GROUND EMERGENCY MEDICAL TRANSPORTATION (GEMT)
The Ground Emergency Medical Transportation (GEMT) Program, brought by the Department of Health Care Services (DHCS) in collaboration with Novato Fire Protection District and Sacramento Metropolitan Fire District, provides insight into the program's eligibility criteria, enrollment procedures, and annual requirements for providers. Discover how to become a GEMT provider, meet program criteria, and ensure compliance with DHCS regulations. Navigate through the steps, agreements, and essential information to participate effectively in this vital healthcare transportation service.
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Presentation Transcript
GROUND EMERGENCY MEDICAL TRANSPORTATION (GEMT) PROGRAM TRAINING Brought to you by: The Department of Health Care Services (DHCS) Novato Fire Protection District Sacramento Metropolitan Fire District 1 August 2017
OVERVIEW Process for new and existing GEMT providers Who s who at DHCS GEMT Program process overview Adjusted Schedule 9 / Transport Adjustments When are they made, why, and how Affordable Care Act Federal Financial Participation Rates Interim Payment Process Interim Settlement Process Final Reconciliation Process DHCS Administrative Cost Process (Separate Slide Show) Cost Report Walkthrough/Training (Separate Slide Show) 2
GEMT PROGRAM ELIGIBILITY In order to be eligible for the GEMT program a provider must meet the following: Provide GEMT services to Medi-Cal beneficiaries (further defined in SPA 09-024). Be enrolled as a Medi-Cal provider for the period being claimed. Be owned or operated by an eligible governmental entity, to include the state, a city, county, city and county, fire protection district, special district, community services district, health care district, or a federally recognized tribe. 3
GEMT PROGRAM ENROLLMENT To enroll into the GEMT Program, providers must: Enter into a Provider Participation Agreement (PPA) with DHCS http://www.dhcs.ca.gov/provgovpart/Documents/GEMT/Participation.pdf http://www.dhcs.ca.gov/provgovpart/Documents/GEMT/Participation.pdf Obtain a DHCS Vendor Number (Form STD. 204) GEMT@dhcs.ca.gov Email GEMT@dhcs.ca.gov for STD. 204 Form Complete the GEMT Point of Contact Form http://www.dhcs.ca.gov/provgovpart/Documents/GEMT/POC.pdf http://www.dhcs.ca.gov/provgovpart/Documents/GEMT/POC.pdf GEMT@dhcs.ca.gov martucci.sherri@metrofire.ca.gov Send form to GEMT@dhcs.ca.gov and cc Sherri Martucci at martucci.sherri@metrofire.ca.gov Agree to reimburse DHCS administrative costs associated with overseeing the program (the provider s allocated costs will be collected by Sacramento Metropolitan Fire District on behalf of DHCS). martucci.sherri@metrofire.ca.gov Email Sherri Martucci at martucci.sherri@metrofire.ca.gov Complete annually, a cost report certifying public expenditures for this program. Participation Requirements Memo For more information and due dates please see our Participation Requirements Memo. 4
ANNUAL REQUIREMENTS FOR ENROLLED PROVIDERS PPAs are evergreen, they do not need to be submitted annually. Once executed, the agreement stands until one or both parties wishes to terminate or edit. Billing Service agreements must be current for the applicable state fiscal year (SFY). Submit cost reports by November 30th. 5
WHOS WHO AT DHCS Audits and Investigations Division Audit Review and Analysis Section (ARAS) Monitors the GEMTSubmissions@dhcs.ca.gov mailbox Completes initial review of submitted cost reports Sends cost report acceptance emails to providers 6
WHOS WHO AT DHCS 2 Safety Net Financing Division (SNFD) Monitors the GEMT@dhcs.ca.gov mailbox Provides oversight and guidance on GEMT program Enrolls new GEMT providers into the GEMT program Monitors and executes Provider Participation Agreements (PPA) Processes GEMT Interim payments, Interim Settlements and Final Reconciliations Report and track expenditures to federal government 7
WHOS WHO AT DHCS 3 Audits and Investigations Division Financial Audits Branch (FAB) Conducts final audits of GEMT cost reports Issues audit findings to GEMT providers and SNFD 8 * FAB does not process payments or recoupments as a result of audit findings. SNFD processes final reconciliation payments and recoupments.
