Georgia Medicaid Expands EMS Reimbursement

Editors Comment: Welcome news from our friends in Georgia!  – Another example of payers moving toward economic models for EMS that include reimbursement for patient assessment, treatment and navigation to the most appropriate resource!  And, confirmation of something that Health Affairs journal identified several issues back – Medicaid programs are one of the most innovative payers in the country…

EMS Partners,

As you may be aware, in early 2017 the Georgia State Office of Rural Health (SORH) submitted three proposals to the Georgia Medicaid office requesting changes to reimbursement for EMS. The three proposals requested consideration to reimburse EMS for Treat Without Transport, Transport to Alternate Destinations, and Mobile Integrated Healthcare/Community Paramedicine (MIH/CP) programs.

Our office has recently received notification that Georgia Medicaid has approved Treatment Without Transport and Transport to Alternate Destinations, with the intent of submitting the MIH/CP proposal to the Centers for Medicare & Medicaid Services (CMS) for approval.

Assuming no unforeseen barriers, Treat Without Transport will be effective April 01, 2018.

Submission of a claim will require that the response originate through a “9-1-1” call and the patient receives treatment with pharmaceuticals before refusing transport to the hospital.

The intent behind this proposal was to allow EMS to recover some of the cost associated with providing medication to patients who, ultimately, choose not to be transported for continuation of care.

Assuming no unforeseen barriers, Transport To Alternate Destination will be effective July 01, 2018.

Submission of a claim will require that the response originate through a “9-1-1” call, an approved protocol signed by the Medical Director specific to patient evaluation and transport to an alternate facility exists, documentation of patient agreement for transport to an alternate facility is included, and a receiving facility agreement is on file.

The intent behind this proposal was to allow EMS an opportunity to transport properly screened patients who have non-emergent conditions to facilities appropriate for their needs, reduce over-crowding of emergency departments with non-emergent patients, and allow patients to receive medical attention in a less costly setting. This option may also allow counties with no local hospital and/or limited ambulance service coverage to shorten “turn-around times” and keep resources within county borders for longer periods.

All Medicaid claims are subject to review and audit, therefore, proper documentation on the patient care report as well as all required supporting documents must be maintained and provided upon request.

Currently, four states in the US have received approval from CMS for Medicaid reimbursement for MIH/CP programs. Georgia Medicaid is submitting a proposal similarly structured as those receiving previous CMS approval, and anticipate this proposal will also be approved. However, this is still uncertain, and confirmation of this change will be contingent upon CMS ruling. The State Office of Rural Health will keep our EMS partners informed of the progress of this proposal.

Please share this information with your Medical Director and billing staff.

We would like to thank Georgia Medicaid, and specifically Deputy Director Heather Bond, for their effort in reviewing and approving these proposals. This change is a huge step forward for the EMS industry in Georgia.

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