State senators want to help EMS agencies get back some much needed money, last week approving a bill that would require insurance companies and Medicaid to reimburse ambulance services regardless of whether the patient is taken to a hospital.
Sen. Don White, R-Indiana, the prime sponsor of Senate Bill 1003, said the legislation would ensure that EMS agencies are properly reimbursed for their services when they are called out to provide care. Currently, insurance companies and Medicaid are required to reimburse EMS organizations for services only when they include transport to a hospital.
“There are cases where crews respond to a scene to provide care and treatment, but transportation is unnecessary or refused,” White said. “Not every case requires hospital treatment, or, in some cases, the patient is reluctant to seek further treatment. That means that these responders can be denied payment by insurance companies and by Medicaid. That’s just not fair.
“There are costs incurred and man hours spent by these organizations. Senate Bill 1003 will ensure those organizations are properly reimbursed for their services.”
Rich Heuser, chief of operations for Eureka Fire Rescue EMS in Tarentum, said that while the legislation isn’t a “cure-all” to the problems facing the EMS industry, it would help his organization.
But by how much remains to be seen.
Heuser estimates his agency will respond to roughly 3,300 billable calls this year and, of those, about 450 stand a chance of applying to the bill. He wasn’t able to say how much the agency might be able to recoup because of the legislation.
“I hope that this passes the full House and gets signed into law,” he said. “I believe it will. It will help somewhat. Certainly, it’s a step in the right direction.”
Larry Davis, business manager for New Kensington’s Ambulance Service, said the legislation is long overdue. He also couldn’t say how much the bill might recoup for the service but indicated it “should help us some.”
“It should have been done a long time ago,“ he said. “Every little bit helps these small ambulance services to get money in.”
The New Ken service runs about 5,000 calls a year. About 90 to 95 percent of their patients go to the hospital, but paramedics have been performing more on-scene treatments than in years past, something Davis attributes to better training and a spike in drug overdoses.
“If you got somebody that cut their finger, or something like that, that doesn’t really require stitches, why tie an ambulance up for an hour?” Davis said.
UPMC spokeswoman Gina Pferdehirt said the insurer is reviewing the legislation and looks forward to working with lawmakers and EMS providers to ensure the continued availability of these life-saving services. She said UPMC officials “share Senator White’s belief that EMS providers provide critically important services to our members and are an asset to our community.”
Aaron Billger, a spokesman for insurer Highmark Inc., said Highmark sees all of its community- and facility-based EMS providers as critical partners and has been working with the Allegheny Health Network and the EMS community to define the appropriate quality and care standards that should be in place for a program providing coverage for EMS treatment without transport to a health care facility.
Colin Day is a spokesman for the Pennsylvania Department of Human Services, which is responsible for coordinating Medicaid benefits for patients in the state.
Day said that while the department understands the issues facing EMS providers and that EMS providers play an essential role in the health care system, the federal Medicaid program does not pay for ambulance transportation services when EMS agencies offer treatment without transportation, so federal funding would not be available for such services.
When, and if, the Senate bill actually becomes law and how much money it could mean for financially strapped EMS agencies is unclear.
Joe Pittman, White’s Chief of Staff, said the bill now goes to the state House for action. He had no indication when or if that might occur.
White said the state House passed a similar measure in May, known as House Bill 1013, but that bill doesn’t include the Medicaid component.
“My bill has the same intent but takes an additional step and improves upon it by including Medicaid reimbursements,” he said. “That further levels the playing field and provides greater support for Pennsylvania’s EMS crews and the good work they provide for our citizens.”