies and procedures;
reports; committee activities; credentialing and re-credentialing activities; denials;
Grievance and Appeals activities; corrective action and follow-up plans; review of
survey results; and staff and Provider qualifications.

H.11.11 Performance Monitoring

H.11.11.1 The District reserves the right to conduct a review of the Contract’s records or to
conduct an on-site review at any time to ensure compliance with these
requirements.

H.11.11.2 The District reserves the right to intervene if problems or issues regarding
Beneficiaries persist and are not satisfied by the Contractor.

H.11.11.3 The District reserves the right to authorize any of its staff members or Agents to
ride on scheduled and unscheduled trips to monitor service. The Contractor and
Transportation Provider’s vehicle shall be made available to DHCF or its Agent(s)
for inspection at any time.

H.11.11.4 The CA shall review reports of complaints from Beneficiaries, providers, or any
individual or group who contact DHCF or the Contractor regarding District
complaints involving the delivery of services under the Contract.

H.11.11.5 The District will receive service complaints via telephone and email from
Beneficiaries and health care providers. The Contractor’s account manager,
project manager or designee shall be available to respond to DHCF concerning
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these complaints within a 30-minute response time.

H.12 CONTRACTOR RESPONSIBILITIES

H.12.1 The Contractor shall provide sufficient staff devoted to delivering the requirements
outlined in this contract. The Contractor shall ensure that its staff responds to the CA
requests for documents and information. The Contractor’s staff shall respond to the CA’s
questions and requests in a timely and efficient manner.

H.12.2 All deliverables, materials or other submissions provided by the Contractor must meet the
requirements specified in Section F.3. Such deliverables or other materials are subject to
DHCF approval.

H.12.3 If DHCF rejects a deliverable, the Contractor will have a resolution period beginning
with notice from DHCF that the deliverable is not approved. The resolution period will
last for ten (10) business days from the notice of deliverable rejection. If, at the end of the
specified time, the deliverable(s) submitted by the Contractor are not approved by DHCF,
DHCF may, at its sole discretion, withhold all or part of the next monthly payment and
any subsequent payments until the deliverable(s) are acceptable to DHCF.

H.12.4 Prohibited Information and Activities
The Contractor shall not violate applicable Federal law as specified in Sections
1903(m)(5)(A) and 1932(e)(1) of the Social Security Act (C.2.1 Applicable Document
#4) and 42 CFR 422.208-210, §438.700-702, and 45 CFR 92.36(i)(1), including:
H.12.4.1 Acting to discriminate among Beneficiaries on the basis of their health status or need
for health care services;
H.12.4.2 Misrepresenting or falsifying information the Contractor furnishes to CMS or the
District;
H.12.4.3 Misrepresenting or falsifying information that the Contractor furnishes to a
Beneficiary or health care provider;
H.12.4.4 Distributing directly or indirectly through any Agent or independent Contractor,
materials that have not been approved by the District or that contain false or
materially misleading information;
H.12.4.5 Violating any of the other applicable requirements of sections 1903(m) or 1932 of the
Social Security Act and any implementing regulations; and
H.12.4.6 Violating District of Columbia law; or regulations or court orders including but not
limited to Salazar v. The District of Columbia et.al (Attachment J.19).
H.13 DIVERSION, REASSIGNMENT AND REPLACEMENT OF KEY PERSONNEL
The Key Personnel specified in Section C.5.26.1 are considered to be essential to the
work being performed hereunder. Prior to diverting any of the Key Personnel for any
reason, the Contractor shall notify the CO in writing at least 30 days in advance and shall
submit justification, including proposed substitutions, in sufficient detail to permit
evaluation of the impact upon Contract performance. The Contractor shall obtain written
approval of the CO for any proposed substitution of Key Personnel.
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H.14 AUDITS AND RECORDS

H.14.1 As used in this clause, “records” includes books, documents, accounting procedures and
practices, and other data, regardless of type and regardless of whether such items are in
written form, in the form of computer data, or in any other form.

H.14.2 Examination of Costs. If this is a cost-reimbursement, incentive, time-and-materials,
labor-hour, or price redeterminable contract, or any combination of these, the Contractor
shall maintain and the CO, or an authorized representative of the CO, shall have the right
to examine and audit all records and other evidence sufficient to reflect properly all costs
claimed to have been incurred or anticipated to be incurred directly or indirectly in
performance of this contract. This right of examination shall include inspection at all
reasonable times of the Contractor’s plants, or parts of them, engaged in performing the
contract.

H.14.3 Cost or pricing data. If the Contractor has been required to submit cost or pricing data
in connection with any pricing action relating to this contract, the CO, or an authorized
representative of the CO, in order to evaluate the accuracy, completeness, and currency of
the cost or pricing data, shall have the right to examine and audit all of the Contractor’s
records, including computations and projections, related to:
(a) The proposal for the contract, subcontract, or modification;
(b) The discussions conducted on the proposal(s), including those related to negotiating;
(c) Pricing of the contract, subcontract, or modification; or
(d) Performance of the contract, subcontract or modification.

H.14.4 Comptroller General. The Comptroller General of the United States, or an authorized
representative, shall have access to and the right to examine any of the Contractor’s
directly pertinent records involving transactions related to this contract or a subcontract
hereunder.

H.14.4.1 This paragraph may not be construed to require the Contractor or subcontractor to
create or maintain any record that the Contractor or subcontractor does not maintain
in the ordinary course of business or pursuant to a provision of law.

H.14.5 Reports. If the Contractor is required to furnish cost, funding, or performance reports,
the CO or an authorized representative of the CO shall have the right to examine and
audit the supporting records and materials, for the purpose of evaluating:
(a) The effectiveness of the Contractor’s policies and procedures to produce data
compatible with the objectives of these reports; and
(b) the data reported.

H.14.6 Availability. The Contractor shall make available at its office at all reasonable times the
records, materials, and other evidence described in clauses H.14.1 through H.14.5, for
examination, audit, or reproduction, until three (3) years after final payment under this
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contract or for any shorter period specified in the solicitation, or for any longer period
required by statute or by other clauses of this contract. In addition:
(a) If this contract is completely or partially terminated, the Contractor shall make
available the records relating to the work terminated until thee (3) years after any
resulting final termination settlement; and
(b) The Contractor shall make available records relating to appeals under the Disputes
clause or to litigation or the settlement of claims arising under or relating to this
contract until such appeals, litigation, or claims are finally resolved.

H.14.7 The Contractor shall insert a clause containing all the terms of this clause, including this
section H.14.7, in all subcontracts under this contract that exceed the small purchase
threshold of $100,000, and:
(a) That are cost-reimbursement, incentive, time-and-materials, labor-hour, or price-
redeterminable type or any combination of these;
(b) For which cost or pricing data are required; or
(c) That requires the subcontractor to furnish reports as discussed in H.14.5 of this
clause.

H.15 HIPAA BUSINESS ASSOCIATE COMPLIANCE

Any contractor with access to or responsibility for creating, transmitting, receiving,
accessing, or maintaining protected health information (PHI) on behalf of the District of
Columbia must comply with the Health Insurance Portability and Accountability Act of
1996 (HIPAA), as amended, and its implementing regulations at 45 CFR Parts 160, 162,
and 164. This includes adherence to the HIPAA Privacy Compliance Business Associate
Agreement and the Business Associate HIPAA Compliance Questionnaire. These
requirements apply to all contracts where the contractor qualifies as a Business Associate,
as defined under HIPAA regulations.

H.16 FRAUD, WASTE AND ABUSE PROVISIONS AND PROTECTIONS

H.16.1 Cooperation with the District

H.16.1.1 The Contractor is subject to all state and Federal laws and regulations relating to
fraud, waste and abuse in health care and the Medicaid program.
H.16.1.2 The Contractor shall cooperate and assist the District of Columbia, and any State or
Federal agency charged with the duty of identifying, investigating, or prosecuting
suspected fraud, waste and abuse.
H.16.1.3 The Contractor shall provide all records and information requested and allow the CA,
CMS, the U.S. Department of Health and Human Services, FBI and the District's
Medicaid Fraud Control Unit access to the Contractor's premises and provide records
to. All copies of records shall be provided free of charge.
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H.16.1.4 The Contractor shall be responsible for promptly reporting suspected fraud, abuse, or
violation of the terms of the Contract to the CA, Office of Program Integrity and the
Contracting Officer, taking prompt corrective actions consistent with the terms of any
subcontract, and cooperating with District investigations.

