EMS, nursing homes fight over funds

They blame the state for changing control of Medicaid
 reimbursements.

JIM NOELKER/Medical Transfer EMT, Chris Fugate, an employees of EMT Inc., in Englewood makes a non-emergency transfer to the Dialysis Center of Dayton North Friday August 13. EMT Inc. and other emergency transfer operation are facing difficulties in the wake of changes in how the state reimburses private ambulance companies. Staff photo by Jim Noelker

By Ben Sutherly, Staff Writer Updated 9:31 PM Sunday, August 15, 2010

DAYTON — The private ambulance industry and nursing homes are quarreling over last year’s change in how payment is made for the transportation of nursing home residents who are on Medicaid.

Both sides also are channeling much of their frustration at the state of Ohio.

In approving the state budget last year, state legislators gave nursing homes control of reimbursements to private ambulance companies for transporting Medicaid residents at their facilities, as well as for other bundled services. In fiscal 2010, the state is giving nursing homes $70 million to pay for such services.

Observers said the change was made in part so the state could use its own Medicaid dollars to match federal Medicaid dollars, thereby helping it secure an additional $55 million in federal funding.

As part of efforts to balance a severely strained state budget, nursing homes also were assessed a franchise fee, or bed tax. To help offset that added cost, nursing homes were given oversight of Medicaid bundling. Through such bundling, nursing homes get $3.91 per Medicaid bed per day.

The state had been directly paying EMS companies on average $1.14 for transportation, one of the services to be covered by the $3.91 bundled payment.

The $3.91 bundled payment turned out to be more than enough for some nursing homes. But for others — particularly those with high-acuity patients who require lots of transportation or expensive equipment such as motorized wheelchairs — the payment has proven grossly insufficient, some say.

Some nursing homes are delaying payments for transportation services rendered, or aren’t paying at all, infuriating private ambulance companies.

The Medicaid reimbursement issue is the biggest flap that the Ohio Ambulance and Medical Transportation Association has dealt with in at least 20 years, said Dianne Farabi, the group’s executive director.

Already, Toledo-based MedCorp, the state’s largest private medical transport company, has gone into receivership and blames the Medicaid reimbursement changes for its predicament.

“With such a narrow margin of operation, when companies don’t get paid, there’s obviously a problem,” Farabi said. “MedCorp’s situation is the very beginning of the blocks that are tumbling.”

Farabi couldn’t assign a dollar value to the state’s private medical transport industry. But more than 300 companies and hospitals have licenses through the Ohio Medical Transportation Board.

The issue isn’t just affecting private ambulance companies. When it billed Medicaid directly for medical transport runs, the city of Dayton typically received reimbursement in 24 to 30 days, said Cheryl Garrett, the city’s finance director. Now, on average, it’s taking an additional 60 days to get such payment from nursing homes, she said.

Ernest Hatmaker, who heads up Eaton Medical Transport (EMT) Inc., which has stations in Eaton, Englewood, Middletown and Cincinnati and employs about 400 people, estimated 25 percent of patients it transports are Medicaid patients who reside at nursing homes.

Geoff Webster, counsel for the Ohio Academy of Nursing Homes, said many nursing homes are struggling to pay their own bills, in part because base nursing home reimbursement rates from Medicaid haven’t increased since 2004.

Many nursing homes are facing the quandary of “Which (bill) do you pay first?” Webster said.

Meanwhile, some in the medical transport industry said the state Department of Job and Family Services should have put in place rules that require nursing homes to reimburse a minimum amount for medical transports, and within a reasonable period of time.

“The state created a mess, and the most frustrating part about it is they just continue to refuse to admit there’s a problem,” said Fred Isch, MedCorp’s chief operating officer.

But Ben Johnson, a JFS spokesman, said matters of reimbursement should be settled between private medical transport companies and nursing homes.

“We wouldn’t get involved in making them (medical transport companies) whole,” he said.

Legislators put bundling in place so nursing homes would have more flexibility and be empowered to make the best decisions about a patient’s care, Johnson said.

The state has received only 13 complaints from Medicaid patients statewide about bundled transportation services since the beginning of February, Johnson said. Those with concerns in the Dayton region may call the long- term care ombudsman at (800) 395-8267 or go to dayton-ombudsman.org.

The Ohio Academy of Nursing Homes’ Webster 
said the nursing home industry did not ask to oversee Medicaid bundling.

“They just decided to dump medical transportation on an entire industry overnight,” he said.

MedCorp’s Isch disputes that. He said the nursing home industry had lobbyists present when the decision was made to let nursing homes oversee reimbursement for medical transportation and other services for Medicaid patients.

House Bill 499, sponsored by state Rep. Kenny Yuko, (D-Cleveland), would remove nursing home resident transportation and wheelchairs from the Medicaid bundled services overseen by nursing homes. But with the legislature on summer break and the November election approaching, Yuko acknowledged it could be months before any legislative fix is made.

“We’re putting quality of life at stake,” Yuko said. “If I’m in a nursing home and I need dialysis and all these medical transport companies go out of business, who’s going to go into those areas to pick up that lost business?”

The Ohio Academy of Nursing Homes opposes House Bill 499, saying skilled nursing facilities have worked hard to incorporate bundled services and changing the bundle mix now would create “new and unnecessary complications.”

But Yuko said passage of House Bill 499 is just one step that needs to be taken to address problems with Medicaid bundling.

“It was loaded with good intentions, but bad consequences,” he said.