Presented by Department of Health Care Services Novato Fire Protection District Sacramento...
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Ground Emergency Medical Transportation Supplemental Reimbursement Program Presented by Department of Health Care Services Novato Fire Protection District Sacramento Metropolitan Fire District This presentation is for training purposes only. Please refer to appropriate legislation, SPA, and introduction packet materials. 1
Presented by Department of Health Care Services Novato Fire Protection District Sacramento Metropolitan Fire District This presentation is for training
Presented by Department of Health Care Services Novato Fire
Protection District Sacramento Metropolitan Fire District This
presentation is for training purposes only. Please refer to
appropriate legislation, SPA, and introduction packet
materials.1
Slide 2
Agenda GEMT Supplemental Reimbursement Program Eligibility
Participation Requirements Reimburse the State for its
Administrative Costs The Cost Report Overview This presentation is
for training purposes only. Please refer to appropriate
legislation, SPA, and introduction packet materials.2
Slide 3
Agenda (cont.) Cost Report Acceptance Process Payment Process
Cost Report Example Questions This presentation is for training
purposes only. Please refer to appropriate legislation, SPA, and
introduction packet materials.3
Slide 4
4
Slide 5
State Authority Assembly Bill 678 (Statute of 2011) enacted the
California Welfare and Institutions (W & I) Code 14105.94, on
October 2, 2011 Certified Public Expenditure (CPE) Program
Participation in this Program is Voluntary This presentation is for
training purposes only. Please refer to appropriate legislation,
SPA, and introduction packet materials.5
Slide 6
What is a CPE program? Allows public entities to obtain a
federal match up to its costs for providing services To obtain a
federal match requires federal approval of the program, including
approval of what costs will be allowed This presentation is for
training purposes only. Please refer to appropriate legislation,
SPA, and introduction packet materials.6
Slide 7
Federal Authority CPE Requires Federal Approval State Plan
Amendment 09-024 was approved by CMS on September 4, 2013. Federal
approval allows DHCS to draw down federal funds. This presentation
is for training purposes only. Please refer to appropriate
legislation, SPA, and introduction packet materials.7
Slide 8
Program Overview Reimburses eligible GEMT providers the federal
match up to their actual costs of providing GEMT services to
fee-for-service Medi-Cal beneficiaries only Example: $100 Medi-Cal
uncompensated costs (via CPEs) $100*50%=$50 (federal match) No
upper payment limit for non hospital based providers This
presentation is for training purposes only. Please refer to
appropriate legislation, SPA, and introduction packet
materials.8
Slide 9
Program Highlights Eligible Services NOT-Eligible Services
Fee-for-Service Transports Dry runs included (as defined by SPA
09-024) Services must have been submitted to Medi-Cal and paid a
Medi-Cal base payment Managed Care Transports Medi-Medi Transports
Services provided by First Responders CMS determined that this is
not a transportation category Certain contract arrangements. (refer
to PPL 13-001 on GEMT website) This presentation is for training
purposes only. Please refer to appropriate legislation, SPA, and
introduction packet materials.9
Slide 10
10
Slide 11
Who IS Eligible to Participate Public GEMT service providers,
as defined by Welfare and Institutions Code 14105.94, meet all of
the following criteria: Provide GEMT services to Medi-Cal
beneficiaries Enrolled as a Medi-Cal provider with a (NPI) for the
period being claimed, and Owned or operated by the State, a city, a
county, a city and county, fire protection district, or a federally
recognized Indian Tribe This presentation is for training purposes
only. Please refer to appropriate legislation, SPA, and
introduction packet materials.11
Slide 12
Who is NOT eligible to participate Non-Public entities and
those entities not meeting the eligibility requirements Public
entities who are in certain contracting arrangements with GEMT
service providers(refer to PPL 13-001 on GEMT website) Hospital
Districts that provide GEMT services, that participate in SPA
02-018 This presentation is for training purposes only. Please
refer to appropriate legislation, SPA, and introduction packet
materials.12
Slide 13
Eligibility vs. Participation Eligibility criteria must be met
Participation is voluntary Additional requirements to participate
This presentation is for training purposes only. Please refer to
appropriate legislation, SPA, and introduction packet
materials.13
Slide 14
This presentation is for training purposes only. Please refer
to appropriate legislation, SPA, and introduction packet
materials.14
Slide 15
Requirements to Participate Provider Participation Agreement
(PPA) with DHCS Vendor Number with DHCS, in addition to your
National Provider Identification (NPI) numbers Enter into an
agreement with the host entity agreeing to pay your share of the
DHCS administrative costs File an Annual Participation Survey (APS)
by July 1st This presentation is for training purposes only. Please
refer to appropriate legislation, SPA, and introduction packet
materials.15
Slide 16
Provider Participation Agreement Agreement between the State
and the participating provider Effective date will be retroactive
to January 30, 2010 or the date your agency is eligible to
participate As long as you remain active in this program annually,
this agreement stays in effect This presentation is for training
purposes only. Please refer to appropriate legislation, SPA, and
introduction packet materials.16
Slide 17
DHCS Vendor Number Obtain Vendor Number from the DHCS This
number allows us to pay you The Department of Health Care Services
has already started collecting these forms and your contact
information forms This presentation is for training purposes only.
