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Transforming Reimbursement for Emergency Ambulance Transportation (TREAT)

 

Program Overview

The Transforming Reimbursement for Emergency Ambulance Transportation (TREAT) program began effective July 1, 2022. In the 2022 regular legislative session, House Bill 657 authorized the additional payments program for emergency ambulance services to be funded with a health care provider fee.

The TREAT upper payment limit program provides reimbursement for emergency ambulance services for Medicaid beneficiaries with traditional Medicaid fee-for-service coverage. The TREAT payments are in addition to regular claims payments and are based on claims volume. The payment arrangement is intended to improve access to care by providing funding needed to maintain adequate emergency services and/or attracting new ambulance service providers to serve the Medicaid population. The payment methodology was approved by CMS through state plan amendment 22-0011.

Additionally, the TREAT directed payment arrangement reimburses eligible emergency ambulance services providers based on emergency ambulance services provided to members in the MississippiCAN program. The payment arrangement is intended to improve access to care by providing funding needed to maintain adequate emergency services and/or attracting new ambulance service providers to serve the MississippiCAN membership. The payment methodology is submitted to CMS each state fiscal year for approval through a Preprint, pursuant to 42 C.F.R. §438.6(c).

A health care provider fee is assessed on all ground emergency ambulance transportation providers, and all proceeds are used to fund the non-federal share of TREAT payments.

  • Participants include all Mississippi-licensed ground emergency ambulance transport providers.
  • The program was effective July 1, 2022, with the first year of the program running through June 30, 2023, and covering state fiscal year 2023.
  • DOM, through its contractor Myers and Stauffer LC, and in coordination with the MS Ambulance Alliance will periodically collect a financial survey from all Mississippi-licensed 911 ground ambulance providers. The survey data and Medicaid claims data will be modeled in compliance with CMS requirements to determine the annual fees and payments eligible under the program.
  • An average commercial rate (ACR) will be calculated for each applicable ambulance service corresponding to the Medicaid-covered procedure codes listed in the State Plan. To calculate the payment limit, the ACR for each procedure code is multiplied by the volume of Medicaid paid ambulance service units for the applicable period. To calculate the payment, the payment limit is reduced by total Medicaid claim payments (Medicaid base claims payments, interim managed care state directed payments, and any third-party liability payments).
  • DOM has designed and implemented an upper payment limit program for fee-for-service (FFS) activity and a directed payments program through the managed care organizations.
  • A mandatory assessment is used to collect funds from eligible providers to fund the non-federal share of program payments. The federal government funds a large share of the Medicaid payments. However, the State must provide matching funds.
  • The State will not contribute funding for the state share of TREAT program payments. The state share of payments will be financed by ambulance companies through the provider assessment.
  • The following procedure codes are eligible for payment:
    • A0427 – Ambulance service, advanced life support, emergency transport, level 1 (ALS 1-emergency)
    • A0429 – Ambulance service, basic life support, emergency transport (BLS-emergency)
    • A0433 – Advanced life support, level 2 (ALS 2)
    • A0434 – Specialty care transport (SCT)
    • A0425 – Ground mileage, per statute mile, when associated with an eligible transport
  • CMS requires a set of quality measures with targets and annual evaluations as a component of managed care state directed payments.  DOM is monitoring performance for the following:
    • The state will monitor access to ground emergency ambulance services throughout the state and will assess at the end of each state fiscal year that each county within the state has a ground emergency ambulance services provider.
    • The state will monitor access to ground emergency ambulance services for managed care beneficiaries by a per member per month (PMPM) calculation with a goal of increasing the utilization rate by 1% in the measurement year.
    • The state will improve the Trauma Pain Scale Assessment rate for EMS Transports originating from a 911 request for patients with injury who were assessed for pain.  The Baseline Measure for Mississippi for CY 2023 is 84.0%.  The state will work to improve that percentage by 5% during the measurement year.
    • The state will improve participation in the CARES program. The Baseline Measure for Mississippi is 60.0% with 49 counties of 82 currently submitting data as of October 2023. The state will work to improve the number of counties submitting data by 5% during the measurement year.

 

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