H.16.1.5 The Contractor shall allow the District of Columbia Medicaid Fraud Control Unit or
its representatives to conduct private interviews of Contractor's employees,
subcontractors, and their employees, witnesses, and patients. The Contractor shall
honor requests for information in the form and the language specified.

H.16.1.6 The Contractor shall ensure that its staff and its subcontractors and their staff shall
cooperate fully and be available in person for interviews, consultation grand jury
proceedings, pre-trial conference, hearings, trials, and in any other process.

H.16.2 Federal False Claims Act

In accordance with Section 6032 of the Deficit Reduction Act, the Contractor shall:
(1) Establish written policies for all employees of the entity (including management),
and of any Contractor or agent of the entity, that provide detailed information about
the False Claims Act established under sections 3729 through 3733 of Title 31, United
States Code, administrative remedies for false claims and statements established
under chapter 38 of Title 31, United States Code, any state laws pertaining to civil or
criminal penalties for false claims and statements, and whistleblower protections
under such laws, with respect to the role of such laws in preventing and detecting
fraud, waste, and abuse in Federal health care programs (as defined in section
1128B(f) of the Social Security Act);

(2) Include as part of such written policies, detailed provisions regarding the entity's
policies and procedures for detecting and preventing fraud, waste, and abuse; and

(3) Include in any employee handbook for the entity, a specific discussion of the laws
described in subparagraph (A), the rights of employees to be protected as
whistleblowers, and the entity's policies and procedures for detecting and preventing
fraud, waste, and abuse.

H.17 CMS REQUIRED PROVISIONS
H.17.1 The state or local government will have all ownership rights in software or modifications
thereof and associated documentation designed, developed or installed with federal
financial participation (FFP). [45 CFR 95.617(a)]
H.17.2 The Federal government reserves a royalty-free, non-exclusive, and irrevocable license to
reproduce, publish, or otherwise use and to authorize others to use for Federal
government purposes, such software, modifications, and documentation. [45 CFR
95.617(b)]
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H.17.3 Proprietary operating/contractor software packages which are provided at established
catalog or market prices and sold or leased to the general public shall not be subject to the
ownership provisions in paragraphs (a) and (b) of this section. FFP is not available for
proprietary applications software developed specifically for the public assistance
programs covered under this subpart. [45 CFR 95.617(c)]

H.17.4 The Contractor is not permitted to use program data for independent projects without
prior written permission from the state. [SMM 2083.5] CW118651– Provider Data
Management System & Services O&M

H.17.5 The right of HHS (CMS) to conduct evaluation of services performed by the contractor
and for audit and inspection of contractor records. [SMM 2080.9]

H.17.6 No subcontract terminates the legal responsibility of the (prime) contractor to the agency
to assure that all activities under the contract are carried out. [42 CFR 434.6 (c) & SMM
2081.2]

H.17.7 Contract includes termination procedures that require the contractor to promptly supply
all materials necessary for continued operation of systems, including:
H.17.7.1 computer programs
H.17.7.2 data files user and operations manuals
H.17.7.3 system and program documentation
H.17.7.4 training programs related to the operation and maintenance of the system [42 CFR
434.10 (b) & SMM 2082.2]

H.18 FNS REQUIRED PROVISIONS

H.18.1 Compliance with Executive Order 11246 related to Equal Employment Opportunity.

H.18.2 Compliance with Clean Air Act:
Clean Air Act (42 U.S.C. 7401-7671q.) and the Federal Water Pollution Control Act (33
U.S.C. 1251-1387), as amended. Contracts and subgrants of amounts in excess of
$150,000 must contain a provision that requires the non-Federal award to agree to
comply with all applicable standards, orders or regulations issued pursuant to the Clean
Air Act (42 U.S.C. 7401-7671q) and the Federal Water Pollution Control Act as amended
(33 U.S.C. 1251-1387). Violations must be reported to the Federal awarding agency and
the Regional Office of the Environmental Protection Agency (EPA). (2 CFR 200, Subpart
F, Appendix II).

H.18.3 Compliance with the Clean Water Act (33 U.S.C. 1251-1387).

H.18.4 Compliance with “Anti-Kickback” Act, 40 USC §276c and 18 USC §874 The Copeland:
The “Anti-Kickback” section of the Act precludes a contractor or sub-contractor from
inducing an employee to give up any part of the compensation to which he or she is
entitled under his or her contract of employment. The Act also requires the contractor and
sub-contractor to submit a weekly statement of the wages paid to each employee
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performing on covered work during the preceding payroll period.

H.18.5 Compliance with the Anti-Lobbying Act:
This Act prohibits the recipients of Federal contracts, grants, and loans from using
appropriated funds for lobbying the Executive or Legislative branches of the Federal
government in connection with a specific contract, grant, or loan. As required by Section
1352, Title 31 of the U.S. Code and implemented at 2 CFR 200, Subpart F, Appendix II,
for persons entering into a grant or cooperative agreement over $100,000, as defined at
31 U.S.C. 1352, the applicant certifies that:
H.18.5.1 No federal appropriated funds have been paid or will be paid, by or on behalf of the
undersigned, to any person for influencing or attempting to influence an officer or
employee of any agency, a member of Congress, an officer or employee of Congress,
or an employee of a member of Congress in connection with the making of any
federal grant, the entering into of any cooperative agreement, and the extension,
continuation, renewal, amendment, or modification of any federal grant or
cooperative agreement;
H.18.5.2 If any funds other than federal appropriated funds have been paid or will be paid to
any person for influencing or attempting to influence an officer or employee of any
agency, a member of Congress, an officer or employee of Congress, or an employee
of a member of Congress in connection with this federal grantor o cooperative
agreement, the undersigned shall complete and submit Standard Form – LLL,
“Disclosure Form to Report Lobbying,” in accordance with its instructions;
H.18.5.3 The undersigned shall require that the language of this certification be included in the
award documents for all sub-awards at all tiers (including sub-grants, contracts under
grants and cooperative agreements, and subcontracts) and that all sub-recipients shall
certify and disclose accordingly.

H.18.6 Compliance with Americans with Disabilities Act:
This Act (28 CFR Part 35, Title II, Subtitle A) prohibits discrimination on the basis of
disability in all services, programs, and activities provided to the public and State and
local governments, except public transportation services.

H.18.7 Compliance with Drug-Free Workplace requirements:
The Federal government implemented 41 U.S. Code § 8103, Drug-free workplace
requirements for Federal grant recipients in an attempt to address the problems of drug
abuse on the job. It is a fact that employees who use drugs have less productivity, a lower
quality of work, higher absenteeism, and are more likely to misappropriate funds or
services. From this perspective, the drug abuser may endanger other employees, the
public at large, or themselves. Damage to property, whether owned by this entity or not,
could result from drug abuse on the job. All these actions might undermine public
confidence in the services this entity provides. Therefore, in order to remain a responsible
source for government contracts, the following guidelines have been adopted:
H.18.7.1 The unlawful manufacture, distribution, dispensation, possession or use of a
controlled substance is prohibited in the workplace.
H.18.7.2 Violators may be terminated or requested to seek counseling from an approved
rehabilitation service.
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H.18.7.3 Employees must notify their employer of any conviction of a criminal drug statute no
later than five days after such conviction.
H.18.7.4 Contractors of federal agencies are required to certify that they will provide drug-free
workplaces for their employees.

H.18.8 Transactions subject to the suspension/debarment rules (covered transactions) include
grants, subgrants, cooperative agreements, and prime contracts under such awards.
Subcontracts are not included. Also, the dollar threshold for covered procurement
contracts is $25,000. Contracts for Federally required audit services are covered
regardless of dollar amount.

