KRS § 205.5604 — KY Code / Title XVII / Chapter 205 / Section 205.5604
205.5604 Department for Medicaid Services to submit Medicaid preprint to establish supplemental payment program for public ground ambulance providers -- Administration of program -- Funding -- Eligibility
Status: in_force

205.5604 Department for Medicaid Services to submit Medicaid preprint to

establish supplemental payment program for public ground ambulance

providers -- Administration of program -- Funding -- Eligibility.

(1) As used in this section, "public ground ambulance provider" means a ground

ambulance provider licensed in accordance with administrative regulations

promulgated by the Kentucky Board of Emergency Medical Services, which is

owned or operated by a city, county, urban-county government, consolidated local

government, charter county government, unified local government, or special

district, except for a local rescue squad district created under KRS Chapter 39F.

(2) (a) The Department for Medicaid Services shall submit a Medicaid preprint with

a January 1, 2026, effective date to the Centers for Medicare and Medicaid

Services seeking authorization to establish and administer a supplemental

payment program to provide state-directed Medicaid managed care payments

to eligible public ground ambulance providers.

(b) If approved by the Centers for Medicare and Medicaid Services, the

department shall:

1. Establish and administer the program to provide state-directed Medicaid

payments to eligible public ground ambulance providers for services

provided under the managed care component of the Medicaid program;

2. Operate the supplemental payment program described in this section

separately from the assessment and directed payment program

established under KRS 142.318, 205.5601, 205.5602, and 205.5603;

3. Utilize a cost report to determine the average cost per transport, which

shall be used in the upper payment limit calculation for the Medicaid

managed care-directed payments;

4. Establish a cost-based payment methodology in accordance with the

Centers for Medicare and Medicaid Services' rules and regulations; and

5. Promulgate administrative regulations necessary to carry out this

section.

(3) (a) The state match funds required for the supplemental payment program for

public ground ambulance providers shall:

1. Be provided by public ground ambulance providers participating in the

supplemental payment program via intergovernmental transfers or

similar government fund transfers; and

2. Include a total of two hundred thousand dollars ($200,000) annually that

shall be retained by the department to offset administrative expenses

related to the supplemental payment program for public ground

ambulance providers. Each participating public ground ambulance

provider shall be responsible for a percentage of the administrative fee

retained by the department under this subparagraph equal to the

percentage of the total number of qualifying ambulance runs a

participating public ground ambulance provider made during the

previous year.

(b) Participating public ground ambulance providers shall identify and utilize a

source of funding for the intergovernmental fund transfers required by

paragraph (a) of this subsection, which shall:

1. Be separate from the assessment authorized under KRS 205.6406;

2. Not be from the state general fund; and

3. Comply with the requirements of the Centers for Medicare and

Medicaid Services.

(c) A continued local source of funding shall be identified for the nonfederal

share, which shall:

1. Be separate from the assessment authorized under KRS 142.318;

2. Not be from the state general fund; and

3. Comply with the requirements of the Centers for Medicare and

Medicaid Services.

(4) To be eligible to receive state-directed payments under this section, a public ground

ambulance provider shall:

(a) Hold a valid Medicaid provider agreement;

(b) Submit an annual cost report in accordance with administrative regulations

promulgated by the department; and

(c) Provide emergency medical transportation services to Medicaid beneficiaries.