Ground Emergency Medical Tranportation (GEMT) Uncompensated Cost Reimbursement Program

GEMT Program Overview

The Ground Emergency Medical Transportation (GEMT) Uncompensated Cost Reimbursement Program is a voluntary program that allows for the reimbursement of uncompensated costs to eligible GEMT providers who provide qualifying emergency ambulance services to Department of Social Services, MO HealthNet participant. This program became effective for services rendered to MO HealthNet participants by eligible GEMT providers on or after July 1, 2017.

Total reimbursement from MHD, including the uncompensated cost reimbursement, will not exceed one hundred percent of the GEMT provider’s actual costs. Reimbursement shall be distributed to eligible and enrolled providers based on GEMT services provided to MO HealthNet participants on a per-transport basis.

Under this voluntary program, providers must agree to fund the non-federal share of GEMT uncompensated cost reimbursement using an intergovernmental transfer (IGT) payment method. The GEMT Program must be implemented without any additional expenditure from the state general fund. As a condition of participation under this program, an eligible provider must agree to reimburse MHD for administering and overseeing the GEMT program.

GEMT Program Authority

Section 208.1030 RSMo
13 CSR 70-6.020; and
State Plan Amendment 17-009

Provider Participation Requirements

Provider participation in the GEMT Program is voluntary. Eligible providers must meet several requirements to participate in the GEMT Program, which include the following:

  • Provide GEMT services to MO HealthNet participants;
  • Be enrolled as a MO HealthNet Ambulance Program provider on or before July 1 of the reporting fiscal year; and
  • Be owned or operated by the state or a political subdivision.

*Non-governmental providers may not participate in the GEMT Program.

Auditor Group

MO HealthNet Division has contracted with Myers and Stauffer to complete the audits on the GEMT costs reports. Please see the link to their web portal where all required documents should be uploaded. Ambulance providers must register to obtain access to this portal. Instructions on how to register can be found below. MO HealthNet Division, Myers and Stauffer, and the Ambulance providers will have access to the portal.

To view the most recent webinar, click on the following link: https://www.mslc.com/missouri/gemtcrsubmission.aspx

Enrollment Requirements

Eligible providers who choose to participate in the GEMT Program must:

The documents above should be uploaded to Myers and Stauffer at: https://mocostreports.mslc.com/.

GEMT Cost Report

Establishing an Indirect Cost Rate

  • GEMT providers are required to establish an indirect cost rate before any indirect costs can be claimed on the cost report (Schedule 9 of cost report).
  • 45 CFR 75.412 indicates there is no universal rule for classifying certain costs as either direct or indirect under every accounting system. A cost may be direct with respect to some specific service or function, but indirect with respect to the Federal award or other final cost objective. Therefore, it is essential that each item of cost incurred for the same purpose be treated consistently in like circumstances as either a direct or an indirect cost in order to avoid possible double charging of Federal awards.
    • Any of the following methodologies may be used to identify indirect costs:
      • A cost allocation plan with the entity’s local government.
      • An indirect rate negotiated with the entity’s local government.
      • Direct identification through use of a cost report.
      • A 10% de minimis rate.

GEMT Reimbursement

Each enrolled GEMT Program provider eligible to participate in the GEMT Program must complete annually the Centers for Medicare and Medicaid Services (CMS) approved GEMT Program cost report and submit the certified cost report to MHD by November 30th for the prior state fiscal year ending June 30th.

GEMT providers eligible to participate in the GEMT Program may receive initial cost settlement payments based on the provider’s completed annual cost report and the provider’s average cost per transport. The GEMT provider will make an intergovernmental transfer of funds to MHD in an amount equivalent to the nonfederal share of the uncompensated Medicaid costs amount shown on the completed annual cost report. MHD will then make an initial payment to the GEMT provider in the amount of the total uncompensated Medicaid costs.

Within one (1) year of receipt of the as-filed cost report, MHD will make adjustments as necessary to the initial cost settlement based on the reconciliation results of the most recently retrieved Medicaid Managed Information Systems (MMIS) report of paid GEMT transports, unless MHD determines that additional time is needed. The reconciliation process will not exceed three (3) years from the receipt of the as-filed cost reports.

If at the end of the final reconciliation it is determined the GEMT provider has been overpaid, the provider will be required to return the overpayment to the MHD and the MHD will return the overpayment to the federal government. If an underpayment is determined, then the GEMT provider is to make an additional intergovernmental transfer to MHD in an amount equivalent to the nonfederal share of the underpayment, and MHD will then make an additional payment to the GEMT provider of the full underpayment amount.

GEMT Program Timeline and Training

To submit GEMT Program documents upload the documents to Myers and Stauffer at https://mocostreports.mslc.com/. Questions regarding the Myers and Stauffer portal should be directed to 1-800-374-6858. Questions about the GEMT Program should be directed to 573-751-6946 or to Ask.GEMT@dss.mo.gov.

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