H.18.9 Compliance with suspension/debarment requirements:
Debarment and Suspension (Executive Orders 12549 and 12689)—A contract award (see
2 CFR 180.220) must not be made to parties listed on the government wide exclusions in
the System for Award Management (SAM), in accordance with the OMB guidelines at 2
CFR 180 that implement Executive Orders 12549 (3 CFR part 1986 Comp., p. 189) and
12689 (3 CFR part 1989 Comp., p. 235), “Debarment and Suspension.” SAM Exclusions
contain the names of parties debarred, suspended, or otherwise excluded by agencies, as
well as parties declared ineligible under statutory or regulatory authority other than
Executive Order 12549. (2 CFR 200, Subpart F, Appendix II)

H.18.10 FNS has royalty-free rights to use software and documentation developed (2 CFR
200.315 Intangible property):
H.18.10.1 Title to intangible property (see §200.59 Intangible property) acquired under a
Federal award vests upon acquisition in the non-Federal entity. The non-Federal
entity must use that property for the originally authorized purpose and must not
encumber the property without approval of the Federal awarding agency. When no
longer needed for the originally authorized purpose, disposition of the intangible
property must occur in accordance with the provisions in §200.313 Equipment
paragraph (e).
H.18.10.2 The non-Federal entity may copyright any work that is subject to copyright and was
developed, or for which ownership was acquired, under a Federal award. The Federal
awarding agency reserves a royalty-free, nonexclusive, and irrevocable right to
reproduce, publish, or otherwise use the work for Federal purposes, and to authorize
others to do so.
H.18.10.3 The non-Federal entity is subject to applicable regulations governing patents and
inventions, including government wide regulations issued by the Department of
Commerce at 37 CFR Part 401, “Rights to Inventions Made by Nonprofit
Organizations and Small Business Firms Under Government Awards, Contracts and
Cooperative Agreements.”
H.18.10.4 The Federal Government has the right to:
H.18.10.4.1 Obtain, reproduce, publish, or otherwise use the data produced under a Federal
award; and
H.18.10.4.2 Authorize others to receive, reproduce, publish, or otherwise use such data for
Federal purposes.
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H.18.11 Required Federal Assurances of FNS Handbook 901. For reference, Appendix F in
FNS Handbook 901 provides the Federal clauses: https://fns-
prod.azureedge.net/sites/default/files/resource-files/HB901v2.4.pdf

H.19 INTELLECTUAL PROPERTY
The Contractor shall comply with CMS’ grantor agency requirements and regulations
pertaining to reporting and patient rights and of CMS requirements and regulations
pertaining to copyrights and rights in data.

H.20 ENERGY EFFICIENCY
The Contractor shall recognize mandatory standards and policies related to energy
efficiency which are contained in the District’s energy conservation plan issued in
compliance with the Energy Policy and Conservation Act (Public Law 94-165, 42 U.S.C.
§ 6-201 et seq.).

H.21 SPECIAL INDEMNIFICATION

The Contractor shall fully indemnify, defend, and hold harmless the District of Columbia,
its officers, employees, and agents from and against any and all losses, liabilities, damages,
penalties, fines, costs, and expenses (including reasonable attorneys’ fees) incurred by the
District that are directly or indirectly attributable to, or arise out of, the Contractor’s
defective performance of its obligations under this Contract.

In the event the federal government reduces, withholds, or recoups all or any portion of the
Federal Medical Assistance Percentage (FMAP) for Medicaid—currently set at seventy-
five percent (75%)—provided to the District, and such reduction, withholding, or
recoupment is determined by the federal government, the District, or any court of
competent jurisdiction to be the result of the Contractor’s acts, omissions, negligence,
willful misconduct, or failure to comply with applicable federal or District laws, rules,
regulations, or contractual requirements, the Contractor shall be liable for, and shall
reimburse the District for, the full amount of the reduction, withholding, or recoupment,
together with any associated interest, penalties, and administrative costs.

H.22 DISCLOSURE OF INFORMATION
H.22.1 In accordance with Federal Regulation 42 CFR 455.104, the Contractor must disclose
the following information to DHCF:
(1) The name and address of each person (individual or corporation) with an
ownership or control interest in the Contractor or in any subcontractor in which
the Contractor has direct or indirect ownership of 5 percent or more. The address
for corporate entities must include as applicable primary business address, every
business location, P.O. Box address, and Federal Tax Identification Number;
(2) Whether any of the persons (individual or corporation) with an ownership or
control interest in the disclosing entity (or fiscal agent) is related to another
person with ownership or control interest in the disclosing entity as a spouse,
parent, child, or sibling; or whether the person (individual or corporation)with an
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ownership or control interest in any subcontractor in which the disclosing entity
(or fiscal agent) has a 5 percent or more interest is related to another person with
ownership or control interest in the disclosing entity as a spouse, parent, child, or
sibling;
(3) The name of any other disclosing entity in which an owner of the disclosing entity
has an ownership or control interest; and
(4) The name, address, date of birth, and Social Security Number of any managing
employee of the disclosing entity.

H.22.2 In accordance with Federal Regulation 42 CFR 455.106, before DHCF enters into or
renews an NEMT agreement, or at any time upon written request by DHCF, the
Contractor must disclose to DHCF the identity of any person who:
(1) Has ownership or control interest in the Contractor, or is an agent or
managing employee of the Contractor; and
(2) Has been convicted of a criminal offense related to that person's
involvement in any program under Medicare, Medicaid, or Title XX of the
Social Security Act since the inception of those programs.
H.22.3 When the disclosures must be provided. The disclosures are due at any of the
following times:
(1) Prior to the Contractor entering into a contractual agreement to provide NEMT
services;
(2) Upon the Contractor executing the contract to provide NEMT services;
(3) Upon request of the DHCF during the contract renewal process; and
(4) Within 35 days after any change in ownership of the Contractor.

H.23 BUSINESS TRANSACTIONS
In accordance with Federal Regulation 42 CFR 455.105, the Contractor must furnish
DHCF, within 35 days of the date on a request, full and complete information related to
business transactions about:
(1) The ownership of any subcontractor with whom the Contractor has had business
transactions totaling more than $25,000 during the 12-month period ending on the
date of the request; and
(2) Any significant business transactions between the Contractor and any wholly owned
supplier, or between the Contractor and any subcontractor, during the 5- year period
ending on the date of the request.

H.24 PUBLICITY
The Contractor shall at all times obtain the prior written approval from the Contracting
Officer before it, any of its officers, agents, employees or subcontractors, either during or
after expiration or termination of the contract, make any statement, or issue any material,
for publication through any medium of communication, bearing on the work performed
or data collected under this contract.
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SECTION I: CONTRACT CLAUSES
I.1 APPLICABILITY OF STANDARD CONTRACT PROVISIONS

The Standard Contract Provisions for use with District of Columbia Government
Supplies and Services Contracts dated July 2010 (“SCP”) are incorporated as part of the
contract. To obtain a copy of the SCP go to http://ocp.dc.gov, under Quick Links click on
“Required Solicitation Documents.”

I.2 CONTRACTS THAT CROSS FISCAL YEARS
Continuation of this contract beyond the current fiscal year is contingent upon future
fiscal appropriations.
I.3 CONFIDENTIALITY OF INFORMATION
The Contractor shall keep all information relating to any employee or customer of the
District in absolute confidence and shall not use the information in connection with any
other matters; nor shall it disclose any such information to any other person, firm or
corporation, in accordance with the District and federal laws governing the
confidentiality of records.

I.4 TIME

Time, if stated in a number of days, will include Saturdays, Sundays, and holidays, unless
otherwise stated herein.

I.5 RIGHTS IN DATA

Delete Article 42, Rights in Data, of the Standard Contract Provisions dated July 2010 for
use with District of Columbia Government Supplies and Services Contracts and
substitute the following Article 42, Rights in Data) in its place:

A. Definitions

1. “Products” - A deliverable under any contract that may include commodities,
services and/or technology furnished by or through Contractor, including existing
and custom Products, such as, but not limited to: a) recorded information,
regardless of form or the media on which it may be recorded; b) document
research; c) experimental, developmental, or engineering work; d) licensed
software; e) components of the hardware environment; f) printed materials
(including but not limited to training manuals, system and user documentation,
reports, drawings); g) third party software; h) modifications, customizations,
custom programs, program listings, programming tools, data, modules,
components; and i) any intellectual property embodied therein, whether in
tangible or intangible form, including but not limited to utilities, interfaces,
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templates, subroutines, algorithms, formulas, source code, and object code.