Please refer to appropriate legislation, SPA, and introduction
packet materials.17
Slide 18
Annual Participation Survey Due July 1 st covering the state
fiscal year ending prior. (e.g. 2013-14 survey will be due July 1,
2014) Certify that you are eligible to participate in the GEMT
Supplemental Reimbursement program Help DHCS budget to ensure we
have sufficient federal funds available to pay you This
presentation is for training purposes only. Please refer to
appropriate legislation, SPA, and introduction packet
materials.18
Slide 19
Reimburse the State for its Administrative Costs Reimburse the
host entity your allocated share for the DHCS administrative costs
incurred GEMT Supplemental Reimbursement Payments will not be made
if agency fails to pay its allocated share of administrative costs
Your share of the States administrative costs should not be
included as an expense in your Cost Report This presentation is for
training purposes only. Please refer to appropriate legislation,
SPA, and introduction packet materials.19
Slide 20
File Annual Cost Report File Cost Reports Annually by November
30 (effective for State Fiscal Year [SFY] 2013/14) Prior year
deadlines SFY 2009/10 due: 12/2/2013 SFY 2010/11due: 12/2/2013 SFY
2011/12due: 2/1/2014 SFY 2012/13due: 2/1/2014 This presentation is
for training purposes only. Please refer to appropriate
legislation, SPA, and introduction packet materials.20
Slide 21
Where do I get the Enrollment and Participation docs? DHCS
emailed the GEMT Notification letter and the following enrollment
and participation documents on 9/13/2013: DHCS Vendor number (form
STD. 204) GEMT Contact Information form Cost Report Signature
Authority Form Provider Participation Agreement URL for the GEMT
website, http://www.dhcs.ca.gov/provgovpart/Pages/GEMT.aspx
http://www.dhcs.ca.gov/provgovpart/Pages/GEMT.aspx This
presentation is for training purposes only. Please refer to
appropriate legislation, SPA, and introduction packet
materials.21
Slide 22
Where do I get the Enrollment and Participation docs? (cont.)
Additional required documents and Program information are available
at: http://www.dhcs.ca.gov/provgovpart/Pages/GEMT.aspx
http://www.dhcs.ca.gov/provgovpart/Pages/GEMT.aspx Copy of the GEMT
Notification Letter Annual Participation Surveys Cost Reports and
Instructions Link to subscribe to the GEMT LISTSERV for website
content updated and additions This presentation is for training
purposes only. Please refer to appropriate legislation, SPA, and
introduction packet materials.22
Slide 23
This presentation is for training purposes only. Please refer
to appropriate legislation, SPA, and introduction packet
materials.23
Slide 24
Host Entity collection of State Admin Reimbursement Host Agency
(Sacramento Metropolitan Fire District) Allocation methodology of
States administrative costs Role of the Host Agency Host Agency
administrative fee This presentation is for training purposes only.
Please refer to appropriate legislation, SPA, and introduction
packet materials.24
Slide 25
This presentation is for training purposes only. Please refer
to appropriate legislation, SPA, and introduction packet
materials.25
Slide 26
Discussion Points A&I and SNFD Statutes and Regulations The
GEMT Cost Report Overview GEMT Supplemental Reimbursement Program
and GEMT Cost Report Flow of the Cost Report Pre-Audit Post Audit
Appeal Process This presentation is for training purposes only.
Please refer to appropriate legislation, SPA, and introduction
packet materials.26
Slide 27
Federal Laws & Regulations Federal: Law / Statute Social
Security Act Regulation 42 CFR Part 413: Principles of Reasonable
Cost Reimbursement Reimbursement Principles CMS Pub 15-1 This
presentation is for training purposes only. Please refer to
appropriate legislation, SPA, and introduction packet
materials.27
Slide 28
State Laws & Regulations State: Law / Statute Welfare and
Institutions Code Section 14170 Authority to Audit Section 14171
Audit Appeal Procedures Section 14105.94(e)(3)&(4) Specific to
GEMT (AB 678) Regulation CA Code of Regulations (CCR), Title 22
Chapter 3, Section 51022 Appeal Process This presentation is for
training purposes only. Please refer to appropriate legislation,
SPA, and introduction packet materials.28
Slide 29
Cost Report Basics Purpose of the Cost Report Average Cost per
Transport Medi-Cal FFS Transports Supplemental Payment Calculated
General Ledger Accounts vs. Cost Center Grouping Schedule Cell
Colors - Yellow vs. Gray vs. Clear This presentation is for
training purposes only. Please refer to appropriate legislation,
SPA, and introduction packet materials.29
Slide 30
Cost of MTS & NON-MTS Services Schedule 1 thru 4 Determine
cost of MTS Services Determine cost of NON-MTS Services Allocate
remaining CRSB based on time on task This presentation is for
training purposes only. Please refer to appropriate legislation,
SPA, and introduction packet materials.30
Slide 31
The Smell Test Schedules 1 thru 4 Is the cost reimbursable?
