Apple Health (Medicaid) Provider Alert
What
is changing?
The Health Care Authority (the agency) has received approval
from the Centers for Medicare and Medicaid Services (CMS) to provide settlement
payments for Ground Emergency Medical Transportation (GEMT) claims submitted to
managed care organizations (MCOs). The payments are to bring providers up to
their determined average cost per transport.
Please note, the mechanism for this process is still
in development. The agency will disburse MCO settlement payments in late
2018.
What
time period will be settled for MCO claims?
As approved by CMS, the MCO settlement period is for calendar year 2017 (January 1, 2017 – December 31, 2017) only.
The agency will not be able to provide any settlement payments back to the program implementation date (June 2, 2016).
How
will providers receive settlement funds for MCO claims?
The agency is working
closely with MCOs and stakeholders to determine the process. The agency will
provide more information as it is available.
The agency will invoice
providers for the non-federal share of the average cost per transport and
participating providers will need to send the funds to the agency as an
intergovernmental transfer (IGT).
- An IGT is a transfer of funds from one governmental entity (e.g. city, county, state, or federal) to the state Medicaid agency.
-
The ability of states to use IGTs to fund their Medicaid program is recognized in statute (§1903(w)(6) of the Social Security Act) and rule (42 CFR §433.51).
Upon receipt of the IGT, the
full cost per transport (minus 20% of the IGT) will be returned to the provider
via the MCOs as a one-time settlement payment.
Going forward, the agency
will perform and reconcile all settlement activity.
For more information, contact Shauna Penn, GEMT Program Manager.
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