2. “Existing Products” - Tangible Products and intangible licensed Products that
exist prior to the commencement of work under the contract. Existing Products
must be identified on the Product prior to commencement of work or else will be
presumed to be Custom Products.

3. “Custom Products” - Products, preliminary, final or otherwise, which are created
or developed by Contractor, its subcontractors, partners, employees, resellers or
agents for the District under the contract.

4. “District” – The District of Columbia and its agencies.

B. Title to Project Deliverables

The Contractor acknowledges that it is commissioned by the District to perform
services detailed in the contract. The District shall have ownership and rights for the
duration set forth in the contract to use, copy, modify, distribute, or adapt Products as
follows:

1. Existing Products: Title to all Existing Licensed Product(s), whether or not
embedded in, delivered or operating in conjunction with hardware or Custom
Products, shall remain with Contractor or third party proprietary owner, who
retains all rights, title and interest (including patent, trademark or copyrights).
Effective upon payment, the District shall be granted an irrevocable, non-
exclusive, worldwide, paid-up license to use, execute, reproduce, display,
perform, adapt (unless Contractor advises the District as part of Contractor’s bid
that adaptation will violate existing agreements or statutes and Contractor
demonstrates such to the District’s satisfaction), and distribute Existing Product to
District users up to the license capacity stated in the contract with all license
rights necessary to fully effect the general business purpose of the project or work
plan or contract. Licenses shall be granted in the name of the District. The
District agrees to reproduce the copyright notice and any other legend of
ownership on any copies authorized under this paragraph.

2. Custom Products: Effective upon Product creation, Contractor hereby conveys,
assigns, and transfers to the District the sole and exclusive rights, title and interest
in Custom Product(s), whether preliminary, final or otherwise, including all
patent, trademark and copyrights. Contractor hereby agrees to take all necessary
and appropriate steps to ensure that the Custom Products are protected against
unauthorized copying, reproduction and marketing by or through Contractor.

C. Transfers or Assignments of Existing or Custom Products by the District

The District may transfer or assign Existing or Custom Products and the licenses
thereunder to another District agency. Nothing herein shall preclude the Contractor
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from otherwise using the related or underlying general knowledge, skills, ideas,
concepts, techniques, and experience developed under a project or work plan in the
course of Contractor’s business.

D. Subcontractor Rights

Whenever any data, including computer software, are to be obtained from a
subcontractor under the contract, the Contractor shall use this clause, Rights in Data,
in the subcontract, without alteration, and no other clause shall be used to enlarge or
diminish the District’s or the Contractor’s rights in that subcontractor data or
computer software which is required for the District.

E. Source Code Escrow

1. For all computer software furnished to the District with the rights specified in
Subparagraph B.2, the Contractor shall furnish to the District, a copy of the source
code with such rights of the scope as specified in Subparagraph B.2 of this
Subsection I.5. For all computer software furnished to the District with the
restricted rights specified in Subparagraph B.1 of this Subsection I.5, the District,
if the Contractor either directly or through a successor or affiliate shall cease to
provide the maintenance or warranty services provided the District under the
contract or any paid-up maintenance agreement, or if the Contractor should be
declared insolvent by a court of competent jurisdiction, shall have the right to
obtain, for its own and sole use only, a single copy of the current version of the
source code supplied under the contract, and a single copy of the documentation
associated therewith, upon payment to the person in control of the source code the
reasonable cost of making each copy.

2. If the Contractor or Product manufacturer/developer of software furnished to the
District with the rights specified in Subparagraph B.1 of this Subsection I.5 offers
the source code or source code escrow to any other commercial customers, the
Contractor shall either: (1) provide the District with the source code for the
Product; (2) place the source code in a third party escrow arrangement with a
designated escrow agent who shall be named and identified to the District, and
who shall be directed to release the deposited source code in accordance with a
standard escrow arrangement acceptable to the District; or (3) will certify to the
District that the Product manufacturer/ developer has named the District as a
named beneficiary of an established escrow arrangement with its designated
escrow agent who shall be named and identified to the District, and who shall be
directed to release the deposited source code in accordance with the terms of
escrow.

3. The Contractor shall update the source code, as well as any corrections or
enhancements to the source code, for each new release of the Product in the same
manner as provided above and certify such updating of escrow to the District in
writing.
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F. Indemnification and Limitation of Liability

The Contractor shall indemnify and save and hold harmless the District, its officers,
agents and employees acting within the scope of their official duties against any
liability, including costs and expenses, (i) for violation of proprietary rights,
copyrights, or rights of privacy, arising out of the publication, translation,
reproduction, delivery, performance, use or disposition of any data furnished under
this contract, or (ii) based upon any data furnished under this contract, or based upon
libelous or other unlawful matter contained in such data.

I.6 OTHER CONTRACTORS

The Contractor shall not commit or permit any act that will interfere with the
performance of work by another District contractor or by any District employee.

I.7 SUBCONTRACTS

The Contractor hereunder shall not subcontract any of the Contractor’s work or services
to any subcontractor without the prior written consent of the CO. Any work or service so
subcontracted shall be performed pursuant to a subcontract agreement, which the District
will have the right to review and approve prior to its execution by the Contractor. Any
such subcontract shall specify that the Contractor and the subcontractor shall be subject
to every provision of this contract. Notwithstanding any such subcontract approved by
the District, the Contractor shall remain liable to the District for all Contractor's work and
services required hereunder.

I.8 INSURANCE

A. GENERAL REQUIREMENTS. The Contractor at its sole expense shall procure and
maintain, during the entire period of performance under this contract, the types of
insurance specified below. The Contractor shall submit a Certificate of Insurance to
the Contracting Officer (CO) giving evidence of the required coverage prior to
commencing performance under this contract. In no event shall any work be
performed until the required Certificates of Insurance signed by an authorized
representative of the insurer(s) have been provided to, and accepted by, the CO.

If the Contractor and/or its subcontractors maintain broader coverage and/or higher
limits than the minimums shown below, the District requires and shall be entitled to
the broader coverage and/or the higher limits maintained by the Contractor and
subcontractors.

B. INSURANCE REQUIREMENTS

1. Commercial General Liability Insurance (“CGL”) - The Contractor shall provide
evidence satisfactory to the CO with respect to the services performed that it
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carries a CGL policy, written on an occurrence (not claims-made) basis, on
Insurance Services Office, Inc. (“ISO”) form CG 00 01 04 13 (or another
occurrence-based form with coverage at least as broad and approved by the CO in
writing), covering liability for all ongoing and completed operations of the
Contractor and under all subcontracts, covering claims for bodily injury, including
without limitation sickness, disease or death and mental anguish of any persons,
broad form property damage, including loss of use resulting therefrom, personal
and advertising injury, and including coverage for liability arising out of an
Insured Contract (including the tort liability of another assumed in a contract) and
acts of terrorism (whether caused by a foreign or domestic source). Such coverage
shall have limits of liability of not less than $1,000,000 for each occurrence, a
$2,000,000 general aggregate, products and completed operations aggregate, and
personal and advertising injury aggregate limit.

The Commercial General Liability shall be further endorsed to:
a) To the fullest extent permitted by law, provide additional insured coverage
using ISO form CG 2010 0413 and CG2037 04 13 (or its equivalent) to The
Government of the District of Columbia
b) Coverage available to the additional insureds shall apply on a primary and
non-contributing basis as respects any other insurance, deductibles, or self-
insurance available to the additional insureds
c) A waiver of subrogation in favor of The Government of the District of
Columbia
d) Any Annual Aggregate shall apply on a per location or per project basis
e) Defense costs shall be in addition to and not erode the limits of liability

2. Automobile Liability Insurance - The Contractor shall provide evidence
satisfactory to the CO of commercial (business) automobile liability insurance
written on ISO form CA 00 01 10 13 (or another form with coverage at least as
broad and approved by the CO in writing) including coverage for all owned,
hired, borrowed and non-owned vehicles and equipment used by the Contractor in
connection with work under this agreement, with a minimum combined single
limit of $5,000,000. Such policy or policies of automobile liability insurance
shall be written on an "occurrence" (as opposed to a "claims made") basis.

