D.C. Mun. Regs. tit. 29, r. 29-10405

Current through Register Vol. 71, No. 44, November 1, 2024

Rule 29-10405 - CALCULATION OF RECONCILED COSTS

10405.1

Reconciled costs shall be equal to an eligible provider's audited allowable costs less the sum of Medicaid fee-for-service payments and other sources of reimbursement.

10405.2

DHCF shall apportion an eligible provider's allowable costs per medical transport to calculate a cost per medical transport rate, as defined in § 10405.3. The cost per medical transport rate will be based on the allowable costs included in the submitted cost report.

10405.3

The cost per medical transport rate shall equal the sum of actual allowable direct and indirect costs of providing emergency medical ground transportation services and dry runs (or treat and refer services) to Medicaid-enrolled beneficiaries, divided by the number of actual medical transports in the applicable service period. Nonmedical consults that do not result in transportation to a medical facility are excluded from the numerator.

10405.4

Direct costs for the provision of emergency medical ground transportation services shall only include: the unallocated payroll costs for personnel who dedicate one hundred percent (100%) of their time to providing medical transport services; medical equipment and supplies; and other costs directly related to the delivery of covered services, such as first-line supervision, materials and supplies, professional and contracted services, capital outlay, travel, and training.

10405.5

Indirect costs shall be determined in accordance to one of the following options, as authorized by DHCF prior to the start of the reporting period:

(a) Eligible providers that receive more than thirty-five million dollars ($35,000,000.00) in direct federal awards must either have a Cost Allocation Plan (CAP) or a cognizant agency approved indirect rate agreement in place with its federal cognizant agency to identify indirect cost. If the eligible provider does not have a CAP or an indirect rate agreement in place with its federal cognizant agency and it would like to claim indirect cost in association with a non-institutional service, it must obtain one or the other before it can claim any indirect cost;

(b) Eligible providers that receive less than thirty-five million dollars ($35,000,000.00) of direct federal awards are required to develop and maintain an indirect proposal for purposes of audit. In the absence of an indirect rate proposal, the eligible provider may use methods originating from a CAP to identify its indirect cost. If the eligible provider does not have an indirect rate proposal on file or a CAP in place and it would like to claim indirect cost in association with a non-institutional service, it must obtain one or the other before it can claim any indirect cost;

(c) Eligible providers that receive no direct federal funding may use any of the following previously established methodologies to identify indirect cost:

(1) A CAP with DHCF or the District government;

(2) An indirect rate negotiated with DHCF or the District government; or

(3) Direct identification through use of a cost report; or

(d) If the eligible provider never established any of the above methodologies, it may do so, or it may elect to use the ten percent (10%) de minimis rate to identify its indirect cost.

10405.6

Total allowable costs, determined in accordance with the requirements of § 10404, shall equal the cost per medical transport, identified in §§ 10405.2 and 10405.3, times the total number of Medicaid fee-for-service transports.

10405.7

The primary source of paid claims data, managed care encounter data, and other Medicaid reimbursement data is the Medicaid Management Information System (MMIS). The number of paid Medicaid fee-for-service transports, as identified in is § 10405.6, is derived from and supported by the MMIS reports for services during the applicable reporting period.

10405.8

Payment of reconciled costs, by DHCF or the eligible provider, shall be made in accordance with the requirements set forth in §§ 10401.6 or 10401.7.

D.C. Mun. Regs. tit. 29, r. 29-10405

Final Rulemaking published at 67 DCR 9204 (7/31/2020)