Section 7 AAC 145.760 - SEMT provider participation, qualification, and reporting requirements(a) If a provider elects to participate in the SEMT program, the provider must comply with the following requirements to qualify and receive supplemental payments: (1) provide emergency medical transportation services to Medicaid fee-for-service (FFS) recipients under 7 AAC 120.415 - 7 AAC 120.420;(2) be publicly owned or operated;(3) be enrolled as a ground, water, or air ambulance Medicaid provider for the service period specified in the claim; and(4) include only claims for dates of service on or after the provider's Medicaid enrollment date, if a provider meets all other qualifications for the SEMT program and enrolls as a ground, water, or air ambulance Medicaid provider in the middle of the provider's fiscal year; the department will not make payment for claims for services provided before the provider's Medicaid enrollment date.(b) Not later than the last day of the fifth month after the close of the provider's fiscal year, the SEMT provider must provide the documentation required under (c) of this section. The department may grant an extension of not more than 30 days, for good cause shown, if the SEMT provider requests the extension in writing. The department may grant an extension equal to the length of time determined by the Centers for Medicare and Medicaid Services (CMS), if CMS grants an extension for Medicare cost reports related to an issue that affects providers in this state.(c) The SEMT provider must (1) renew SEMT participation annually by submitting a Supplemental Emergency Medical Transportation (SEMT) Provider Participation Agreement, adopted by reference in 7 AAC 160.900;(2) complete and submit the Supplemental Emergency Medical Transportation [SEMT) Cost Report, adopted by reference in 7 AAC 160.900, in accordance with the Supplemental Emergency Medical Transportation {SEMT) Cost Report Instructions, adopted by reference in 7 AAC 160.900, and with CMS Publication 15-1: Principles of Reimbursement for Provider Costs;(3) provide supporting documentation for the cost report and the cost determination prepared under AS 47.07.040 (state plan for provision of medical assistance), including (A) audited financial statements, completed in accordance with generally accepted auditing standards (GAAS) or generally accepted government auditing standards (GAGAS), related to the cost report, or a separate schedule related to the cost report;(B) a post-audit working trial balance for the audited financial statements;(C) a reconciliation of the post-audit working trial balance to the cost report; and(D) supporting documentation requested by the department;(4) comply the allowable cost requirements provided in 2 C.F.R. Part 200, 42 C.F.R. Part 413, and Medicaid non-institutional reimbursement policy; and(5) annually certify and allocate the provider's direct and indirect costs as qualifying expenditures eligible for federal financial participation (FFP).(d) The SEMT provider must maintain the records required in this section for at least seven years from the date the documentation is submitted. Failure to maintain documentation to support allowable SEMT costs may result in the unsupported costs categorized as disallowed costs.(e) Each participating provider must agree to reimburse the department for the cost of administering the SEMT program. The cost may not be included as an expense in the participating provider's cost report.(f) The eligible SEMT provider must identify indirect costs using one of the following options: (1) an eligible SEMT provider that receives $35,000,000 or more in direct federal awards must have either a cost allocation plan (CAP) or a cognizant agency-approved indirect rate agreement with its cognizant agency to identify indirect costs; if the eligible SEMT provider does not have a CAP or an indirect rate agreement with its cognizant agency and wants to claim indirect costs in association with non-institutional services, the eligible SEMT provider must obtain one or the other before it can claim any indirect costs;(2) an eligible SEMT provider that receives less than $35,000,000 in direct federal awards must develop and maintain an indirect rate proposal for audit; if the eligible SEMT provider does not have an indirect rate proposal, that provider may use methods originating from a CAP to identify its indirect costs; if the eligible SEMT provider does not have an indirect rate proposal or a CAP and wants to claim indirect costs in association with non-institutional services, the eligible SEMT provider must secure one or the other before it can claim any indirect costs;(3) an eligible SEMT provider that receives no direct federal funding may use the following previously established methodology to identify indirect costs: (A) a CAP with its local government;(B) an indirect rate negotiated with its local government;(C) direct identification through use of a cost report;(4) if the eligible SEMT provider has never used any of the methodologies in (1) - (3) of this subsection, it may do so, or it may elect to use the 10 percent de minimis rate to identify its indirect costs.(g) Each participating provider is responsible for submitting claims to the department for services provided to eligible recipients. A participating provider must submit the claim according to the rules and billing instructions in effect at the time the service was provided.(h) For the report for federal fiscal year 2019, calendar year 2019, state fiscal year 2020, federal fiscal year 2020, calendar year 2020, and state fiscal year 2021, the SEMT provider must submit the documentation required under (c) of this section not later than {180 days after effective date of regulations}.Eff. 10/9/2021, Register 240, January 2022Authority:AS 47.05.010
AS 47.07.040
AS 47.07.085