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HomeMy WebLinkAboutIDOH and IDHS - Provider Participation Agreement FY2026 - 10.21.2024 HeaLth and I rn WA,. I Human Services INTERGOVERNMENTAL TRANSFER OF PUBLIC FUNDS AGREEMENT BETWEEN THE IOWA DEPARTMENT OF HEALTH AND HUMAN SERVICES AND Waterloo Fire Rescue 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-19-002 (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. 470-0086 (07/24) 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 Jason Hernandez Printed Name: Medical Supervisor Title: 425 E 3rd Street Address: 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 470-0086 (07/24) 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 party beneficiaries to this Agreement. This Agreement is intended onlyto benefit the HHS and the GEMT Provider. 10. Amendment: This Agreement maybemodified at anytime bythe written agreement of both parties. 11. Term& Termination: This Agreement covers the period beginning on or after July I, 2025 and ending June 30, 2026. 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 620X/Z�in S�GU 10/21/2024 Authortized Representative Signature Date Quentin Hart Authorized Representative Printed Name Mayor Authorized Representative Title IOWA DEPARTMENT OF HEALTH AND HUMAN SERVICES Director Date 470-0086 (07/24) Attachment A-Approved State Plan Amendment IA-19-002 Attachment 4.19-13 Revised Submission 7.10.19 PAGE - 16d- State/Territory: 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 Attachment 4.19-13 Revised Submission 7.10.19 PAGE - 16e- State/Territory: 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 Attachment 4.19-13 Revised Submission 7.10.19 PAGE - 16f- State/Territory: 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 Attachment 4.19-13 Revised Submission 7.10.19 PAGE - 16g- State/Territory: 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 Attachment 4.19-13 Revised Submission 7.10.19 PAGE - 16h- State/Territory: 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.La) 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.La, C.Lb, 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 I. 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 Attachment 4.19-13 Revised Submission 7.10.19 PAGE - 16i- State/Territory: 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: I. 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 7uly 12, 2019 Attachment 4.19-13 Revised Submission 7.10.19 PAGE - 16j- State/Territory: 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 Department 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