WSR 23-06-014
HEALTH CARE AUTHORITY
[Filed February 16, 2023, 4:27 p.m.]
NOTICE
Title or Subject: Supplemental Notice for Ground Emergency Medical Transportation (GEMT) Medicaid State Plan Amendment (SPA) 22-0035 - now 23-0009.
Effective Date: July 1, 2023.
Description: The health care authority (HCA) previously filed notice of the intent to submit SPA 22-0035 to remove from allowable costs the costs associated with treatment by eligible GEMT providers that do not result in a transport under WSR 22-23-007. This change is a result of communications from the Centers for Medicare and Medicaid Services (CMS). During subsequent communications, CMS advised HCA to also amend the following:
•The definition of "dry run" in order to differentiate between treatment without transport and responses where there is no patient at the scene.
•The definition of "treat and refer" in order to clearly identify costs that may be eligible for inclusion in the cost calculation methodology.
•A change to the cost calculation methodology in order to accurately identify the average cost per service for participating providers.
As a result, HCA intends to submit SPA 23-0009 to incorporate CMS's requirements into the GEMT section of the medicaid state plan.
SPA 22-0035 was expected to decrease the annual aggregate reimbursement for participating GEMT providers. SPA 23-0009 is expected to decrease the annual aggregate reimbursement for participating GEMT providers. HCA does not currently have the data to provide an estimate of the amount of the anticipated decrease. The total reimbursement will not exceed the cost of providing transportation services, excluding the costs of responses that do not result in a transport.
SPA 23-0009 is in the development process. HCA would appreciate any input or concerns regarding this SPA. To request a copy of the SPA when it becomes available or submit comments, please contact the person named below (please note that all comments are subject to public review and disclosure, as are the names of those who comment).
CONTACT: Abigail Cole, Section Manager, Hospital Finance and Drug Rebate, FSD, P.O. Box 45510, Olympia, WA 98504-5510, phone 360-725-1835, TRS 711, email abby.cole@hca.wa.gov, website https://www.hca.wa.gov/billers-providers-partners/program-information-providers/ground-emergency-medical-transportation-gemt.