Okla. Stat. tit. 63 § 3242

Current through Laws 2024, c. 453.

Section 3242 - Supplemental Medicaid reimbursement for ground emergency transportation

A. An eligible provider, as described in subsection B of this section, in addition to the rate of payment that the provider would otherwise receive for Medicaid ground emergency medical transportation services, shall receive supplemental Medicaid reimbursement to the extent provided by law.

B. A provider shall be eligible for supplemental reimbursement only if the provider meets the following conditions during the state fiscal year:

1. Provides ground emergency medical transportation services to Medicaid beneficiaries;

2. Is a provider that is enrolled as a Medicaid provider for the period being claimed; and

3. Is owned or operated by the state, a political subdivision or local government, that employs or contracts with persons who are licensed to provide emergency medical services in this state, and includes private entities to the extent permissible under federal law.

C. An eligible provider's supplemental reimbursement pursuant to this section shall be calculated and paid as follows:

a. for services reimbursed through fee-for-service contracts, the amount of federal financial participation received because of the claims submitted pursuant to paragraph 3 of subsection F of this section, and

b. for services reimbursed through capitated contracts, an amount to be determined in accordance with the approved directed payment pre-print, based on claims submitted pursuant to paragraph 3 of subsection F of this section;

2. In no instance shall the amount certified pursuant to paragraph 1 of subsection E of this section, when combined with the amount received from all other sources of reimbursement from the Medicaid program, exceed one hundred percent (100%) of actual costs, as determined pursuant to the Medicaid state plan, for ground emergency medical transportation services; and

3. The supplemental Medicaid reimbursement provided by this section shall be distributed exclusively to eligible providers under a payment methodology based on ground emergency medical transportation services provided to Medicaid beneficiaries by eligible providers on a per-transport basis or other federally permissible basis. The Oklahoma Health Care Authority shall obtain approval from the Centers for Medicare and Medicaid Services for the payment methodology to be utilized, and shall not make any payment pursuant to this section prior to obtaining that approval.

1. It is the Legislature's intent in enacting this section to provide the supplemental reimbursement described in this section without any expenditure from the state General Revenue Fund. An eligible provider, as a condition of receiving supplemental reimbursement pursuant to this section, shall enter into, and maintain, an agreement with the Authority for the purposes of implementing this section and reimbursing the state for the costs of administering this section.

2. The nonfederal share of the supplemental reimbursement submitted to the federal Centers for Medicare and Medicaid Services for purposes of claiming federal financial participation shall be paid only with funds from the governmental entities described in paragraph 3 of subsection B of this section and certified to the state as provided in subsection E of this section.

E. Participation in the reimbursement program provided by this section by an eligible provider as set forth in subsection B of this section is voluntary. If an applicable governmental entity elects to seek supplemental reimbursement pursuant to this section on behalf of an eligible provider, the governmental entity shall do the following:

a. certify, in conformity with the requirements of 42 C.F.R. , Section 433.51, that the claimed expenditures for the ground emergency medical transportation services are eligible for federal financial participation,

b. provide evidence supporting the certification as specified by the Oklahoma Health Care Authority,

c. submit data as specified by the Authority to determine the appropriate amounts to claim as expenditures qualifying for federal financial participation, and

d. keep, maintain, and have readily retrievable any records specified by the Authority to fully disclose reimbursement amounts to which the eligible provider is entitled, and any other records required by the Centers for Medicare and Medicaid Services; or

2. Enter into and maintain an intergovernmental agreement with the Authority, as specified by the Authority.

1. The Authority shall promptly seek any necessary federal approvals for the implementation of this section. The Authority may limit the program to those costs that are allowable expenditures under Title XIX of the Social Security Act, 42 U.S.C. , Section 1396 et seq. If federal approval is not obtained for implementation of this section, this section shall not be implemented.

2. The Authority shall submit claims for federal financial participation for the expenditures for the services delineated in subsection E of this section that are allowable expenditures under federal law.

3. The Authority shall submit any necessary materials to the federal government to provide assurances that claims for federal financial participation will include only those expenditures that are allowable under federal law.

Okla. Stat. tit. 63, § 3242

Amended by Laws 2023EX1, c. 37,s. 1, eff. 6/2/2023.

Added by Laws 2018 , c. 269, s. 1, eff. 11/1/2018.