Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-546 - Transportation services › GROUND EMERGENCY MEDICAL TRANSPORTATION (GEMT) › Section 182-546-0525 - GEMT claim submission and cost reporting

Current through Register Vol. 24-14, July 15, 2024
(1) Each participating provider is
				  responsible for submitting claims to the agency for services provided to
				  eligible clients. Participating providers must submit the claims according to
				  the rules and billing instructions in effect at the time the service is
				  provided.
(2) On an annual basis,
				  participating providers must certify and allocate their direct and indirect
				  costs as qualifying expenditures eligible for FFP.
(3) The claimed costs must be necessary to
				  carry out GEMT.
(4) Participating
				  providers must complete cost reporting according to the Centers for Medicare
				  and Medicaid Services (CMS)-approved cost identification principles and
				  standards such as the most current editions of the CMS
Provider
				  Reimbursement Manual
and the United States Office of Management and
				  Budget Circular (OMB) Circular A-87.
(5) Participating providers must completely
				  and accurately document the CMS-approved cost report as required under OMB
				  Circular A-87 Attachment A.
(6)
				  Participating providers must allocate direct and indirect costs to the
				  appropriate cost objectives as indicated in the cost report
				  instructions.
(7) Reported
				  personnel costs including wages, salaries, and fringe benefits must be
				  exclusively attributable to ground emergency ambulance services provided.
				  Services do not include fire suppression.
(8) Revenues received directly, such as
				  foundation grants and money from private fund-raising, are not eligible for
				  certification because such revenues are not expenditures of a government
				  entity.
(9) The sum of a
				  participating provider's allowable direct and indirect costs are divided by the
				  number of ground emergency medical transports to determine a participating
				  provider's average cost per qualifying transport.
(10) Participating providers must complete an
				  annual cost report documenting the participating provider's total CMS-approved,
				  direct and indirect costs of delivering medicaid-covered services using a
				  CMS-approved cost-allocation methodology. Participating providers must:
(a) Submit the cost report within five months
				  after the close of the service period.
(b) Request an extension to the cost report
				  deadline in writing to the agency, if needed. The agency will review requests
				  for an extension on a case-by-case basis.
(c) Provide additional documentation
				  justifying the information in the cost report, upon request by the
				  agency.
(d) Assure the agency
				  receives the cost report or additional documentation according to WAC
				  182-502-0020.
(i) Participating providers must comply with
				  WAC
				  182-502-0020
				  to receive the supplemental payment under this program.
(ii) The agency pays the claims for the
				  following service period according to the agency's current ambulance fee
				  schedule.