GEMT COST REPORT FLOW AND TIMELINE Step 1 Enrolled GEMT provider goes to DHCS website to download current version of cost report. Cost reports are state fiscal year (SFY) specific. Step 2 GEMT provider fills out cost report, signs and dates certification page. GEMT provider submits signed PDF and Excel versions of cost report to GEMTSubmissions@dhcs.ca.gov with a cc to GEMT@dhcs.ca.gov by November 30th of each SFY. 9
GEMT COST REPORT FLOW AND TIMELINE 2 Step 3 ARAS reviews cost report. ARAS sends acceptance email to provider, requests additional information, or rejects cost report within 90 days of receipt. If cost report is rejected provider must make edits and resubmit signed PDF and Excel version as soon as possible. Step 4 SNFD processes invoice for payment within 30 days of acceptance. Invoice goes through 3 levels of review/signature. Invoice is sent to DHCS Accounting Section for processing. Accounting Section has 10 business days to process and send payment information to the State Controllers Office (SCO). 10
GEMT COST REPORT FLOW AND TIMELINE 3 Step 5 SCO processes invoice and issues Warrant/Check. SCO has 15 business days to issue warrant. Warrant is mailed to GEMT provider. Allow 3-5 business days for delivery. Step 6* 2 years after the close of each SFY SNFD will conduct interim reconciliations. SNFD will process invoice for providers who were underpaid. Invoice will go through steps 4 and 5. SNFD will send demand letter to providers who were overpaid. Providers have 60 days to remit payment to SNFD. 11 *Due to timing, SFY 09/10 through SFY 12/13 will not have a interim reconciliation. DHCS will only conduct final reconciliations based on final audits.
GEMT COST REPORT FLOW AND TIMELINE 4 Step 7 FAB conducts final audit within 3 years of accepted cost report. Step 8 SNFD will conduct final reconciliations based on final audit. SNFD will process invoice for providers who were underpaid. Invoice will go through steps 4 and 5. SNFD will send demand letter to providers who were overpaid. Providers have 60 days to remit payment to SNFD. *Note about SFYs 2009-10 through SFYs 2012-13 (retro period) All retro period audits are estimated to be completed by the end of SFY 2017/18. 12 *Due to timing, SFY 09/10 through SFY 12/13 will not have a interim reconciliation. DHCS will only conduct final reconciliations based on final audits.
FREQUENT COST REPORT MISTAKES THAT LEAD TO DELAY IN PAYMENT OR COST REPORT REJECTION Page 1 (certification page) is not signed or dated. Incorrect claiming period (page 1, box 25 and 26). SFY is July 1st through June 30th Transports listed on Schedule 9 not complete. All categories (Managed Care, Medi-Medi, Fee-for-service, and Other) must be populated. Billing Contract on file is expired and does not cover claiming period. Cost report not complete, missing schedules or pages when submitted. All submitted cost report must have 15 pages. 13
TOP OF ADJUSTED SCHEDULE 9 15
AVERAGE COST PER TRANSPORT BOX 16
TRANSPORT DISCREPANCY Providers may see a variance in the total FFS transports as there could be a lag in our system-generated report. Any discrepancy (high or low) in the FFS transports will be adjusted in the other category. For example, if a provider reported 10 FFS transports and 15 other transports and our system-generated report only showed 8 FFS transports we adjust the FFS transports down to 8 and increase the other transports to 17 in an effort to not change the average cost per transport. Any additional transports you may be eligible for that are not captured on our report will be addressed during the interim settlement. 17
NON-ACA PAYMENT CALCULATION BOX 18
ACA PAYMENT CALCULATION BOX 19
AFFORDABLE CARE ACT FEDERAL FINANCIAL PARTICIPATION PERCENTAGE Pursuant to federal law, the increased federal financial participation rate will equal: 100% for calendar years 2014 through 2016; 95% for calendar year 2017; 94% for calendar year 2018; 93% for calendar year 2019; and 90% for calendar year 2020 and all subsequent calendar years. 21
INTERIM PAYMENT (STEP 4 AND 5) Interim payment issued based on calculation from adjusted schedule 9 Non-ACA transport reimbursement based on line 15 of Non-ACA box . As required by federal law ACA and Non-ACA payments will be processed separately. 22
INTERIM PAYMENT CONT (STEP 4 AND 5) Interim payment issued based on calculation from adjusted schedule 9 ACA transport reimbursement based on line 13 of ACA box . As required by federal law ACA and Non-ACA payments will be processed separately. 23
INTERIM SETTLEMENT (STEP 6) SNFD will run new CA-MMIS report to capture any additional transports and payments. For SFY 15/16 SNFD will run the report no sooner than 9/1/18 to capture all SFY 15/16 transports through 6/30/18. 24
FINAL RECONCILIATION (STEP 7 AND 8) Step 7 FAB conducts final audit within 3 years of accepted cost report. Step 8 SNFD will conduct final reconciliations based on final audit. SNFD will process invoice for providers who were underpaid. Invoice will go through steps 4 and 5. SNFD will send demand letter to providers who were overpaid. Providers have 60 days to remit payment to SNFD. 25
WANT MORE GEMT INFORMATION? http://www.dhcs.ca.gov/provgovpart/Pages/GEMT.aspx Please visit our website: http://www.dhcs.ca.gov/provgovpart/Pages/GEMT.aspx http://apps.dhcs.ca.gov/listsubscribe/default.aspx?list=dhcsgemt Join our email distribution list: http://apps.dhcs.ca.gov/listsubscribe/default.aspx?list=dhcsgemt GEMT@dhcs.ca.gov Email questions to GEMT@dhcs.ca.gov 26
