Ground Emergency Medical Transportation Supplemental Reimbursement Program

Ground Emergency Medical Transportation Supplemental Reimbursement Program Ground Emergency Medical Transportation Supplemental Reimbursement Program - Start

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Ground Emergency Medical Transportation Supplemental Reimbursement Program - Description

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.. ID: 724513 Download Presentation

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Ground Emergency Medical Transportation Supplemental Reimbursement Program




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Presentations text content in Ground Emergency Medical Transportation Supplemental Reimbursement Program

Slide1

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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Slide2

Agenda

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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Slide3

Agenda (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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Slide4

GEMT Supplemental Reimbursement Program

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

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Slide5

State 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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Slide6

What 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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Slide7

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.

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Slide8

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 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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Slide9

Program 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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Slide10

Eligibility

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

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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, 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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Who 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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Slide13

Eligibility 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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Slide14

Participation Requirements

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

Slide15

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.

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Slide16

Provider 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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Slide17

DHCS 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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Slide18

Annual 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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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

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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Slide20

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: 12/2/2013SFY 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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Slide21

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.aspx

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

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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.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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Slide23

Reimburse 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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Slide24

Host 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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Slide25

Cost 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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Federal 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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State 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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Slide29

Cost 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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Slide30

Cost 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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Slide31

The 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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Slide32

Allocation 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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Slide33

Reclassifications & 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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Slide34

Revenue / 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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Slide35

Final 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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Slide36

DHCS 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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Slide37

Pre-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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Post 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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Slide39

Cost Report Acceptance Process

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

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Slide40

Cost 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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Slide41

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.

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Slide42

Payment Process

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

Slide43

Getting 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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Slide44

SPA 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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Slide45

Cost 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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Slide47

Questions?

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


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