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Transforming Reimbursement for Emergency Ambulance Transportation (TREAT)

 

Program Overview

The TREAT program is on schedule to begin 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 will provide reimbursement for emergency ambulance services for Medicaid beneficiaries with traditional Medicaid fee-for-service coverage.  The TREAT payments will be in addition to regular claims payments and will be 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 will be submitted to CMS for approval through state plan amendment 22-0011.

Additionally, The TREAT directed payment arrangement will reimburse eligible emergency ambulance services providers based on actual 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 will be submitted to CMS for annual approval through a Preprint, pursuant to 42 C.F.R. section 438.6(c).

A health care provider fee will be assessed on all 911 ground ambulance transportation providers, and all proceeds will be used to fund the state share of the TREAT payments.

  • Participants include all Mississippi-licensed 911 ground ambulance transport providers.
  • DOM is working to have a program effective date of 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 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 design a program for MS.  The selected model will include calculations for the assessment and the payments.
  • An average commercial rate (ACR) will be calculated for each applicable ambulance service corresponding to the Medicaid-covered procedure codes listed in Schedule 3 of the Financial Survey. To calculate the payment limit, the ACR for each procedure code will be multiplied by the volume of Medicaid paid ambulance service units for the period. To calculate the payment, the payment limit will be reduced by total Medicaid claim payments (Medicaid payments and any third-party liability payments).
  • DOM is planning an upper payment limit program for fee-for-service (FFS) activity and a directed payments program through the managed care organizations.
  • A mandatory assessment will 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.

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