205.5604 Department for Medicaid Services to submit Medicaid preprint to
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/ky/205-5604A research copy — for the controlling text, always check the official state or federal source. Not legal advice.
establish supplemental payment program for public ground ambulance
providers -- Administration of program -- Funding -- Eligibility.
(1)As used in this section, "public ground ambulance provider" means a ground
ambulance provider licensed in accordance with administrative regulations
promulgated by the Kentucky Board of Emergency Medical Services, which is
owned or operated by a city, county, urban-county government, consolidated local
government, charter county government, unified local government, or special
district, except for a local rescue squad district created under KRS Chapter 39F.
(a)The Department for Medicaid Services shall submit a Medicaid preprint with
a January 1, 2026, effective date to the Centers for Medicare and Medicaid
Services seeking authorization to establish and administer a supplemental
payment program to provide state-directed Medicaid managed care payments
to eligible public ground ambulance providers.
(b)If approved by the Centers for Medicare and Medicaid Services, the
department shall:
1. Establish and administer the program to provide state-directed Medicaid
payments to eligible public ground ambulance providers for services
provided under the managed care component of the Medicaid program;
2. Operate the supplemental payment program described in this section
separately from the assessment and directed payment program
established under KRS 142.318, 205.5601, 205.5602, and 205.5603;
3. Utilize a cost report to determine the average cost per transport, which
shall be used in the upper payment limit calculation for the Medicaid
managed care-directed payments;
4. Establish a cost-based payment methodology in accordance with the
Centers for Medicare and Medicaid Services' rules and regulations; and
5. Promulgate administrative regulations necessary to carry out this
section.
(a)The state match funds required for the supplemental payment program for
public ground ambulance providers shall:
1. Be provided by public ground ambulance providers participating in the
supplemental payment program via intergovernmental transfers or
similar government fund transfers; and
2. Include a total of two hundred thousand dollars ($200,000) annually that
shall be retained by the department to offset administrative expenses
related to the supplemental payment program for public ground
ambulance providers. Each participating public ground ambulance
provider shall be responsible for a percentage of the administrative fee
retained by the department under this subparagraph equal to the
percentage of the total number of qualifying ambulance runs a
participating public ground ambulance provider made during the
previous year.
(b)Participating public ground ambulance providers shall identify and utilize a
source of funding for the intergovernmental fund transfers required by
paragraph
(a)of this subsection, which shall:
1. Be separate from the assessment authorized under KRS 205.6406;
2. Not be from the state general fund; and
3. Comply with the requirements of the Centers for Medicare and
Medicaid Services.
(c)A continued local source of funding shall be identified for the nonfederal
share, which shall:
1. Be separate from the assessment authorized under KRS 142.318;
2. Not be from the state general fund; and
3. Comply with the requirements of the Centers for Medicare and
Medicaid Services.
(4)To be eligible to receive state-directed payments under this section, a public ground
ambulance provider shall:
(a)Hold a valid Medicaid provider agreement;
(b)Submit an annual cost report in accordance with administrative regulations
promulgated by the department; and
(c)Provide emergency medical transportation services to Medicaid beneficiaries.