HomeMy WebLinkAboutIntergovernmental Transfer (GEMT) 12.18.2023STATE OF IOWA DEPARTMENT OF
Health AND Human
SERVICES
INTERGOVERNMENTAL TRANSFER OF PUBLIC FUNDS AGREEMENT
BETWEEN
THE IOWA DEPARTMENT OF HEALTH AND HUMAN SERVICES AND
Ground Emergency Medical Transportation Provider (GEMT Provider)
This Intergovernmental Transfer Agreement (Agreement) is entered into between the Iowa
Department of Health and Human Services (HHS) and the ground emergency medical
transportation (GEMT) Provider. It provides for an intergovernmental transfer of funds to the HHS
from the GEMT Provider in order to provide the non-federal share of the reconciled cost
reimbursement amount for the uncompensated Medicaid cost associated with GEMT services.
The GEMT Provider is authorized by House File (HF) 2285 of the 2018 Iowa legislative session to
enter into and carry out an Intergovernmental Transfer (IGT) Agreement to transfer funds through
IGTs to the HHS for use as the non-federal share of Medicaid expenditures.
AGREEMENT
I. GEMT Program Compliance. Attached hereto as Attachment A is State Plan Amendment
IA-I9-002 (SPA), which address the GEMT Program. The GEMT Provider shall at all times
comply with all requirements of the SPA.
2. Compliance with Provider Agreement and GEMT Program Eligibility. The GEMT
Provider's Iowa Medicaid Provider Agreement is incorporated herein by reference. The parties
stipulate to the inclusion of any future amendments or replacement of any such Provider
Agreements by this reference. The GEMT Provider hereby represents, warrants and covenants
that is and at all relevant times will be an Eligible GEMT Provider as that term is defined in the
SPA. If at any time the GEMT Provider's status changes such that it is no longer an Eligible
GEMT Provider, the GEMT Provider shall immediately notify the HHS.
3. Fund Transfer. The GEMT Provider agrees to transfer funds to HHS at the times and in the
amounts determined in accordance with the following paragraphs of this Agreement. The
transfer shall be made prior to the payment by HHS for the uncompensated Medicaid cost
associated with GEMT services. The GEMT Provider will transfer funds to HHS equivalent to
the non-federal share of the payments to be made upon notification by HHS.
4. Funds Certification. The GEMT Provider shall certify that the funds transferred qualify for
federal financial participation (FFP) pursuant to 42 CFR part 433 subpart B, and are not derived
from impermissible sources such as recycled Medicaid payments, federal money excluded from
use as State match, impermissible taxes, and non -bona fide provider -related donations.
Impermissible sources do not include revenue received from programs such as Medicare or
Medicaid to the extent that the program revenue is not obligated to the State as the source of
funding.
Updated July 26, 2023
5. Record Retention and Access. The parties agree that each shall maintain necessary
records and supporting documentation applicable to the uncompensated Medicaid cost
associated with GEMT services payments to assure that claims for total funds and federal funds
are in accordance with applicable federal requirements, including but not limited to those
record retention requirements set forth in the SPA. The parties agree to make those records
available to the parties and to any and all state or federal oversight authorities immediately
upon request.
6. Notices: Any written notice required by this Agreement shall be sent to:
For:
Waterloo Fire Rescue
GEMT Provider
Printed Name Jason Hernandez
Title Medical Supervisor
Address: 425 E 3rd St
Waterloo, IA 50703
E-mail address
jason.hernandez@waterloo-ia.org
For HHS:
Printed Name: Iowa Department of Health and Human Services
Title:
Iowa Medicaid
Address: 1305 East Walnut Street
Des Moines, IA 50319
E-mail address:
costaudit@dhs.state.ia.us
7. Repayment Obligation: In the event that any State and/or federal funds are deferred
and/or disallowed as a result of any audits or expended in violation of the laws applicable to the
expenditure of such funds, the GEMT Provider shall be liable to the Agency for the full amount
of any claim disallowed and for all related penalties incurred. The requirements of this paragraph
shall apply to the GEMT Provider as well as any subcontractors of the GEMT Provider. To the
extent that the GEMT Provider receives
Updated July 26, 2023
payments that exceed the permissible amount allowed pursuant to the SPA, the parties
hereby deem the excess funds received by the GEMT Provider to be an "overpayment"
subject to return to the HHS within 60 days pursuant to Section 2.5 of the Provider
Agreement.
