Alaska Administrative Code › Title 7 - Health and Social Services › Part 8 - Medicaid Coverage and Payment › Chapter 145 - Medicaid Payment Rates › Article 11 - Payment Rates; Rural Health Clinic and Federally Qualified Health Center Services › 7 AAC 145.780 - SEMT cost reconciliation and settlement process

Current through May 31, 2024
(a) The department
				  will adjust the cost report submitted by the provider for costs based on
				  financial documentation provided during the desk review process, and to
				  revenues and medical transports based on the reconciliation results from the
				  most recently retrieved report from the Medicaid Management Information System
				  (MMIS) described in
				  42 C.F.R.
				  433.111(b).
(b) The cost associated with a dry run is not
				  eligible for FFP and is not an eligible expenditure. The SEMT administrative
				  fee in 7 AAC 145.790 is not eligible for FFP and is not an eligible
				  expenditure.
(c) All financial and
				  medical transport information must be based on an accrual method of accounting
				  and the participating provider must comply with generally accepted accounting
				  principles (GAAP). Revenue must be reported in the period earned, regardless of
				  when payment was received. Expenses must be reported in the period in which
				  incurred.
(d) To determine the
				  final supplemental payment, the department will perform cost settlements based
				  on the final SEMT cost report for all participating providers using the
				  following formula:
(1) the sum of a
				  participating provider's allowable direct and indirect costs for ground, air,
				  and water medical transport services will be divided by the number of medical
				  transports, separated into ground, air, and water services by the
				  service-specific components, to determine a participating provider's average
				  cost per medical transport for each ground, air, or water service;
(2) the average cost per medical transport
				  for each ground, air, or water service will be multiplied by the number of
				  qualifying Medicaid fee-for-service emergency medical transports by Medicaid
				  fund type, described in 7 AAC 145.750(d), to determine allowable Medicaid
				  emergency medical transportation costs per Medicaid fund type;
(3) the allowable Medicaid emergency
				  transportation costs will be offset by Medicaid revenue for fee-for-service,
				  third party liability emergency medical transports, and the interim payment for
				  the service year in which the interim supplemental payment is made for each
				  Medicaid fund type for emergency medical transports, to calculate the Medicaid
				  emergency medical transportation costs that have not been paid by any other
				  source by Medicaid fund type;
(4)
				  the calculated Medicaid emergency medical transportation costs not paid by any
				  other source for each Medicaid fund type described in 7 AAC 145.750(d) will be
				  multiplied by the federal medical assistance percentage (FMAP) within the
				  meaning given in
				  42
				  U.S.C. 1396d(b) for that
				  Medicaid fund type, including claims for non-Indian Health Service providers
				  that have been tribally refinanced in accordance with CMS State Health Official
				  (SHO) letter #16-002, Re:
Federal Funding for Services "Received
				  Through" an IHS/Tribal Facility and Furnished to Medicaid-Eligible American
				  Indians and Alaska Natives
(February 26, 2016), to determine the final
				  settlement.