Cost actually incurred Is the cost related to patient care? Cost
related to providing the service Does it meet Prudent Buyer
Concept? This presentation is for training purposes only. Please
refer to appropriate legislation, SPA, and introduction packet
materials.31
Slide 32
Allocation of Admin & General Schedule 5 - Overhead
Administration Cost Overhead Not directly related to MTS or NON-MTS
Allocated based on Accumulated Cost Alternative to Administrative
Cost Indirect Cost Factor This presentation is for training
purposes only. Please refer to appropriate legislation, SPA, and
introduction packet materials.32
Slide 33
Reclassifications & Adjustments Schedules 6 & 7
Reclassify cost from one cost center or category to another cost
center or category Cost Adjustments Unallowable Cost Inclusion of
post-F/S adjustments Reminder to manually flow Reclasses and
Adjustments Amounts flow to Schedules 1 thru 5 This presentation is
for training purposes only. Please refer to appropriate
legislation, SPA, and introduction packet materials.33
Slide 34
Revenue / Funding Sources Schedule 8 Medicare / Medi-Cal /
Third Party / Private Pay Grants Contributions This presentation is
for training purposes only. Please refer to appropriate
legislation, SPA, and introduction packet materials.34
Slide 35
Final Settlement Schedule 9 Average Cost per Transport Medi-Cal
FFS Transports Non-Federal Match (50%) ARRA Inclusion (if
applicable) Net Federal Participation Amount This presentation is
for training purposes only. Please refer to appropriate
legislation, SPA, and introduction packet materials.35
Slide 36
DHCS GEMT Program Expectations Documentation Grouping Schedule
Cost Report Binder Check Figure on Certification Page This
presentation is for training purposes only. Please refer to
appropriate legislation, SPA, and introduction packet
materials.36
Slide 37
Pre-Audit Cost Report Filings & Acceptance Three levels of
audit activity Desk Limited Field Announced Visit Entrance Letter
Site Visit what to expect This presentation is for training
purposes only. Please refer to appropriate legislation, SPA, and
introduction packet materials.37
Slide 38
Post Audit Exit Conference or 15-day Letter Appeal Rights
Transmittal Letter 60 days to file Informal Hearing (180 day
turnaround) 30 days to file Formal Hearing Process (2+ year
process) Superior Court This presentation is for training purposes
only. Please refer to appropriate legislation, SPA, and
introduction packet materials.38
Slide 39
This presentation is for training purposes only. Please refer
to appropriate legislation, SPA, and introduction packet
materials.39
Slide 40
Cost Report Acceptance Process Cost Reports are due annually to
DHCS November 30 Cost Report submittals must include the following:
CMS-approved GEMT Cost Report Medi-Cal certification statement
(included in Cost Report) Supporting documentation, which includes
but not limited to supporting general ledger, grouping schedules,
and contracts. (This will be requested after the PDF Cost Report
has been accepted) This presentation is for training purposes only.
Please refer to appropriate legislation, SPA, and introduction
packet materials.40
Slide 41
Cost Report Acceptance Process (cont.) A signed PDF Cost Report
must be submitted to [email protected].
[email protected] Upon acceptance of the Cost Report the
provider will be notified to submit the electronic Excel version as
well as the supporting documentation. The provider must maintain
both a signed hardcopy, electronic copy and supporting
documentation on site as well. DHCS will verify your entitys
eligibility An invoice will be created and processed through ac
This presentation is for training purposes only. Please refer to
appropriate legislation, SPA, and introduction packet
materials.41
Slide 42
This presentation is for training purposes only. Please refer
to appropriate legislation, SPA, and introduction packet
materials.42
Slide 43
Getting Paid DHCS will not accept your Cost Report until all
required hardcopy, wet signature documents (PPA and APS have been
received and accepted) DHCS will not make payments until DHCS has
been reimbursed for its administrative costs Payments will be
processed when A&I accepts your Cost Report This presentation
is for training purposes only. Please refer to appropriate
legislation, SPA, and introduction packet materials.43
Slide 44
SPA 09-024 Requirements Interim Supplemental Payment Interim
Settlement Final Reconciliation Overpayments & Underpayments
This presentation is for training purposes only. Please refer to
appropriate legislation, SPA, and introduction packet
materials.44
Slide 45
Presented By Dan Hom, CPA, Finance Director, Novato Fire
Protection District This presentation is for training purposes
only. Please refer to appropriate legislation, SPA, and
introduction packet materials.45
Slide 46
Contact Us Website GEMT E-mail Public Request Sacramento
Metropolitan Fire District Novato Fire Protection District This
presentation is for training purposes only. Please refer to
appropriate legislation, SPA, and introduction packet
materials.46
Slide 47
Questions? This presentation is for training purposes only.
Please refer to appropriate legislation, SPA, and introduction
packet materials.47