8. Assignment: This Agreement is not assignable.
9. No Third Party Beneficiaries. There are no third partybeneficiariesto this Agreement. This
Agreement is intended onlyto benefit the HHS and the GEMT Provider.
10. Amendment: This Agreement maybe modified at anytime bythe written agreement of both
parties.
I I. Term & Termination: This Agreement covers the period beginning on or after July I, 2024
and ending June 30, 2025. This Agreement maybe canceled by either partyafter giving thirty (30)
days prior notice in writing to the other party. All obligations of the parties incurred or existing
under this Agreement as of the date of expiration or termination survive the expiration or
termination of the Agreement.
12. Execution: In consideration of the mutual covenants in this Agreement and for other good
and valuable consideration, the receipt, adequacy and legal sufficiency of which are hereby
acknowledged, the parties have entered into this Agreement and have caused their duly
authorized representatives to execute this Agreement.
Waterloo Fire Rescue
GEMT Provider Name
Qa2/Zi'Z 9 a
Authortized Representative Signature
Quentin Hart
Authorized Representative Printed Name
Mayor
Authorized Representative Title
IOWA DEPARTMENT OF HEALTH AND HUMAN SERVICES
12/18/2023
Date
Director Date
Updated July 26, 2023
Attachment A - Approved State Plan Amendment IA-19-002
State/Territory:
Revised Submission 7.10.19
Attachment 4.19-B
PAGE - 16d -
IOWA
Methods and Standards for Establishing Payment Rates for Other Types of Care
Supplemental payment for publicly owned or operated ground emergency medical
transportation providers
This program provides supplemental payments for eligible Ground Emergency Medical
Transportation (GEMT) providers that meet specified requirements and provide GEMT services
to Iowa Medicaid members.
Supplemental payments provided by this program are available only for the uncompensated and
allowable direct and indirect costs incurred by eligible GEMT providers while providing GEMT
services to Iowa Medicaid members. The supplemental payment covers the gap between the
eligible GEMT provider's total allowable costs for providing GEMT services as reported on the
GEMT services cost report and the amount of the base payment, mileage, and all other sources of
reimbursement.
The supplemental payment amounts shall be calculated annually on a prospective basis after the
conclusion of each state fiscal year (SFY). Payments shall not be paid as individual increases to
current reimbursement rates as described in other parts of this state plan for GEMT services.
This supplemental payment applies only to Iowa Medicaid services rendered to Iowa Medicaid
members by eligible GEMT providers on or after July 1, 2019.
A. Definitions
1. "Department" means the Iowa Department of Human Services.
2. "Direct Costs" means all costs that can be identified specifically with particular final
cost objectives in order to meet all medical transportation mandates.
3. "Shared Direct Costs" are direct costs that can be allocated to two or more
departmental functions or cost objectives on the basis of shared benefits.
4. "Indirect Costs" means costs for a common or joint purpose benefitting more than
one cost objective that are allocated to each benefiting objective using an agency
approved indirect rate or an allocation methodology. Indirect costs rate or allocation
methodology must comply with 2 C.F.R. Part 200 and CMS non -institutional
reimbursement policy.
State Plan TN # IA-19-002 Effective July 1, 2019
Superseded TN # NEW Approved July 12, 2019
State/Territory:
Revised Submission 7.10.19
Attachment 4.19-B
PAGE - 16e-
IOWA
Supplemental payment for publicly owned or operated ground emergency medical
transportation providers
5. "Eligible GEMT Provider" means a provider who is eligible to receive supplemental
reimbursement because it meets all of the following requirements continuously during
the claiming period:
a. Provides Ground Emergency Medical Transportation services to Iowa
Medicaid members.
b. It is a provider that is enrolled as an Iowa Medicaid provider for the period
being claimed.
c. Is owned or operated by an eligible governmental entity, to include the state, a
city, county, fire protection district, community services district, health care
district, federally recognized Indian tribe or any unit of government as defined
in 42 C.F.R. Sec. 433.50.
6. "Dry Run" means a run that does not result in either a transport or a delivery on -site
of Medicaid covered services.
7. "GEMT Transport" means GEMT services provided by eligible GEMT providers to
individuals and does not, include dry runs as defined in Paragraph, A.6.
8. "GEMT Services" means both the act of transporting an individual from any point of
origin to the nearest medical facility capable of meeting the emergency medical needs
of the patient, as well as the advanced, limited -advance, and basic life support
services provided to an individual by GEMT providers before or during the act of
transportation.
a. "Advanced Life Support" means special services designed to provide
definitive prehospital emergency medical care, including but not limited to,
cardiopulmonary resuscitation, cardiac monitoring, cardiac defibrillation,
advanced airway management, intravenous therapy, administration with drugs
and other medicinal preparations, and other specified techniques and
procedures.
