If your ambulance service is enrolled in Iowa’s GEMT program, the annual cost report is the single most important deliverable of your year. Miss it and you forfeit a year’s worth of supplemental Medicaid payments. Submit it incomplete and you risk reconciliation adjustments later.

This post walks through the key dates, the process, and a starter list of documents to gather.

The key dates

  • State fiscal year covered: July 1 – June 30
  • Cost report due: November 30
  • Prospective supplemental payments begin: July 1 of the next state fiscal year
  • Reconciliation: typically within 12 months of submission, against actual paid GEMT transports in the Medicaid Management Information System (MMIS)

The process, end to end

1. Confirm eligibility and participation

Notify the Iowa Medicaid Enterprise Provider Cost Audit and Rate Setting (PCA) Unit if you haven’t already, and execute the Provider Participation Agreement (Form 470-0087) for the applicable state fiscal year.

2. Execute (or renew) the intergovernmental transfer (IGT) agreement

The IGT is the mechanism for funding the non-federal share of your supplemental payment. It has to be in place before payments flow.

3. Establish an indirect cost rate

Before any indirect costs can be claimed on the cost report (Schedule 9), you must establish a federally compliant indirect cost rate. 45 CFR 75.412 governs the principles; the rate typically comes from your jurisdiction’s Cost Allocation Plan or from a negotiated rate with the cognizant federal agency.

4. Gather source documents

See the next section.

5. Build the cost report

The Iowa report has multiple schedules covering personnel, vehicles, equipment, supplies, allocations, and indirect costs. Direct vs. indirect classification has to be consistent across the report.

6. Certify and submit

The cost report must be certified by an authorized official of the provider and submitted to costaudit@hhs.iowa.gov by November 30.

7. Audit support

Iowa Medicaid may request supporting documentation or clarification after submission. Respond promptly.

Documents to gather

  • Payroll detail by employee for the state fiscal year, with hours and labor distribution between transport and non-transport activities
  • Run/call data: total transports, GEMT-eligible Medicaid transports, and supporting CAD or ePCR exports
  • Financial statements for the period
  • Depreciation schedules for ambulances, equipment, and facilities
  • Vendor invoices for major non-personnel expenses
  • Existing indirect cost rate documentation (or Cost Allocation Plan)
  • Lease agreements for stations or vehicles, if applicable
  • Insurance schedules

Common stumbling blocks

  • Inconsistent direct/indirect classification across schedules
  • Missing or expired indirect cost rate documentation
  • Run data that doesn’t reconcile to the Medicaid claims
  • Forgotten allocation of shared-resource costs — for example, a station shared with fire suppression
  • Certification signed by someone without authority

Most cost report failures aren’t math errors. They’re consistency errors and missing signatures.

For the Iowa-specific source, see the Iowa HHS GEMT Provider Training PDF.