Current through November 28, 2024
(a) If a provider elects to participate in
the SEMT program, the provider must comply with the following requirements to
qualify and receive supplemental payments:
(1) provide emergency medical transportation
services to Medicaid fee-for-service (FFS) recipients under
7
AAC 120.415 -
7
AAC 120.420;
(2) be publicly owned or operated;
(3) be enrolled as a ground, water, or air
ambulance Medicaid provider for the service period specified in the claim;
and
(4) include only claims for
dates of service on or after the provider's Medicaid enrollment date, if a
provider meets all other qualifications for the SEMT program and enrolls as a
ground, water, or air ambulance Medicaid provider in the middle of the
provider's fiscal year; the department will not make payment for claims for
services provided before the provider's Medicaid enrollment
date.
(b) Not later than
the last day of the fifth month after the close of the provider's fiscal year,
the SEMT provider must provide the documentation required under (c) of this
section. The department may grant an extension of not more than 30 days, for
good cause shown, if the SEMT provider requests the extension in writing. The
department may grant an extension equal to the length of time determined by the
Centers for Medicare and Medicaid Services (CMS), if CMS grants an extension
for Medicare cost reports related to an issue that affects providers in this
state.
(c) The SEMT provider must
(1) renew SEMT participation annually by
submitting a
Supplemental Emergency Medical Transportation (SEMT)
Provider Participation Agreement, adopted by reference in
7
AAC 160.900;
(2) complete and submit the
Supplemental Emergency Medical Transportation [SEMT) Cost
Report, adopted by reference in
7
AAC 160.900, in accordance with the
Supplemental Emergency Medical Transportation {SEMT) Cost Report
Instructions, adopted by reference in
7
AAC 160.900, and with CMS Publication 15-1:
Principles of Reimbursement for Provider Costs;(3) provide supporting documentation for the
cost report and the cost determination prepared under
AS
47.07.040 (state plan for provision of
medical assistance), including
(A) audited
financial statements, completed in accordance with generally accepted auditing
standards (GAAS) or generally accepted government auditing standards (GAGAS),
related to the cost report, or a separate schedule related to the cost
report;
(B) a post-audit working
trial balance for the audited financial statements;
(C) a reconciliation of the post-audit
working trial balance to the cost report; and
(D) supporting documentation requested by the
department;
(4) comply
the allowable cost requirements provided in 2 C.F.R. Part 200, 42 C.F.R. Part
413, and Medicaid non-institutional reimbursement policy; and
(5) annually certify and allocate the
provider's direct and indirect costs as qualifying expenditures eligible for
federal financial participation (FFP).
(d) The SEMT provider must maintain the
records required in this section for at least seven years from the date the
documentation is submitted. Failure to maintain documentation to support
allowable SEMT costs may result in the unsupported costs categorized as
disallowed costs.
(e) Each
participating provider must agree to reimburse the department for the cost of
administering the SEMT program. The cost may not be included as an expense in
the participating provider's cost report.
(f) The eligible SEMT provider must identify
indirect costs using one of the following options:
(1) an eligible SEMT provider that receives
$35,000,000 or more in direct federal awards must have either a cost allocation
plan (CAP) or a cognizant agency-approved indirect rate agreement with its
cognizant agency to identify indirect costs; if the eligible SEMT provider does
not have a CAP or an indirect rate agreement with its cognizant agency and
wants to claim indirect costs in association with non-institutional services,
the eligible SEMT provider must obtain one or the other before it can claim any
indirect costs;
(2) an eligible
SEMT provider that receives less than $35,000,000 in direct federal awards must
develop and maintain an indirect rate proposal for audit; if the eligible SEMT
provider does not have an indirect rate proposal, that provider may use methods
originating from a CAP to identify its indirect costs; if the eligible SEMT
provider does not have an indirect rate proposal or a CAP and wants to claim
indirect costs in association with non-institutional services, the eligible
SEMT provider must secure one or the other before it can claim any indirect
costs;
(3) an eligible SEMT
provider that receives no direct federal funding may use the following
previously established methodology to identify indirect costs:
(A) a CAP with its local
government;
(B) an indirect rate
negotiated with its local government;
(C) direct identification through use of a
cost report;
(4) if the
eligible SEMT provider has never used any of the methodologies in (1) - (3) of
this subsection, it may do so, or it may elect to use the 10 percent de minimis
rate to identify its indirect costs.
(g) Each participating provider is
responsible for submitting claims to the department for services provided to
eligible recipients. A participating provider must submit the claim according
to the rules and billing instructions in effect at the time the service was
provided.
(h) For the report for
federal fiscal year 2019, calendar year 2019, state fiscal year 2020, federal
fiscal year 2020, calendar year 2020, and state fiscal year 2021, the SEMT
provider must submit the documentation required under (c) of this section not
later than {180 days after effective date of regulations}.
Authority:AS
47.05.010
AS 47.07.040
AS
47.07.085
