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2005 Testimony

Testimony Before The Senate Human Services Committee

SB Bill 2192 - Medicaid reimbursement for ambulance service

January 17, 2005

Chairman Lee, members of the committee, I am Maggie Anderson, Assistant Director of Medical Services for the Department of Human Services. I appear before you to provide information on this bill.

The bill is designed to change existing statute by requiring Medical Services to provide reimbursement to ambulance service providers responding to calls that result in transport, even when it is determined that the recipient’s medical condition was not of an emergent nature.

The 2001 Legislature passed House Bill 1282, which required Medical Services to make payment for calls to an ambulance provider that resulted in response and treatment, but not transport. The Department implemented this in August of 2001.

In addition, the Department does cover a Basic Life Support service code that involves non-emergency transport. This code is typically reserved for situations involving transporting a recipient from a hospital to a nursing home or for transporting a recipient in “end of life” situations to home, hospice or nursing facility. Other non-emergency transport is not covered.

See Attachment A

If the provisions of this bill are enacted, Medical Services would be required to pay for the “other” non-emergency transport. Because these services are currently denied as not being medically necessary, Medical Services would be obligated to cover the cost of the services with 100 percent general funds.

In the present version of the Medical Services Administrative Code (75-02-02), there is no definition of proper medical protocol. If it is the intention of the Legislature to claim Federal Match and direct the Department to pay the non-emergent ambulance service, we can implement the necessary payment procedures. This would eliminate the non-emergent claims from any utilization review and the Federal Match payments may be subjected to audit.

Finally, Medicaid recipients can be billed for charges that are denied because the service was not medically necessary.

I would be happy to respond to any questions.


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