The Ground Emergency Medical Transportation (GEMT) Program is a federally funded initiative that provides supplemental funding to publicly operated ambulance service providers registered with Medicaid. The program allows municipalities an opportunity to collect an additional Medicaid reimbursement for ambulance services, above and beyond what the State currently reimburses for Medicaid claims for emergency transportation. The GEMT supplemental payment methodology allows public providers to receive additional compensation above the current fee schedule rates, if their cost to provide the services exceeds the standard reimbursement amount.
The standard reimbursement for ambulance transports for those covered by Medicaid is significantly less than actual costs experienced by the Village. Under the Illinois Health & Family Services (HFS) Department's Transportation Fee Schedule, the standard reimbursement for ambulance transport of persons covered by Medicaid is approximately $250 per transport. Participation in the GEMT Program offers a revenue sharing opportunity with HFS which has helped to cover the funding gap between the reimbursement amount and the actual cost to provide services. For the last 3 years, the Fire Department has submitted an annual cost report to the State, identifying our cost per transport based on actual expenses incurred. Pursuant to the terms of the Illinois GEMT Program Intergovernmental Agreement (“IGA”), the Village is entitled to keep 50% of these federal funds and disburse the remaining 50% of the funds to the State of Illinois.
As an increasing number of Illinois municipalities have become participants in the GEMT Program, the Centers for Medicaid and Medicare Services (CMMS) and Illinois Health and Family Services have begun to look more closely at submitted cost reports. Though much attention so far has been given to outlier reports, HFS has indicated that their next focus may be significant variations between local billing rates and GEMT rates, as federal guidelines stipulate that Medicaid cannot be charged more than private insurance. Therefore, it is suggested that GEMT rates, which the Village has indicated are based upon actual costs of service, and published (ordinance) ambulance service billing rates be equal and that steps to ensure the uniformity of billing rates should be taken as soon as possible. Agencies will have some flexibility on this during 2024 but should make changes to adopt a standard uniform rate based on the cost report for 2025.
Currently, the Fire Department, through our 3rd party billing company, bills a flat fee of $1,500.00 for providing emergency medical transportation to the hospital. This fee is billed to the patient’s private insurance, Medicare, Medicaid, or, when no medical insurance is available, the patient themselves. The Village does not balance bill Arlington Heights residents. This billing rate was last updated in 2018. Based on our most recently submitted cost report, for expenses realized in 2022, our actual cost per transport, as approved by HFS, is $2,458.64 (BLS) and $2,304.98 (ALS).
Recommendation
At this time, the Fire Department is recommending that the Village Board consider an Ordinance establishing ambulance service fees at a rate commensurate with the Village’s actual costs of providing such ambulance services, as determined annually by HFS through the GEMT process. Applying this calculation to all emergency medical transportation service patient bills would satisfy the rate alignment requirement and allow the Village to recover costs closer to the actual cost of services rendered. We also recommend that the Ordinance be revised to allow for the automatic update of the ambulance billing rate based on the GEMT rate approved annually by HFS.