NOTICES

DEPARTMENT OF HUMAN SERVICES

Medical Assistance Program Payment for Ambulance Transportation

[54 Pa.B. 1024]
[Saturday, February 24, 2024]

Background

 Act 15 of 2023 (P.L. 63, No. 15), enacted on October 23, 2023, provides for the payment of ground mileage for every loaded mile and that the fees for ambulance services are the greater of the highest Medicare rates published in the Ambulance Fee Schedule Public Use File for calendar year 2023 or the current Medicaid Ambulance Fees as updated by Medical Assistance (MA) Bulletin 26-22-07, titled ''2023 Ambulance Fee Increases,'' in both the Fee-for-Service (FFS) and managed care delivery systems, subject to Federal approval as may be necessary and contingent on the availability of Federal financial participation, beginning January 1, 2024. On December 30, 2023, the Department of Human Services (Department) announced its intent to increase fees for certain ambulance services for dates of service on and after January 1, 2024, upon approval by the Centers for Medicare & Medicaid Services (CMS) of a State Plan Amendment (SPA). See 53 Pa.B. 8162 (December 30, 2023). The Department is announcing updates to those previously published fees, as well as fee changes to two additional ambulance transportation procedure codes.

Discussion

 Upon approval by the CMS of the SPA, the Department will update the fees on the MA Fee Schedule, for dates of service on and after January 1, 2024, as follows:

Procedure Code	Procedure Code Definition	Pricing Modifier	Current MA Fee	MA Fee Effective January 1, 2024
A0425	Ground mileage, per statute mile	U8	$4 per mile for each loaded mile beyond 20 loaded miles of a trip	$13.20 per mile for each loaded mile of a trip
A0426	Ambulance service, advanced life support, nonemergency transport, level 1 (ALS 1)		$400	$421.54
A0427	Ambulance service, advanced life support, emergency transport, level 1 (ALS 1—emergency)		$400	$667.43
A0428	Ambulance service, basic life support, nonemergency transport (BLS)		$325	$351.29
A0429	Ambulance service, basic life support, emergency transport (BLS, emergency)		$325	$562.05
A0430	Ambulance service, conventional air services, transport, one way (fixed wing)		$3,325.53	$5,589
A0431	Ambulance service, conventional air services, transport, one way (rotary wing)		$3,325.53	$6,498.05
A0432	Paramedic intercept (PI), rural area, transport furnished by a volunteer ambulance company which is prohibited by State law from billing third-party payers		$80	$501.42
A0433	Advanced life support, level 2 (ALS 2)		$400	$966.01
A0434	Specialty care transport (SCT)		$400	$1,141.66
A0436	Rotary wing air mileage, per statute mile		$22.45 per mile for each loaded mile beyond 20 loaded miles of a trip	$40.92 per mile for each loaded mile beyond 20 loaded miles of a trip

 Upon CMS approval, the Department will issue an MA Bulletin advising ambulance providers of the change.

Fiscal Impact

 The overall estimated fiscal impact for Fiscal Year 2023-2024 is $2.313 million ($0.634 million in State funds and $1.678 million in Federal funds) for FFS, $41.561 million ($13.161 million in State funds and $28.400 million in Federal funds) for Capitation and $13.935 million ($6.394 million in State funds and $7.542 million in Federal funds) for Community HealthChoices (CHC). The overall annualized amount is $4.625 million ($1.268 million in State funds and $3.357 million in Federal funds) for FFS, $99.747 million ($30.850 million in State funds and $68.897 million in Federal funds) for Capitation and $33.445 million ($15.101 million in State funds and $18.344 million in Federal funds) for CHC.

Public Comment

 Interested persons are invited to submit written comments to the Department of Human Services, Office of Medical Assistance Programs, c/o Regulations Coordinator, P.O. Box 2675, Harrisburg, PA 17120 or RA-PWMAProgComments@ pa.gov. Comments received within 30 days will be reviewed and considered for any subsequent revision of the MA Program Fee Schedule.

 Persons with a disability who require an auxiliary aid or service may submit comments using the Pennsylvania Hamilton Relay Service at (800) 654-5984 (TDD users) or (800) 654-5988 (voice users).

VALERIE A. ARKOOSH, 
Secretary

 Fiscal Note: 14-NOT-1614. Under section 612 of The Administrative Code of 1929 (71 P.S. § 232), (1) General Fund;

 (7) MA—FFS; (2) Implementing Year 2023-24 is $634,000; (3) 1st Succeeding Year 2024-25 through 5th Succeeding Year 2028-29 are $1,268,000; (4) 2022-23 Program—$589,137,000; 2021-22 Program—$644,059,000; 2020-21 Program—$808,350,000;

 (7) MA—Capitation; (2) Implementing Year 2023-24 is $13,161,000; (3) 1st Succeeding Year 2024-25 through 5th Succeeding Year 2028-29 are $30,850,000; (4) 2022-23 Program—$4,557,000,000; 2021-22 Program—$3,060,000,000; 2020-21 Program—$2,507,000,000;

 (7) MA—Community HealthChoices; (2) Implementing Year 2023-24 is $6,394,000; (3) 1st Succeeding Year 2024-25 through 5th Succeeding Year 2028-29 are $15,101,000; (4) 2022-23 Program—$4,251,000,000; 2021-22 Program—$3,165,000,000; 2020-21 Program—$2,328,000,000;

 (8) recommends adoption. Funds have been included in the budget to cover this increase.

[Pa.B. Doc. No. 24-244. Filed for public inspection February 23, 2024, 9:00 a.m.]

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