- Frustrated with expensive air ambulances, Wyoming is proposing a creative solution to rein in costs and improve coverage and eliminate surprise bills. To achieve this, the state wants CMS approval to regulate air ambulances like a public utility.
- Wyoming wants to extend Medicaid to every state resident, nearly 578,000 people, but only as it pertains to covering air ambulance rides and as a way to regulate the industry within Wyoming. The state is proposing to pay air ambulances a periodic, flat payment as opposed to payment per ride.
- The state is asking federal regulators for approval through its application, or what's known as a 1115 Medicaid waiver.
Wyoming is not alone in its efforts to thwart sky-high air ambulances prices. Congress is mulling over different pieces of legislation to curb surprise bills including from air ambulances as consumers and advocates call for relief.
A majority of air ambulances rides were out-of-network in 2017, putting patients at risk of receiving a surprise bill, according to a government report that analyzed private insurance data.
Many states have been handcuffed by a federal regulation, specifically the Airlines Deregulation Act of 1978, that bars them from regulating the price or routes of air carriers. Under the law, air ambulances are considered air carriers.
Wyoming is attempting to circumvent that by expanding Medicaid, but only applying it to residents when it comes to air ambulance services. The idea, Wyoming's Department of Health says, will solve a number of issues including access issues and an overabundance of providers.
Here's how it would work:
The state would pay a select number of air ambulance providers a fixed price, moving away from payment per ride. Wyoming believes this would alleviate the oversupply of air ambulances in some areas and gaps in other parts of the state. At the same time, it would also eliminate what it sees as perverse incentives set up by the fee-for-service model.
Air ambulances would also be selected by the state after going through a competitive bid process and the state would establish a statewide call center that would direct air ambulance volume.
Resident eligibility would be determined retroactively or after an air ambulance ride, according to the department of health's application. There were about 4,000 air ambulance trips in Wyoming in the state's 2018 fiscal year. About 500 of these were for current Medicaid members.
The state explained how it doesn't make sense to have competing water utilities "digging and connecting water lines to your house," or "ten toll road operators building roads from the same origin to the same destination."
"Closer to air ambulance in operation, fire departments, police services, and even ground EMS services are all often regulated monopolies chosen by their local jurisdictions for the same reasons."
However, during informal conversations with the department it seems CMS is not enthusiastic about the idea, Franz Fuchs, policy analyst for the department, told Healthcare Dive.
So it remains to be seen whether CMS will approve the idea when the application is submitted closer to the end of September.
However CMS has approved a number of applications when states have requested to implement controversial Medicaid work requirements tying coverage eligibility to job or volunteering hours.