C.R.S. § 25.5-1-806: Nonemergency medical transportation provider and broker audits - reporting.

(1) The state department shall, subject to available appropriations, audit transportation providers to ensure reimbursement is made only for trips performed by credentialed drivers operating credentialed vehicles pursuant to the rules adopted pursuant to section 25.5-1-802.

(2) The state department may use data analytics, complaints by members, and other program integrity indicators to prioritize which transportation providers to audit. The state department is not required to annually perform audits but must perform audits as resources allow. An audit of a transportation provider may include a review of the following, as they relate to the provider:

(a) Claims submitted;

(b) The provider's policies and procedures;

(c) Driver and vehicle credentials;

(d) Compliance with state department and broker requirements;

(e) Trip records;

(f) Member grievances, complaints, and incidents, including their resolution; or

(g) Other data necessary to evaluate safety, timeliness, and quality of the services provided by the provider.

(3) The state department shall, subject to available appropriations, conduct audits of each transportation broker at least annually. The department may use third-party contractors to conduct audits of transportation brokers. An audit of a transportation broker may include a review of the broker's:

(a) Policies and procedures;

(b) Trip distribution among transportation providers, including analysis by geography and trip type;

(c) Compliance with prohibitions on trip caps established in state department rule;

(d) Compliance with driver, vehicle, and provider credentialing requirements established in state department rule; and

(e) Response to member requests for specific transportation providers, including whether they were honored and, if not, the reason for denial.