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

Universal Citation: 7 AK Admin Code 145.780

Current through November 28, 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.

(e) Based on the process set out in (a) - (d) of this section, the department will

(1) recover from the participating provider the federal payments that exceed the participating provider's cost per qualifying transport, after adjustments for other sources of reimbursement as described in (d) of this section; or

(2) pay the participating provider a federal funds supplemental payment if the process described in (d) of this section results in additional Medicaid emergency medical transportation costs that have not been covered by any other source of reimbursement.

(f) The department will report to the Centers for Medicare and Medicaid Services (CMS) any difference between the payment of federal funds made to the participating providers and the federal share of the qualifying expenditures and return the excess funds to CMS.

(g) The department will conduct the cost settlement process within three years of receipt of the as-filed annual report in 7 AAC 145.760.

Authority:AS 47.05.010

AS 47.07.040

AS 47.07.085

Disclaimer: These regulations may not be the most recent version. Alaska may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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