Missouri Code of State Regulations › Title 13 - DEPARTMENT OF SOCIAL SERVICES › Division 70 - MO HealthNet Division › Chapter 6 - Emergency Ambulance Program › Section 13 CSR 70-6.020 - Ground Emergency Medical Transportation Uncompensated Cost Reimbursement Program

Current through Register Vol. 49, No. 14, July 15, 2024
PURPOSE: This rule implements the Ground Emergency
				  Medical Transportation (GEMT) Uncompensated Cost Reimbursement Program
				  established pursuant to section
				  208.1030,
				  RSMo, which is a voluntary program that makes reconciled cost reimbursement to
				  eligible GEMT providers that furnish qualifying emergency ambulance services to
				  MO HealthNet participants on or after July 1, 2017.
PUBLISHER'S NOTE: The secretary of state has
				  determined that the publication of the entire text of the material which is
				  incorporated by reference as a portion of this rule would be unduly cumbersome
				  or expensive. This material as incorporated by reference in this rule shall be
				  maintained by the agency at its headquarters and shall be made available to the
				  public for inspection and copying at no more than the actual cost of
				  reproduction. This note applies only to the reference material. The entire text
				  of the rule is printed here.
(1) Scope and Definitions.
(A) Under the Ground Emergency Medical
				Transportation (GEMT) Uncompensated Cost Reimbursement Program (hereinafter the
				"program"), the MO HealthNet Division (MHD) makes reconciled cost reimbursement
				to eligible GEMT providers up to the uncompensated Medicaid costs associated
				with GEMT services. This reconciled cost reimbursement applies only to GEMT
				services rendered to MHD participants by eligible GEMT Providers on or after
				July 1, 2017. Total reimbursements from MHD, including the reconciled cost
				reimbursement, will not exceed one hundred percent (100%) of the eligible GEMT
				provider's actual costs of providing GEMT services to MHD participants. The
				supplemental MHD reimbursement shall be distributed to eligible GEMT providers
				based on GEMT services provided to MHD participants on a per-transport basis.
				The reconciled cost reimbursement is not an individual increase to current
				fee-for-service reimbursement rates.
(B) Definitions.
1. Cost objective means a function or
				category of service for which costs are incurred.
2. Direct cost means, in accordance with
				2
				CFR 200.413, direct costs are those costs
				that-
A. Can be identified specifically with
				a particular final cost objective, such as a federal award, or other internally
				or externally funded activity; or
B. Can be directly assigned to such
				activities relatively easily with a high degree of accuracy.
3. Eligible GEMT provider means a
				provider who is eligible to receive reconciled cost reimbursement under this
				program because it meets the following requirements continuously during the
				claiming period:
A. Provides GEMT services to
				MHD participants;
B. Is enrolled as
				an MHD provider for the period being claimed; and
C. Is owned, operated, or contracted by the
				state or a political subdivision of the state.
4. Emergency Medical Response (EMR) means a
				cost objective that includes all expenditures for GEMT services.
5. GEMT services means both the act of
				transporting an individual from any point of origin to the nearest medical
				facility capable of meeting the emergency medical needs of the patient, as well
				as the advanced, limited-advanced, and basic life support services provided to
				an individual by eligible GEMT providers before or during the act of
				transportation. As of January 1, 2020, GEMT services also include advanced,
				limited-advanced, and basic life support services provided to an individual who
				is released on the scene without transportation by ambulance to a medical
				facility. Advanced, limited-advanced, or basic life support services provided
				to an individual who is released on the scene without transportation by
				ambulance to a medical facility prior to January 1, 2020, shall not be
				considered GEMT services. A run that does not result in a transport or delivery
				of on-site advanced, limited-advanced, or basic life support services shall not
				be considered GEMT services.
6.
				Indirect cost means those costs that are incurred by a supporting organization
				or related party which are not directly accounted for as costs for EMR
				services, non-EMR services or shared costs. Examples of indirect costs include
				overhead costs (i.e. accounting, human resources, etc.) incurred by a city,
				county, or other local government agency or special district that benefit the
				eligible GEMT provider, but the eligible GEMT provider has not been charged for
				those costs. The identification of shared costs does not preclude an eligible
				GEMT provider from also incurring indirect costs, and it is appropriate in
				certain cases for the uncompensated Medicaid costs to include both shared costs
				and indirect costs.
7. MHD
				participant means a patient enrolled in fee-for service Missouri
				Medicaid.
8. Non-Emergency Medical
				Response (non-EMR) means a cost objective that includes expenditures for
				non-medical emergency services, such as fire suppression not including medical
				services, and non-emergency ancillary services, such as fire prevention and
				fire permit issuance that are performed in the absence of an emergency in order
				to support preparedness, mitigate the need for emergency response, or lessen
				the severity of an emergency that might occur.
9. Reconciled cost reimbursement means a
				payment to eligible GEMT providers up to the uncompensated Medicaid costs
				associated with GEMT services for MHD participants.
10. Shared costs means costs that cannot be
				directly assigned to EMR services or non-EMR services relatively easily with a
				high degree of accuracy. Examples of shared costs include personnel who perform
				EMR and non-EMR services and overhead departments who perform EMR and non-EMR
				services.
11. Shift means a
				standard period of time assigned for a complete cycle of work, as set by each
				eligible GEMT provider. The number of hours in a shift may vary among providers
				but will be consistent for each individual provider.
12. Service period means July 1 through June
				30 of each Missouri State fiscal year.
13. Transport means GEMT services that are
				provided by eligible GEMT providers to individuals, regardless of whether the
				service was billed or paid. Medicaid transports includes GEMT services for
				Medicaid managed care, Medicaid crossover and Medicaid fee for service
				patients. Other payer program transports shall be GEMT services provided to
				patients with payer sources other than Medicaid. Transportation services that
				do not involve an emergency or which are non-medical emergencies shall not be
				included as Transports. GEMT services that are denied as not medically
				necessary shall not be included as transports.
14. Uncompensated Medicaid costs means the
				cost of GEMT Services for MHD participants that exceeds the reimbursement
				received from, but not limited to, Medicaid, patients, and enhanced
				supplemental payments received from the ambulance service reimbursement
				allowance under 13 CSR 70-3.200. Cost excludes
				Medicaid managed care and dual-eligible Medicaid Transports.
15. Dual-eligible Medicaid transport means
				any transport where Medicaid is not the primary payor due to other coverage
				including Medicare or other private insurance. These costs will not be
				reimbursed in the GEMT supplemental program.