In-state government-owned ambulance providers may be eligible to receive a supplemental payment adjustment for eligible Indiana fee-for-service Medicaid ambulance services provided on or after January 1, 2011.
The Centers for Medicare and Medicaid Services recently granted approval to the Office of Medicaid Policy and Planning (OMPP) to provide the supplemental payments intended to reimburse in-state government-owned ambulance providers for the actual cost of providing ambulance services.
According to the June 4, 2013, Indiana Health Coverage Programs IHCP bulletin, to receive the payment adjustment, eligible government-owned ambulance providers must submit the following documentation electronically to Myers and Stauffer LC (MSLC), a certified public accounting firm that provides contracted services to the Indiana Office of Medicaid Policy and Planning:
- A signed letter requesting the payment adjustment
- Cost Data (Nonhospital government-owned ambulance providers must use the Indiana Medicaid Freestanding Governmental Ambulance Provider Cost Report form to submit the data. Hospital government-owned ambulance providers’ cost data will be collected from existing hospital cost reports by MSLC.)
- Cost Report Supporting Documentation (Nonhospital government-owned ambulance providers must also submit a trial balance of expenses reporting in the cost report, as well as a reconciliation of the trial balance does not tie directly to the cost report.)
- Proof of government-owned status via the Proof of Government Ownership form.
- A signed payment agreement (provided by MSLC with notification of payment amount).
- Certified Public Expenditure Statement (provided by MSLC with notification of payment amount).
Generally, completed cost reports must be submitted by eligible providers within five months of the end of the fiscal year. However, because the supplemental payment adjustment will be retroactive to service dates on or after January 1, 2011, the OMPP is granting a one-time extension for service years 2011 and 2012. Cost data for those years must be submitted by November 30, 2013. The five-month submission window will apply to 2013 dates of service and beyond.
An initial settlement payment will be processed within 18 months of receiving the approved cost report for a specified fiscal year; the final settlement should be processed within 24 months of receiving the approved cost report.
Supplemental payment adjustments will be calculated by taking the reconciled costs to provide ambulance services to Medicaid recipients (actual charges multiplied by the cost-to-charge ratio from the cost report on file for that fiscal year), less any amounts already paid by Medicaid to the provider for those services.
If the amount calculated is greater than 0, that amount will be multiplied by the Federal Medical Assistance Percentage for Indiana in effect at the time of the initial payment in order to determine the additional payment that will be distributed to the provider.
However, if the amount calculated is less than 0, Medicaid has overpaid the provider for ambulance services, and the OMPP will recover the overpayment through refunds and/or recoupment.
For additional information about the supplemental payment adjustment, review the June 4, 2013, IHCP bulletin. Questions can be directed to MSLC at 1-800-877-6927.
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