Oklahoma § 63-3242 - Supplemental Medicaid reimbursement for ground emergency

§ 63-3242. Supplemental Medicaid reimbursement for ground emergency

transportation.

A. An eligible provider, as described in subsection B of this

section, in addition to the rate of payment that the provider would

otherwise receive for Medicaid ground emergency medical

transportation services, shall receive supplemental Medicaid

reimbursement to the extent provided by law.

B. A provider shall be eligible for supplemental reimbursement

only if the provider meets the following conditions during the state

fiscal year:

1. Provides ground emergency medical transportation services to

Medicaid beneficiaries;

2. Is a provider that is enrolled as a Medicaid provider for

the period being claimed; and

3. Is owned or operated by the state, a political subdivision

or local government, that employs or contracts with persons who are

Oklahoma Statutes - Title 63. Public Health and Safety

licensed to provide emergency medical services in this state, and

includes private entities to the extent permissible under federal

law.

C. An eligible provider’s supplemental reimbursement pursuant

to this section shall be calculated and paid as follows:

1.

a.

for services reimbursed through fee-for-service

contracts, the amount of federal financial

participation received because of the claims submitted

pursuant to paragraph 3 of subsection F of this

section, and

b.

for services reimbursed through capitated contracts,

an amount to be determined in accordance with the

approved directed payment pre-print, based on claims

submitted pursuant to paragraph 3 of subsection F of

this section;

2. In no instance shall the amount certified pursuant to

paragraph 1 of subsection E of this section, when combined with the

amount received from all other sources of reimbursement from the

Medicaid program, exceed one hundred percent (100%) of actual costs,

as determined pursuant to the Medicaid state plan, for ground

emergency medical transportation services; and

3. The supplemental Medicaid reimbursement provided by this

section shall be distributed exclusively to eligible providers under

a payment methodology based on ground emergency medical

transportation services provided to Medicaid beneficiaries by

eligible providers on a per-transport basis or other federally

permissible basis. The Oklahoma Health Care Authority shall obtain

approval from the Centers for Medicare and Medicaid Services for the

payment methodology to be utilized, and shall not make any payment

pursuant to this section prior to obtaining that approval.

D. 1. It is the Legislature’s intent in enacting this section

to provide the supplemental reimbursement described in this section

without any expenditure from the state General Revenue Fund. An

eligible provider, as a condition of receiving supplemental

reimbursement pursuant to this section, shall enter into, and

maintain, an agreement with the Authority for the purposes of

implementing this section and reimbursing the state for the costs of

administering this section.

2. The nonfederal share of the supplemental reimbursement

submitted to the federal Centers for Medicare and Medicaid Services

for purposes of claiming federal financial participation shall be

paid only with funds from the governmental entities described in

paragraph 3 of subsection B of this section and certified to the

state as provided in subsection E of this section.

E. Participation in the reimbursement program provided by this

section by an eligible provider as set forth in subsection B of this

section is voluntary. If an applicable governmental entity elects

Oklahoma Statutes - Title 63. Public Health and Safety

to seek supplemental reimbursement pursuant to this section on

behalf of an eligible provider, the governmental entity shall do the

following:

1.

a.

certify, in conformity with the requirements of 42

C.F.R., Section 433.51, that the claimed expenditures

for the ground emergency medical transportation

services are eligible for federal financial

participation,

b.

provide evidence supporting the certification as

specified by the Oklahoma Health Care Authority,

c.

submit data as specified by the Authority to determine

the appropriate amounts to claim as expenditures

qualifying for federal financial participation, and

d.

keep, maintain, and have readily retrievable any

records specified by the Authority to fully disclose

reimbursement amounts to which the eligible provider

is entitled, and any other records required by the

Centers for Medicare and Medicaid Services; or

2. Enter into and maintain an intergovernmental agreement with

the Authority, as specified by the Authority.

F. 1. The Authority shall promptly seek any necessary federal

approvals for the implementation of this section. The Authority may

limit the program to those costs that are allowable expenditures

under Title XIX of the Social Security Act, 42 U.S.C., Section 1396

et seq. If federal approval is not obtained for implementation of

this section, this section shall not be implemented.

2. The Authority shall submit claims for federal financial

participation for the expenditures for the services delineated in

subsection E of this section that are allowable expenditures under

federal law.

3. The Authority shall submit any 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.

Added by Laws 2018, c. 269, § 1, eff. Nov. 1, 2018. Amended by Laws

2023, 1st Ex. Sess., c. 37, § 1, emerg. eff. June 2, 2023.