What is the purpose of the Ground Ambulance Assessment Program?
To enhance EMS services and improve access to emergency medical pre-hospital care in this state through increased Medicaid reimbursement payments.
Frequently Asked Questions (FAQ)
To enhance EMS services and improve access to emergency medical pre-hospital care in this state through increased Medicaid reimbursement payments.
The program is funded through a combination of state dollars raised through broad-based, uniform ambulance provider assessment fees and matching federal funds.
The supplemental payment (also known as the kicker or directed payment) is $229.50 for each paid, allowable emergency-coded TN Medicaid claim during the identified quarter.
Supplemental payments apply strictly to claims paid during this specific period—not necessarily based on the date of service. This setup does not change current and normal payments for claims, as these kicker payments will be handled and submitted entirely separately.
Payments will be issued quarterly. These payments are calculated using Medicaid paid claims from the previous quarter.
Effective beginning SFY22 Q3: Payments are strictly based on adjudicated emergency Medicaid claims paid during the previous quarter.
TennCare directs each Managed Care Organization (MCO) to deliver supplemental payments to providers corresponding to their submitted claims recorded during a given quarter.
These will be paid out in the same manner as normal claim payments (e.g., EFT or paper checks) directly to the specific EMS service. Disbursements will come from the regional branches of the three major MCOs:
Effective for SFY24, each qualifying ground ambulance service will be assessed $20.00 per emergency response that results in a transport—regardless of the insurer or eventual payment status of the claims.
These transport numbers are derived from the TN Office of Emergency Medical Services’ TNEMSIS database and pull data from two quarters behind. For example, SFY24 Q1 assessment invoices are based upon transport volume recorded during SFY23 Q3.
Effective beginning SFY22 Q3: Assessments are fundamentally based on emergency responses that result in a transport.
Due Date: Assessment invoice payments to TennCare are due exactly 30 days from the date listed on the invoice.
There is no specific usage restriction or granular requirement on how these funds must be spent. However, TN Code Annotated § 71-5-1502 defines the core purpose of the Ground Ambulance Service Provider Act is “to enhance EMS services and improve access to emergency medical pre-hospital care in this state.”
Per TN Code Annotated § 71-5-1506 (Policy Measures to Ensure Enforcement and Compliance — Penalties — Quarterly Transport Count Data):
The bureau has full authority to establish policy measures ensuring enforcement and compliance. An ambulance provider that fails to pay an assessment when due shall pay a penalty of fifty dollars ($50.00) per calendar day for each day the assessment remains unpaid in full past the due date.
Payment Plans & Extensions: The bureau may opt to waive penalties for a delinquent provider if they enter an approved payment plan. If the provider fails to strictly follow the terms of that plan, all waived penalties may be immediately reinstated.
Additional Enforcement Actions include, but are not limited to:
wd