State Plan TN # IA-19-002 Effective July 1, 2019
Superseded TN # NEW Approved July 12, 2019
State/Territory:
Revised Submission 7.10.19
Attachment 4.19-B
PAGE - 16f-
IOWA
Supplemental payment for publicly owned or operated ground emergency medical
transportation providers
b. "Limited -Advanced Life Support" means special services to provide
prehospital emergency medical care limited to techniques and procedures that
exceed basic life support but are less than advanced life support services.
c. "Basic Life Support" means emergency first aid and cardiopulmonary
resuscitation procedures to maintain life without invasive techniques.
9. "Service Period" means the period from July 1 through June 30 of each SFY.
10. "Shift" means a standard period of time assigned for a complete cycle of work, as set
by each eligible GEMT provider. The number of hours in a shift may vary by GEMT
provider, but will be consistent to each GEMT provider.
B. Supplemental Reimbursement Methodology — General Provisions
1. Computation of allowable costs and their allocation methodology must be determined
in accordance with Medicaid cost principles at 2 C.F.R. Part 200, which establish
principles and standards for determining allowable costs and the methodology for
allocating and apportioning those expenses to the Iowa Medicaid program, except as
expressly modified below.
2. Iowa Medicaid base payments to the GEMT providers for providing GEMT services
are derived from the Ambulance provider fee schedule established for
reimbursements payable by the Iowa Medicaid program by procedure code. The base
payments for these eligible GEMT providers are fee -for -service (FFS) payments. The
primary source of paid claims data and other Iowa Medicaid reimbursements is the
Iowa Medicaid Management Information System (IA-MMIS). The number of paid
Iowa Medicaid FFS GEMT transports is derived from and supported by the IA-MMIS
reports for services during the applicable service period.
State Plan TN # IA-19-002 Effective July 1, 2019
Superseded TN # NEW Approved July 12, 2019
State/Territory:
Attachment 4.19-B
Revised Submission 7.10.19 PAGE - 16g-
IOWA
Supplemental payment for publicly owned or operated ground emergency medical
transportation providers
3. The total uncompensated care costs of each eligible GEMT provider available to be
reimbursed under this supplemental payment program will equal the shortfall
resulting from the allowable costs determined using the Cost Determination Protocols
(Section C.) for each eligible GEMT provider rendering GEMT services to Iowa
Medicaid members net of the amounts received and payable from the Iowa Medicaid
program and all other sources of reimbursement for GEMT services provided to Iowa
Medicaid members. If the eligible GEMT providers do not have any uncompensated
care costs, then the provider will not receive supplemental reimbursement under this
supplemental payment program.
4. The Iowa Medicaid supplemental payment under this segment are the uncompensated
care costs for GEMT services provided by eligible GEMT providers to Iowa
Medicaid members as determined by the Prospective Supplemental Payment Amount
(Section D.).
C. Cost Determination Protocols
1. An eligible GEMT provider's specific allowable cost per-GEMT transport rate will
be calculated based on the provider's audited financial data reported on the GEMT
services cost report. The per-GEMT transport cost rate will be the sum of actual
allowable direct, shared direct, and indirect costs of providing GEMT services
(excluding cost associated with dry runs as defined in Paragraph A.6 and runs
where a Medicaid covered service was delivered but no transport occurred)
divided by the actual number of GEMT transports (including dry runs as defined in
Paragraph A.6 and runs where a Medicaid covered service was delivered but no
transport occurred) provided for the applicable service period.
a. Direct costs for providing GEMT services include only the unallocated payroll
costs for the shifts in which personnel dedicate 100 percent of their time to
providing GEMT services, medical equipment and supplies, and other costs
directly related to the delivery of covered services, such as first -line
supervision, materials and supplies, professional and contracted services,
capital outlay, travel, and training. These costs must be in compliance with
Medicaid non -institutional reimbursement policies and are directly
attributable to the provision of the GEMT services.
