As ground ambulance service providers in Ohio know all too well, the gap between the cost of providing emergency medical services (EMS) and the reimbursement rates from Medicaid has placed immense financial pressure on departments across the state. These pressures threaten the sustainability of essential, life-saving services, as EMS providers continue to contend with rising operational costs.
Recognizing this challenge, the Ohio Department of Medicaid (ODM) has introduced a solution—the Ohio Ambulance Supplemental Payment Program (ASPP)—designed to bridge the funding gap and help EMS providers remain financially viable. This blog will explore what the ASPP is, how it benefits providers, and how Public Consulting Group (PCG) can assist ambulance services in Ohio in successfully navigating the complexities of the program to maximize their Medicaid reimbursement.
The Financial Reality for Ohio EMS Providers
Medicaid reimbursement rates for ambulance services have not kept pace with the actual costs of providing those services. The average cost of an ambulance transport in Ohio is around $1,000, while Medicaid payments typically range from just $200 to $300. This significant disparity results in a shortfall for ambulance providers, making it challenging for many to cover the full cost of services, invest in necessary equipment, and maintain high levels of patient care to best support local communities.
For EMS providers, these financial challenges are nothing new. For years, departments have been underfunded for the critical role they play in the healthcare system. As operational costs such as fuel, personnel, and equipment continue to rise, ambulance services across Ohio are struggling to sustain their operations—leaving them in dire need of additional financial support.
The Ohio Ambulance Supplemental Payment Program: A Solution for EMS Providers
To address these challenges, Ohio Governor Mike DeWine signed into legislation on July 4, 2023, a bill that paves the way for the implementation of the Ambulance Supplemental Payment Program (ASPP). This initiative aims to provide additional revenue to EMS providers across the state, specifically those serving Medicaid beneficiaries.
This program will allow public ambulance providers to receive supplemental Medicaid payments that account for some of the difference between what it costs to provide transport services and what Medicaid currently reimburses. Through the ASPP program, Ohio EMS providers will have the opportunity to leverage existing EMS expenditures to generate additional Medicaid revenue. According to ODM, this program could generate up to $50 million in additional federal funding for the transport of Medicaid beneficiaries by ambulance providers across the state.
It is important to note that this ASPP program is not the first of its kind. More than 20 states currently have similar programs in place, with 10 more actively pursuing them. The implementation of Ohio’s ASPP program will follow this proven model, providing a much-needed financial boost for EMS providers who participate.
How Does ASPP Work?
ASPP works by supplementing the standard Medicaid reimbursement for ground ambulance transports. Providers that opt into the program and complete the required cost report will be eligible for supplemental payments that account for the actual cost of transporting Medicaid beneficiaries. This is a critical financial lifeline for departments that have been operating with significant unfunded costs.
As of May 2024, Public Consulting Group (PCG) has been actively collaborating with ODM to design the program, which involves the submission of a Preprint Form to the Centers for Medicare and Medicaid Services (CMS). This submission will mark the official start date of the program, meaning that once CMS approves it, providers will be able to retroactively submit claims for reimbursement, going back to the initial submission date.
However, it’s important to note that EMS providers who wish to participate in the first year of the program must opt in by mid-fall 2024.However, it’s important to note that EMS providers who wish to participate in the first year of the program must opt in by mid-fall 2024. Failure to do so could result in missing out on these critical supplemental payments during the initial year of the ASPP’s implementation.
The Benefits for EMS Providers
The primary benefit of ASPP is financial. For EMS providers struggling to cover the cost of services, the program offers the opportunity to close the gap between operational costs and Medicaid reimbursements. This additional funding will help departments maintain their operations, continue providing high-quality care, and invest in necessary personnel and equipment.
In addition to closing the funding gap, ASPP offers EMS providers a more sustainable financial model moving forward. By participating in the program, ambulance services can ensure they are adequately reimbursed for the critical, life-saving services they provide to Medicaid beneficiaries.
How Public Consulting Group (PCG) Can Help
Navigating the complexities of Medicaid supplemental payment programs can be daunting, especially for providers who are already stretched thin. This is where PCG can be an invaluable partner.
PCG has extensive experience in the design and implementation of Medicaid supplemental payment programs, having worked with over 550 EMS providers in more than a dozen states to establish this much-needed funding source. Our comprehensive services cover every aspect of the ASPP process, from initial program development and cost analysis to ongoing administrative support and compliance management.
PCG will handle all of the administrative work associated with the ASPP, alleviating the burden on EMS providers. This includes conducting cost analysis, preparing cost reports, and assisting with data collection to ensure that departments can draw down the maximum amount of federal funding. By working with PCG, Ohio EMS providers can focus on what they do best—delivering high-quality emergency medical services—while PCG ensures that they are fully compliant with all program requirements and maximizing their reimbursement potential.
Moreover, PCG’s services don’t end with the initial implementation. We offer ongoing support, including assistance with audits, post-payment reviews, and program updates. This end-to-end service model is designed to minimize the administrative burden on EMS providers while maximizing the financial benefits of the ASPP.
How to Participate
To participate in the ASPP, Ohio EMS providers must meet the following criteria:
- Provide ground emergency medical transportation services to Medicaid beneficiaries;
- Be enrolled as a Medicaid provider during the period being claimed;
- Be owned or operated by the state or a political subdivision of the state and employ or contract with licensed emergency medical service providers.
By meeting these criteria and opting into the program by mid-fall, providers can ensure they are eligible for supplemental payments during the first year of the ASPP.
Conclusion
The Ohio Ambulance Supplemental Payment Program offers a crucial financial lifeline for EMS providers across the state, helping to close the gap between Medicaid reimbursements and the true cost of providing services. By participating in this program, ambulance services can secure the funding they need to continue offering high-quality care to Medicaid beneficiaries.
PCG can guide EMS departments through the complexities of the program, ensuring that they maximize their Medicaid reimbursement and maintain full compliance with all program requirements. Don’t miss this opportunity—let PCG assist in applying for critical federal funding for your department. Contact us today to learn more!
