Nevada Public Welfare

Sec. § 422.2735
Program to provide increased capitation payments to Medicaid managed care plans for ground emergency medical transportation services provided by governmental provider.


1.

The Director may, in consultation with governmental providers and Medicaid managed care plans, develop a program to include in the managed care organization rate certification for the Medicaid managed care plans increased capitation payments to the Medicaid managed care plans for ground emergency medical transportation services which are provided by a governmental provider pursuant to a contract or other arrangement between the governmental provider and a Medicaid managed care plan. Participation in such a program by a governmental provider is voluntary and, if a governmental provider elects to participate in such a program, the governmental provider must pay the nonfederal share of the expenditures on the program.

2.

If a program is established pursuant to this section, a governmental provider or Medicaid managed care plan that wishes to participate in the program must enter into an agreement with the Department to comply with any request by the Department for information or data necessary to claim federal money or obtain federal approval in connection with the program.

3.

In addition to complying with subsection 2, a governmental provider that wishes to participate in a program established pursuant to this section must:

(a)

Hold a permit to operate an ambulance or a permit to operate a vehicle of a fire-fighting agency at the scene of an emergency issued pursuant to NRS 450B.200; and

(b)

Provide ground emergency medical services to recipients of Medicaid pursuant to a contract or other arrangement with a Medicaid managed care plan.

4.

If a program is established pursuant to this section, a governmental provider that meets the requirements of subsections 2 and 3 and wishes to receive increased capitation payments must make an intergovernmental transfer of money to the Department in an amount corresponding with the amount that the governmental provider has spent on ground emergency medical transportation services or pay the nonfederal share of expenditures on the program. To the extent that such money is accepted from a governmental provider, the Department shall make increased capitation payments to the applicable Medicaid managed care plan. To the extent permissible under federal law, the increased capitation payments must be in amounts actuarially equivalent to or greater than the supplemental cost based payments available under a program of supplemental reimbursements for governmental providers who provide services on a fee-for-service basis.

5.

Except as otherwise provided in subsection 6, all money associated with intergovernmental transfers or the nonfederal share of expenditures made and accepted pursuant to subsection 4 must be used to make additional payments to governmental providers under a program established pursuant to this section. A Medicaid managed care plan shall pay all of any increased capitation payments made pursuant to subsection 4 to a governmental provider for ground emergency medical transportation services pursuant to a contract or other arrangement with the Medicaid managed care plan.

6.

The Department may implement the program described in this section only to the extent that the program is approved by the Centers for Medicare and Medicaid Services and federal financial participation is available. To the extent authorized by federal law, the Department may implement the program for ground emergency medical transportation services provided before the effective date of this section.

7.

If the Director determines that payments made under the provisions of this section do not comply with federal requirements relating to Medicaid, the Director may:

(a)

Return or refuse to accept an intergovernmental transfer; or

(b)

Adjust any payment made under the provisions of this section to comply with federal requirements relating to Medicaid.

8.

As used in this section:

(a)

“Advanced emergency medical technician” has the meaning ascribed to it in NRS 450B.025.

(b)

“Ambulance” has the meaning ascribed to it in NRS 450B.040.

(c)

“Emergency medical technician” has the meaning ascribed to it in NRS 450B.065.

(d)

“Fire-fighting agency” has the meaning ascribed to it in NRS 450B.072.

(e)

“Governmental provider” means a provider of ground emergency medical transportation services that is owned or operated by a state or local governmental entity or federally recognized Indian tribe.

(f)

“Ground emergency medical transportation services” means emergency medical transportation services provided by an ambulance or a vehicle of a fire-fighting agency, including, without limitation, services provided by emergency medical technicians, advanced emergency medical technicians and paramedics in prestabilizing patients and preparing patients for transport.

(g)

“Medicaid managed care plan” means a health maintenance organization that provides health care services through managed care to recipients of Medicaid under the State Plan for Medicaid.

(h)

“Paramedic” has the meaning ascribed to it in NRS 450B.095.
Source

Last accessed
Feb. 5, 2021