2023 West Virginia Code › Chapter 9. Human Services › Article 5. Miscellaneous Provisions › §9-5-26. Supplemental Medicare and Medicaid Reimbursement

(a) A ground emergency medical transportation services provider, owned, operated by, or providing services under contract to, the state, or a city, a county, or city and county, that provides services to Medicare and Medicaid beneficiaries is eligible for supplemental reimbursement.
(b) An eligible provider’s supplemental reimbursement shall be calculated and paid as follows:
(1) The supplemental reimbursement to an eligible provider shall be equal to the amount of federal financial participation received as a result of the claims submitted.
(2) In no instance may the amount certified, when combined with the amount received from all other sources of reimbursement from the Medicare or Medicaid program, exceed 100 percent of actual costs, as determined pursuant to the Medicaid State Plan or the state’s Medicare plan, for ground emergency medical transportation services.
(3) The supplemental Medicare and Medicaid reimbursement shall be distributed exclusively to eligible providers under a payment methodology based on ground emergency medical transportation services provided to Medicare and Medicaid beneficiaries by eligible providers on a per-transport basis or other federally permissible basis. The Department of Health and Human Resources shall obtain approval from the Centers for Medicare and Medicaid Services for the payment methodology to be used, and may not make any payment pursuant to this section prior to obtaining that approval.
(c) No funds may be expended from the State Fund, General Revenue for any supplemental reimbursement paid under this section.
(d) The nonfederal share of the supplemental reimbursement submitted to the federal Centers for Medicare and Medicaid Services for purposes of claiming federal financial participation may be paid only with funds from the governmental entities.
(e) Participation in the program by an eligible provider described in this section is voluntary.
(f) If an applicable governmental entity elects to seek supplemental reimbursement pursuant to this section on behalf of an eligible provider, the governmental entity shall:
(1) Certify, in conformity with the requirements of Section 433.51 of Title 42 of the Code of Federal Regulations, that the claimed expenditures for the ground emergency medical transportation services are eligible for federal financial participation;
(2) Provide evidence supporting the certification as specified by the Department of Health and Human Resources;
(3) Submit data as specified by the Department of Health and Human Resources to determine the appropriate amounts to claim as expenditures qualifying for federal financial participation; and
(4) Keep, maintain, and have readily retrievable any records specified by the Department of Health and Human Resources to fully disclose reimbursement amounts to which the eligible provider is entitled, and any other records required by the federal Centers for Medicare and Medicaid Services.
(g) (1) The Department of Health and Human Resources shall promptly seek any necessary federal approvals for the implementation of this section. The Department of Health and Human Resources may limit the program to those costs that are allowable expenditures under Title XIX of the federal Social Security Act (42 U.S.C. §1396 et seq.). If federal approval is not obtained for implementation of this section, this section may not be implemented.
(2) The Department of Health and Human Resources shall submit claims for federal financial participation for the expenditures for the services that are allowable expenditures under federal law.
(3) The Department of Health and Human Resources shall, on an annual basis, 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.
(4) Notwithstanding the provisions of §9-5-26(g)(1) of this code, the Department of Health and Human Resources shall, prior to seeking federal approval of any supplemental reimbursement pursuant to this section, attempt to maximize the number of qualified group emergency medical transportation service providers eligible to receive the supplemental reimbursement. These emergency medical transportation service providers would include:
(A) Any not-for-profit emergency medical transport providers not owned by the state or a city, a county, or a city and county;
(B) Any voluntary emergency transportation service providers not owned by the state or a city, a county, or a city and county; and
(C) All other emergency medical transportation service providers licensed pursuant to the provisions of §16-4C-1 et seq. of this code.