WASHINGTON — A proposed rule could significantly affect long-term reimbursement for Ground Emergency Medical Transportation programs nationwide.
The rule, proposed Centers for Medicare & Medicaid Services (CMS), would etablish a formal provider-specific payment limit on certain targeted Medicaid supplemental payments to transportation providers, including GEMT, air ambulance and NEMT providers, PWW|AG said in a press release.
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The proposed limits would not take effect until rating periods beginning Jan. 1, 2029, but could have long-term implications for EMS reimbursement strategy and supplemental payment programs, PWW|AG said.
Under the proposal, targeted Medicaid supplemental payments for GEMT providers would be capped at equivalent Medicare Ambulance Fee Schedule rates for comparable services.
CMS said those payments could not exceed applicable Medicare AFS amounts, including base rates, mileage, geographic adjustments and rural or super-rural add-ons.
For example, if the Medicare Ambulance Fee Schedule rate for an ALS emergency transport in a provider’s area is $450, that amount could become the maximum reimbursement available through the GEMT program, including payments already received from Medicaid.
If finalized, the rule could change how GEMT programs are funded and limit future Medicaid supplemental reimbursement for ambulance agencies nationwide, PWW|AG said.
