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PDFWAC 182-546-0525

GEMT claim submission and cost reporting.

(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.
(11) The costs associated with releasing a client on the scene without transportation by ambulance to a medical facility are eligible for FFP and are eligible expenditures.
(12) Other expenses associated with the prehospital care are eligible costs associated with GEMT.
(13) Expenditures are not eligible costs until the services are provided.
[Statutory Authority: RCW 41.05.021, 41.05.160, 2015 c 157, 2017 c 273, and 2016 1st sp.s. c 29. WSR 20-17-010, § 182-546-0525, filed 8/6/20, effective 9/6/20. Statutory Authority: RCW 41.05.021, 41.05.160, and 2015 c 147. WSR 19-08-058, § 182-546-0525, filed 3/29/19, effective 5/1/19.]
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