Allows for reimbursement of transportation costs for emergency care without prior authorization by the social services official including emergency medical transportation by an ambulance service certified under article 30 of the public health law; authorizes the commissioner of health to establish a reimbursement methodology to ensure providers are reimbursed.
Summary
S03768 would change New York’s Medicaid transportation rules for emergency care. It removes the prior-authorization requirement for transportation to obtain emergency care, including emergency ambulance transportation by an ambulance service certified under Article 30 of the Public Health Law. The bill also directs the Department of Health to set a reimbursement methodology for eligible emergency transportation and care that pays providers at the greater of the current Medicaid rate or the Medicare allowable charge.
The reimbursement increase would be phased in over three state fiscal years: 33 percent in the first year the bill takes effect, 66 percent in the second year, and 100 percent thereafter. The bill further requires the state to reimburse 100 percent of the Medicaid expenditures for covered emergency transportation and care under the specified Social Services Law provision, after accounting for any federal funds received. The bill is intended to improve provider payment levels and reduce administrative barriers for emergency transport services.
Impact
The bill amends Social Services Law section 365-h to exempt emergency transportation from prior authorization requirements and adds a new reimbursement standard for ambulance services providing emergency transportation and care. It also amends Social Services Law section 368-a to require full state reimbursement of the covered medical assistance expenditures, net of federal funds, for transportation and care furnished under the emergency transportation provision. In practical terms, it would affect Medicaid administration, local social services officials, the Department of Health, ambulance providers, and eligible recipients needing emergency transport.
Sentiment
The available legislative history suggests generally favorable sentiment. The bill passed the Senate Health Committee unanimously, 13-0, indicating broad support at the committee level. The text and caption frame the measure as a provider reimbursement and access improvement bill, and there is no recorded opposition in the provided materials.
Contention
The main policy issues are likely to be fiscal and administrative rather than ideological. Potential points of contention include the cost to the state of increasing reimbursement to the greater of Medicaid or Medicare allowable charges, the phase-in schedule, and the shift away from prior authorization for emergency transport. Supporters would likely emphasize faster access to emergency care and more adequate ambulance reimbursement, while any concerns would center on state spending, Medicaid program costs, and implementation by the Department of Health and local social services agencies.
Same As
Allows for reimbursement of transportation costs for emergency care without prior authorization by the social services official including emergency medical transportation by an ambulance service certified under article 30 of the public health law; authorizes the commissioner of health to establish a reimbursement methodology to ensure providers are reimbursed.
Allows for reimbursement of transportation costs for emergency care without prior authorization by the social services official including emergency medical transportation by an ambulance service certified under article 30 of the public health law; authorizes the commissioner of health to establish a reimbursement methodology to ensure providers are reimbursed.
Allows for reimbursement of transportation costs for emergency care without prior authorization by the social services official including emergency medical transportation by an ambulance service certified under article 30 of the public health law; authorizes the commissioner of health to establish a reimbursement methodology to ensure providers are reimbursed.
Ground ambulance services; to prohibit balance billing and set minimum reimbursement rates by health care insurers to emergency medical service providers
Ground ambulance services; to prohibit balance billing and set minimum reimbursement rates by health care insurers to emergency medical service providers
Ambulance Service Provider Access Payment Program; relating to supplemental Medicaid reimbursement for ground emergency transportation; deleting certain requirement for reimbursement. Emergency.