FAQ’s – Enhanced Medicaid Reimbursement

Frequently Asked Questions

What is the purpose of the Ground Ambulance Assessment Program?

Improve access to EMS in TN by increasing EMS response vehicles on the streets and enhanced pre-hospital cardiac therapy/treatment 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.

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.

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.

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.

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:

(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.