MAA continued working to improve the reimbursement rate for MaineCare by being actively involved with support for LD 998 An Act To Require the State To Adequately Pay for Emergency Medical Services. This legislation would have modestly increased MaineCare reimbursement for ambulance services closer to the Medicare allowable rate.
The cost of preparedness for Maine EMS providers is higher than national averages.
Maine Law requires EMS providers to respond to emergency calls and transport patients without regard for their ability to pay. As a rural State, Maine EMS providers have very long distances to travel for these responses and transport to hospitals, especially when transporting patients to the tertiary care hospitals in Bangor, Lewiston and Portland.
The GAO has studied EMS costs around the nation, and found that rural EMS providers have higher costs. This is especially true for Maine, where the small population is spread over a large area.
Maine EMS providers are struggling to maintain the emergency network in Maine.
EMS services must maintain equipment and trained personnel to meet state licensing standards. Maine law also requires the EMS network to be able to respond to emergency calls within 20 minutes on an annual average. With limited available resources, some EMS services around the State are forced to cut costs that affect preparedness. Some examples include deferred maintenance and borrowing to maintain vehicles.
Unlike other healthcare services, consolidation of EMS services to reduce costs is not an option for EMS providers because the same equipment and personnel infrastructure must be located around the state in order to meet the response time requirement.
Mainecare funding is not sufficient to pay for EMS costs for its members.
Maine EMS providers are reimbursed for only about 50% of the costs to provide services to MaineCare members. This rate is 35% below the Medicare rate, which is also below the cost of service. With rising costs of personnel and equipment, many services are struggling financially. Private, volunteer services are at risk; and municipalities are being pressured to raise property taxes to make up for the lack of state funding.
LD 998 was introduced in the 1st Regular session as a bill to direct DHHS to work with Maine ambulance providers to determine the MaineCare reimbursement rate. This bill was carried over to the 2nd Regular session with an amendement to require MaineCare payment at 70% of the Medicare rate and prohibit the rate from going below the the rate as of January 1, 2017.
However, the bill did not pass during the 2nd Regular session and MAA will continue advocating for improved reimbursement during the next legislative session.