MEDICAID SECTION 1115 (WAIVER) PROGRAMS: As of March 1, 2015, eight states were participating in the Medicaid Section 1115 Delivery System Reform Incentive Payment Programs (DSRIP).
health care and social services organizations to discuss the positive benefits that EMS currently provides or could provide that do not have a funding stream. Once these externalities have been identified, stakeholders can use their creativity to connect the dots so that beneficiaries might contribute to offset the cost of a program. Community and civic leaders should thus be convening meetings, facilitating conversations, and fostering partnerships between EMS with other public health, public safety, and community health care stakeholders. One of the issues a community-wide approach such as this might address is how to generate a multi-payer solution for EMS. It is unrealistic for EMS to arrive at a unique payment agreement for EACH possible downstream group, since there are so many potential beneficiaries. STATE MEDICAID INITIATIVES Many states have established, or are seeking to establish, Medicaid reimbursement and reform committees, Medicare State Innovation Model projects, or other health insurance policy committees. EMS advocates need to push for representation on these committees while state authorities should themselves be seeking to have EMS representation on those committees. By being included in high level reform and innovation conversations, a state is more likely to direct resources and funding toward testing new payment models or new delivery pathways for EMS that help support the rest of an integrated health care system. A useful example comes from Arizona, where in May of 2016, the state Medicaid program, interestingly called the Arizona Health Care Cost Containment System, created a program with the
California
Texas
Massachusetts
New Mexico
New Jersey
Kansas
Oregon
NewYork
These programs can provide states with significant federal funding to support health care transformation. State EMS leaders should be vocal about their challenges, opportunities, and proposed pilots from the beginning of the application process through project implementation.
Arizona Department of Health Services called the Treat and Refer EMS Agency Recognition Program. Under the program, a high performing EMS system could qualify for reimbursement for situations where patients are assessed but not transported to a hospital emergency department. 55 Where there is no representation, EMS agencies and their partners should still engage state Medicaid leadership to seek reimbursement for innovative care models through the Medicaid waiver process. While the state Medicaid program may not be able to directly reimburse EMS for non- transports due to the regulations on Medicare, it may be able to wrap EMS services into bundles of care or other innovative payment mechanisms that effectively enable EMS to participate in services not directly linked to transportation.
Some states such as Texas have been successful
55 “Community Paramedicine – Treat & Refer EMS Agency Recognition.” Arizona Department of Health Services . Accessed June 28, 2017. http://www.azdhs.gov/preparedness/emergency-medical-services-trauma-system/index.php#community-paramedicine-treat-refer-ems-agency
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MOUNT SINAI HEALTH SYSTEM | UNIVERSITY OF CALIFORNIA, SAN DIEGO
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