NEW ALERT – as of 12-12-18 – deadline for submission of all participation documents has been extended to December31, 2018. Cost Reports are also due December 31, 2018. There has been no change to the Cost Report due date. See New Timeline. 

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 participants. It is 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

Senate Bill 607 passed during the 2016 legislative session
RSMo 208.1030 and 208.1032
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
  • Be owned or operated by the state or a political subdivision.

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

Enrollment Requirements

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

The above documents should be e-mailed to Ask.GEMT@dss.mo.gov . The subject of the e-mail must first indicate your provider NPI number. For example: “SUBJECT: NPI 1234567890 Enrollment Documents”.

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.

Within two (2) years 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. Each GEMT Program enrolled provider will receive reimbursement in an amount equal to the greater of the interim payment or the total CMS approved Medicaid-allowable costs for GEMT services.

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 will receive an uncompensated cost reimbursement in the amount of the underpayment.

GEMT Program Timeline and Training

To submit GEMT Program documents or for questions please Ask.GEMT@dss.mo.gov or call MO HealthNet Division, GEMT Program Staff at 573-751-6963.