Tag: Provider

MM Curator summary

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

 
 

[MM Curator Summary]: In which WA ambulance companies get $14M more a year, with some of it coming from higher mileage rates for the 50% of their rides that are really taxi rides. Uber anyone?

 
 

Clipped from: https://kpq.com/washington-ambulance-companies-feeling-better-after-medicaid-boost/

 
 

Ambulance companies across Washington State are feeling better after lawmakers increased their funding to carry non-emergency patients from point-to-point. 

The increase of nearly $14 million applies specifically to non-emergency Medicaid calls, which had not had a boost in funding for 19 years. 

Washington Ambulance Association President Mike Battis says Governor Inslee and the State Health Care Authority, which oversees the Medicaid program in Washington, supported the increase, but drumming up support in the legislature was more difficult. 

“I personally spent weeks over there this winter, living in hotels and meeting face to face with elected officials, kind of pleading our case,” said Battis. 

The increase in funding is seen as a major step in the right direction, but ambulance companies will still lose money on non-emergency Medicaid calls. 

“It’s the first step forward we’ve seen in two decades,” Battis said. “So, it’s refreshing and it’s encouraging that in the future, maybe, we can continue to use this as a steppingstone to get some more fiscal relief where it’s not losing money every time we go see a Medicaid patient.” 

Battis is also the Director of Operations for Ballard Ambulance in Wenatchee. He said about half their calls are for non-emergency transportation of patients, mostly through Medicaid or Medicare. 

Medicare reimburses at a better rate than Medicaid, which allows ambulance companies to more easily recover costs and break even on the calls. 

The Medicaid boost of $13.87 million from the legislature came through a line-item expenditure in the state operating budget. 

It amounts to a 64% increase for non-emergency advanced life support (ALS) ambulance service, which requires a paramedic on board, along with an Emergency Medical Technician.  

The boost is 80% for basic life support (BLS) transport, which is for patients with less severe conditions and requires two Emergency Medical Technicians.  

The increase is 35% to cover milage costs.  

Ambulance companies are only reimbursed for the miles a patient is transferred through Medicaid and Medicare. If a service such as Ballard is called to pick up and transport a patient from Colville to Spokane, Ballard is stuck with the costs of driving from Wenatchee to Colville, and from Spokane back to Wenatchee. 

Non-emergency calls take place when ambulances haul patients on scheduled trips, typically between two different hospitals or health care providers.  

The Medicaid non-emergency reimbursement rate has been so low that one of the largest ambulance companies in the world, Falck, recently pulled out of Washington state.  

The new rates go into effect on July 1. 

About 70-80 percent of calls handled by Washington ambulance agencies involve Medicaid or Medicare patients. 

MM Curator summary

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

 
 

[MM Curator Summary]: There is no Medicaid provider network in New Mexico. (Practically speaking).

 
 

Clipped from: https://www.abqjournal.com/2557265/study-calls-to-medicaid-providers-are-mostly-futile-ex-only-about-1.html

SANTA FE – A “secret shopper” accountability study shows that medical patients can’t readily schedule appointments by phone through Medicaid providers in New Mexico, even as the state and federal government spend $8.8 billion annually on the health care program that serves nearly half of state residents.

The budget and accountability office of the Legislature presented its findings Tuesday to a panel of lawmakers as evidence of an inadequate network of health care providers.

The agency surveyed private providers of Medicaid health care services as well as providers of mental health and addiction counseling. About 13% of attempts to make an appointment were successful.

“That’s almost 90% of the time – almost all of the time – that they can’t get an appointment,” said Democratic state Sen. Nancy Rodriguez of Santa Fe, responding to the report. “So their health, obviously to me, would get worse in time if they can’t be seen by good medical care or any medical care at all.”

In about half of calls, appointments could not be made because of inaccurate phone listings or voicemails that went unreturned.

When primary health care providers were reached by phone, more than one-quarter were either not accepting new patients or had left the listed medical practice. The study found that patients who were able to connect with Medicaid care providers confronted waiting lists or appointment times that exceeded contractual requirements.

The consumer-protection survey was part of a broader program evaluation indicating that New Mexico residents who are enrolled in Medicaid are not using more services even as enrollment and spending on the program have surged.

Nicole Comeaux, director of the state’s Medicaid program, told legislators that satisfaction surveys of Medicaid participants have shown consistent improvements since 2019 – though about 7% of respondents reported an absence of medical providers.

She outlined initiatives aimed at shoring up networks of medical providers, including requirements that 90% of Medicaid spending go toward medical care and not administrative costs.

Enrollment in Medicaid has climbed by 16% since 2019, according to program evaluators for the Legislature. Spending is up 56% over the same period. But per-patient use of certain Medicaid physical care services declined or remained steady. Program evaluators for the Legislature say pandemic-related curtailments in medical services could be partly to blame.

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Managed care organizations, which manage the delivery and payment of health care services for people using Medicaid insurance, are required to conduct their own secret-shopper surveys. A review of those surveys found there was no standard methodology and that some overbooked medical providers were exempt from participation.