State Plan TN # IA-19-002 Effective July 1, 2019
Superseded TN # NEW Approved July 12, 2019
State/Territory:
Revised Submission 7.10.19
Attachment 4.19-B
PAGE - 16h-
IOWA
Supplemental payment for publicly owned or operated ground emergency medical
transportation providers
b. Shared direct costs for GEMT services must be allocated for personnel, capital
outlay and other costs; such as medical supplies, professional and contracted
services, training and travel. The personnel costs will be allocated based on a
percentage of total hours logged performing GEMT services activities versus
other service activities. The capital and other shared direct costs will be
allocated based on the percentage of total call volume.
c. Indirect costs are determined by applying the cognizant agency specific
approved indirect cost rate to its total direct costs (Paragraph C.1.a) or derived
from provider's approved cost allocation plan. Eligible GEMT providers that
do not have a cognizant agency approved indirect cost rate or approved cost
allocation plan, the costs and related basis used to determine the allocated
indirect costs must be in compliance with Medicaid cost principles specified
at 2 C.F.R. Part 200.
d. The GEMT provider specific per-GEMT transport cost rate is calculated by
dividing the total net GEMT services allowable costs (Paragraph C.l.a, C.1.b,
and C.l.c) of the specific provider by the total number of GEMT transports
provided by the provider for the applicable service period.
D. Prospective Supplemental Payment Amount
1. The Department will calculate annual prospective supplemental payment amounts for
eligible GEMT provider on a per-GEMT transport basis. The per-GEMT transport
prospective supplemental payment amount for each provider is based on the
provider's completed annual cost report in the format prescribed by the Department
for the applicable cost reporting year. The Department will make adjustments to the
as -filed cost report based on the results of the most recently retrieved IA-MMIS
report.
2. Each eligible GEMT provider must compute the annual cost in accordance with the
Cost Determination Protocols (Section C.) and must submit the completed annual as -
filed cost report, to the Department five (5) months after the close of the service
period.
State Plan TN # IA-19-002
Effective July 1, 2019
Superseded TN # NEW Approved July 12, 2019
State/Territory:
Revised Submission 7.10.19
Attachment 4.19-B
PAGE - 16i-
IOWA
Supplemental payment for publicly owned or operated ground emergency medical
transportation providers
3. The prospective supplemental payment amount is calculated by subtracting from
Iowa Medicaid's portion of the total GEMT allowable costs (Paragraph C.1) from the
as -filed cost report adjusted by the Department (Paragraph D.1), the total Iowa
Medicaid base payments (Paragraph B.2) and other payments, such as Iowa Medicaid
co -payments, received by the providers for providing GEMT services to Iowa
Medicaid members. The result of this calculation is the uncompensated care costs for
GEMT services provided to Iowa Medicaid members.
4. The result in Paragraph D.3 is divided by the Iowa Medicaid GEMT transports
(including dry runs as defined in Paragraph A.6) from the as -filed cost report adjusted
by the Department to calculate the per-GEMT services prospective supplemental
payment amount. This amount will be paid prospectively, in addition to the Iowa
Medicaid base payments (Paragraph B.2) on a claim by claim basis.
5. The prospective supplemental payment amount will be updated the following July 1,
and every year thereafter, following submission and review of the cost report.
Specifically, the prior year's uncompensated care amount per Medicaid transport will
be paid as an adjustment to the following year's base rate.
E. Eligible GEMT Provider Reporting Requirements
Eligible GEMT providers shall:
1. Submit the GEMT services cost report no later than five (5) months after the close of
the CY, unless a provider has made a written request for an extension and such
request is granted by the Department.
2. Provide supporting documentation to serve as evidence supporting information on the
submitted cost report and the cost determination as specified by the Department.
3. Keep, maintain, and have readily retrievable, such records as specified by the
Department to fully disclose reimbursement amounts to which the eligible
government entity is entitled, and any other records required by CMS.
State Plan TN # IA-19-002
Effective July 1, 2019
Superseded TN # NEW Approved July 12, 2019
State/Territory:
Revised Submission 7.10.19
Attachment 4.19-B
PAGE - 16j-
IOWA
Supplemental payment for publicly owned or operated ground emergency medical
transportation providers
4. Comply with the allowable cost requirements provided in 2 C.F.R. Part 200, and
Medicaid non -institutional reimbursement policy.
F. Department Responsibilities
1. The Department will submit to CMS claims for GEMT services that are allowable
and in compliance with federal laws and regulations and Medicaid non -institutional
reimbursement policy.
2. The Department will, on an annual basis, submit any necessary materials to the
federal government to provide assurances that claims will include only those
expenditures that are allowable under federal law.
3. The Depaitnient may conduct on -site audits as necessary and will complete the audit
within two years of the postmark date of the accepted cost report.
State Plan TN # IA-19-002
Effective July 1, 2019
Superseded TN # NEW Approved July 12, 2019