The Commercial Auto Liability policy shall be further endorsed to:
a) To the fullest extent permitted by law, provide additional insured coverage to
The Government of the District of Columbia
b) Coverage available to the additional insureds shall apply on a primary and
non-contributing basis as respects any other insurance, deductibles, or self-
insurance available to the additional insureds
c) A waiver of subrogation in favor of The Government of the District of
Columbia
d) Defense costs shall be in addition to and not erode the limits of liability
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e) If applicable, include Form CA 99 48 03 06 Pollution Liability - Broadened
Coverage for Covered Autos - Business Auto, Motor Carrier, and Truckers (or
its equivalent)
f) Moving and Storage Companies shall be required to provide evidence of
BMC91 or BMC91X filing

For Contractors providing transportation:
Contractors providing transportation must additionally comply with the following:
a) Operators holding a restricted WMATC Certificate of Authority must have a
single limit of $1.5 million in combined (bodily injury and physical damage)
coverage, or
b) Operators holding an unrestricted WMATC Certificate of Authority must have
a single limit of $5M in combined (bodily injury and physical damage)
coverage.
In addition, both types of WMATC certificate holders must have in place the
following Licensing Requirements as applicable:
a) Commercial Driver’s License (CDL) with the following endorsements:
i. P (Passenger): All drivers MUST have a P endorsement enabling them to
transport passengers (16 or more).
ii. S (School Bus): All drivers operating school buses (flashing lights, swing
arm w/stop sign) must also have an S endorsement. Please note that driver
credentials for any vehicles that are converted school buses must have S.
b) Valid (unexpired) US Department of Transportation Medical Examiner
Certification (“Medical Card”).

For Contractors using District Government-Owned Vehicles:
Agencies that provide Contractors with District Government-owned or leased
motor vehicles are responsible for ensuring that such vehicles are used only for
the performance under this Contract. Contractor and its subcontractors are
prohibited from using such vehicles for home-to-work transportation unless
specifically provided for under the terms of the contract and approved in writing
by the Contracting Officer, or otherwise provided by law. Contractor shall obtain
automobile liability insurance with a minimum combined single limit of
$5,000,000 to cover bodily injury and property damage to protect the Contractor
and the District Government against third-party claims arising from the use of
District Government-owned vehicles. The Commercial Auto Liability Policy
shall be endorsed to include:
a) To the fullest extent permitted by law, provide additional insured coverage to
The Government of the District of Columbia;
b) Coverage available to the additional insureds shall apply on a primary and
non-contributing basis as respects any other insurance, deductibles, or self-
insurance available to the additional insureds; and
c) A waiver of subrogation in favor of The Government of the District of
Columbia.
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In the event of loss, destruction, or damage to any government-owned vehicles
used in the performance of contact, Contractor shall be liable for full cost of
repair or replacement of lost, destroyed, or damaged vehicle.

3. Workers’ Compensation Insurance - The Contractor shall provide evidence
satisfactory to the CO of Workers’ Compensation insurance in accordance with
the statutory mandates of the District of Columbia or the jurisdiction in which the
contract is performed.

Employer’s Liability Insurance - The Contractor shall provide evidence
satisfactory to the CO of employer’s liability insurance as follows: $500,000 per
accident for injury; $500,000 per employee for disease; and $500,000 for policy
disease limit.

The Workers Compensation and Employers Liability shall be further endorsed to:
a) Include a Waiver of Subrogation in favor of The Government of the District of
Columbia.
b) Where applicable, include United States Longshore and Harbor Workers
Compensation Act (USL&H)
c) Where applicable, include Jones Act Coverage for seamen or crew members
on an “if any” basis.

4. Media Liability and Network Security/Privacy (Cyber) Liability Insurance
covering acts, errors, omissions, and violation of any consumer protection laws
arising out of Contractor’s operations or services with a limit of $1,000,000 per
claim and in the aggregate. Such coverage shall include but not be limited to, third
party and first party coverage for loss or disclosure of any data, including
personally identifiable information and payment card information, network
security failure, violation of any consumer protection laws, unauthorized access
and/or use or other intrusions, infringement of any intellectual property rights
(except patent), negligence or breach of duty to use reasonable care, breach of any
duty of confidentiality, invasion of privacy, or violations of any other legal
protections for personal information, defamation, libel, slander, commercial
disparagement, negligent transmission of computer virus, or use of computer
networks in connection with denial of service attacks. Such coverage shall include
regulatory defense and fines/penalties in any jurisdiction anywhere in the world.
Such coverage shall include contractual privacy coverage for data breach response
and crisis management costs that would be incurred by Contractor on behalf of
The Government of the District of Columbia in the event of a data breach
including legal and forensic expenses, notification costs, credit monitoring costs,
and costs to operate a call center. Contractor shall maintain coverage in force
during the term of this Agreement and for an extended reporting period of not less
than two (2) years after.

5. Professional Liability Insurance (Errors & Omissions) - The Contractor shall
provide Professional Liability Insurance (Errors and Omissions) to cover liability
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resulting from any error or omission in the performance of professional services
under this Contract. The policy shall provide limits of $1,000,000 per claim or per
occurrence for each wrongful act and $2,000,000 annual aggregate. The
Contractor warrants that any applicable retroactive date precedes the date the
Contractor first performed any professional services for the Government of the
District of Columbia and that continuous coverage will be maintained or an
extended reporting period will be exercised for a period of at least ten years after
the completion of the professional services. Limits may not be shared with other
lines of coverage.

6. Commercial Umbrella or Excess Liability - The Contractor shall provide evidence
satisfactory to the CO of commercial umbrella with minimum limits of
$10,000,000 per occurrence and $10,000,000 in the annual aggregate. Coverage
must excess of required commercial general liability, commercial auto liability,
and employers’ liability. The insurance required under this paragraph shall be
written in a form that annually reinstates all required limits. Coverage shall be
primary to any insurance, self-insurance or reinsurance maintained by The
Government of the District of Columbia and the “other insurance” provision must
be amended in accordance with this requirement and principles of vertical
exhaustion.

7. Crime Insurance (3rd Party Indemnity) - The Contractor shall provide a Crime
policy including 3rd party fidelity to cover the dishonest acts of Contractors, its
employees and/or volunteers which result in a loss to the District. The
Government of the District of Columbia shall be included as loss payee. The
policy shall provide a limit of $10,000 per occurrence.

8. Environmental Liability/Contractors Pollution Liability Insurance - The
Contractor shall provide evidence satisfactory to the CO of environmental liability
insurance covering losses caused by pollution or other hazardous conditions
arising from ongoing or completed operations of the Contractor. Such insurance
shall apply to bodily injury, property damage (including loss of use of damaged
property or of property that has been physically injured), clean-up costs, transit
and non-owned disposal sites. Coverage shall extend to defense costs and
expenses incurred in the investigation, civil fines, penalties and damages or
settlements. There shall be neither an exclusion nor a sublimit for mold or
fungus-related claims, legionella, asbestos, lead paint, or silica. The minimum
limits required under this paragraph shall be $1,000,000 per occurrence and
$2,000,000 in the annual aggregate. If such coverage is written on a claims-made
basis, the Contractor warrants that any retroactive date applicable to coverages
under the policy precedes the Contractor’s performance of any work under the
Contract and that continuous completed operations coverage will be maintained
for at least ten (10) years or an extended reporting period shall be purchased for
no less than ten (10) years after completion.

The Contractor also must furnish to the CO Owner certificates of insurance
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evidencing environmental liability insurance maintained by third party
transportation and disposal site operators(s) used by the Contractor for losses
arising from facility(ies) accepting, storing or disposing hazardous materials or
other waste as a result of the Contractor’s operations. Such coverages must be
maintained with limits of at least the amounts set forth above.

