KRS 281.872: Program coordinators' duties relating to eligibility for participation in

human service transportation delivery program -- Resolution of

complaints -- Penalties.

(1) The cabinet shall employ a pool of program coordinators. Each program

coordinator shall be a state employee and reside in the cabinet.

(2) The program coordinator shall initially investigate all complaints regarding

recipients, subcontractors, and the broker for the area and attempt to

immediately resolve the problem. All complaints relating to Medicaid fraud or

abuse shall be forwarded by the cabinet to the Cabinet for Health and Family

Services. The program coordinator shall further be responsible for assisting a

person with a complaint as required in subsection (4) of this section.

(3) The program coordinator shall investigate issues of eligibility that result in a

person being denied transportation, determine the status of the person's case,

and attempt to immediately resolve the matter in order for the person to

continue to receive transportation services. A broker shall not deny any person

transportation services until the program coordinator resolves the question of

the person's eligibility and verifies to the broker that the person is actually

ineligible to receive transportation services. A broker who violates the

provisions of this subsection shall be fined one thousand dollars ($1,000) and

shall be subject to his or her contract being revoked by the cabinet. The

program coordinator shall coordinate information about eligibility to participate

in the human service transportation delivery program between the cabinet, the

Cabinet for Health and Family Services, and the Education and Labor Cabinet.

The cabinet shall ensure each program coordinator has direct computer access

to all relevant databases used by all state agencies to administer the human

service transportation delivery program. The Department for Medicaid Services

shall provide each program coordinator with a monthly eligibility list for the

area.

(4) If a program coordinator is unable to resolve a complaint against a broker or

subcontractor to the satisfaction of the person lodging the complaint on the

same business day the complaint is made, the program coordinator shall

immediately act to assist the person in contacting the appropriate state agency

to resolve the complaint. The program coordinator shall ensure that the

cabinet, the Cabinet for Health and Family Services, and the Education and

Labor Cabinet strictly adhere to the provisions of 42 C.F.R. governing a

person's right to appeal the denial of service or failure for a complaint to be

acted upon promptly. The cabinet shall be required to inform in writing, every

person who has either been denied transportation or who has failed to have a

complaint resolved in a prompt manner under the human service transportation

delivery program, of their right to a hearing to be held in the county where the

person lives, and the process to follow to obtain a hearing.

(5) All brokers and subcontractors shall be prohibited from retaliating or attempting

retribution in any way against any person using the human service

transportation delivery program who files a complaint. A broker or

subcontractor who is determined by the cabinet to have violated the provisions

of this subsection, after an investigation and hearing conducted by the cabinet,

shall have his or her contract revoked by the cabinet within ninety (90) days of

the hearing and shall be prohibited from participating in the human service

transportation delivery program for five (5) years from the date of the cabinet's

determination.