RS 2626 - Fees on emergency ground ambulance service providers; disposition of fees
A. The Louisiana Department of Health may adopt and impose fees for healthcare services provided by the Medicaid program on emergency ground ambulance service providers. The amount of any fee shall not exceed the total cost to the state of providing the healthcare service subject to the fee.
B. The amount of the fees imposed in the first year under the rules and regulations adopted pursuant to this Section shall not exceed one and one-half percent of the net operating revenue of emergency ground ambulance service providers as defined in Subsection I of this Section.
C. Any fee authorized by and imposed pursuant to this Section shall be considered an allowable cost for the purposes of insurance or other third party reimbursements and shall be included in the establishment of reimbursement rates.
D. Subject to the exceptions contained in Article VII, Section 9(A) and Article VII, Section 10.14 of the Constitution of Louisiana, all fees collected by the department pursuant to the authority granted in this Section shall be paid into the state treasury and shall be credited to the Bond Security and Redemption Fund. Out of the funds remaining in the Bond Security and Redemption Fund after a sufficient amount is allocated from that fund to pay all obligations secured by the full faith and credit of the state which become due and payable within any fiscal year, the treasurer shall, prior to placing the remaining funds in the state general fund, pay into the Emergency Ground Ambulance Service Provider Trust Fund Account, established by the treasurer, within the Louisiana Medical Assistance Trust Fund an amount equal to the total amount of the fees collected. Thereafter the secretary shall use the fees within the fund to carry out the provisions of Subsection G of this Section.
E.(1) Notwithstanding any other provision of law to the contrary, except for the first year maximum fee of one and one-half percent of the net operating revenue, the department shall not impose any new fee or increase any fee on any emergency ground ambulance service provider on or after July 1, 2016, without first obtaining either of the following:
(a) Prior approval of the specific fee amount by record vote of two-thirds of the elected members of each house of the legislature while in regular session.
(b) Written agreement of those providers subject to the fee which provide a minimum of sixty-five percent of the emergency ground ambulance transports.
(2) Any fee otherwise imposed or increased by the department on or after July 1, 2016, shall be null and of no effect.
F. Notwithstanding any provision of this Section to the contrary, the department shall adopt and promulgate, pursuant to the Administrative Procedure Act and in compliance with Article VII, Section 10.14 of the Constitution of Louisiana, a fee to be imposed pursuant to Subsection A of this Section in accordance with all of the following:
(1) The department shall calculate, levy, and collect a fee from every emergency ground ambulance service provider on each emergency and nonemergency ground ambulance transport upon the occurrence of all of the following:
(a) Implementation of the reimbursement enhancements as provided for in Subsection G of this Section.
(b)(i) Approval from the Centers for Medicare and Medicaid Services.
(ii) The department shall submit all required documentation necessary for approval and implementation of the reimbursement enhancements set forth in Subsection G of this Section on or before August 31, 2016.
(2) The total assessment for the initial state fiscal year in which the assessment is charged shall not exceed the lesser of the following:
(a) The state portion of the cost, excluding any federal financial participation, of the reimbursement enhancements provided for in this Section that are directly attributable to payments to emergency ground ambulance service providers.
(b) One and one-half percent of the net operating revenue of all emergency ground ambulance service providers assessed relating to the provision of emergency ground ambulance transportation.
(3) The department shall uniformly impose and shall allocate the assessment to each emergency ground ambulance service provider on a consistent basis and the assessment formula shall be the same for every emergency ground ambulance service provider.
(4) For the initial year of the assessment, the department shall assess each emergency ground transport provider in accordance with Paragraph (2) of this Subsection. The total amount of the assessment shall be paid by the emergency ground ambulance service provider in installments as prescribed by the secretary in conjunction with the written consent of emergency ground ambulance service providers, and shall be due from the provider within thirty days of the notification of assessment owed.
(5) After the initial year, the department shall assess each emergency ground ambulance service provider a percentage fee, determined at the discretion of the secretary subject to the provisions of Paragraph (3) of this Subsection in collaboration and with the express and written mutual agreement of the emergency ground ambulance service providers subject to the assessment and which make up a minimum of sixty-five percent of all emergency ground ambulance transports in the state of Louisiana. The maximum fee allowable pursuant to this Section in any year, shall not exceed the percentage of net patient service revenues permitted by federal regulation pursuant to 42 CFR 433.68 as determined by the department, as reported by the provider and subject to audit for the previous fiscal year of the provider. The total amount of the assessment shall be paid by the emergency ground ambulance service provider in installments as prescribed by the secretary in conjunction with the agreement of emergency ground ambulance service providers, and shall be due from the provider within thirty days of the notification of the fee amount owed.