The Environmental Liability policy shall be further endorsed to include The
Government of the District of Columbia as an Additional Insured.

9. Medical Professional Liability - The Contractor shall provide evidence
satisfactory to the CO of a Medical Professional Liability policy with limits of not
less than $1,000,000 for each incident and $2,000,000 in the annual aggregate.
The definition of insured shall include the Contractor and all Contractor’s
employees and agents. The policy shall be either (1) written on an occurrence
basis or (2) written on a claims-made basis. If the coverage is on a claims-made
basis, Contractor hereby agrees that prior to the expiration date of Contractor’s
current insurance coverage, Contractor shall purchase, at Contractor’s sole
expense, either a replacement policy annually thereafter having a retroactive date
no later than the effective date of this Contract or unlimited tail coverage in the
above stated amounts for all claims arising out of this Contract.

10. Sexual/Physical Abuse & Molestation - The Contractor shall provide evidence
satisfactory to the CO with respect to the services performed that it carries
$1,000,000 per occurrence limits; $2,000,000 aggregate of affirmative abuse and
molestation liability coverage. Coverage should include physical abuse, such as
sexual or other bodily harm and non-physical abuse, such as verbal, emotional, or
mental abuse; any actual, threatened or alleged act; errors, omission or
misconduct. This insurance requirement will be considered met if the general
liability insurance includes an affirmative sexual abuse and molestation
endorsement for the required amounts or through a separate stand-alone sexual
abuse and molestation policy with confirmation there are no exclusions for abuse
or assault & battery under the General Liability. So called “silent” coverage or
“shared” limits under a commercial general liability or professional liability
policy will not be acceptable. Limits may not be shared with other lines of
coverage. The applicable policy may need to be submitted to the Office of Risk
Management for compliance review.

C. SUBCONTRACTOR INSURANCE REQUIREMENTS
Any and all subcontractors engaged by Contractor for work under this agreement
shall be required to have the same insured required of Contractor. Should the
Contractor wish to propose different insurance requirements for the subcontractor
than the ones outlined in the Contract, then, prior to commencement of work by the
subcontractor, the Contractor shall submit in writing the name and brief description of
work to be performed by the subcontractor to the CO. The CO will promptly provide
in writing to the Contractor with a decision regarding the insurance requirements
applicable to the subcontractor. When requested by the CO, the Contractor must
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provide proof of the subcontractor's required insurance prior to commencement of
work by the subcontractor.

D. PRIMARY AND NONCONTRIBUTORY INSURANCE
The insurance required herein shall be primary to and will not seek contribution from
any other insurance, reinsurance or self-insurance including any deductible or
retention, maintained by the Government of the District of Columbia.

E. DURATION. The Contractor shall carry all required insurance until all contract work
is accepted by The Government of the District of Columbia and shall carry listed
coverages for ten years for construction projects following final acceptance of the
work performed under this contract and two years for non-construction related
contracts.

F. LIABILITY. These are the required minimum insurance requirements established by
The Government of the District of Columbia. However, it is understood that The
Government of the District of Columbia does not in any way represent that the
insurance or the limits of insurance specified herein are sufficient or adequate to
protect your interests or liabilities and will not in any way limit the contractor’s
liability under this contract.

G. CONTRACTOR’S PROPERTY. Contractor and subcontractors are solely
responsible for any loss or damage to their personal property, including but not
limited to tools and equipment, scaffolding, and temporary structures, rented
machinery, or owned and leased equipment. A waiver of subrogation shall apply in
favor of The Government of the District of Columbia.

H. MEASURE OF PAYMENT. The Government of the District of Columbia shall not
make any separate measure or payment for the cost of insurance and bonds. The
Contractor shall include all the costs of insurance and bonds in the contract price.

I. NOTIFICATION. The Contractor shall ensure that all policies provide that the CO
shall be given thirty (30) days prior written notice in the event of cancellation, non-
renewal, or material changes to the extent such cancellation or material changes
results in Contractor no long complying with the above requirements. The Contractor
shall provide the CO with ten (10) days’ prior written notice in the event of non-
payment of premium. The Contractor will also provide the CO with an updated
Certificate of Insurance should its insurance coverages renew during the contract. The
Government of the District of Columbia may reasonably change the above insurance
coverage requirements during the Term by giving Contractor at least 30 days’ notice
of the change. Contractor must comply, at your expense, and deliver to the CO
evidence of compliance before the change becomes effective.

J. CERTIFICATES OF INSURANCE. The Contractor must send to CO, at least 10
days after execution of this Agreement, certificates of insurance evidencing the
required insurance coverage and endorsements required herein. Contractor must also
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provide us with evidence of renewal before the expiration date of each insurance
policy. Contractor is responsible for providing us with 30 days advanced written
notice if the certificate of insurance by the insurer has been canceled, reduced in
coverage, or otherwise altered. Certificates of insurance must reference the
corresponding contract number. Evidence of insurance shall be submitted to:
The Government of the District of Columbia
And mailed to the attention of:
Jarad Dorsey
Office of Contracting and Procurement
441 4th Street, NW, Suite 330 South
Washington, DC 20001
202-478-2436
Jarad.dorsey4@dc.gov

The CO may request, and the Contractor shall promptly deliver updated certificates of
insurance, endorsements indicating the required coverages, and/or certified copies of
the insurance policies. If the insurance initially obtained by the Contractor expires
prior to completion of the contract, renewal certificates of insurance and additional
insured and other endorsements shall be furnished to the CO prior to the date of
expiration of all such initial insurance. For all coverage required to be maintained
after completion, an additional certificate of insurance evidencing such coverage shall
be submitted to the CO on an annual basis as the coverage is renewed (or replaced).

K. DISCLOSURE OF INFORMATION. The Contractor agrees that The Government of
the District of Columbia may disclose the name and contact information of its
insurers to any third party which presents a claim against The Government of the
District of Columbia for any damages or claims resulting from or arising out of work
performed by the Contractor, its agents, employees, servants or subcontractors in the
performance of this contract.

L. CARRIER RATINGS. All Contractor’s and its subcontractors’ insurance required in
connection with this contract shall be written by insurance companies with an A.M.
Best Insurance Guide rating of at least A- VII or better (or the equivalent by any other
rating agency) and licensed in the District of Columbia.

M. WARRANTIES. When applicable, the Contractor should be named as an additional
insured on the applicable manufacturer’s/distributer’s Commercial General Liability
policy using Insurance Services Office, Inc. (“ISO”) form CG 20 15 04 13 (or another
occurrence-based form with coverage at least as broad). CO should collect, review
for accuracy, and maintain all warranties for goods and services.
I.9 EQUAL EMPLOYMENT OPPORTUNITY
In accordance with the District of Columbia Administrative Issuance System, Mayor’s
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Order 85-85 dated June 10, 1985, the forms for completion of the Equal Employment
Opportunity Information Report are incorporated herein as Section J.3. An award cannot
be made to any offeror who has not satisfied the equal employment requirements.

I.10 ORDER OF PRECEDENCE

The contract awarded as a result of this RFP will contain the following clause:

ORDER OF PRECEDENCE

A conflict in language shall be resolved by giving precedence to the document in the
highest order of priority that contains language addressing the issue in question. The
following documents are incorporated into the contract by reference and made a part of
the contract in the following order of precedence:

(1) An applicable Court Order, if any
(2) Contract document
(3) Supplemental Provisions to the Standard Contract Provision
(4) Standard Contract Provisions
(5) Contract attachments other than the Standard Contract Provisions
(6) RFP, as amended
(7) BAFOs (in order of most recent to earliest)
(8) Proposal

I.11 DISPUTES

Delete Article 14, Disputes, of the Standard Contract Provisions dated July 2010 for use
with District of Columbia Government Supplies and Services Contracts and substitute the
following Article 14, Disputes, in its place:

14. Disputes
All disputes arising under or relating to the contract shall be resolved as provided herein.

(a) Claims by the Contractor against the District: Claim, as used in paragraph (a) of
this clause, means a written assertion by the Contractor seeking, as a matter of right,
the payment of money in a sum certain, the adjustment or interpretation of contract
terms, or other relief arising under or relating to the contract. A claim arising under a
contract, unlike a claim relating to that contract, is a claim that can be resolved under
a contract clause that provides for the relief sought by the claimant
(1) All claims by a Contractor against the District arising under or relating to a
contract shall be in writing and shall be submitted to the CO for a decision. The
Contractor’s claim shall contain at least the following:
(i) A description of the claim and the amount in dispute;
(ii) Data or other information in support of the claim;
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(iii) A brief description of the Contractor’s efforts to resolve the dispute prior to
filing the claim; and
(iv) The Contractor’s request for relief or other action by the CO.

