FAQ’s – Enhanced Medicaid Reimbursement

Frequently Asked Questions

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.

How is the assessment program funded? 

The program is funded through a combination of state dollars raised through a broad-based and uniform ambulance tax and federal matching funds.

How much is the increased reimbursement?

The increased reimbursement is $140.30 for each paid allowable Medicaid claim during the identified period. Increased reimbursement is for claims “paid” during this period – not date of service. This does not change current and normal payments for claims as this will be in addition to those payments.

5-1-2018 Due to a low collection rate of assessments and an increase in the number of paid TennCare claims, the rate for increased reimbursement is being revised from $140.30 to $122.26.

10-7-2022 With the recent change to include emergencies only, the new increased reimbursement for SFY23 is $229.50

Payments (aka kicker payments) SFY22 Q3, Q4 and SFY23 all quarters: $229.50 per emergency TennCare claim paid in the respective quarter. Qualifying paid TennCare claims = HCPCS codes: A0427, A0429, A0433, A0434. Example: ABC Ambulance Service was paid for 365 qualifying TennCare claims during SFY Q3. The kicker payment for this quarter would be: 365 x $229.50 = $83,767.50 

How often will we receive payments?

Payments will be issued quarterly. These payments will be based on medicaid transports that occurred each quarter for calendar year 2017 (CY2017). As we move into Fiscal Year 2018-19, payments will be based on quarterly medicaid transports beginning January 1, 2018 (CY2018).

5-1-2018 CMS (Medicare) has directed TennCare to use a more current reflection of data for calculating the increased reimbursements. This has caused TennCare use 1st quarter 2018 (Jan 2018 – Mar 2018) reimbursed TennCare claim numbers instead of 3rd quarter 2017 to pay the 3rd quarter payments being sent out in May 2018.

10-7-2022 Payments are based on adjudicated emergency Medicaid claims paid during the previous quarter.

How will the payment be delivered?

TennCare has directed each MCO to deliver supplemental payments to providers that correspond to their submitted claims recorded during a given quarter.  These will be paid out as physical checks from the regional branches of the three MCOs—AmeriGroup, Blue Cross, and UHC.

10-7-2022 Supplemental payments are made in the same manner as normal claims for the provider (i.e. check or EFT).

How much is the assessment and when is it due?

Each qualifying ground ambulance service will be assessed $9.09 per transport in SFY 2018 – regardless of insurer and/or payment for claims. This encompasses ALL transports as reported to the state Office of EMS during the service’s annual audit. The base period for counting transports is CY 2016. Assessment payments to TennCare are due 30 days from date of invoice. Please direct all payment and assessment inquiries to TennCare.Assessments@tn.gov.

10-7-2022 With the recent change to only include emergencies only, the new assessment for SFY22 Q3 and Q4 is $26.32. The assessment rate for SFY23 will be $20.43

Assessments (invoices) SFY22 Q3 & Q4 (Jan-Mar & Apr-Jun 2022): $26.32 per emergency response that resulted in a transport in 2020. Example: ABC Ambulance Service made 5,648 total emergency responses that resulted in transport in 2020. This number is divided by 4 to get the per quarter responses then multiplied by the assessment rate. (5,648 / 4) x $26.32 = $37,163.84 each quarter.

Assessments (invoices) SFY23 Q1, Q2, Q3 & Q4 (July-Sep, Oct-Dec, Jan-Mar, Apr-Jun 2023): $20.43 per emergency response that resulted in a transport in 2021. Example: ABC Ambulance Service made 6,823 total emergency responses that resulted in transport in 2020. This number is divided by 4 to get the per quarter responses then multiplied by the assessment rate. (6,823 / 4) x $20.43 = $34,848.72 each quarter.  

What can we use this money for?

That is up to each ground ambulance provider service. However, the goal of this program is to provide improved access to EMS services throughout TN with increased EMS response vehicles and enhanced pre-hospital cardiac therapy/treatment. This goal has been communicated to the federal Center for Medicare and Medicaid Services (CMS) in our application for this program.

Revised language from 2017-18 legislative session that addresses this question:

71-5-1501.
(a) This part shall be known and may be cited as the “Ground Ambulance
Service Provider Assessment Act.”
(b) The intent of this part is to enhance EMS services and improve
access to emergency medical pre-hospital care in this state.