Presentations text content in Ground Emergency Medical Transportation Supplemental Reimbursement Program
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Ground Emergency Medical Transportation Supplemental Reimbursement Program
Presented by Department of Health Care ServicesNovato Fire Protection DistrictSacramento Metropolitan Fire District
This presentation is for training purposes only. Please refer to appropriate legislation, SPA, and introduction packet materials.
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Slide2Agenda
GEMT Supplemental Reimbursement ProgramEligibilityParticipation RequirementsReimburse the State for its Administrative CostsThe Cost Report Overview
This presentation is for training purposes only. Please refer to appropriate legislation, SPA, and introduction packet materials.
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Slide3Agenda (cont.)
Cost Report Acceptance ProcessPayment ProcessCost Report ExampleQuestionsThis presentation is for training purposes only. Please refer to appropriate legislation, SPA, and introduction packet materials.
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Slide4GEMT Supplemental Reimbursement Program
This presentation is for training purposes only. Please refer to appropriate legislation, SPA, and introduction packet materials.
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Slide5State 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) Program
Participation in this Program is Voluntary
This presentation is for training purposes only. Please refer to appropriate legislation, SPA, and introduction packet materials.
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Slide6What 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 allowed
This presentation is for training purposes only. Please refer to appropriate legislation, SPA, and introduction packet materials.
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Slide7Federal 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.
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Slide8Program 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.
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Slide9Program Highlights
Eligible ServicesNOT-Eligible ServicesFee-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 TransportsMedi-Medi TransportsServices
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.
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Slide10Eligibility
This presentation is for training purposes only. Please refer to appropriate legislation, SPA, and introduction packet materials.10
Slide11Who 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, 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.
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Slide12Who is NOT eligible to participate
Non-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.
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Slide13Eligibility vs. Participation
Eligibility 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.
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Slide14Participation Requirements
This presentation is for training purposes only. Please refer to appropriate legislation, SPA, and introduction packet materials.14
Slide15Requirements 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.
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Slide16Provider Participation Agreement
Agreement between the State and the participating providerEffective 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.
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Slide17DHCS Vendor Number
Obtain 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.
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Slide18Annual Participation Survey
Due 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 you
This presentation is for training purposes only. Please refer to appropriate legislation, SPA, and introduction packet materials.
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Slide19Reimburse 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
costsYour 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.
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Slide20File 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: 12/2/2013SFY 2010/11 due: 12/2/2013
SFY 2011/12 due: 2/1/2014SFY 2012/13 due: 2/1/2014
This presentation is for training purposes only. Please refer to appropriate legislation, SPA, and introduction packet materials.
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Slide21Where 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.aspx
This presentation is for training purposes only. Please refer to appropriate legislation, SPA, and introduction packet materials.
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Slide22Where 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 Letter
Annual Participation SurveysCost Reports and InstructionsLink 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.
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Slide23Reimburse the State for its Administrative Costs
This presentation is for training purposes only. Please refer to appropriate legislation, SPA, and introduction packet materials.
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Slide24Host Entity collection of State Admin Reimbursement
“Host Agency” (Sacramento Metropolitan Fire District)Allocation methodology of State’s 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.
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Slide25Cost Report Overview
This presentation is for training purposes only. Please refer to appropriate legislation, SPA, and introduction packet materials.
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Slide26
Discussion Points
A&I and SNFDStatutes and RegulationsThe GEMT Cost Report OverviewGEMT Supplemental Reimbursement Program and GEMT Cost ReportFlow of the Cost ReportPre-Audit
Post AuditAppeal ProcessThis presentation is for training purposes only. Please refer to appropriate legislation, SPA, and introduction packet materials.
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Slide27Federal Laws & Regulations
Federal:Law / Statute – Social Security ActRegulation – 42 CFRPart 413: Principles of Reasonable Cost ReimbursementReimbursement Principles – CMS Pub 15-1
This presentation is for training purposes only. Please refer to appropriate legislation, SPA, and introduction packet materials.
