The Register-Herald, Beckley, West Virginia

November 18, 2013

Proposal jeopardizes state EMS agencies

Brokerage system could end source of revenue

By Brandi Underwood
Register-Herald Reporter

— Emergency medical services (EMS) in the Mountain State may be in jeopardy if a proposal issued by the West Virginia Department of Health and Human Resources — which would alter transportation services for Medicaid patients — is carried out.

The proposed state plan amendment, which requires no legislative action, would involve the Bureau for Medical Services contracting with a transportation broker to handle all non-emergency medical transportation (NEMT) services, which includes transportation of Medicaid patients to doctor’s appointments and other non-emergency medical appointments, including dialysis and other common clinical treatments.

Implementing a brokerage system was one of 78 cost-saving recommendations outlined in a recent audit of the Department of Health and Human Resources. According to Public Works LLC, the Bureau for Medical Services could save more than $5 million a year from the transition to a brokerage system.

With ambulance services included in that brokerage system, the risk arises that EMS agencies and private ambulance companies, many of which currently depend on the revenue generated from NEMT calls to stay afloat, would be forced to shut down, explained Chris Hall, a Beckley city councilman and executive director for the West Virginia EMS Coalition.

While many assume that EMS agencies are government supported, the truth is that very little of their agency funding comes from state or local levels, but rather comes from billing insurance companies, Hall said.

By bidding the contract for NEMT out to a broker, Hall explained, a private out-of-state firm will likely win out as it will not have the higher operating fees necessary to also provide rural emergency medical services.

The concern lies in the possibility that a for-profit broker may cut the current rates associated with NEMT, or even cut some EMS agencies out completely and bring in another NEMT service provider.

That loss of revenue could prove critical to the operation of some agencies.

“The revenue from emergency services is not enough for most ambulance agencies to pay the fixed cost associated with keeping rural stations open and continuing to provide the same response times,” Hall said.

“The broker will only be concerned with NEMT services and will not have the community-service interests that we find in our West Virginia-based ambulance agencies,” Hall explained. “They won’t be volunteering to stand by at high school football games on Friday nights, meaning the public at large will be affected by the revenue cuts in local EMT services.”

Hall asserts that the DHHR is looking to save money in the wrong place, as only 25 percent of its Medicaid transportation program goes toward compensating NEMT services.

 Rather, 75 percent of the budget goes toward the Friends and Family Transportation Program, which allows friends and relatives to file for reimbursement after transporting Medicaid patients to appointments.

“There’s a lot of fraud and abuse in that program because it’s difficult to monitor,” Hall explained.  

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West Virginia would not be revolutionary for tasking NEMT to a Medicaid brokerage system. Kentucky, Ohio and Pennsylvania already employ a broker program for those services, but have chosen to allow ambulance services to continue making non-emergency runs. The brokerages in those states took the place of public transportation, senior centers, behavioral health centers and public-service regulated carriers, like taxi cabs.

The Bureau for Medical Services has tried to implement a brokerage system for NEMT many times in the last several years.

Hall explained that last year, Senate Bill 188 would have integrated the system, but the House refused it. Now, Medicaid is taking a new approach which  bypasses legislation and attempts to make the change through a state plan amendment.

“The EMS community feels as though it’s almost being attacked,” Hall said. “They have assessed no rate increases on NEMT services in 13 years, and that’s with several minimum rate increases, insurance rate increases and rising gas prices.”

Unlike other states, such as Virginia that adds a $4 fee to driver’s license renewals to fund state EMS agencies, West Virginia has no program to support its emergency service providers other than a small number of levy subsidies, Hall explained.


Beginning at 1 p.m. today, West Virginia EMS squads, including medical first responders, paramedics and emergency medical technicians, will rally on the south-side steps of the Capitol building in Charleston to urge Gov. Earl Ray Tomblin to protect rural emergency medical services and reject a proposal for the state to contract with a broker for NEMT.

“This change would take away access to the very little revenue we have to protect the public with,” Hall said. “We’re appealing to the Legislature to reach out to the governor’s office and convince them this is the wrong call for West Virginia.”

— E-mail: bunderwood@