1. What is the Ambulance Assessment and Medicaid Match Program?

• This program will increase Medicaid revenue for all non-governmental ambulance providers in Montana. This includes for profit, non-profit, and volunteer ambulance services. Program possibilities for municipal services are described in the next section.
• The Montana Ambulance Association (MTAA) is working with Sellers Dorsey, a Medicaid financing consulting firm, to design the assessment and supplemental payments and obtain legislative and CMS approval for the program.

2. How does the program work?

• Under the program, the State imposes an assessment on private non-governmental providers (as defined above). These funds will be used as the state share for federal Medicaid matching funds. The State will then make Medicaid payments to these private providers using the revenue raised through the assessment plus federal matching dollars. These payments would be made directly to providers as supplemental payments (as opposed to base rate adjustments).

3. Is this being done in other states?

• Yes, over a dozen other states have passed legislation authorizing an assessment program. These programs have proven incredibly successful for providers, bringing in tens of millions of new dollars for the ambulance industry.

4. How can I make sure this beneficial program gets implemented?

• Industry support is integral to the program’s success. The program will only move forward with broad support from state’s non-governmental providers.

5. Who will participate in the program once it is approved?

• Once the required legislation passes, Sellers Dorsey and the Association will work with the Department of Public Health and Human Services (DPHHS) to get approval from the Centers for Medicare and Medicaid Services (CMS) for the program. Once approved, all private ambulance providers will pay the assessment and, in turn, will receive supplemental payments based on their Medicaid volume.

6. What about hospital-based services? Will they participate in this program?

• As long as the hospital’s ambulance services are separate from other hospital services, that is they bill and receive payments separately and their revenue is not already included in any hospital tax program, they will be part of this program.
• If ambulance services are “bundled” with hospital services – they are not billed and paid for separately and ambulance revenue is part of the hospital tax base – the hospital could choose to “unbundle” the services to participate in this program.

7. How is the assessment determined? Is it a flat dollar amount for all providers?

• The assessment can be structured in a variety of ways but is typically a fixed percentage of a provider’s revenue that will be paid quarterly. Under federal regulations, the assessment may not be more than 6%. There are several options for determining the assessment, though the goal is to maximize the assessment amount to maximize the matching federal dollars.
• Sellers Dorsey and the MTAA are working to identify the methodology most beneficial to Montana’s EMS industry. The revenue base options for the assessment methodology include assessing up to 6% of the following:
  • Commercial revenue
  • Commercial revenue plus Medicare revenue and/or Medicaid revenue
  • Net patient operating revenue from all payors

8. How soon after paying the assessment will a provider receive the supplemental payment dollars?

• Sellers Dorsey’s goal is to minimize the time between paying the assessment and receiving increased Medicaid revenue. We will work with DPHHS to ensure that quarterly payments are made as close to the assessment date as possible.

9. Why is the Montana Ambulance Association working with Sellers Dorsey?

• Since its founding in 2000, Sellers Dorsey has generated over $19 billion in new federal financial participation for its clients. In the last four years, over 40 Sellers Dorsey designed Medicaid supplemental payment programs (in either managed care or fee-for-service) across 17 states have been approved by CMS.