Public Notice: Ambulance Services Reimbursement Modification

PUBLIC NOTICE

Department of Health Services

Ambulance Services Reimbursement Modification

The State of Wisconsin reimburses providers for services provided to Medical Assistance recipients under the authority of Title XIX of the Social Security Act and ss. 49.43 to 49.47, Wisconsin Statutes. This program, administered by the State's Department of Health Services (the Department), is called Medical Assistance (MA) or Medicaid. In addition, Wisconsin has expanded this program to create the BadgerCare Plus programs under the authority of Title XIX and Title XXI of the Social Security Act and s. 49.471 of the Wisconsin Statutes. Federal statutes and regulations require that a state plan be developed that provides the methods and standards for reimbursement of covered services. A plan that describes the reimbursement system for the services (methods and standards for reimbursement) is in effect.

The following changes will be contained in the January 1, 2023 ambulance services state plan amendment.

— Create a Ground Emergency Medical Transportation (GEMT) reimbursement program for eligible public emergency medical transportation providers, pursuant to WI ACT 228.  

— Eligible public emergency Medicaid transportation providers that elect to participate in the GEMT program will be eligible to receive reimbursement for MA transports up to their costs as determined through an annual cost report process.

— Eligible providers that elect to not participate in the GEMT program will continue to be reimbursed at the established fee schedule rates.

— The GEMT payments will be funded by Certification of Public Expenditures (CPE) and matching federal Medicaid funds. No state general funds will be used.

Proposed Change

It is estimated that the total fiscal impact will be $ 46,351,936 consisting of federal funds and will not result in any increase in state fund spending.

Copies of Changes

Copies of the ambulance services reimbursement modification may be obtained free of charge by calling or writing:

Mail:

Bailey Dvorak

Bureau of Benefits Policy

Division of Medicaid Services

P.O. Box 309

Madison, WI 53701-0309

[phone]

Fax:

[phone]

Attention: Bailey Dvorak

E-Mail: [e-mail]

Copies of the state plan change will be made available for review at the main office of any county department of social services or human services.

Written Comments

Written comments are welcome. Written comments on the proposed changes may be sent by FAX, e-mail, or regular mail to the Division of Medicaid Services. The FAX number is [phone]. The e-mail address is [e-mail]. Regular mail can be sent to the above address. All written comments will be reviewed and considered.

The written comments will be available for public review between the hours of 7:45 a.m. and 4:30 p.m. daily in Room 350 of the State Office Building, 1 West Wilson Street, Madison, Wisconsin. Revisions may be made in the proposed change based on comments received.