State of Maine Department of Health and Human Service, Office of MaineCare Services

Redesign of a supplemental payment program for emergency medical transport services provided to Medicaid clients

The State of Maine was facing decreased federal revenue in FY 2007 – FY 2008 after MaineCare discontinued its supplemental payment program. The state needed to develop an auditable program with sound methodology in order to capture all allowable reimbursement for EMS services. PCG Health™ had been working with MaineCare on a related project and was contracted to administer the EMS supplemental payment program.

To restart MaineCare’s supplemental payment program, PCG Health followed a careful methodology, based on more than 20 years of experience with revenue enhancement projects for state and local government agencies across the U.S. Steps included:

• Extensive research into federal and state regulations that impact MaineCare;
• Development and implementation of a CMS-compliant EMS provider-specific cost report to support claimable expenditures and/or certified seed money;
• Development of Medicaid Upper Payment Limit (UPL) calculations utilizing Medicare and Medicaid Fee Schedules;
• Development of cost reporting and expenditure data housing tools that would allow MaineCare to meet all federal requirements, including OMB A-87, and to significantly improve the current Rider A supporting documentation process; and,
• Development of a methodology to equitably redistribute pooled federal funds received from the supplemental payment program to program participants.

To date, PCG Health has helped MaineCare increase reimbursement by over $4 million dollars. PCG Health projects future claiming will increase with improved provider participation.