HomeMy WebLinkAboutItem 01 Ground Emergency Medical Transport (GEMT) Update AGENDA ITEM SUMMARY Meeting Date: 2/26/2018
Meeting Type: Work Session
Staff Contact/Dept.: Zaludek Staff Phone No: 541-682-7115
Estimated Time: 30 minutes
S P R I N G F I E L D C I T Y C O U N C I L Council Goals: Strengthen Public Safety by Leveraging
Partnerships and Resources
ITEM TITLE: GROUND EMERGENCY MEDICAL TRANSPORT (GEMT) UPDATE
ACTION REQUESTED:
Information share, update on the implementation of Oregon GEMT.
ISSUE STATEMENT: In March of 2016, Governor Kate Brown signed HB 4030 into law allowing first responders to receive payment for a percentage of their work in preparation for
transport of Medicaid patients. Negotiations are in process to adopt the rules and
processes for payment from the State in early 2019.
ATTACHMENTS: Attachment 1: Council Briefing Memorandum
DISCUSSION/
FINANCIAL IMPACT:
Last year, Springfield EMS providers transported approximately 272 non-managed
Medicaid patients. No additional charges will be experienced by community members that are
transported by ambulance, this payment is passed through the State for Medicaid patients
Estimates for present Medicaid ambulance transports covered under GEMT are approximately $150,000 annually.
M E M O R A N D U M City of Springfield 2/22/2018Page 1
Attachment 1, Page 1 of 2
M E M O R A N D U M City of Springfield
Date: 2/26/2018
To: Gino Grimaldi COUNCIL
From: Fire Chief – Joe Zaludek BRIEFING
Subject: Ground Emergency Medical Transport (GEMT) MEMORANDUM
ISSUE:
In March of 2016, Governor Kate Brown signed HB 4030 into law allowing first responders to receive payment for a percentage of their work in preparation for transport of Medicaid patients.
Negotiations are in process to adopt the rules and processes for payment from the State in early
2019. This briefing will provide an update on the next steps for the implementation of Oregon GEMT.
COUNCIL GOALS/
MANDATE:
Strengthen Public Safety by Leveraging Partnerships and Resources
BACKGROUND:
The GEMT State Plan Amendment (SPA) was submitted by Oregon Health Authority to the Center for Medicare and Medicaid Services (CMS) on Tuesday, September 26th for review. CMS returned the SPA via a Request for Additional Information (RAI) on late December 19,
2017. The response to the RAI should be submitted by the end of February 2018. Per the contracting agency working on GEMT implementation for Oregon, it’s expected that the
response will be accepted. CMS has an additional 90 day period to review the respond to the
RAI and ask for additional information. Once the RAI is approved, a rules committee will be established to create policy surrounding the
administration of the GEMT program. It’s expected the rules committee will need four months to complete policy development. Subsequently, the state will need to hire and train staff on
program administration.
After CMS approval of the payment rules for Oregon, agencies will be required to determine
direct and indirect costs to provide EMS services. To determine costs, an Indirect Cost Report
(ICR) will be utilized to request reimbursement from the federal government via the state. The contractor will provide training to EMS agencies on how to determine actual cost for service and
ICR completion. This training is expected to be delivered in summer 2018. To receive payment, EMS agencies will have to submit approximately 50% of the claim value
via an Intergovernmental Transfer (IGT) program. Within 30-90 days the EMS agency will be reimbursed the full value of the claim minus up to a 20% administrative fee (not a recoverable
cost). Per statute, state general funds cannot be used to support this program.
MEMORANDUM 2/22/2018 Page 2
Attachment 1, Page 2 of 2
The timely response to the RAI has allowed Oregon providers to keep the retrospective reimbursement date of July 1, 2017. Initial funding will only be for non-managed Medicaid
patients. It has not been determined when managed Medicaid patients will be eligible for GEMT
reimbursement. For this discussion, a patient is considered “managed” when assigned to and receiving benefits from a Coordinated Care Organization.
According the Oregon GEMT website, the potential reimbursement per transport is approximately $559.00. The process to determine the actual direct and in-direct costs to provide
service is yet to be developed.
Last year, Springfield EMS providers transported approximately 272 non-managed Medicaid
patients.
RECOMMENDED ACTION: Information share in preparation for receiving payments after
program rules are approved by CMS and adopted by the State.