Melinda J. Overstreet
Glasgow Daily Times, Ky.
GLASGOW, Ky. — A proposed bill is making its way through a chain of committees in the 2020 General Assembly that most ground ambulance service providers in Kentucky are expecting to boost their reimbursements for service from Medicaid.
To get that “enhanced” payment, though, the providers would put up some of their own money.
Federal Medicaid funds come to Kentucky as matching dollars. For every dollar the state puts in, the federal government puts in roughly $2, and that applies to any provider of a Medicaid-eligible service. So the idea behind the proposed law is to build the amount Kentucky provides – an estimated $7 million through assessment fees – to get more matching funds.
House Bill 8, originally filed as Bill Request 83 by 58th District Rep. Rob Rothenburger of Shelby County, calls for the ambulance services to pay a provider assessment fee on a quarterly basis. How much each would pay is based on a formula: the state General Fund dollars required to pay the fee-for-service ambulance provider rates divided by the total number of statewide emergency ground transports, multiplied by the number of emergency ground transports completed by that provider.
That money would be put into a trust fund within the State Treasury that is administered by the Finance and Administration Cabinet and “shall not be diverted to the General Fund or any other public fund.”
The Cabinet would be allowed $200,000 annually for administration of the fund.
Currently, the formula would equate to a maximum of roughly 6% of net revenue for emergency transports, said Joe Middleton, interim executive director for Barren-Metcalfe County Emergency Medical Services.
“The premise of it is, at no point will we ever pay more than what we can maximally recover,” he said. “That’s the goal of it. And if they reduce what they’re reimbursing, then that automatically trickles down to what our provider assessment is, and it would fluctuate based on what we can recover.”
Using the fiscal year that ended June 30 as an example, Barren-Metcalfe had $2,817,795 in revenue for emergency transports from all payer sources for that 12 months. Of that, $455,000 or 16.2% was Medicaid payments, but under the new system, that amount would change to $857,828, Middleton said.
The ambulance service would pay $169,068 in provider assessment fees, so it would have a net gain of $688,761, he said.
Barren-Metcalfe ended up that fiscal year with a total deficit of $850,559, so had this system been in place at that time, it could have reduced the deficit to $161,798.
Knowing retirement contributions are going to increase 12% and possibly even more in the coming years, that additional revenue could help considerably.
Some of the ambulance services in the northern Kentucky region have been in favor of a different approach. Instead of paying the cash assessment, the providers would take the net loss they have from not getting enough in Medicaid reimbursement compared to the actual cost of a run and apply that amount of loss instead of making a cash payment and getting a drawback, Middleton said.
The model being proposed in the law would yield more for Barren-Metcalfe than the other one, he said. If the bill becomes law, every ambulance service would have to participate; it’s not something they could opt into or out of, he said.
Middleton said he went to Frankfort last month for the House Health and Family Services Committee, of which Rep. Steve Riley of Glasgow is a member, for the hearing in which the bill was under consideration. Rothenburger and Jim Duke, legislative liaison for the Kentucky Ambulance Providers Association, were there to testify on behalf of the bill, Middleton said, and about 50 EMS directors from across the state were there to support it.
It unanimously passed favorably from that committee to the Rules Committee and recommitted to the House Appropriations and Revenue Committee.
The A/R Committee has to develop the actual fund where the money goes, he said.
Middleton said the standard reimbursement through Medicaid in 2018 averaged $145 for an emergency response and transport run, but the actual costs range from $350 to $750.
The average reimbursement rate in this area is about $120 a run, he said, and a true advanced-life-support run would near $1,000 in billable expenses.
He used an example of an opioid overdose patient, it’s common to need three doses of naloxone to bring a patient back from the brink of death, and the ambulance service’s cost is $40 a dose, so that $120 reimbursement for the run would not cover anything except the cost of the medication – nothing for staffing, the cost of the truck or fuel or any other supplies.
Middleton said he had some concerns, including that the managed care organizations that offer Medicaid plans would be able to increase what they get and siphon off those funds, but some additional language is expected to be added with a committee amendment that would resolve that.
Riley confirmed he voted for the bill in the Health and Family Services Committee, and he is aware of the upcoming anticipated amendments and said he still favors the legislation. He said it is his understanding that it now has widespread support among ambulance providers.
According to the bill as drafted, it would take effect upon approval of any Medicaid waiver amendment that would be necessary.
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©2020 the Glasgow Daily Times (Glasgow, Ky.)