River Forest has joined a state program that has the potential to provide an extra $125,000 in ambulance fee reimbursements annually.
Village officials actually entered into an intergovernmental agreement with the Illinois Department of Healthcare and Family Services (IDHFS) to participate in the Illinois Ground Emergency Medical Transport Program (GEMT) in March 2020. At the July 11 village board meeting, the four trustees present voted unanimously to approve amending the ambulance fees ordinance to meet IDHFS requirements. Trustees Erika Bachner and Lisa Gillis did not attend.
GEMT is a federally funded Medicaid program that has been in existence for years but was introduced to Illinois via legislation in 2019. The program allows municipalities an opportunity to collect an additional Medicaid reimbursement for ambulance services, above and beyond what the state reimburses the village for Medicaid claims.
Fire Chief Tom Gartner said Illinois is one of 10 states participating in the program with over 250 departments in the state joining.
In a memo to Village President Cathy Adduci, Gaertner explained that the program provides supplemental federal funding for Advance Life Support (ALS) or Basic Life Support (BLS) emergency ground ambulance service trips under the Illinois Medicaid state plan and provides additional reimbursement for unrecovered costs associated with those transports. Through this program, the federal government will pay the state the difference between the set amount for Medicaid transports and the actual costs incurred by the village, he said.
The village is required to submit an annual Integrated Disclosure and Medicaid Cost Report (IDMCR) to IDHFS to determine the covered ambulance rate for the subsequent year. The intergovernmental agreement eliminates the division between Medicaid ambulance calls and ambulance transportation fees charged to service and managed care organizations. As a result, the village is required to apply the rate structure determined in the annual IDMCR across all users of the village’s ambulance services.
The ordinance change incorporates the requirements outlined in the intergovernmental agreement with a fee structure that is reflected in the annual IDMCR as filed with IDHFS. Amending the ordinance this way will eliminate the need to amend the ordinance whenever the village changes the rates. Under the previous ordinance, River Forest charged residents $900 and nonresidents $1,150 for BLS service and charged residents $1,150 and nonresidents $1,550 for ALS service. Increasing fees required amending the ordinance. Under the change, the fee will reflect the actual cost according to the IDMCR filing.
Gaertner said if the 2022 IDMCR rate had been applied to the 2021 emergency medical service response calls, the village would have recaptured approximately $250,000. After subtracting the state of Illinois program costs, the village would have likely recaptured $125,000 from the program.
Medicare/Medicaid transports account for 16 percent of the department’s ambulance calls but 54 percent of the revenue according to Gaertner.