Checks From Ill. for Medicaid Patients Not in Mail

Checks From Ill. for Medicaid Patients Not in Mail

News Jan 23, 2013

When an ambulance is dispatched in Illinois to help the victim of a car crash, shooting or heart attack, the paramedics who arrive don't ask - and are prohibited by law from considering - whether that person has a certain kind of health insurance or no coverage at all.

Ambulance services can't discriminate when it comes to relieving patients' suffering. But the state's ongoing backlog of bills is inflicting financial pain on ambulance providers if those patients are covered by Illinois' Medicaid program or the group health-insurance program for state employees, retirees and dependents.

"Nobody seems to care," said Andrew Thornton, the Illinois State Ambulance Association's chairman for governmental affairs.

Delays of six months to a year for Medicaid payments, and delays of more than a year for state employee insurance, have prompted ambulance services to borrow money to make payroll. The delays, on top of already inadequate Medicaid payments, also have depressed salaries for ambulance crew members and made it harder to replace aging equipment, emergency medical service officials say.

Though there's no hard data, there are anecdotal reports that the cash-flow problems have resulted in fewer ambulances on the road and longer response times, Thornton said. Delays in medical attention can result in death and in longterm health consequences for those who survive, he said.

"There is a human cost involved, but it's hard to quantify," said Thornton, a paramedic who lives in Springfield and directs the not-for-profit Fulton County Emergency Medical Association.

'Complaints everywhere'

The 400 to 500 ambulance services in Illinois operate under a variety of structures. Some are part of city or village government, some are not-for-profit organizations that contract with local governments, and some are private companies that may be dispatched to "911" emergency calls by government-operated call centers.

But when they bill for services, many are suffering because of payment delays.

"There are complaints everywhere," said Van Prater, chief paramedic for the Springfield division of LifeStar Ambulance Service Inc., one of three for-profit ambulance companies serving Sangamon County.

Continue Reading

At LifeStar, where at least one-third of patients are covered by either Medicaid or state insurance, the state owes the company "a few hundred-thousand dollars," according to LifeStar billing manager Julia Pate.

Payment delays have prevented the company from purchasing the latest cardiac monitors, which automatically measure blood pressure rather than having a paramedic manually inflate an arm cuff, Prater said.

And when an ambulance needs to be replaced, he said, "You go with a not-sofancy unit."

At Springfield's America Ambulance, where the clientele covered by the state through private insurance or Medicaid is similar, the state owes more than $330,000 - some of it for services provided 14 months ago, office manager Carla Berg said.

The oldest bills covered by the state's self-funded Quality Care plan, which is administered by Cigna, she said.

The late payments have resulted in America Ambulance replacing its ambulances less often, which costs the business more for repairs and fuel for older, less-efficient vehicles, America owner Susan Zappa said.

In 2012, the state paid America $7,000 just for interest on late payments. As a taxpayer, Zappa said she considers that a "sickening" waste of state revenues.

1990s-level pay

Delays in state payments began to get worse in 2009 and 2010 and are closely related to the economic downturn, Thornton said. The impact of the delays was magnified in July, when a 2.7 percent Medicaid rate cut imposed by Gov. Pat Quinn and the General Assembly took effect for most services provided by ambulance crews.

That cut, on top of a 6 percent Medicaid rate cut in 2002, rolled the rates back to levels paid in the 1990s, Thornton said.

An ambulance trip and aggressive medical services provided by paramedics might generate a $700 to $900 payment from private insurance but less than $300 from Medicaid, Berg said.

There's no end in sight to the payment delays. The legislature approved $550 million in spending for state employee health coverage this fiscal year, but the bills for that coverage are expected to total $2.65 billion. Underfunding of the employee health liability means bills get pushed into the next fiscal year before they can be paid.

The state paid $87 million in interest payments last year to medical providers owed money by the state insurance program, according to Scott Adams, director of research and employee benefits for Council 31 of the American Federation of State, County and Municipal Employees.

Illinois currently owes about $20 million statewide to medical transportation providers, with most of the money owed to ambulance providers, according to Kelly Jakubek, spokeswoman for the Illinois Department of Healthcare and Family Services.

The state owes an estimated $9 billion to vendors of all types - an amount that hasn't changed much in the past two years, according to Bradley Hahn, spokesman for Illinois Comptroller Judy Baar Topinka.

