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016.06.79-9. Emergency medical transportation access payments.

AR ADC 016.06.79-9Arkansas Administrative CodeEffective: November 1, 2020

West's Arkansas Administrative Code
Title 016. Department of Human Services
Division 06. Division of Medical Services
Rule 79. Administrative Procedures for the Emergency Medical Transportation Assessment Fee and Access Payment
Effective: November 1, 2020
Ark. Admin. Code 016.06.79-9
016.06.79-9. Emergency medical transportation access payments.
Currentness
To preserve and improve access to medical transportation services, for medical transportation services rendered on or after July 1, 2019, the Division shall make emergency medical transportation access payments as set forth in this section. These access payments are considered supplemental payments and do not replace any currently authorized Medicaid payments for medical transportation services.
Eligibility: Medical transportation providers eligible to receive emergency medical transportation access payments are those medical transportation providers:
(A) Subject to the assessment imposed under Ark. Code Ann. ยง 20-77-2803; and
(B) That apply to receive the emergency medical transportation access payments as provided herein.
Application:
(A) Not less than one-hundred eighty (180) days prior to the beginning of each state fiscal year, the Division will send to all qualified licensed medical transportation providers an application for emergency medical transportation access payments. The application will:
a. Allow the medical transportation provider to submit all information needed to calculate that medical transportation provider's average commercial rate;
b. Provide that the application must be received by the Division on a date certain which will be no less than one hundred twenty (120) days prior to the beginning of the state fiscal year;
c. Explain that, unless exempt from payment by law, the medical transportation provider will be required to pay the medical transportation provider assessment even if it fails to apply for the emergency medical transportation access payments; if it fails to supply the Revenue Survey the assessment will be calculated based on the state average assessment for that year; and
d. Explain that the medical transportation provider will not be eligible to receive emergency medical transportation access payments in the next fiscal year if the application is not timely filed but will still be assessed based on the average assessment.
(B) A medical transportation provider that has previously received emergency medical transportation access payments is required to make an application for such payments and provide the Revenue Survey every year.
Calculation of Average Commercial Rate:
(A) The emergency medical transportation access payment shall be determined in a manner to bring the payments for these services up to the average commercial rate level as described herein. The average commercial rate level is defined as the average amount payable by the commercial payers for the same service.
(B) The Division shall align the paid Medicaid claims with the Medicare fees for each healthcare common procedure coding system (HCPCS) or current procedure terminology (CPT) code for the ambulance provider and calculate the Medicare payment for those claims.
(C) The Division shall calculate an overall Medicare to commercial conversion factor for each qualifying medical transportation provider that submits an emergency medical transportation access payment application by dividing the total amount of the average commercial payments for the claims by the total Medicare payments for the claims.
(D) The commercial to Medicare ratio for each provider will be re-determined every year.
Payment Methodology:
(A) The emergency medical transportation access payment to each eligible medical transportation provider shall not exceed the sum of the difference between the Medicaid payments otherwise made to these providers for the provision of emergency medical transportation services and the average amount that would have been paid at the equivalent community rate, expressed as the average commercial rate.
(B) The emergency medical transportation access payment shall be determined in a manner to bring payments for these services up to the community rate level.
(C) The specific payment methodology to be used in establishing the emergency medical transportation access payment due to each eligible medical transportation provider is as follows:
a. The Division will identify the emergency medical transportation services in the payment period for which the eligible medical transportation provider is eligible to be reimbursed.
b. The Division will calculate the reimbursement paid to the medical transportation provider for the provision of emergency medical transportation services in the payment period.
c. The Division will calculate the medical transportation provider's average commercial rate for the provider's services.
d. The Division shall calculate the medical transportation provider's upper payment limit gap by subtracting actual Medicaid services in the payment period from the amount that would have been paid using the medical transportation provider's average commercial rate.
e. The Division shall reimburse all eligible providers the same proportion of their upper payment limit gap, up to the lesser of:
i. the total computable generated from the available balance in the Medical Transportation Assessment Account; or
ii. 80 percent (80%) of the eligible medical transportation provider's upper payment limit gap.
(D) Emergency medical transportation access payments shall be made quarterly.

Credits

Adopted Nov. 1, 2020.
Current with amendments received through February 15, 2024. Some sections may be more current, see credit for details.
Ark. Admin. Code 016.06.79-9, AR ADC 016.06.79-9
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