Medicaid Coverage for Ambulance Services in Kentucky
Ambulance services covered under Kentucky Medicaid including requirements for emergency and nonemergency transportation, documentation needed, reimbursement rates, and managed care directed payment program. Learn about the guidelines for transportation to hospital emergency rooms and other medical facilities, as well as the rates for basic and advanced life support services.
Download Presentation
Please find below an Image/Link to download the presentation.
The content on the website is provided AS IS for your information and personal use only. It may not be sold, licensed, or shared on other websites without obtaining consent from the author.If you encounter any issues during the download, it is possible that the publisher has removed the file from their server.
You are allowed to download the files provided on this website for personal or commercial use, subject to the condition that they are used lawfully. All files are the property of their respective owners.
The content on the website is provided AS IS for your information and personal use only. It may not be sold, licensed, or shared on other websites without obtaining consent from the author.
E N D
Presentation Transcript
Emergency Medical Services Task Force September 20, 2022 Department for Medicaid Services Lisa Lee, Commissioner Steve Bechtel, Chief Financial Officer
Medicaid Coverage for Ambulance Services Ambulance transportation: ground or air transportation provided at advanced life support level or basic life support level by a carrier licensed by the Kentucky Board of Emergency Medical Services Emergency Ambulance services covered to and from a hospital emergency room in the medical service area Documentation for post-payment review required Transportation to an appropriate medical facility other than hospital shall require documentation from attending physician of: Medical necessity Absence of hospital emergency room in the medical service area Delivery of emergent care to the patient 2
Medicaid Coverage for Ambulance Services Nonemergency Transportation to a provider within the medical service area if: Member s medical condition warrants transport by stretcher Member is traveling to or from a Medicaid-covered service, excluding pharmacy Service is the least expensive available for the member s needs Transportation outside of the medical service area if: All items above are met Medical service required by the member is not available in medical service area Member is referred by a physician 3
Medicaid Reimbursement for Ambulance Services Basic life support to ER of hospital Base rate of $82.50 Mileage allowance of $3 per mile If transported concurrently, flat rate of $20 for additional members Advanced life support to ER of hospital Base rate of $110 Mileage allowance of $4 per mile If transported concurrently, flat rate of $25 for additional members Additional reimbursement rates outlined in 907 KAR 1:061 Payments contingent upon a statement of medical necessity 4
Managed Care Directed Payment Program The May 2016 Managed Care Final Rule allows states to make directed payments, which can take the form of uniform payment increases or value- based purchasing for a class of providers. In general, directed payments allow states with managed care programs to make enhanced payments to providers to advance the goals of the Medicaid program and must be: Based on the utilization and delivery of services. Designed to advance at least one goal of the State Medicaid program s quality strategy with appropriate oversight to evaluate progress on the goals. Evaluated at the end of each program year to measure progress on achieving outlined goals. Submitted to the Center for Medicare and Medicaid Service (CMS) for approval annually. 5
HB8 (2020 session) HB8 (2020 session) Ambulance Provider Assessment Program (APAP) Ambulance Provider Assessment Program (APAP) On March 31, 2021, the Department for Medicaid Services received CMS approval to implement APAP. APAP was submitted to CMS as a result of HB8 that was passed in the 2020 legislative session and became effective July 15, 2020. This legislation authorized an enhanced payment program for ground ambulance services. Reimburses up to available provider tax funding on Medicaid transports only, for all Kentucky ground ambulance providers Medicaid-licensed as Classes I III (defined by KRS 142.301). As a result of the new directed payment financing mechanism, Kentucky stakeholders elected to leverage this opportunity to achieve the following goals: Provide enhanced reimbursement for qualifying ground transports. Promote access to high quality care and reduce unnecessary spending. 6
HB8 (2020 session) Ambulance Provider Assessment Program (APAP) Provider tax funding: State share of payments funded by the new provider tax Tax is flat 5.5% of cash collections for emergency ground transports from all payors (tax is on all payors and enhancements are paid on Medicaid only) Gross revenues should be reported only for transports originating in Kentucky as defined in KRS 142.301 and the draft regulation 907 KAR 3:060 All Class I III ground ambulance providers will be taxed regardless of Medicaid utilization Quality measures for the program are: Promote access to high-quality care by reducing ambulance response times Increasing the number of certified EMS practitioners 7
HB8 (2020 session) Ambulance Provider Assessment Program (APAP) Authorizes enhanced payment programs for fee for service (FFS) and managed care organization (MCO) ground ambulance services First program year was CY 2021 but requires to be approved every year. Annual add-ons are applied to historical utilization to determine interim payments and paid monthly (approximately $3.8m/month). A final reconciliation to actual utilization will be performed after appropriate claims adjudication has occurred. CY 2021 (total payments) = $45,393,208.86 CY 2022 (thru August 2022) = $29,758,948.20 8