No easy fix

State payment delays for ambulance providers haven't "materially worsened" in the current fiscal year compared with fiscal 2012, Jakubek said, but she added that HFS "cannot speculate as to when provider time frames will improve. It is, however, likely that similar delays will continue for the foreseeable future."

Until lawmakers and the governor can resolve funding issues involving state employee pensions, Jakubek said, "there will be many funding issues that will be very challenging for the state to deal with. This is across-theboard in terms of health care, education, public safety and many other vital state programs."

Lawmakers tell advocates for ambulance services that they care about the problem and how it can affect the lives of their constituents, but the problem persists, Thornton said.

State Rep. Donald Moffitt, R-Galesburg, who sat on a bipartisan Illinois House task force that held hearings throughout the state and produced a report in November on emergency medical service funding, said the payment delays "absolutely worry me. If it's your loved one suffering a cardiac arrest, you want a quick response and the best that there is."

Moffitt, who co-chaired the task force with former Rep. Lisa Dugan, DBradley, said EMS service is "a very basic funding role of government and should be considered an essential service," regardless of whether the EMS provider is for-profit or not-forprofit.

"They all need to be paid," he said.

Can't afford to wait

Moffitt said he will continue to advocate that EMS funding be given higher priority, and he plans to work with Lt. Gov. Sheila Simon, a Democrat, to push for legislation in the spring session that carries out the task force's recommendations. The task force report is available at http://tinyurl.com/emsfunding.

The group's recommendations include establishment of zero-percentage interest loans to EMS providers, a boost in Medicaid rates, quicker state payments and a dedicated funding source for EMS equipment and training.

Not-for-profit EMS providers would receive priority if a dedicated funding source were created, Moffitt said.

Charles Kelley, president of MedStar Ambulance Inc. in Sparta, said he doesn't know how long his business can wait for relief.

Look for a Deadbeat Illinois story every Monday in The Carmi Times from our sister publications in central Illinois. This is the second installment of the series.

Copyright 2013 Carmi TimesDistributed by Newsbank, Inc. All Rights Reserved

Source
Carmi Times (Illinois)
Dean Olsen; Staff Writer, DEAN.OLSEN@SJ-R.COM
Crestline Coach attended the Eighth Annual Saskatchewan Health & Safety Leadership conference on June 8 to publicly sign the “Mission: Zero” charter on behalf of the organization, its employees and their families.
ImageTrend, Inc. announced the winners of the 2017 Hooley Awards, which recognize those who are serving in a new or innovative way to meet the needs of their organization, including developing programs or solutions to benefit providers, administrators, or the community.
Firefighters trained with the local hospital in a drill involving a chemical spill, practicing a decontamination process and setting up a mass casualty tent for patient treatment.
Many oppose officials nationwide who propose limiting Narcan treatment on patients who overdose multiple times to save city dollars, saying it's their job to save lives, not to play God.
While it's unclear what exact substance they were exposed to while treating a patient for cardiac arrest, two paramedics, an EMT and a fire chief were observed at a hospital after experiencing high blood pressure, rapid heartbeat, and mood changes.
After a forest fire broke out, students, residents and nursing home residents were evacuated and treated for light smoke inhalation before police started allowing people to return to their buildings.
AAA’s Stars of Life program celebrates the contributions of ambulance professionals who have gone above and beyond the call of duty in service to their communities or the EMS profession.
Forthcoming events across the country will provide a forum for questions and ideas
The Harris County Office of Homeland Security & Emergency Management (HCOHSEM) has released its 2016 Annual Report summarizing HCOHSEM’s challenges, operations and key accomplishments during the past year.
Patients living in rural areas can wait up to 30 minutes on average for EMS to arrive, whereas suburban or urban residents will wait up to an average of seven minutes.
Tony Spadaro immediately started performing CPR on his wife, Donna, when she went into cardiac arrest, contributing to her survival coupled with the quick response of the local EMS team, who administered an AED shock to restore her heartbeat.
Sunstar Paramedics’ clinical services department and employee Stephen Glatstein received statewide awards.
A Good Samaritan, Jeremy English, flagged down a passing police officer asking him for Narcan after realizing the passengers in the parked car he stopped to help were overdosing on synthetic cannabinoids.
Family and fellow firefighters and paramedics mourn the loss of Todd Middendorf, 46, called "one of the cornerstones" of the department.