NWFR seeking reimbursement for transport of Medicaid recipients

By Stefanie Donahue

North Whatcom Fire and Rescue (NWFR) is enrolling in a new state program that reimburses public organizations for transporting Medicaid recipients.

The program, called Ground Emergency Medical Transportation (GEMT), was established as a result of House Bill 2007 that was passed by the state legislature during the 2015-16 session. It’s open to publicly-owned or operated organizations that provide ground emergency transportation to Washington Apple Health Medicaid recipients and funds the actual cost of transport.

“Federal monies have always been available to assist with the actual cost of providing care to patients that are on Medicaid programs. Until recently, only hospitals were able to take advantage of this program,” NWFR fire chief William Pernett said in a presentation to the NWFR fire commissioners. “EMS transport agencies have never had access to these monies due to a lack of legislation allowing access and instead have settled for reimbursement that does not reflect our actual costs.”

The district currently charges a base rate of $585, plus $15 per mile, for ground emergency medical transportation, Pernett said, but the actual cost of transport exceeds that amount. NWFR currently receives reimbursement of $115 for basic life support and $168 for advanced life support for the transport of Medicaid recipients.

Once enrolled in the GEMT program, the district will be reimbursed up to 66 percent of the actual cost to provide ground transportation to Medicaid patients, which according to a feasibility study that looked at the district’s 2016 fiscal year, amounts to $9,057.

In 2016, NWFR transported 660 individuals; 230 of them were Medicaid recipients. The total cost to transport Medicaid recipients was $2,038,331. If enrolled in the program, the district would have received 66 percent of that cost, or $1.3 million, adding to a total annual budget of $7,472,280.

Pernett said the estimates were very generous and he expects the program to generate approximately $700,000 annually. Either way, “It’s a huge chunk of change,” he said.

So far, the district submitted three applications to the Washington State Health Care Authority (HCA), which oversees the program, to seek reimbursement for 2017, 2018 and 2019. Next, the district will submit a cost report to the HCA so it can establish a new rate for billing. Once that step is complete, NWFR stands to receive reimbursement for the 2017 fiscal year as early as August, Pernett said.

The money will be placed in the capital budget, which can be used to repair facilities.