(1) This rule applies to all publicly owned or operated emergency transportation services providers rendering Florida Medicaid emergency transportation services to recipients under the fee-for-service delivery system.

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    (2) Providers must submit AHCA Form 5000-0035, May 2017, Emergency Medical Transportation Integrated Disclosure and Medicaid Cost Report General Information, incorporated by reference, and available at http://ahca.myflorida.com/Medicaid/Finance/finance/LIP-DSH/PEMT/index.shtml, and at https://www.flrules.org/Gateway/reference.asp?No=Ref-08173, to the Agency for Health Care Administration (AHCA) annually, to be eligible to use certified public expenditure funds as state match in order to receive federal financial participation in accordance with the state’s Supplemental Payment for Publicly Owned or Operated Emergency Medical Transportation Providers, SPA 2015-014, incorporated by reference, available at http://ahca.myflorida.com/Medicaid/Finance/finance/LIP-DSH/PEMT/index.shtml, and at https://www.flrules.org/Gateway/reference.asp?No=Ref-08178. The form must be completed in accordance with AHCA Form 5000-0035A, May 2017, Emergency Medical Transportation Services Cost Report Instructions, incorporated by reference, and available at http://ahca.myflorida.com/Medicaid/Finance/finance/PEMT/index.shtml, and at https://www.flrules.org/Gateway/reference.asp?No=Ref-08176.
    (3) Funds are appropriated from the Medical Care Trust Fund for the Certified Public Expenditures Program for Emergency Transportation Services and are supplemental to the reimbursement rates on the Florida Medicaid Emergency Transportation Services Fee Schedule, incorporated by reference in Fl. Admin. Code R. 59G-4.002
    (4) The Provider Reimbursement Manual CMS PUB. 15-1, April 5, 2012, is incorporated by reference, and available at https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Paper-Based-Manuals-Items/CMS021929.html, and at http://www.flrules.org/Gateway/reference.asp?No=Ref-08256.
    (5) Title 2, Code of Federal Regulations (CFR), Subtitle A, Chapter II Part 200, December 19, 2014, is incorporated by reference, and available at https://www.ecfr.gov/cgi-bin/text-idx?tpl=/ecfrbrowse/Title02/2cfr200_main_02.tpl, and at http://www.flrules.org/Gateway/reference.asp?No=Ref-08177.
Rulemaking Authority 409.919 FS. Law Implemented Florida Statutes § 409.908. History-New 6-15-17.