(2) The CO may meet with the Contractor in a further attempt to resolve the claim by
agreement.

(3) The CO shall issue a decision on any claim within 120 days after receipt of the
claim. Whenever possible, the CO shall take into account factors such as the size
and complexity of the claim and the adequacy of the information in support of the
claim provided by the Contractor.

(4) The CO’s written decision shall do the following:
(i) Provide a description of the claim or dispute;
(ii) Refer to the pertinent contract terms;
(iii) State the factual areas of agreement and disagreement;
(iv) State the reasons for the decision, including any specific findings of fact,
although specific findings of fact are not required and, if made, shall not be
binding in any subsequent proceeding;
(v) If all or any part of the claim is determined to be valid, determine the
amount of monetary settlement, the contract adjustment to be made, or other
relief to be granted;
(vi) Indicate that the written document is the CO’s final decision; and
(vii) Inform the Contractor of the right to seek further redress by appealing the
decision to the Contract Appeals Board.

(5) Failure by the CO to issue a decision on a contract claim within 120 days of
receipt of the claim will be deemed to be a denial of the claim and will authorize
the commencement of an appeal to the Contract Appeals Board as provided by
D.C. Official Code § 2-360.04.

(6) If a contractor is unable to support any part of its claim and it is determined that
the inability is attributable to a material misrepresentation of fact or fraud on the
part of the Contractor, the Contractor shall be liable to the District for an amount
equal to the unsupported part of the claim in addition to all costs to the District
attributable to the cost of reviewing that part of the Contractor’s claim. Liability
under this paragraph (a)(6) shall be determined within six (6) years of the
commission of the misrepresentation of fact or fraud.

(7) Pending final decision of an appeal, action, or final settlement, the Contractor
shall proceed diligently with performance of the contract in accordance with the
decision of the CO.

(b) Claims by the District against the Contractor: Claim as used in paragraph (b) of this
clause, means a written demand or written assertion by the District seeking, as a matter of
right, the payment of money in a sum certain, the adjustment of contract terms, or other
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relief arising under or relating to the contract. A claim arising under a contract, unlike a
claim relating to that contract, is a claim that can be resolved under a contract clause that
provides for the relief sought by the claimant.

(1) The CO shall decide all claims by the District against a contractor arising under or
relating to a contract.

(2) The CO shall send written notice of the claim to the contractor. The CO’s written
decision shall do the following:
(i) Provide a description of the claim or dispute;
(ii) Refer to the pertinent contract terms;
(iii) State the factual areas of agreement and disagreement;
(iv) State the reasons for the decision, including any specific findings of fact,
although specific findings of fact are not required and, if made, shall not be
binding in any subsequent proceeding;
(v) If all or any part of the claim is determined to be valid, determine the amount
of monetary settlement, the contract adjustment to be made, or other relief to
be granted;
(vi) Indicate that the written document is the CO’s final decision; and
(vii) Inform the Contractor of the right to seek further redress by appealing the
decision to the Contract Appeals Board.

(3) The CO shall support the decision by reasons and shall inform the Contractor of its
rights as provided herein.

(4) Before or after issuing the decision, the CO may meet with the Contractor to attempt
to resolve the claim by agreement.

(5) The authority contained in this paragraph (b) shall not apply to a claim or dispute for
penalties or forfeitures prescribed by statute or regulation which another District
agency is specifically authorized to administer, settle, or determine.

(6) This paragraph shall not authorize the CO to settle, compromise, pay, or otherwise
adjust any claim involving fraud.

(c) Decisions of the CO shall be final and not subject to review unless the Contractor timely
commences an administrative appeal for review of the decision, by filing a complaint
with the Contract Appeals Board, as authorized by D.C. Official Code § 2-360.04.
(d) Pending final decision of an appeal, action, or final settlement, the Contractor shall
proceed diligently with performance of the contract in accordance with the decision of
the CO.

I.12 CHANGES

Delete clause 15, Changes, of the Standard Contract Provisions dated July 2010 for use
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with District of Columbia Government Supplies and Services Contracts and substitute the
following clause 15, Changes in its place:
15. Changes

(a) The CO may, at any time, by written order, and without notice to the surety, if any,
make changes in the contract within the general scope hereof. If such change causes
an increase or decrease in the cost of performance of the contract, or in the time
required for performance, an equitable adjustment shall be made. Any claim for
adjustment for a change within the general scope must be asserted within ten (10)
days from the date the change is ordered; provided, however, that the CO, if he or she
determines that the facts justify such action, may receive, consider and adjust any
such claim asserted at any time prior to the date of final settlement of the contract. If
the parties fail to agree upon the adjustment to be made, the dispute shall be
determined as provided in clause 14 Disputes.

(b) The District shall not require the Contractor, and the Contractor shall not require a
subcontractor, to undertake any work that is beyond the original scope of the contract
or subcontract, including work under a District-issued change order, when the
additional work increases the contract price beyond the not-to-exceed price or
negotiated maximum price of this contract, unless the CO:
(1) Agrees with Contractor, and if applicable, the subcontractor on a price for the
additional work;
(2) Obtains a certification of funding to pay for the additional work;
(3) Makes a written, binding commitment with the Contractor to pay for the
additional work within 30-days after the Contractor submits a proper invoice; and
(4) Provides the Contractor with written notice of the funding certification.

(c) The Contractor shall include in its subcontracts a clause that requires the Contractor
to:
(1) Within 5 business days of its receipt of notice the approved additional funding,
provide the subcontractor with notice of the amount to be paid to the
subcontractor for the additional work to be performed by the subcontractor;
(2) Pay the subcontractor any undisputed amount to which the subcontractor is
entitled for the additional work within 10 days of receipt of payment from the
District; and
(3) Notify the subcontractor and CO in writing of the reason the Contractor withholds
any payment from a subcontractor for the additional work.
(d) Neither the District, Contractor, nor any subcontractor may declare another party to
be in default, or assess, claim, or pursue damages for delays, until the parties to agree
on a price for the additional work.

I.13 NON-DISCRIMINATION CLAUSE

Delete clause 19, Non-Discrimination Clause, of the Standard Contract Provisions dated
CW135340 Non-Emergency Medical Transportation
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July 2010 for use with District of Columbia Government Supplies and Services Contracts
and substitute the following clause 19, Non-Discrimination Clause, in its place:

19. Non-Discrimination Clause

(a) The Contractor shall not discriminate in any manner against any employee or
applicant for employment that would constitute a violation of the District of
Columbia Human Rights Act, effective December 13, 1977, as amended (D.C.
Law 2-38; D.C. Official Code § 2-1401.01 et seq.) (“Act”, as used in this clause).
The Contractor shall include a similar clause in all subcontracts, except
subcontracts for standard commercial supplies or raw materials. In addition, the
Contractor agrees, and any subcontractor shall agree, to post in conspicuous
places, available to employees and applicants for employment, a notice setting
forth the provisions of this non-discrimination clause as provided in section 251
of the Act.

(b) Pursuant to Mayor’s Order 85-85, (6/10/85), Mayor’s Order 2002-175 (10/23/02),
Mayor’s Order 2011-155 (9/9/11) and the rules of the Office of Human Rights,
Chapter 11 of Title 4 of the D.C. Municipal Regulations, the following clauses
apply to the contract:

(1) The Contractor shall not discriminate against any employee or applicant for
employment because of actual or perceived: race, color, religion, national
origin, sex, age, marital status, personal appearance, sexual orientation, gender
identity or expression, family responsibilities, genetic information, disability,
matriculation, political affiliation, or credit information. Sexual harassment is
a form of sex discrimination which is prohibited by the Act. In addition,
harassment based on any of the above protected categories is prohibited by the
Act.

