A meeting was held with the Division of Medical Assistance (DMA) - Medicaid on April 29, 2004 as a follow up to a meeting held in December regarding several Medicaid issues.  The EMS Committee was comprised of both county based and private EMS services.  DMA was represented by Ambulance Policy and Reimbursement Staff. 

The goal of the committee is to establish a line of communication between the EMS community and DMA to discuss issues of importance in the EMS industry, to develop a consistent policy between Medicare and Medicaid, and to establish a fair method of reimbursement for Medicaid services to ensure that the patients receive the transportation services that they need.

The committee discussed the importance of Medicaid adopting a medical policy that would be more consistent with Medicare's policy.  This would include the acceptance of the level of services, HCPCS codes and definitions consistent with CMS and Medicare policy, the allowance for in-county mileage, and the deletion of the "round trip" procedure code to be replaced with reimbursement for two separate trips when a round trip transport occurs. 

The committee suggested that the in-county mileage issue should be top priority of the changes in which they are suggesting.  This change could immediately help to offset the negative impact to Medicaid providers from the deletion of the Medicare crossover process.   The DMA policy staff stated that the process would be to revise the current Medicaid Ambulance Policy to include in-county mileage.  In order to begin this process, DMA would need an average number of loaded miles from the EMS providers so that they could realize the reimbursement impact that this change would have.  Jeff White agreed to request this information from the EMS providers via the NCEMS list serve and submit to DMA within a couple of weeks.  Upon review of this information, DMA will submit a policy update to the Physicians Advisory Group (PAG), as this is the general process for making this type of change. 

The committee is currently researching the PAG committee to entertain an idea of having an EMS representative as a standing member for issues related to ambulance billing.

The committee reinforced the issue regarding the current Medicaid allowances as they compare to Medicare reimbursement, as well as other states Medicaid allowables.  Jeff White presented a 15 state rate comparison of Medicaid reimbursement rates.  It was noted that NC was the lowest reimbursed of the 15 states in which allowables were available. 

Kim Stanley explained the Medicare Fee Schedule reimbursement process as it is based on level of skill and services provided during the transport, as well as the current transition between the old and new rates.    The committee recommended that Medicaid adopt the Medicare Fee Schedule Methodology as a fair and consistent rate of reimbursement.   Pat Jeter, DMA, stated that the process to make a change such as this would be presented as a change to the "state plan", which must be approved by a number of committees, including CMS, DMA, and state legislation. 

Several issues were discussed for policy clarification, such as an increasing concern for transportation of Bariatric patients.   The cost of specialized equipment, manpower, and added liability of transporting these individuals is becoming an increasing concern for EMS providers.  The issue is currently being discussed with CMS to allow for additional reimbursement under the Medicare policy.

The meeting adjourned with the consent to provide additional information of average loaded miles to DMA.  The next meeting is scheduled for June 23, 2004.