Michigan § 400.109p - Ground emergency medical transportation reimbursement program; limitations; provider requirement; calculation of supplemental reimbursements; documentation; definitions.

(1) No later than 90 days after the submission of a complete and acceptable cost report by 2 or more eligible ground emergency medical transportation providers, the department shall initiate the process to amend this state's Medicaid state plan to establish and administer a program to provide supplemental reimbursement to eligible ground emergency medical transportation providers that provide ground emergency medical transportation services to medical assistance recipients.

(2) The department may limit the program described under subsection (1) to those costs that are allowable expenditures under title XIX of the social security act, 42 USC 1396 to 1396w-7. The department shall do both of the following:

(a) Submit claims for federal financial participation for the expenditures for services that are allowable expenditures under federal law.

(b) Submit 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. The department may utilize intergovernmental transfers or certified public expenditures to implement this subdivision.

(3) A ground emergency medical transportation provider is eligible for supplemental reimbursement if the ground emergency medical transportation provider meets all of the following conditions during the period reimbursement is being claimed:

(a) Provides ground emergency medical transportation services to medical assistance recipients.

(b) Is enrolled as a Medicaid provider for the period reimbursement is being claimed.

(c) Is owned or operated by an eligible governmental entity.

(4) A supplemental reimbursement claimed under this section must be calculated and paid as follows:

(a) Except as otherwise provided in subdivision (b), the supplemental reimbursement to an eligible provider is equal to the amount of federal financial participation received for the eligible provider's cost for the emergency medical transportation services under subdivision (c).

(b) The amount certified, when combined with the amount received from all other sources of reimbursement from the medical assistance program, must not exceed 100% of actual cost incurred, as determined under this state's Medicaid state plan for ground emergency medical transportation services.

(c) The supplemental reimbursement must be distributed exclusively to eligible providers under a payment methodology that is based on ground emergency medical transportation services provided to medical assistance recipients by eligible providers.

(5) An eligible provider shall make readily available to the department documentation, data, and certification, as prescribed by the department, that are necessary to establish that the emergency medical services expenditures qualify for federal financial participation in order to calculate the amount of supplemental reimbursement that is due.

(6) The department shall pay supplemental reimbursements to eligible providers for services provided on a fee-for-services basis and managed care program recipients in this state's Medicaid state plan.

(7) Participation in the program described under subsection (1) is voluntary.

(8) As used in this section:

(a) "Eligible governmental entity" means an entity that is eligible under federal law to provide ground medical transportation services and includes this state, a city, a county, a fire authority, a township, an ambulance authority, a federally recognized Indian tribe, or a local unit of government.

(b) "Eligible ground emergency medical transportation provider" or "eligible provider" means a public provider that provides ground emergency medical transportation services to medical assistance recipients and meets the conditions described under subsection (3).