SB 826

This bill implements an ambulance service provider assessment on private

ambulance service providers for supplemental reimbursements under the Medical

Assistance program and a supplemental reimbursement under the Medical

Assistance program to public ambulance service providers though certified public

expenditures. Currently, the Department of Health Services administers the

Medical Assistance program, which is a joint federal and state program that provides

health services to individuals who have limited financial resources. Generally, under

the Medical Assistance program, the state provides its share of the funding for

benefits and the federal government then contributes its designated share of

funding, also known as federal financial participation.

The bill imposes on each ambulance service provider a fee for the privilege of

doing business in Wisconsin. The fee, as established by DHS is a percentage of the

ambulance service provider's net patient revenues from ground emergency

ambulance transports such that the total fee for a fiscal year is no less than one

quarter of 1 percent lower than the maximum limit for a provider fee under federal

regulation. DHS must obtain approval from the federal government, if necessary, to

obtain matching funds, and if federal approval is required, is prohibited from

collecting the fee until DHS receives that approval. The bill requires DHS to expend

the moneys collected from the fee assessment to supplement reimbursements to

ambulance service providers for services provided on a fee-for-service basis and

through managed care to Medical Assistance program recipients.

The bill also requires DHS to submit a state plan amendment to the federal

government to allow supplemental reimbursements under the Medical Assistance

program to public ambulance service providers for ground emergency medical

transportation through certified public expenditures. In certain circumstances

under the certified public expenditure process under current federal law, a public

provider may certify its costs for providing services to Medical Assistance recipients

that are in excess of the usual Medical Assistance reimbursement for those services

and then receive a supplement to cover otherwise unreimbursed costs.