An estimated $14 million will annually be infused into Missouri’s ground ambulance industry as the result of a newly approved Federal Reimbursement Allocation (FRA) program similar to other existing FRAs which have been funding Missouri hospitals, pharmacies, nursing homes and mental health institutions for roughly twenty years.  The goal of the program is to replenish what ground ambulance companies cannot collect due to shortfalls in Medicaid reimbursement payments.

Currently, Medicaid pays about 45% of what Medicare pays for the same emergency call.  For every dollar Medicare pays in reimbursement, Medicaid pays forty-five cents, leaving ambulance services at a loss.

The FRA concept is based on a ‘self-taxing’ or ‘provider tax’ plan whereby qualifying ground ambulance services impose a state tax on themselves which in turn creates a state fund that qualifies to receive additional funding through the Federal Medicaid program.

The funds, estimated to be about $14 million annually, will be collected by the newly created Emergency Medical Services Agent Corporation, (EMSAC) a 501(c)3 nonprofit entity, which will administer the program and contract with ground ambulance services in the state.  

The funds will then be reimbursed back to the association and dispersed to the ambulance services on an equal share basis, i.e., according the number of Medicaid runs each service responds to annually. The Federal Medicaid program match's every 37 cents of state money with 63 cents of federal money.  

The Missouri Department of Social Services has budgeted to have the program up and running in the current fiscal year.

In the meantime, EMSAC, the intermediary between DSS and the ground ambulance industry, will be setting up an overall cost reporting methodology that assures reports are accurate, using the same relative values statewide.    Hospitals and nursing homes participating in FRAs annually report their financial figures on standardized forms to the DSS. To date, ambulance services have had no reason to provide such reporting.  The whole process is a first for the EMS industry in the nation.

EMSAC’s primary concern is creating a reporting system that works for the large and small ambulance services and districts.  The majority of services do not have staff support or finance offices to help manage the reporting process which will provide DSS the necessary data to be sent to the federal government,  which then performs statistics modeling of the program to make sure it meets federal rules and regulations. The number crunching will determine the amount of taxes collected by the ground ambulance participants and verify that EMSAC’s method of dispersing funds to the agencies is appropriate.

The management of the reporting process is not expected to be terribly complicated, with 214 ambulance services in Missouri.  

When the reporting system is solidified, DDS will mail an industry survey with a mandatory 100% return policy in order to collect the first year’s cost reporting data.  Similar surveys will follow annually.
Because the relationship between ambulance services and EMSAC will be contractual, each agency will have to sign a formal agreement.  EMSAC board members are working now to educate as many agencies as possible.  To date, key people at over half the ambulance services in Missouri Contracts have been educated as to the nature of the EMSAC relationship and system.  Contracts will be mailed to each agency in the Fall.  Board members will continue to contact and communicate with all remaining agencies until that time.

Inquiring ambulance services are encouraged to contact EMSAC at Jason White at jason.white@mastambulance.org.