GEMT Supplemental Reimbursement Program

Ground Emergency Medical Transportation Supplemental Reimbursement ProgramPresented by Department of Health Care ServicesNovato Fire Protection DistrictSacramento Metropolitan Fire DistrictThis presentation is for training purposes only. Please refer to appropriate legislation, SPA, and introduction packet materials.11AgendaGEMT Supplemental Reimbursement ProgramEligibilityParticipation RequirementsReimburse the State for its Administrative CostsThe Cost Report OverviewThis presentation is for training purposes only. Please refer to appropriate legislation, SPA, and introduction packet materials.2Agenda (cont.)Cost Report Acceptance ProcessPayment ProcessCost Report ExampleQuestionsThis presentation is for training purposes only. Please refer to appropriate legislation, SPA, and introduction packet materials.3

GEMT Supplemental Reimbursement ProgramThis presentation is for training purposes only. Please refer to appropriate legislation, SPA, and introduction packet materials.4State Authority

Assembly Bill 678 (Statute of 2011) enacted the California Welfare and Institutions (W & I) Code 14105.94, on October 2, 2011Certified Public Expenditure (CPE) ProgramParticipation in this Program is Voluntary

This presentation is for training purposes only. Please refer to appropriate legislation, SPA, and introduction packet materials.5What is a CPE program?

Allows public entities to obtain a federal match up to its costs for providing servicesTo obtain a federal match requires federal approval of the program, including approval of what costs will be allowedThis presentation is for training purposes only. Please refer to appropriate legislation, SPA, and introduction packet materials.6Federal Authority

CPE Requires Federal ApprovalState Plan Amendment 09-024 was approved by CMS on September 4, 2013.Federal approval allows DHCS to draw down federal funds.

This presentation is for training purposes only. Please refer to appropriate legislation, SPA, and introduction packet materials.7Program Overview

Reimburses eligible GEMT providers the federal match up to their actual costs of providing GEMT services to fee-for-service Medi-Cal beneficiaries onlyExample:$100 Medi-Cal uncompensated costs (via CPEs)$100*50%=$50 (federal match)

No upper payment limit for non hospital based providers

This presentation is for training purposes only. Please refer to appropriate legislation, SPA, and introduction packet materials.8Program HighlightsEligible ServicesNOT-Eligible ServicesFee-for-Service TransportsDry runs included (as defined by SPA 09-024)Services must have been submitted to Medi-Cal and paid a Medi-Cal base payment

Managed Care TransportsMedi-Medi TransportsServices provided by First RespondersCMS determined that this is not a transportation category Certain contract arrangements. (refer to PPL 13-001 on GEMT website)

This presentation is for training purposes only. Please refer to appropriate legislation, SPA, and introduction packet materials.9EligibilityThis presentation is for training purposes only. Please refer to appropriate legislation, SPA, and introduction packet materials.10Who IS Eligible to ParticipatePublic GEMT service providers, as defined by Welfare and Institutions Code 14105.94, meet all of the following criteria:Provide GEMT services to Medi-Cal beneficiaries Enrolled as a Medi-Cal provider with a (NPI) for the period being claimed, andOwned or operated by the State, a city, a county, a city and county, fire protection district, or a federally recognized Indian Tribe

This presentation is for training purposes only. Please refer to appropriate legislation, SPA, and introduction packet materials.11Who is NOT eligible to participateNon-Public entities and those entities not meeting the eligibility requirementsPublic entities who are in certain contracting arrangements with GEMT service providers(refer to PPL 13-001 on GEMT website)Hospital Districts that provide GEMT services, that participate in SPA 02-018

This presentation is for training purposes only. Please refer to appropriate legislation, SPA, and introduction packet materials.12Eligibility vs. ParticipationEligibility criteria must be metParticipation is voluntary Additional requirements to participateThis presentation is for training purposes only. Please refer to appropriate legislation, SPA, and introduction packet materials.13Participation RequirementsThis presentation is for training purposes only. Please refer to appropriate legislation, SPA, and introduction packet materials.14Requirements to ParticipateProvider Participation Agreement (PPA) with DHCSVendor Number with DHCS, in addition to your National Provider Identification (NPI) numbersEnter into an agreement with the host entity agreeing to pay your share of the DHCS administrative costsFile an Annual Participation Survey (APS) by July 1st

This presentation is for training purposes only. Please refer to appropriate legislation, SPA, and introduction packet materials.15Provider Participation AgreementAgreement between the State and the participating providerEffective date will be retroactive to January 30, 2010 or the date your agency is eligible to participateAs long as you remain active in this program annually, this agreement stays in effect