(6) Repealed by Acts 2018, No. 272, §2.
G. For each year in which the assessment is in effect, the department shall provide for reimbursement enhancements in accordance with all of the following:
(1) Reimbursement or payment to emergency ground ambulance service providers by any state or state-sponsored program, including but not limited to the Bayou Health Plans or their successors, at or above rates at the level which were in effect on July 1, 2015, for emergency and nonemergency transport and related services provided pursuant to the Louisiana medical assistance program provided that funds are appropriated in the budget.
(2) The legislature shall annually appropriate from the state general fund and not from the Emergency Ground Ambulance Service Provider Trust Fund Account an amount necessary to fund the state share of the reimbursement to emergency ground ambulance service providers pursuant to Paragraph (1) of this Subsection.
(3) Monies collected from the fees shall be appropriated by the state in accordance with Article VII, Section 10.14 of the Constitution of Louisiana as necessary for the state to maximize federal matching funds and all proceeds, including interest from the fees collected, shall be deposited in the Emergency Ground Ambulance Service Provider Trust Fund Account for application in accordance with this Subsection and State Plan Amendment LA-11-23 and any amendments thereto.
(4) The enhancement payment level shall be determined in a manner to bring the payments for these services up to the average commercial rate level as described in Section C(8) of State Plan Amendment LA-11-23 and any amendments thereto to the extent of the availability of funds in the Emergency Ground Ambulance Service Trust Fund. The enhancement payment level shall be the difference between the reimbursement levels provided for in Paragraph (1) of this Subsection and the average commercial rate.
(5) Funds from the Emergency Ground Ambulance Service Provider Trust Fund Account shall be used to achieve the maximum reimbursement under federal law and appropriated solely to fund the reimbursement enhancements provided for in Paragraph (4) of this Subsection as provided in the most recent formula adopted by the legislature or the secretary as applicable and distributed exclusively among emergency ground ambulance service providers for emergency and nonemergency ambulance transportation services provided.
H.(1) No additional assessment shall be collected and any assessment shall be terminated for the remainder of the fiscal year from the date on which any of the following occur:
(a) The secretary and the emergency ground ambulance service provider representing a minimum of sixty-five percent of all emergency ground transports fail to reach an agreement on any proposed changes to the formula for the next fiscal year.
(b) The department, or its successor or contractors, reduces or does not pay reimbursement enhancements established in the current formula as adopted by the legislature.
(c) The appropriations provided for in Subsection D of this Section are reduced.
(d) The amount of the reimbursement for emergency and nonemergency ground ambulance services payable by any participant in the Bayou Health Plan or Medicaid managed care organization falls below one hundred percent of the Medicaid rate in effect at the time the service is rendered.
(2) The treasurer shall return any monies collected after the date of termination of an assessment to the emergency ground ambulance service provider from which it was collected, including any interest collected thereon.
I. For purposes of this Section, the following definitions apply:
(1) "Ambulance service" has the same meaning as provided in R.S. 40:1131.
(2) "Average commercial rate" means the average amount payable by commercial payors for the same services and as further defined in State Plan Amendment LA-11-23 and any amendments thereto in effect on the effective date of this Section.
(3) "Centers for Medicare and Medicaid Services" or "CMS" means the division of the United States Department of Health and Human Services which regulates the medical assistance program provided for in Title XIX of the Social Security Act.
(4) "Department" means the Louisiana Department of Health.
(5) "Emergency ground ambulance service provider" means a nonpublic, nonfederal provider of emergency ground ambulance services.
(6) "Emergency Ground Ambulance Service Provider Trust Fund Account" or "the fund" means the fund provided for in Article VII, Section 10.14 of the Constitution of Louisiana upon the payment of fees by emergency ground ambulance service providers pursuant to this Section and to which all fees shall be paid into and utilized solely for the reimbursement enhancements to be provided to emergency ground ambulance service providers.
(7) "Net operating revenue" means the gross revenues of the emergency ground ambulance service provider for the provision of emergency and nonemergency ground ambulance transportation services, excluding any Medicaid reimbursements, less any deducted amounts for bad debts, charity care, and payer discounts.
(8) "Secretary" means the secretary of the Louisiana Department of Health.
(9) "State" means the state of Louisiana.
Acts 2016, No. 305, §1, eff. June 2, 2016; Acts 2017, No. 179, §1, eff. June 12, 2017; Acts 2018, No. 272, §§1, 2; Acts 2019, No. 299, §1; Acts 2019, No. 404, §1, eff. July 1, 2020.