PAAW | Professional Ambulance Association of Wisconsin - EMS Live Webcast: Wisconsin's Medicaid ambulance rates being discussed with state DHS leadership

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EMS Live Webcast: Wisconsin's Medicaid ambulance rates being discussed with state DHS leadership

Thursday, February 25, 2016 4:41 PM | PAAW Administrator (Administrator)

The rate hasn't changed since 2008 - and back then it was a 1% increase

>> Click to listen to this audio webcast.

Currently, one in five Wisconsin residents is on state funded Medicaid. Like other states, Wisconsin is not immune from seeing its Medicaid population rolls increase. When an ambulance is called by or for a Medicaid covered beneficiary (patient), the services paid for by the state doesn't come close to the actual cost to deliver care and transport.

Last week representatives with PAAW and the EMS System Management and Development Committee, which is part of the state's EMS Advisory Board, met with leadership from the Wisconsin Department of Health Services (DHS). Last week's meeting had a few goals regarding Medicaid reimbursement rates to ambulance services: 1. Where does the money come from?, 2. How is the payment pie allotted?, and 3. What percentage goes to ambulance services?

The state's current Medicaid budget is $9.1 billion; however, it isn't clear what percentage goes to ambulance medical care and transportation. Besides having lower ambulance reimbursement rates than many other states, Wisconsin ambulance services also saw the number of non-emergency transports decrease since 2011 when the state contracted with a broker to manage them. Besides selecting an ambulance service, typically the most expensive non-emergency option, the broker can also choose other modes of transportation, to include taxis, buses, and medical or wheelchair vans.

According to officials with DHS, a change in the ambulance reimbursement rates, or fee structure, will require either an adjustment by DHS or a legislative initiative. One of the meeting's participants included Paratech Ambulance Vice President Larry Knuth, who commented on the webcast, "DHS would like follow-up with us on this to gain an in-depth understanding and where the industry wants to be. DHS is open to discuss a future plan and any proposals".

EMS Chief Dana Sechler with Baraboo District Ambulance also attended the meeting. He commented during the webcast, "The federal Government Accountability Office (GOA) did a study in 2007 and 2012. It summarized that federal MediCARE reimbursement rates were less than the actual cost to run an ambulance call. The interesting thing is when you compare federal MediCARE to Wisconsin MediCAID rates, Wisconsin MediCAID is less than half of MediCARE." (refer to the chart below)

Nowadays, the ability for an ambulance service to meet its operational, financial sustainability and any debt obligations truly rests in a favorable payer mix, local taxes and per capita charges. If your payer mix skews more towards MediCARE and state MediCAID patients, and less on insurance and private pay, it can be a difficult road to travel financially.

Without DHS increasing the reimbursement rate or industry stakeholders pursuing legislative action, growing budget gaps caused by low Medicaid payments will continue to plague the industry and lead to a greater cost shift to other payers, increase local property taxes, or potentially result in a reduction of services.

Federal MediCARE and State MediCAID Ambulance Reimbursement Rates - 2015

Description	Federal MediCARE	Wisconsin MediCAID	Minnesota MediCAID	Illinois** MediCAID
Per Mile	$10.74*	$5.56	$7.06	$5.00
BLS Non-Emergent	$216.44	$94.90	$221.34	$127.34
BLS Emergent	$346.31	$151.84	$430.03	$127.34
ALS Non-Emergent	$259.73	$113.88	$265.60	$198.49
ALS Emergent	$411.24	$180.31	$430.03	$198.49
ALS2	$595.21	$260.97	$608.77	$198.49
SCT	$703.43	$308.42	$719.45	$273.49

*MediCARE pays $10.74/mile for the first 17 miles, then $7.10/mile thereafter.
**Illinois MediCAID rates vary by county. Lake County (borders WI) 2014 rates shown.

The webcast concluded with EMS Advisory Board Chairman Jerry Biggart reviewing several highlights and priority items the board is working on. One of the items also discussed included EMS worker protection laws, since many states' like Minnesota are drafting legislation to enact them. The good news for Wisconsin's EMS workers is protection laws already exist. >> Click for Wisconsin's EMS protection laws.

>> Click to listen to this audio webcast.

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