This presentation is for training purposes only. Please refer to appropriate legislation, SPA, and introduction packet materials.16DHCS Vendor NumberObtain Vendor Number from the DHCSThis number allows us to pay youThe Department of Health Care Services has already started collecting these forms and your contact information formsThis presentation is for training purposes only. Please refer to appropriate legislation, SPA, and introduction packet materials.17Annual Participation SurveyDue July 1st covering the state fiscal year ending prior. (e.g. 2013-14 survey will be due July 1, 2014)Certify that you are eligible to participate in the GEMT Supplemental Reimbursement programHelp DHCS budget to ensure we have sufficient federal funds available to pay youThis presentation is for training purposes only. Please refer to appropriate legislation, SPA, and introduction packet materials.18

Reimburse the State for its Administrative CostsReimburse the host entity your allocated share for the DHCS administrative costs incurredGEMT Supplemental Reimbursement Payments will not be made if agency fails to pay its allocated share of administrative costsYour share of the States administrative costs should not be included as an expense in your Cost ReportThis presentation is for training purposes only. Please refer to appropriate legislation, SPA, and introduction packet materials.19File Annual Cost ReportFile Cost Reports Annually by November 30 (effective for State Fiscal Year [SFY] 2013/14)Prior year deadlinesSFY 2009/10 due: 12/2/2013SFY 2010/11due: 12/2/2013SFY 2011/12due: 2/1/2014SFY 2012/13due: 2/1/2014This presentation is for training purposes only. Please refer to appropriate legislation, SPA, and introduction packet materials.2020

Where do I get the Enrollment and Participation docs?DHCS emailed the GEMT Notification letter and the following enrollment and participation documents on 9/13/2013:DHCS Vendor number (form STD. 204)GEMT Contact Information formCost Report Signature Authority FormProvider Participation Agreement URL for the GEMT website, http://www.dhcs.ca.gov/provgovpart/Pages/GEMT.aspxThis presentation is for training purposes only. Please refer to appropriate legislation, SPA, and introduction packet materials.21Where do I get the Enrollment and Participation docs? (cont.)Additional required documents and Program information are available at: http://www.dhcs.ca.gov/provgovpart/Pages/GEMT.aspxCopy of the GEMT Notification LetterAnnual Participation SurveysCost Reports and InstructionsLink to subscribe to the GEMT LISTSERV for website content updated and additionsThis presentation is for training purposes only. Please refer to appropriate legislation, SPA, and introduction packet materials.22Reimburse the State for its Administrative CostsThis presentation is for training purposes only. Please refer to appropriate legislation, SPA, and introduction packet materials.23Host Entity collection of State Admin ReimbursementHost Agency (Sacramento Metropolitan Fire District)Allocation methodology of States administrative costsRole of the Host AgencyHost Agency administrative fee

This presentation is for training purposes only. Please refer to appropriate legislation, SPA, and introduction packet materials.24Cost Report OverviewThis presentation is for training purposes only. Please refer to appropriate legislation, SPA, and introduction packet materials.25 25Discussion PointsA&I and SNFDStatutes and RegulationsThe GEMT Cost Report OverviewGEMT Supplemental Reimbursement Program and GEMT Cost ReportFlow of the Cost ReportPre-AuditPost AuditAppeal ProcessThis presentation is for training purposes only. Please refer to appropriate legislation, SPA, and introduction packet materials.2626Federal Laws & RegulationsFederal:Law / Statute Social Security ActRegulation 42 CFRPart 413: Principles of Reasonable Cost ReimbursementReimbursement Principles CMS Pub 15-1This presentation is for training purposes only. Please refer to appropriate legislation, SPA, and introduction packet materials.2727State Laws & RegulationsState:Law / Statute Welfare and Institutions CodeSection 14170 Authority to AuditSection 14171 Audit Appeal ProceduresSection 14105.94(e)(3)&(4) Specific to GEMT (AB 678)Regulation CA Code of Regulations (CCR), Title 22Chapter 3, Section 51022 Appeal ProcessThis presentation is for training purposes only. Please refer to appropriate legislation, SPA, and introduction packet materials.2828Cost Report BasicsPurpose of the Cost Report Average Cost per TransportMedi-Cal FFS TransportsSupplemental Payment CalculatedGeneral Ledger Accounts vs. Cost CenterGrouping ScheduleCell Colors - Yellow vs. Gray vs. ClearThis presentation is for training purposes only. Please refer to appropriate legislation, SPA, and introduction packet materials.2929

