EMS agency and community leaders should monitor developments like this to assure logical public policy that modernizes EMS reimbursement to include reasonable reimbursement rates and coverage for valuable Treatment in Place (TIP) and Transport to Alternate Destinations (TAD) remain in place.
It's also a good reminder that during legislative processes, all stakeholders should be engaged in the process.
---------------------
Health insurance advocacy group seeks to block ambulance reimbursement bill
By Anthony Warren
Jul. 12, 2024
https://www.wlbt.com/2024/07/12/health-insurance-advocacy-group-seeks-block-ambulance-reimbursement-bill/
JACKSON, Miss. (WLBT) - An advocacy group for health insurance providers in the state wants to block a new law that would increase how much its members would have to pay ambulance companies for certain services.
The Mississippi Association of Health Plans (MAHP) recently filed for an injunction to block the State Insurance Commissioner from implementing H.B. 1489.
The petition was filed on June 28 in U.S. District Court for the Southern District of Mississippi, just days before the new law was set to take effect.
The bill, which was signed by Gov. Tate Reeves on May 2 after passing both the House and Senate on unanimous votes, requires insurance providers to compensate ambulance companies for certain services they previously were not paid for.
That compensation would be what is charged under the ambulance’s contract with a city or county, or 350 percent of the reimbursement rate of Medicare, whichever is larger.
Among concerns, MAHP argues the law is too vague to understand, and that provisions of the measure could drive up healthcare costs for customers. Additionally, the group is concerned about what impact the new law has on health insurance policies already in place.
“The vague language will create uncertainty for MAHP’s member plans, leaving plans without direction as to what claims may require coverage and what claims may not,” the suit states. “Furthermore, the significant lack of clarity will leave the interpretation and enforcement of these provisions to the sole discretion of the Commissioner [of Insurance]... or to courts deciding whether a denied claim is required to be covered as a matter of law.”
H.B. 1489, the “Mississippi Triage, Treat and Transport to Alternate Destination Act,” was passed during the 2024 legislative session and signed into law by Gov. Tate Reeves. The measure took effect on July 1.
The bill, in part, increases how much insurance companies must pay ambulance firms for services provided.
H.B. 1489
The measure also mandates insurance providers reimburse EMTs for services that they were previously not reimbursable, such as instances where individuals are treated in place or are transported to “alternative destinations” other than emergency rooms.
1489 defines those destinations as federally qualified health centers, urgent care centers, physician’s offices or medical clinics, and behavioral health facilities.
Currently, EMTs can transport individuals to those locations but are not reimbursed by insurance companies for doing so.
Rep. Stacey Hobgood-Wilkes rejects the lawsuit, saying ambulances shouldn’t have to provide services for free. “If you provide a service, you should be compensated for it,” she said. “Without adequate reimbursement for these services, the citizens of Mississippi will not receive the reliable, high-quality care they deserve and pay for.”
Figures provided by the Ambulance Alliance show EMS providers in the state charge between $988 and $1,224.82 for a basic life support emergency response in urban areas. Medicare reimburses those companies just $398.56.
MAHP takes issue with the bill’s use of the phrase, “including but not limited to” endlessly expands the list of destinations insurance companies now must pay for.
“As written, it is substantially unclear what constitutes an ‘alternative destination’ and if an ‘alternative destination’ includes medical providers who do not provide any degree of emergency medical services, such as a dermatologist, pharmacist, chiropractor, and the like,” the suit states.
MAHP members include Amerigroup, CareSource, Cigna Healthcare, CVS Health, Magnolia Health, Molina Healthcare, TrueCare, United Healthcare, and others. A list of members can be found here.
The group also takes umbrage with the bill’s requirement that insurance providers reimburse ambulances for “encounters” between EMTs and those seeking medical help.
Under the act, third-party payers would be required to pay for treatment in place when a patient is not transported to an emergency room. Before the passage of the bill, EMTs were only reimbursed if a patient was taken to the hospital.
That amount of the reimbursements would be the local fees set by a city or county contract or 325 percent of Medicare, whichever is greater. In the absence of a local rate, the ambulance provider would be paid their billed charges or 325 percent of Medicare, whichever is greater, the bill states.
However, MAHP says the law does not say what level of service would have to be provided, only that the service must be initiated by a 911 call.
The group also is unsure whether companies are required to pay the reimbursements under current insurance plans, or if they would only be required to do so under plans issued after the law took effect.
“These unintelligible provisions create no standard at all and/or cause House Bill 1489, Section 1 to be substantially incomprehensible,” the suit states. “Section 1 does not give a person of ordinary intelligence a reasonable opportunity to know what is prohibited, and increases the risk of arbitrary application and enforcement.”
MAHP is asking the court for a summary judgment ruling that Section 1 of H.B. 1489 violates the due process clause of the Fourteenth Amendment to the Constitution; it also is asking the court to void Section 2 of the bill, saying it violates the Constitution’s Contract Clause.
The group is also asking the court to prevent the state to implement or take any action to enforce provisions of the bill being challenged.