Another example of a growing number of state legislature’s stepping up to make EMS reimbursement reform a priority. 

This bill not only provides a mechanism for reimbursement for Treatment in Place and Transport to Alternate Destinations, but also removes patients from balance billing disputes by requiring state regulated health plans to reimburse EMS at billed charges, or at least 325% of the Medicare allowable fee.

It was announced yesterday that Governor Tate Reeves signed this bill into law!

Link to the legislation below.

-----------------

Bill to increase third-party reimbursements for EMS headed to governor

By Anthony Warren

Apr. 24, 2024

https://www.wlbt.com/2024/04/24/bill-increase-third-party-reimbursements-ems-headed-governor/

JACKSON, Miss. (WLBT) - A bill that will increase compensation for ambulance service providers is on its way to the governor’s desk.

On Wednesday, the state House of Representatives adopted the committee report for H.B. 1489, the “Mississippi Triage, Treat and Transport to Alternative Destination Act,” a bill that would, in part, increase how much insurance companies must pay ambulance firms for services provided.

The House approved the committee report on a 119-0 vote, with three representatives absent or not voting.

The Senate approved the report last week on a 50-0 vote, with one senator absent or not voting, and another senator voting present.

Julia Clarke, president of the Mississippi Ambulance Alliance, was sitting in the House gallery when the measure was approved.

“With this legislation, Mississippi would join our neighbors [in] Louisiana, Texas, Arkansas, and other states in recognizing this is a first-responder cost-of-readiness issue for ambulance providers large and small,” she said. “I’m so pleased they [passed] it.”

Under the act, third-party payors would be required to pay for treatment in place when a patient is not transported to a hospital.

That amount would be the local fees set by the city or county contract or 325 percent of Medicare, whichever is greater. In the absence of a local rate, the ambulance provider would be paid their billed charges or 325 percent of Medicare, whichever is greater, Clarke explained.

Figures provided by the Ambulance Alliance show EMS providers in the state charge between $988 and $1,224.82 for a basic life support emergency response in urban areas. Medicare reimburses those companies just $398.56.

Basic Life Support ambulances are staffed with two EMTs, rather than an EMT and a paramedic. EMTs are trained to provide emergency first aid, assess a person’s condition and determine the treatment needed, and administer some medications, such as epinephrine, according to WebMD.

State Health Officer Dr. Daniel Edney backed the measure, saying the funding will be a major boost for EMS providers, who are currently not paid when a patient refuses transport, or if they’re transported to a facility other than a hospital.

“If an ambulance goes to a home and there’s a diabetic whose blood sugar has dropped, they correct it and stabilize the patient, and the patient [who needs] to go to the ER chooses not to go, then they’re not reimbursed for the services they just provided, which makes no sense,” he said.

“They need to be reimbursed for the care that [they’re] rendering and the cost of that care, which includes running an ambulance and doing all the things it takes to have an ambulance ready to go.”

----------------

Governor Tate Reeves signed into law HB1489

https://billstatus.ls.state.ms.us/documents/2024/pdf/HB/1400-1499/HB1489SG.pdf

From their legislative team:

As a summary, the 1489 bill mandates for Health Benefit Plan Private Insurance to:

• To pay for Treatment in Place (TIP) (lines 61- 96)

• Pay for trips that are Transported to Alternate Destinations (TAD) (lines 39 -54)

• The reimbursement rate for an ambulance service provider whose operators assess, triage, treat or transport an enrollee to an alternative destination shall be not less than the minimum allowable reimbursement for advanced life support rate with mileage to the scene. (line 87-91)

• Out of Network Ambulance to reimbursed for all covered services, which will now include TIP and TAD, at the greater of:
• • Contracted rates between ambulance service and county, municipality, special district or by ordinance (lines 95-103)
  • 325 % of Medicare for respective services originating in the respective geographical area (lines 107-109)
  • The ambulance providers billed charges in the absence of contracted rates between ambulance service and county, municipality, special district or by ordinance (line 104-111)