By Kecia Bal
The Tribune-Democrat
JOHNSTOWN, Pa. — Two key pieces of legislation could relieve some financial strain on emergency medical service departments – though long-term concerns remain.
The state House of Representatives unanimously passed two bills in June that the Ambulance Association of Pennsylvania says could increase the amount of money EMS departments recover from insurance companies. Those now rest in the state Senate’s banking and insurance committee.
“There are EMS agencies that are so hurting for money,” association Executive Director Heather Sharar said. “It’s not a perfect fix, but it gives some critical help.”
If the bills become law without significant changes, the association members say they will achieve key changes:
EMS departments would receive payment for treatment when transport is refused or unnecessary at a network’s contracted rate for the service provided.
They would give every EMS agency the ability to decide on its own to receive direct payment for services in exchange for not “balance billing,” or billing a beneficiary after receiving payment from an insurance company.
They would give EMS agencies the ability to opt into an insurer’s network and receive direct payment from the insurer for the service provided.
“Costs, of course, have increased,” Sharar said. “Getting the ambulance service paid is the best short-term fix. Long-term would like to see Medicare increase its rates.”
Emergency Medical Service providers have not received an increase in reimbursement for transporting people covered by Medicaid for more than a decade.
The current rates for transport are $200 for an advanced life support trip and $120 for a basic life support trip – nowhere near the actual cost, Sharar said.
Both state bills have been committed to the Senate Banking and Insurance Committee, where similar measures have stalled.
But state Sen. Don White, R-Indiana, committee chairman, said in email responses that he is hopeful that a resolution can be reached – but he is most concerned about the Medicaid issues.
“My committee actually reported out SB 401 on June 11, 2013,” he said. “This bill would have required insurers to directly pay EMS providers, but would have also prohibited EMS providers from billing a patient for more than what was paid by their insurer.
The Ambulance Association could not agree to this bill and, as a result, it was tabled.”
White said he is reviewing the bills passed by the House in June and has asked Gov. Tom Wolf’s administration whether it is in support of them.
“The bills passed by the House are very different than those passed in previous sessions and must be seriously considered,” White said. “However, I think the most important issue for EMS is to increase the reimbursement to EMS providers for Medicaid patients. The reimbursement for services provided to Medicaid patients has not been increased since 2004 and it is one of the main reasons EMS providers are feeling a financial pinch.
“Addressing the Medicaid reimbursement would provide real relief to the EMS system by enhancing revenues, particularly in light of the increasing population covered by Medicaid.”
White is among the state legislators who have received tens of thousands in campaign donations from the Insurance Federation of Pennsylvania, but White said he works on behalf of his constituents’ interest.
“I’m confident that if you would contact the leadership of the Ambulance Association, and the main EMS provider in Indiana County (Citizens’ Ambulance Service) they would tell you I’ve not only had an open door on every issue, but have worked very hard to reach consensus on their legislative priorities,” he said. “More importantly, I’ve carried the banner for an increase in Medicaid reimbursements and worked to provide direct support to the EMS providers that serve my constituents. I’ll continue that work because EMS services are important to my constituents – and their interests are the only ones I represent in Harrisburg.”
Sam Marshall, president and CEO?of the Insurance Federation of Pennsylvania, said the group does have a political action committee, but that the EMS-related bills are one of a number of ongoing issues the organization keeps an eye on and that donations don’t come with strings attached.
“Do we have a pol action committee?” he said. “Yes, we do. Do we have tally sheets or anything like that? No.”
Ambulance reimbursements are a longstanding issue, he said, but private insurance payments are “a relatively small part of their reimbursement pie.”
“Medicare and Medicaid are a major part of reimbursement services,” he said. “That’s not us.”
Cutting balanced billing, he said, helped the measures on the table progress.
“The concern on the insurance side has been not so much insurance company but consumers,” Marshall said. “The ambulance has always said: ‘Why not just pay us directly?’
“We have said we’re happy to do that so long as you don’t balance bill the consumer beyond copay and deductible.
“We’re willing to pay the ambulance company directly, so long as the ambulance company does not then go and bill the consumer still more. We have a responsibility to our policy holders.”
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©2015 The Tribune-Democrat (Johnstown, Pa.)