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 assessment fees and federal matching funds.

How much is the increased reimbursement?

The increased reimbursement (aka kicker payment, directed payment) is $229.50 for each paid allowable TN Medicaid claim during the identified period. Increased reimbursement is for claims “paid” during this period – not necessarily the date of service. This does not change current and normal payments for claims as these payments will be handled and submitted separately.

Example: ABC Ambulance Service was paid for 365 qualifying TennCare claims during the most recently completed quarter. 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 in the previously completed quarter.

Effective beginning SFY22 Q3: Payments are based on adjudicated emergency Medicaid claims paid during the previous quarter.

 How will the payment be delivered?

TennCare directs each MCO to deliver supplemental payments to providers that correspond to their submitted claims recorded during a given quarter. These will be paid out in the same manner as normal claim payments are made (i.e. EFT or paper checks) to the specific EMS service. These payments will come from the regional branches of the three MCOs—AmeriGroup, Blue Cross, and UHC.

How much is the assessment and when is it due?

Beginning with SFY23, each qualifying ground ambulance service will be assessed $20.43 per emergency response that results in a transport – regardless of insurer and/or payment for claims. These transports are derived from the TN Office of Emergency Medical Services’ TNEMSIS database.

Currently, data is collected for the most recently completed calendar year for each ground ambulance provider. Those numbers are divided by 4 to create the quarterly assessment.

Example: ABC Ambulance Service made 5,648 total emergency responses that resulted in a transport in 2021. This number is divided by 4 to get the per quarter responses then multiplied by the assessment rate. (5,648 / 4) x $20.43 = $28,847.16 each quarter.

Assessment payments to TennCare are due 30 days from the date of invoice.

Please direct all payment and assessment inquiries to TennCare.Assessments@tn.gov.

What can we use this money for?

There is no specific requirement on how the funds must be used. However, TN Code Annotated § 71-5-1502 defines the purpose of the Ground Ambulance Service Provider Act is to “to enhance EMS services and improve access to emergency medical pre-hospital care in this state.”

What are the penalties for non-payment or delinquent payment for the assessment invoices?

Per TN Code Annotated § 71-5-1506. Policy Measures to Ensure Enforcement and Compliance — Penalties — Quarterly Transport Count Data

  1. The bureau has the authority to create policy measures that ensure the enforcement and compliance of this part. The bureau shall require an ambulance provider that fails to pay an assessment due under this part to pay the bureau, in addition to the assessment, a penalty of fifty dollars ($50.00) per calendar day for each day the assessment remains unpaid in full after the date due. The bureau may waive penalties for a delinquent provider if the provider has entered into a payment plan approved by the bureau. If the provider fails to comply with the terms of the payment plan, then the bureau may reinstate the waived penalties. Other enforcement measures determined by the bureau include, but are not limited to, recoupments, withholding of future payments, and loss of medicaid ID.