GEMT - Ground Emergency Medical Transport

Across the nation, EMS agencies are looking for ways to offset the disparity between their costs to provide services and the reimbursement received from payers.  This inequity in reimbursement, especially from state and federally funded programs, can be as much as 70% between the payments and the costs incurred.  State budgets are already stretched to the maximum, but there are some alternatives on the horizon.  The federal government has a process called GEMT, which is a unique process where States can draw on Federal Financial Participation funds from Medicaid cost matching.  This allows the State to count the unreimbursed costs incurred by tax based EMS agencies as if it was part of the State's portion of the match.  Unlike many federal grant or funding programs, GEMT falls under the Social Security Act/Title XIX and is an entitlement program, so is unlikely to change in the near future. 

The first step is at the State level passing legislation to establish the program.  The second step is for the state health care agency to design and implement the program.  The last step is for EMS providers to enroll in the program.  

Once enrolled, you will need to submit annual cost reports associated with the services provided to state Medicaid patients as well as an accurate accounting of reimbursement already received for those same transports.  This is where Systems Design can help! 

Systems Design's team will work closely with you to identify the eligible claims and the associated costs, provide a detailed accounting of any partial reimbursements, then prepare the reports and ensure both compliance and auditability.

GEMT Washington State

April 2015 Governor Inslee signed legislation that began the GEMT process for Washington. The state's Health Care Agency is developing the State Plan Amendment (SPA) which will detail how the GEMT program will function in Washington.  This process may take several months but could ultimately result in $100 million in additional revenue annually, the vast majority of which is passed right back to the EMS agencies participating.

GEMT Oregon State

March 2016 Governor Brown signed legislation that began the GEMT process for Oregon.  Like Washington, Oregon is in the SPA development process.  The program start date is unknown at this time, but is not anticipated to start prior to 7/1/2017.

Oregon GEMT Coalition website:

What's next...

The SPA development process is very involved and requires CMS approval before it can be enacted. This could involve multiple revisions and 'negotiations' before final CMS approval is granted. The final version could be expanded beyond just basic Medicaid claims to also include Managed Care patients under CCOs. As CMS also has the final word on provider eligibility, it is possible that under certain circumstances, non-tax based agencies may also be allowed to participate.

Washington UPDATE - 11/1/2016

Washington Health Care Authority (HCA) and CMS are still negotiating.  It is hoped that the program may be in place by mid-2017.  When those negotiations have been completed, WFCA will announce the time and location of the Town Hall Meetings.