Cost of MTS & NON-MTS ServicesSchedule 1 thru 4Determine cost of MTS ServicesDetermine cost of NON-MTS ServicesAllocate remaining CRSB based on time on taskThis presentation is for training purposes only. Please refer to appropriate legislation, SPA, and introduction packet materials.3030The Smell TestSchedules 1 thru 4Is the cost reimbursable?Cost actually incurredIs the cost related to patient care?Cost related to providing the serviceDoes it meet Prudent Buyer Concept?This presentation is for training purposes only. Please refer to appropriate legislation, SPA, and introduction packet materials.3131Allocation of Admin & GeneralSchedule 5 - OverheadAdministration Cost OverheadNot directly related to MTS or NON-MTSAllocated based on Accumulated CostAlternative to Administrative CostIndirect Cost FactorThis presentation is for training purposes only. Please refer to appropriate legislation, SPA, and introduction packet materials.3232Reclassifications & AdjustmentsSchedules 6 & 7Reclassify cost from one cost center or category to another cost center or categoryCost AdjustmentsUnallowable CostInclusion of post-F/S adjustmentsReminder to manually flow Reclasses and AdjustmentsAmounts flow to Schedules 1 thru 5This presentation is for training purposes only. Please refer to appropriate legislation, SPA, and introduction packet materials.3333Revenue / Funding SourcesSchedule 8Medicare / Medi-Cal / Third Party / Private PayGrantsContributionsThis presentation is for training purposes only. Please refer to appropriate legislation, SPA, and introduction packet materials.3434Final SettlementSchedule 9Average Cost per TransportMedi-Cal FFS TransportsNon-Federal Match (50%)ARRA Inclusion (if applicable)Net Federal Participation AmountThis presentation is for training purposes only. Please refer to appropriate legislation, SPA, and introduction packet materials.3535DHCS GEMT Program ExpectationsDocumentationGrouping ScheduleCost Report BinderCheck Figure on Certification PageThis presentation is for training purposes only. Please refer to appropriate legislation, SPA, and introduction packet materials.3636Pre-AuditCost Report Filings & AcceptanceThree levels of audit activityDeskLimitedFieldAnnounced VisitEntrance LetterSite Visit what to expectThis presentation is for training purposes only. Please refer to appropriate legislation, SPA, and introduction packet materials.3737Post AuditExit Conference or 15-day LetterAppeal RightsTransmittal Letter60 days to file Informal Hearing (180 day turnaround)30 days to file Formal Hearing Process (2+ year process)Superior Court This presentation is for training purposes only. Please refer to appropriate legislation, SPA, and introduction packet materials.3838Cost Report Acceptance ProcessThis presentation is for training purposes only. Please refer to appropriate legislation, SPA, and introduction packet materials.39Cost Report Acceptance ProcessCost Reports are due annually to DHCS November 30 Cost Report submittals must include the following:CMS-approved GEMT Cost Report Medi-Cal certification statement (included in Cost Report)Supporting documentation, which includes but not limited to supporting general ledger, grouping schedules, and contracts. (This will be requested after the PDF Cost Report has been accepted)This presentation is for training purposes only. Please refer to appropriate legislation, SPA, and introduction packet materials.4040Cost Report Acceptance Process (cont.)A signed PDF Cost Report must be submitted to GEMTSubmissions@dhcs.ca.gov.Upon acceptance of the Cost Report the provider will be notified to submit the electronic Excel version as well as the supporting documentation.The provider must maintain both a signed hardcopy, electronic copy and supporting documentation on site as well.DHCS will verify your entitys eligibilityAn invoice will be created and processed through ac

This presentation is for training purposes only. Please refer to appropriate legislation, SPA, and introduction packet materials.4141Payment ProcessThis presentation is for training purposes only. Please refer to appropriate legislation, SPA, and introduction packet materials.42

Getting PaidDHCS will not accept your Cost Report until all required hardcopy, wet signature documents (PPA and APS have been received and accepted)DHCS will not make payments until DHCS has been reimbursed for its administrative costsPayments will be processed when A&I accepts your Cost Report

This presentation is for training purposes only. Please refer to appropriate legislation, SPA, and introduction packet materials.43SPA 09-024 RequirementsInterim Supplemental PaymentInterim SettlementFinal ReconciliationOverpayments & Underpayments

This presentation is for training purposes only. Please refer to appropriate legislation, SPA, and introduction packet materials.44Cost Report ExamplePresented By Dan Hom, CPA, Finance Director, Novato Fire Protection DistrictThis presentation is for training purposes only. Please refer to appropriate legislation, SPA, and introduction packet materials.45Contact UsWebsiteGEMT E-mailPublic RequestSacramento Metropolitan Fire DistrictNovato Fire Protection DistrictThis presentation is for training purposes only. Please refer to appropriate legislation, SPA, and introduction packet materials.46Questions?This presentation is for training purposes only. Please refer to appropriate legislation, SPA, and introduction packet materials.47