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Slide28State Laws & Regulations
State: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 Process
This presentation is for training purposes only. Please refer to appropriate legislation, SPA, and introduction packet materials.
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Slide29Cost Report Basics
Purpose of the Cost Report Average Cost per TransportMedi-Cal FFS TransportsSupplemental Payment CalculatedGeneral Ledger Accounts vs. Cost Center
Grouping ScheduleCell Colors - Yellow vs. Gray vs.
ClearThis presentation is for training purposes only. Please refer to appropriate legislation, SPA, and introduction packet materials.
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Slide30Cost of MTS & NON-MTS Services
Schedule 1 thru 4
Determine cost of MTS ServicesDetermine cost of NON-MTS ServicesAllocate remaining CRSB based on “time on task”
This presentation is for training purposes only. Please refer to appropriate legislation, SPA, and introduction packet materials.
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Slide31The Smell Test
Schedules 1 thru 4Is the cost reimbursable?Cost actually incurred
Is 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.
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Slide32Allocation of Admin
& GeneralSchedule 5 - Overhead
Administration Cost – OverheadNot directly related to MTS or NON-MTS
Allocated based on Accumulated CostAlternative to Administrative CostIndirect Cost Factor
This presentation is for training purposes only. Please refer to appropriate legislation, SPA, and introduction packet materials.
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Slide33Reclassifications & Adjustments
Schedules 6 & 7Reclassify cost from one cost center or category to another cost center or category
Cost AdjustmentsUnallowable CostInclusion of post-F/S adjustmentsReminder to manually flow
Reclasses and AdjustmentsAmounts flow to Schedules
1 thru 5
This presentation is for training purposes only. Please refer to appropriate legislation, SPA, and introduction packet materials.
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Slide34Revenue / Funding Sources
Schedule 8Medicare / Medi-Cal / Third Party / Private Pay
GrantsContributions
This presentation is for training purposes only. Please refer to appropriate legislation, SPA, and introduction packet materials.
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Slide35Final Settlement
Schedule 9Average Cost per Transport
Medi-Cal FFS TransportsNon-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.
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Slide36DHCS GEMT Program Expectations
DocumentationGrouping ScheduleCost Report BinderCheck Figure on Certification Page
This presentation is for training purposes only. Please refer to appropriate legislation, SPA, and introduction packet materials.
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Slide37Pre-Audit
Cost Report Filings & AcceptanceThree levels of audit activityDeskLimitedFieldAnnounced VisitEntrance Letter
Site Visit – what to expectThis presentation is for training purposes only. Please refer to appropriate legislation, SPA, and introduction packet materials.
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Slide38Post Audit
Exit 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.
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Slide39Cost Report Acceptance Process
This presentation is for training purposes only. Please refer to appropriate legislation, SPA, and introduction packet materials.
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Slide40Cost Report Acceptance Process
Cost Reports are due annually to DHCS November 30 Cost R
eport 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.
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Slide41Cost 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.
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Slide42Payment Process
This presentation is for training purposes only. Please refer to appropriate legislation, SPA, and introduction packet materials.42
Slide43Getting Paid
DHCS 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 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.
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Slide44SPA 09-024 Requirements
Interim Supplemental PaymentInterim SettlementFinal ReconciliationOverpayments & Underpayments
This presentation is for training purposes only. Please refer to appropriate legislation, SPA, and introduction packet materials.
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Slide45Cost Report Example
Presented 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.
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Slide46
Contact Us
WebsiteGEMT E-mailPublic RequestSacramento Metropolitan Fire DistrictNovato Fire Protection District
This presentation is for training purposes only. Please refer to appropriate legislation, SPA, and introduction packet materials.
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Slide47Questions?
This presentation is for training purposes only. Please refer to appropriate legislation, SPA, and introduction packet materials.47
Ground Emergency Medical Transportation Supplemental Reimbursement Program
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