What we need to do as an industry:  We need to mobilize EMS Providers and their employees in each district and in Rep. Carbaugh’s District to reach out before next Wednesday and fill the room at the committee hearing. 

 

What are we asking to be done:  We would like the bill amended to delete the current language (attached) and include the proposed language (attached).  The proposed language will hold patient’s harmless from a balance/surprise bill but will provide an avenue for out of network providers and insurance companies to reach resolution if a negotiated rate cannot be reached (through arbitration through the Dept. of Insurance). 

 

What is wrong with the current language in the bill:  This language solves the surprise/balance bill issue (i.e. patients receiving large bills) but does not address the cause of this problem.  The reason so many EMS providers are out of network is because the in network rates which are offered to ambulance providers are below are cost to provide services since those rates are based on Medicare rates.  In Fall 2018 the largest insurance provider in IN (Anthem) sent notices to all out of network providers setting their out of network rate schedule at the in-network rate which resulted in larger balanced bills to the patient.  For example, a bill for $800 from an out of network EMS provider would result in an Anthem payment of $251.00 (which is sent to the patient for the ambulance provider to collect) and a balance bill of $549.00 would be sent to the patient.  If the EMS provider was in-network, a payment of $251.00 would be sent to the ambulance provider.  The current language in HB1372 requires the out of network provider to accept the in-network rate of $251.00 and prohibits the balance bill.

 

What will happen if the current HB 1372 language becomes law:  On average 70 % of all EMS reimbursement in Medicare and Medicaid - currently IN Medicaid pays EMS providers less than what was paid in 1976 which is less than it costs to perform an ambulance transport and Medicare also reimburses rates which are below the costs necessary to have 24/7 EMS.    Many elements of EMS costs (equipment, vehicle specifications, staffing, response times, level of service, protocols, medications, annual education, etc.) are regulated by local and state regulation, therefore there is limited ability to reduce costs.  For 911 EMS, providers are obligated to transport regardless of ability to pay so there are many transports which result in no payment.  For non-911 transports including hospital discharges and hospital to hospital transports, EMS providers are notified within a matter of hours for these urgent transports and the costs associated are the same as 911 and are regulated.  Overall, this legislation will  result in the following:

A piece of legislation which was filed this week in Indianapolis which would be devastating to the Indiana EMS industry as a whole.  In short, this language will reduce the amount of reimbursement we can receive from insurance for ambulance transports.  Currently IN Medicaid pays us less than what we were paid in 1976 of what it costs us to perform an ambulance transport and Medicare also reimburses us a rate which is below our cost to perform services.  Furthermore, since many elements of EMS costs are mandates by local and state regulations (equipment, vehicle specifications, staffing, response times, level of service, protocols, medications, annual education, etc.) we are limited in our ability to reduce costs. 

 If this legislation passes, it will limit our ability to purchase new equipment and possibly limit wage increases and service capabilities.

Please help us education other IN State Representatives about the detrimental impact of this legislation by contacting your state representative.  Only YOU can impact the way your state representative will vote on this legislation. 

 

*****Please email your representative ASAP and perhaps call your state representative on Monday morning to let them know that AMENDMENT 7 to House Bill 1372 will be detrimental to EMS in your district as well as could impact EMS operations for you and the company you work for (see below for more information) and encourage your state representative to reach out to fellow representative Martin Carbaugh who is the sponsor of the bill to tell him to withdraw this amendment.

Your state representative is Rep. Chuck Moseley with an email address of h10@iga.in.gov

 In addition You can also call and leave a voicemail at  (219) 331-8875 send a message via the website

https://indianahousedemocrats.org/members/chuck-moseley/full#form_individual-member-contact

OR:

Find your legislator here.

http://iga.in.gov/legislative/find-legislators/

 

It is important that your state representative hears from you BEFORE they go back into session on Monday afternoon – please bcc myself or forward your manager or myself the email you send!

Thank you for helping us stop this legislation

Reasons why EMS should not be included in this legislation:

o   EMS is unique from other healthcare providers

o   State and local governments regulate non-emergency and emergency ambulances services.  

§  These localities may assign a single comprehensive ambulance service provider to provide 911 in their geographic area.  In these instances, the local governments again control the rates and establish other requirements by which the ambulance service suppliers and providers must abide (i.e. staffing, response times, level of service)

§  Local ordinances and state laws establish specific requirements for non-emergency ground ambulance services that drive costs and direct the rates of reimbursement as well.  These requirements often include ground ambulance vehicle specifications, personnel training, specific medications and equipment which must be available on the ambulance, among other things.

§  Ground ambulances providing emergency services are not permitted to refuse to respond to an emergency request and may not refuse care based on a patients’ insurance coverage or lack there of.

o   Unfair Treatment by Insurance Companies  

o   EMS experiences unfair or non-existent negotiations with insurance companies.  Why?

§  Insurers know that State and local laws require ambulance services to treat and take all patients, regardless of their ability to pay so the transport will happen regardless of coverage 

§  There is no way to quantify the number of ambulance transports since not every patient requires an ambulance transport, therefore, ambulance providers are at a disadvantage when negotiating with insurance companies and asked to discount rates since there is no guaranteed volume (different from an emergency department where every patient sees a physician

§  Insurance companies set a rate and tell ambulance service to take it or leave it; there is no chance to talk with anyone at the insurance company.  If the ambulance provider refuses the “offer,” then it is deemed to be “out-of-network” and the insurance company walks away from its responsibility to provide adequate coverage for emergency and non-emergency ambulance services.

§  In some instances, insurers refuse to pay the 911 rates set by the State or local governing body, so ground ambulance services must bill the patient to be compliant with laws