Current Medicaid Reimbursement Shortfall

Medicaid payment rates for ambulance services are often more than 70 percent less than the cost of providing services. In South Carolina, EMS providers have not received a Medicaid rate increase in nearly two decades. With state budgets under significant pressure, the prospects for addressing this inequity with traditional measures are dim and as a result has put immense financial and operational pressures on individual EMS providers.

The Solution: An Ambulance Supplemental Payment Program

The ASPP program is an opportunity to enhance federal funding and help cover the Medicaid shortfall that exists between the cost of providing services and what Medicaid currently reimburses providers. Upon the Centers for Medicare and Medicaid Services (CMS) approval, participation in the ASPP will allow government owned or operated ambulance providers to recover up to the federal share of the cost of providing transports that are currently paid through Medicaid Fee-for-service (FFS) and Medicaid Managed Care Organization (MCO) delivery systems.

The mechanism by which payments will be made to providers will vary based upon the Medicaid service
delivery system. Below is a description of how each component of the ASPP will be implemented.

Medicaid FFS

• Implementation requires the submission of a Medicaid State Plan Amendment (SPA) to CMS.
• Once implemented, providers that wish to participate will be required to submit an annual costreport and sign a Certification of Public Expenditures in order to receive provider-specific cost-based reimbursement for Medicaid FFS transports.
  

Medicaid MCO

• Implementation requires the submission of a Medicaid Section 42 CFR § 438.6(c) Preprint outlining the state directed payment arrangement and associated quality measures.
• Once implemented, incremental enhancements for Medicaid MCO transports will be achieved through development of a per trip add-on rate that is tied to the average cost per trip for all providers submitting annual cost reports under the Medicaid FFS program.
• Unlike the Medicaid FFS program, public providers will transfer the state share via an Intergovernmental Transfer (IGT) in advance of the supplemental payments being disbursed by MCOs.
  

Existing Programs

Currently more than 30 states have active ASPP programs or are in the process of developing and
implementing a program.

PCG Experience

PCG has over 32 years of experience supporting revenue enhancement projects and is a leader in ASPP cost reporting and cost recovery services. Over the past decade, the PCG team has helped more than 520 ambulance providers nationwide capture over $300 million through Medicaid cost recovery programs. Partnering with PCG enables providers to leverage their proven approach, deep program knowledge, and experienced team to design and implement an ASPP program for public ambulance providers in South Carolina.

For more information about PCG’s background, services, and experience with EMS providers visit http://publicconsultinggroup.com/ems.