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07/19/2024 08:34 AM
Pennsylvania House of Representatives
https://www.legis.state.pa.us/cfdocs/Legis/CSM/showMemoPublic.cfm?chamber=H&SPick=20230&cosponId=42433
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House of Representatives
Session of 2023 - 2024 Regular Session

MEMORANDUM

Posted: April 3, 2024 02:51 PM
From: Representative Martin T. Causer
To: All House members
Subject: EMS Reimbursement - Treat No Transport
 
In the near future, I will be introducing legislation to assist our EMS agencies by providing proper Medicaid reimbursement for EMS calls in which treatment is provided but the patient is not transported to a hospital. It is important our ambulance companies, many of which are struggling financially, are properly reimbursed for the time, supplies, equipment and life-saving expertise they deliver to our constituents, regardless of whether the end result is a trip to the hospital.
 
A recent Legislative Budget and Finance Committee (LBFC) report issued pursuant to Senate Resolution 120 highlighted this issue and further explained that legislation passed in 2018 mandated that MCOs reimburse EMS agencies for “treat, no transport” calls based on “reasonable costs.”  Since that time the reimbursement has varied greatly and is often significantly less than the average cost for the service.
 
The issue of reasonable cost is complex for EMS agencies. Each agency has a cost of readiness, a fixed expense to staff EMS personnel ready to respond at any moment with supplies and lifesaving equipment. Call volume and inconsistent reimbursement rates and payments also impact the cost or readiness.
 
The LBFC report specifically recommended that the General Assembly consider implementing a specific state-directed payment or minimum fee for treat, no transport. This legislation will do just that by requiring Pennsylvania’s Medicaid program to reimburse EMS services for treat, no transport calls at the same rates required under the provisions of the fiscal code amendments approved last year.

Please consider joining me in sponsoring this important EMS initiative to address this issue and assist our EMS agencies with proper reimbursement for their life-saving services to our communities.



Introduced as HB2404