CHARLESTON, W.Va. -- A proposed change to the way Medicaid patients are transported to doctor's appointments and other non-emergency medical appointments would hurt local emergency medical services agencies, representatives say.The state Bureau for Medical Services plans to accept bids from agencies interested in managing all of the non-emergency medical transportation for Medicaid patients. Currently, local EMS agencies and private ambulance companies handle those non-emergency calls within their areas.Using a brokerage system was one of nearly 80 cost-saving recommendations that Pennsylvania-based Public Works LLC made in its state-commissioned audit of the Department of Health and Human Resources. In the audit, released in April, the agency wrote that the Bureau for Medical Services could save $5.2 million in one year and $26 million over five years using a broker.Representatives from local EMS agencies, though, say the revenue they get from non-emergency runs help offset the costs of emergency calls. They're concerned that a broker may cut the rates they get for non-emergency transportation or bring in other agencies that can do the work cheaper.In Kanawha County, rural areas like Clendenin may not survive without non-emergency medical transportation calls, Joe Lynch, director of the Kanawha County Emergency Ambulance Authority, said."Our ambulance system [in Clendenin], if it didn't do non-emergency with emergency we would never afford to pay for it," Lynch said. "And it's subsidized by a levy, too, but [EMS agencies] have to do all those all those levels of services so it pays for itself."More than 60 people, including representatives from EMS agencies around the state, attended a pre-bid meeting about the brokerage system Thursday afternoon at the Department of Health and Human Resources.According to the request for proposals from DHHR, the broker would have to have at least three years of experience handling non-medical transportation and have experience in three different states.EMS representatives say that would rule out any local emergency service provider from West Virginia that might want to apply.
"When you've got someone from out of state that totally has no skin in the game... they're going to take that from those ... EMS providers and [EMS providers] are going to go out of business," Lynch said. "Part of that safety net for the state is going to be gone."Ambulance agencies that don't do emergency calls can do non-emergency calls at a lower cost than the local agencies, Lynch said."We call it cream-skimming because [what] they do is they go home on holidays, they don't go to the ballgames because none of that's paid for," he said. "We're on standby because of you and the public. When brokerages come in here and carve out that level of funding, it's going to be disastrous to a lot of the EMS agencies."Trish Watson, director of Lincoln County EMS, called the brokerage plan "worse than a bad idea." DHHR officials have not thought about the impact to local EMS agencies, she said.
"What's your plan B?" Watson said. "There is no plan B. They're going to hope that we're still going to be there when we're not going to be there because we're not going to have the funding to be there."The Bureau for Medical Services has attempted to create a brokerage system for non-emergency transportation several times, Lynch said. Most recently, Senate Bill 188 would have created the system. The state Senate approved the bill earlier this year but the House didn't take it up.
This time, Medicaid officials are attempting to make the change via a state plan amendment.DHHR spokeswoman Allison Adler said Thursday afternoon the agency is not trying to sidestep the need for legislative action."The Bureau for Medical Services is attempting to comply with Federal statutory and regulatory guidelines and also a mandate from CMS," she said in an email to the Gazette. "This was not defeated at legislature. It was brought up but then all realized legislation was not needed."Further, this process is undertaken in vast majority of states and is designed to protect our consumers," she said.Lynch said stopping the change has been a yearly effort for the past two or three years. Now Medicaid wants to make an administrative change before the legislature comes back into session, he said."Why would we fast-track something like this that the legislature can't approve?" Lynch said.
Bids for the brokerage system are expected to begin being accepted Dec. 3. One company, though, has already been contacting local EMS agencies in the area, asking them to join its network of providers.Logisticare, an Atlanta-based Medicaid transportation management company, is considering placing a bid on the request for proposal, according to a letter sent to the Kanawha County EMS, among others.The letter asks representatives at the agencies to fill out and return a questionnaire and letter of intent to participate in the network."LogistiCare operates as a 'pure broker,' which means we do not provide direct transportation services, own vehicles or hire drivers," the letter states. "We rely 100% on local transportation companies and organizations to provide service. In order to be successful, Logisticare needs relations with transportation providers like you to provide the actual transportation in sedans, vans, wheelchair vehicles as well as stretcher vehicles and ambulances in certain markets."A call to Logisticare's public relations agency was not returned at press time.Reach Lori Kersey at firstname.lastname@example.org or 304-348-1240.