2023 Idaho Code › Title 56 - PUBLIC ASSISTANCE AND WELFARE › Chapter 2 - PUBLIC ASSISTANCE LAW › Section 56-268 - SUPPLEMENTAL MEDICAID REIMBURSEMENT FOR GROUND EMERGENCY MEDICAL TRANSPORTATION.

56-268. SUPPLEMENTAL MEDICAID REIMBURSEMENT FOR GROUND EMERGENCY MEDICAL TRANSPORTATION. (1) An eligible provider, as described in subsection (2) of this section, in addition to the rate of payment that the provider would otherwise receive for medicaid ground emergency medical transportation services, shall receive supplemental medicaid reimbursement to the extent provided by law.
(2) A provider shall be eligible for supplemental reimbursement only if, during the state fiscal year, the provider:
(a) Provides ground emergency medical transportation services to medicaid beneficiaries;
(b) Is enrolled as a medicaid provider for the period being claimed; and
(c) Is owned or operated by the state or a political subdivision of the state that employs or contracts with persons who are licensed to provide emergency medical services in the state of Idaho.
(3) An eligible provider’s supplemental reimbursement pursuant to this section shall be calculated and paid as follows:
(a) The supplemental reimbursement to an eligible provider, as described in subsection (2) of this section, shall be equal to the amount of federal financial participation received because of the claims submitted pursuant to subsection (6)(b) of this section;
(b) In no instance may the amount certified pursuant to subsection (5)(a) of this section, when combined with the amount received from all other sources of reimbursement from the medicaid program, exceed one hundred percent (100%) of actual costs, as determined pursuant to the medicaid state plan, for ground emergency medical transportation services; and
(c) The supplemental medicaid reimbursement provided by this section must be distributed exclusively to eligible providers under a payment methodology based on ground emergency medical transportation services provided to medicaid beneficiaries by eligible providers on a per-transport basis or other federally permissible basis. The state department of health and welfare shall obtain approval from the centers for medicare and medicaid services for the payment methodology to be utilized and shall not make any payment pursuant to this section prior to obtaining that approval.
(4)(a) It is the legislature’s intent in enacting this section to provide the supplemental reimbursement described in this section without any expenditure from the state general fund. An eligible provider, as a condition of receiving supplemental reimbursement pursuant to this section, shall enter into and maintain an agreement with the state department of health and welfare for the purposes of implementing this section and reimbursing the state for the costs of administering this section.
(b) The nonfederal share of the supplemental reimbursement submitted to the centers for medicare and medicaid services for purposes of claiming federal financial participation shall be paid only with funds from the governmental entities described in subsection (2)(c) of this section and certified to the state as provided in subsection (5) of this section.
(5) Participation in the program by an eligible provider described in this section is voluntary. If an applicable governmental entity elects to seek supplemental reimbursement pursuant to this section on behalf of an eligible provider, the governmental entity shall do the following:
(a) Certify, in conformity with the requirements of 42 CFR 433.51 or a successor regulation, that the claimed expenditures for the ground emergency medical transportation services are eligible for federal financial participation;
(b) Provide evidence supporting the certification as specified by the state department of health and welfare;
(c) Submit data as specified by the state department of health and welfare to determine the appropriate amounts to claim as expenditures qualifying for federal financial participation; and
(d) Keep, maintain, and have readily retrievable any records specified by the state department of health and welfare to fully disclose reimbursement amounts to which the eligible provider is entitled and any other records required by the centers for medicare and medicaid services.
(6) The state department of health and welfare shall promptly seek any necessary federal approval for the implementation of this section. The department may limit the program to those costs that are allowable expenditures under title XIX of the social security act, 42 U.S.C. 1396 et seq. If federal approval is not obtained for implementation of this section, then this section shall not be implemented.
(a) The state department of health and welfare shall submit claims for federal financial participation for the expenditures for the services described in this section that are allowable expenditures under federal law.
(b) The state department of health and welfare shall submit any necessary materials to the federal government to provide assurances that claims for federal financial participation will include only those expenditures that are allowable under federal law.
History:
[56-268, added 2022, ch. 67, sec. 1, p. 203.]