(2) The Contractor agrees to take affirmative action to ensure that applicants are
employed, and that employees are treated during employment, without regard
to their actual or perceived: race, color, religion, national origin, sex, age,
marital status, personal appearance, sexual orientation, gender identity or
expression, family responsibilities, genetic information, disability,
matriculation, political affiliation, or credit information. The affirmative
action shall include, but not be limited to the following:
(a) employment, upgrading or transfer;
(b) recruitment, or recruitment advertising;
(c) demotion, layoff, or termination;
(d) rates of pay, or other forms of compensation; and
(e) selection for training and apprenticeship.

(3) The Contractor agrees to post in conspicuous places, available to employees
and applicants for employment, notices to be provided by the contracting
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agency, setting forth the provisions in paragraphs 19(b)(1) and (b)(2)
concerning non-discrimination and affirmative action.

(4) The Contractor shall, in all solicitations or advertisements for employees
placed by or on behalf of the Contractor, state that all qualified applicants will
receive consideration for employment pursuant to the non-discrimination
requirements set forth in paragraph 19(b)(2).

(5) The Contractor agrees to send to each labor union or representative of workers
with which it has a collective bargaining agreement or other contract or
understanding, a notice to be provided by the contracting agency, advising the
said labor union or workers’ representative of that contractor’s commitments
under this nondiscrimination clause and the Act, and shall post copies of the
notice in conspicuous places available to employees and applicants for
employment.

(6) The Contractor agrees to permit access to its books, records, and accounts
pertaining to its employment practices, by the Chief Procurement Officer or
designee, or the Director of the Office of Human Rights or designee, for
purposes of investigation to ascertain compliance with the Act, and to require
under terms of any subcontractor agreement each subcontractor to permit
access of such subcontractors’ books, records, and accounts for such purposes.

(7) The Contractor agrees to comply with the provisions of the Act and with all
guidelines for equal employment opportunity applicable in the District
adopted by the Director of the Office of Human Rights, or any authorized
official.

(8) The Contractor shall include in every subcontract the equal opportunity
clauses, i.e., paragraphs 19(b)(1) through (b)(9) of this clause, so that such
provisions shall be binding upon each subcontractor.

(9) The Contractor shall take such action with respect to any subcontract as the
CO may direct as a means of enforcing these provisions, including sanctions
for noncompliance; provided, however, that in the event the Contractor
becomes involved in, or is threatened with, litigation with a subcontractor or
vendor as a result of such direction by the contracting agency, the Contractor
may request the District to enter into such litigation to protect the interest of
the District.

I.14 COST AND PRICING DATA

Delete Article 25, Cost and Pricing Data, of the Standard Contract Provisions dated July
2010 for use with District of Columbia Government Supplies and Services Contracts.
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Page 181 of 183

I.15 CONTINUITY OF SERVICES

I.15.1 The Contractor recognizes that the services provided under this contract are vital to the
District and must be continued without interruption and that, upon contract expiration or
termination, a successor, either the District or another contractor, at the District’s option,
may continue to provide these services. To that end, the Contractor agrees to:
I.15.1.1 Furnish phase-out, phase-in (transition) training; and
I.15.1.2 Exercise its best efforts and cooperation to effect an orderly and efficient transition to
a successor.

I.15.2 The Contractor shall, upon the CO’s written notice:
I.15.2.1 Furnish phase-in, phase-out services for up to 90 days after this contract expires and
I.15.2.2 Negotiate in good faith a plan with a successor to determine the nature and extent of
phase-in, phase-out services required. The plan shall specify a training program and a
date for transferring responsibilities for each division of work described in the plan
and shall be subject to the CO’s approval.

I.15.3 The Contractor shall provide sufficient experienced personnel during the phase-in, phase-
out period to ensure that the services called for by this contract are maintained at the
required level of proficiency.

I.15.4 The Contractor shall allow as many personnel as practicable to remain on the job to help
the successor maintain the continuity and consistency of the services required by this
contract. The Contractor also shall disclose necessary personnel records and allow the
successor to conduct on-site interviews with these employees. If selected employees are
agreeable to the change, the Contractor shall release them at a mutually agreeable date
and negotiate transfer of their earned fringe benefits to the successor.

I.15.5 Only in accordance with a modification issued by the CO, the Contractor shall be
reimbursed for all reasonable phase-in, phase-out costs (i.e., costs incurred within the
agreed period after contract expiration that result from phase-in, phase-out operations)
and a fee (profit) not to exceed a pro rata portion of the fee (profit) under this contract.

I.16 ESTIMATED QUANTITIES
It is the intent of the District to secure a contract for all of the needs of the designated
agencies for items specified herein which may occur during the contract term. The
District agrees that it will purchase its requirements of the articles or services included
herein from the Contractor. Articles or services specified herein have a history of
repetitive use in the District agencies. The estimated quantities stated in the RFP reflect
the best estimates available. They shall not be construed to limit the quantities which may
be ordered from the Contractor by the District or to relieve the Contractor of his
obligation to fill all such orders. Orders will be placed from time to time if and when
needs arise for delivery, all charges prepaid, to the ordering agency. The District does not
guarantee to order any specific quantities of any item(s) or work hours of service.
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SECTION J: ATTACHMENTS

The following list of attachments are incorporated into the solicitation and resulting contract by
reference:

Attachment
Number Document

J.1
Government of the District of Columbia Standard Contract Provisions for Use
with the Supplies and Services Contracts (July 2010)
available at http://ocp.dc.gov, Center of Excellence, “Required Solicitation
Documents”

J.2
U.S. Department of Labor Wage Determination 2015-4281
Revision 35, dated December 3, 2025
https://sam.gov/content/wage-determinations

J.3
Office of Local Business Development Equal Employment Opportunity
Employer Information Report and Mayor’s Order 85-85
available at http://ocp.dc.gov, Center of Excellence, “Required Solicitation
Documents”
J.4
Department of Employment Services First Source Initial Employment Plan
available at http://ocp.dc.gov, Center of Excellence, “Required Solicitation
Documents”
J.5
Department of Employment Services First Source Employment Agreement
available at http://ocp.dc.gov, Center of Excellence, “Required Solicitation
Documents”
J.6
Way to Work Amendment Act of 2006 – Living Wage Notice
available at available at http://ocp.dc.gov, Center of Excellence, “Required
Solicitation Documents”

J.7
Way to Work Amendment Act of 2006 – Living Wage Fact Sheet
available at http://ocp.dc.gov, Center of Excellence, “Required Solicitation
Documents”
J.8
Tax Certification Affidavit
available at http://ocp.dc.gov, Center of Excellence, “Required Solicitation
Documents”
J.9 Notice of Prohibition of Sexual Harassment in the Workplace
J.10
Bidder/Offeror Certification Form
available at http://ocp.dc.gov, Center of Excellence, “Required Solicitation
Documents”
J.11
Subcontracting Plan
available at http://ocp.dc.gov, Center of Excellence, “Required Solicitation
Documents”
J.12 HIPAA Privacy Compliance Business Associate Agreement (BAA),
Department of Health Care Finance
J.13 Business Associate HIPAA Compliance Questionnaire
J.14 Past Performance Evaluation Form
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Attachment
Number Document
available at http://ocp.dc.gov, Center of Excellence, “Required Solicitation
Documents”
J.15 Certificate of Clean Hands
available at http://mytax.dc.gov
J.16
Cost/Price Disclosure Certification
available at http://ocp.dc.gov, Center of Excellence, “Required Solicitation
Documents
J.17
Business License
available at https://dlcp.dc.gov, DC Department of Licensing and Consumer
Protection
J.18 State Plan Amendment
J.19 Actively Enrolled Transportation Providers
J.20 Verida’s Technical Proposal
J.21 Verida’s Price Proposal