MEDICARE/MEDICAID CROSSOVER PROPOSED FOR ELIMINATION IN 2011 BUDGET
Contact your Legislators and let them know the impact this proposed cut will have on your company or agency! Contact them today!
DMAHS proposed to eliminate the crossover payment for patients transported by ambulance who have both Medicare and Medicaid coverage. The crossover appropriation pays the 20% co-pay and deductible not paid by Medicare. The Division has identified $3,841,000 to be cut from the budget.
With a federal match of 50%, that amounts to a revenue loss of $7,682,000 to private, non-profit, and EMS ambulance providers. Sixteen members of the MTANJ alone will incur revenue losses totaling $4,972,779 if the crossover is removed from the budget. Providers cannot bill Medicaid beneficiaries for their Medicare co-pay or deductible.
According to an analysis by the MTANJ, losing the crossover puts 188 New Jersey EMT and paramedic jobs at risk and has the potential to remove up to 22 ambulances from service each day. The elimination of the crossover may lead providers to decline transports in non-emergency cases.
Many private ambulance providers respond to emergencies and even serve as primary 9-1-1 responders or as back-up to municipalities. For those municipalities who provide EMS services to residents, under-reimbursement for EMS services by Medicaid will place an undue burden on local taxpayers.
With inadequate Medicare payments, a looming cap on out-of-network reimbursement, and probably the nation's lowest Medicaid rate, the loss of the crossover would be almost impossible to absorb - without a reduction in service of some kind -- unless the provider is tax-based or, possibly, hospital-based.
The current crossover appropriation has been in effect since 2006. Since that time, New Jersey's medical transportation and EMS industry has faced continuous challenges to its stability:
· Under the privatized broker program, rules were changed without any input from the provider community, without any public comment period, and without any assessment of the impact.
o Providers incurred thousands of dollars each to comply with transportation broker program requirements.
o Medicaid approved a 20% reduction in the rate for some MAV (wheelchair van) trips.
o Employees lost jobs when providers had to adhere to standards that exceeded current DHSS licensing regulations.
· Medicaid's 1994 $58 rate for non-emergency and emergency ambulance trips covers less than 14% of the cost of an ambulance trip. The transportation broker is now authorized to negotiate non-emergency ambulance rates as they choose. If the rate decreases, there will be serious access issues for Medicaid beneficiaries as more providers leave the broker network.
· According to the GAO, in 2004/2005, the Medicare rate covered less than 82% of what it costs for each ambulance trip. Estimates for 2009 show that while the Medicare rate improved slightly, it still covered only 88% of costs.
· There is discussion now at the legislative level that New Jersey non-emergency ambulance trips may be subject to a cap on out-of-network reimbursement from private insurance. Ambulance providers gain little or no benefit from directed volumes through private insurance contracts. By capping out-of-network rates, providers will not able to offset reduced funding from Medicare and Medicaid which typically account for 60 to 70 percent of New Jersey ambulance transports.
On page 34 of the Office of Legislative Services Analysis of the New Jersey Budget - Department of Human Services, the crossover is explained as no longer necessary due to the implementation of the transportation broker system. In fact, dual eligible patients are not required to go through the broker. Such patients have that option but most dual-eligible Medicare/Medicaid patients contact their preferred provider directly. Furthermore, emergency trips for all patients, including those with both Medicare and Medicaid, are specifically excluded from the broker program. The explanation is incorrect.
Medicaid shows a savings of over $13,000,000 in its medical transportation budget and yet the overal medical transportation budget increases by $272,000. We will get an explanation as to what the increase is attributed. Check back soon...
