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Ground Emergency Medical Transportation Supplemental Reimbursement Program

Ground Emergency Medical Transportation Supplemental Reimbursement Program

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Ground Emergency Medical Transportation Supplemental Reimbursement Program

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Presentation Transcript

  1. Ground Emergency Medical Transportation Supplemental Reimbursement Program Presented by Department of Health Care Services Novato Fire Protection District Sacramento Metropolitan Fire District This presentation is for training purposes only. Please refer to appropriate legislation, SPA, and introduction packet materials.

  2. Agenda • GEMT Supplemental Reimbursement Program • Eligibility • Participation Requirements • Reimburse the State for its Administrative Costs • The Cost Report Overview This presentation is for training purposes only. Please refer to appropriate legislation, SPA, and introduction packet materials.

  3. Agenda (cont.) • Cost Report Acceptance Process • Payment Process • Cost Report Example • Questions This presentation is for training purposes only. Please refer to appropriate legislation, SPA, and introduction packet materials.

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

  5. State Authority • Assembly Bill 678 (Statute of 2011) enacted the California Welfare and Institutions (W & I) Code 14105.94, on October 2, 2011 • Certified Public Expenditure (CPE) Program • Participation in this Program is Voluntary This presentation is for training purposes only. Please refer to appropriate legislation, SPA, and introduction packet materials.

  6. What is a CPE program? • Allows public entities to obtain a federal match up to its costs for providing services • To obtain a federal match requires federal approval of the program, including approval of what costs will be allowed This presentation is for training purposes only. Please refer to appropriate legislation, SPA, and introduction packet materials.

  7. Federal Authority • CPE Requires Federal Approval • State 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.

  8. Program Overview • Reimburses eligible GEMT providers the federal match up to their actual costs of providing GEMT services to fee-for-service Medi-Cal beneficiaries only Example: $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.

  9. Program Highlights Eligible Services NOT-Eligible Services • Fee-for-Service Transports • Dry 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 Transports • Medi-Medi Transports • Services provided by “First Responders” • CMS 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.

  10. Eligibility This presentation is for training purposes only. Please refer to appropriate legislation, SPA, and introduction packet materials.

  11. Who IS Eligible to Participate Public 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, and • Owned 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.

  12. Who is NOT eligible to participate • Non-Public entities and those entities not meeting the eligibility requirements • Public entities who are in certain contracting arrangementswith 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.

  13. Eligibility vs. Participation • Eligibility criteria must be met • Participation is voluntary • Additional requirements to participate This presentation is for training purposes only. Please refer to appropriate legislation, SPA, and introduction packet materials.

  14. Participation Requirements This presentation is for training purposes only. Please refer to appropriate legislation, SPA, and introduction packet materials.

  15. Requirements to Participate • Provider Participation Agreement (PPA) with DHCS • Vendor Number with DHCS, in addition to your National Provider Identification (NPI) numbers • Enter into an agreement with the host entity agreeing to pay your share of the DHCS administrative costs • File 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.

  16. Provider Participation Agreement • Agreement between the State and the participating provider • Effective date will be retroactive to January 30, 2010 or the date your agency is eligible to participate • As 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.

  17. DHCS Vendor Number • Obtain Vendor Number from the DHCS • This number allows us to pay you • The Department of Health Care Services has already started collecting these forms and your contact information forms This presentation is for training purposes only. Please refer to appropriate legislation, SPA, and introduction packet materials.

  18. Annual Participation Survey • Due July 1stcovering 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 program • Help DHCS budget to ensure we have sufficient federal funds available to pay you This presentation is for training purposes only. Please refer to appropriate legislation, SPA, and introduction packet materials.

  19. Reimburse the State for its Administrative Costs • Reimburse the host entity your allocated share for the DHCS administrative costs incurred • GEMT Supplemental Reimbursement Payments will not be made if agency fails to pay its allocated share of administrative costs • Your share of the State’s administrative costs should not be included as an expense in your Cost Report This presentation is for training purposes only. Please refer to appropriate legislation, SPA, and introduction packet materials.

  20. File Annual Cost Report • File Cost Reports Annually by November 30 (effective for State Fiscal Year [SFY] 2013/14) • Prior year deadlines • SFY 2009/10 due: 12/2/2013 • SFY 2010/11 due: 12/2/2013 • SFY 2011/12 due: 2/1/2014 • SFY 2012/13 due: 2/1/2014 This presentation is for training purposes only. Please refer to appropriate legislation, SPA, and introduction packet materials.

  21. 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 form • Cost Report Signature Authority Form • Provider Participation Agreement • URL for the GEMT website, http://www.dhcs.ca.gov/provgovpart/Pages/GEMT.aspx This presentation is for training purposes only. Please refer to appropriate legislation, SPA, and introduction packet materials.

  22. Where 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.aspx • Copy of the GEMT Notification Letter • Annual Participation Surveys • Cost Reports and Instructions • Link to subscribe to the GEMT LISTSERV for website content updated and additions This presentation is for training purposes only. Please refer to appropriate legislation, SPA, and introduction packet materials.

  23. Reimburse the State for its Administrative Costs This presentation is for training purposes only. Please refer to appropriate legislation, SPA, and introduction packet materials.

  24. Host Entity collection of State Admin Reimbursement • “Host Agency” (Sacramento Metropolitan Fire District) • Allocation methodology of State’s administrative costs • Role of the Host Agency • Host Agency administrative fee This presentation is for training purposes only. Please refer to appropriate legislation, SPA, and introduction packet materials.

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

  26. Discussion Points • A&I and SNFD • Statutes and Regulations • The GEMT Cost Report Overview • GEMT Supplemental Reimbursement Program and GEMT Cost Report • Flow of the Cost Report • Pre-Audit • Post Audit • Appeal Process This presentation is for training purposes only. Please refer to appropriate legislation, SPA, and introduction packet materials.

  27. Federal Laws & Regulations • Federal: • Law / Statute – Social Security Act • Regulation – 42 CFR • Part 413: Principles of Reasonable Cost Reimbursement • Reimbursement Principles – CMS Pub 15-1 This presentation is for training purposes only. Please refer to appropriate legislation, SPA, and introduction packet materials.

  28. State Laws & Regulations • State: • Law / Statute – Welfare and Institutions Code • Section 14170 – Authority to Audit • Section 14171 – Audit Appeal Procedures • Section 14105.94(e)(3)&(4) – Specific to GEMT (AB 678) • Regulation – CA Code of Regulations (CCR), Title 22 • Chapter 3, Section 51022 – Appeal Process This presentation is for training purposes only. Please refer to appropriate legislation, SPA, and introduction packet materials.

  29. Cost Report Basics • Purpose of the Cost Report • Average Cost per Transport • Medi-Cal FFS Transports • Supplemental Payment Calculated • General Ledger Accounts vs. Cost Center • Grouping Schedule • Cell Colors - Yellow vs. Gray vs. Clear This presentation is for training purposes only. Please refer to appropriate legislation, SPA, and introduction packet materials.

  30. Cost of MTS & NON-MTS Services Schedule 1 thru 4 • Determine cost of MTS Services • Determine cost of NON-MTS Services • Allocate remaining CRSB based on “time on task” This presentation is for training purposes only. Please refer to appropriate legislation, SPA, and introduction packet materials.

  31. The Smell Test Schedules 1 thru 4 • Is the cost reimbursable? • Cost actually incurred • Is the cost related to patient care? • Cost related to providing the service • Does it meet “Prudent Buyer” Concept? This presentation is for training purposes only. Please refer to appropriate legislation, SPA, and introduction packet materials.

  32. Allocation of Admin & General Schedule 5 - Overhead • Administration Cost – Overhead • Not directly related to MTS or NON-MTS • Allocated based on Accumulated Cost • Alternative to Administrative Cost • Indirect Cost Factor This presentation is for training purposes only. Please refer to appropriate legislation, SPA, and introduction packet materials.

  33. Reclassifications & Adjustments Schedules 6 & 7 • Reclassify cost from one cost center or category to another cost center or category • Cost Adjustments • Unallowable Cost • Inclusion of post-F/S adjustments • Reminder to manually flow Reclasses and Adjustments • Amounts flow to Schedules 1 thru 5 This presentation is for training purposes only. Please refer to appropriate legislation, SPA, and introduction packet materials.

  34. Revenue / Funding Sources Schedule 8 • Medicare / Medi-Cal / Third Party / Private Pay • Grants • Contributions This presentation is for training purposes only. Please refer to appropriate legislation, SPA, and introduction packet materials.

  35. Final Settlement Schedule 9 • Average Cost per Transport • Medi-Cal FFS Transports • Non-Federal Match (50%) • ARRA Inclusion (if applicable) • Net Federal Participation Amount This presentation is for training purposes only. Please refer to appropriate legislation, SPA, and introduction packet materials.

  36. DHCS GEMT Program Expectations • Documentation • Grouping Schedule • Cost Report Binder • Check Figure on Certification Page This presentation is for training purposes only. Please refer to appropriate legislation, SPA, and introduction packet materials.

  37. Pre-Audit • Cost Report Filings & Acceptance • Three levels of audit activity • Desk • Limited • Field • Announced Visit • Entrance Letter • Site Visit – what to expect This presentation is for training purposes only. Please refer to appropriate legislation, SPA, and introduction packet materials.

  38. Post Audit • Exit Conference or 15-day Letter • Appeal Rights • Transmittal Letter • 60 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.

  39. Cost Report Acceptance Process This presentation is for training purposes only. Please refer to appropriate legislation, SPA, and introduction packet materials.

  40. Cost Report Acceptance Process • Cost 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.

  41. Cost 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 entity’s eligibility • An 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.

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

  43. Getting Paid • DHCS will not accept your Cost Report until all required hardcopy, wet signature documents (PPAand APS have been received and accepted) • DHCS will not make payments until DHCS has been reimbursed for its administrative costs • Payments 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.

  44. SPA 09-024 Requirements • Interim Supplemental Payment • Interim Settlement • Final Reconciliation • Overpayments & Underpayments This presentation is for training purposes only. Please refer to appropriate legislation, SPA, and introduction packet materials.

  45. Cost Report Example Presented By Dan Hom, CPA, Finance Director, Novato Fire Protection District This presentation is for training purposes only. Please refer to appropriate legislation, SPA, and introduction packet materials.

  46. Contact Us • Website • GEMT E-mail • Public Request • Sacramento Metropolitan Fire District • Novato Fire Protection District This presentation is for training purposes only. Please refer to appropriate legislation, SPA, and introduction packet materials.

  47. Questions? This presentation is for training purposes only. Please refer to appropriate legislation, SPA, and introduction packet materials.