2021 - 2022 LEGISLATURE
ASSEMBLY SUBSTITUTE AMENDMENT 1,
TO ASSEMBLY BILL 874
February 21, 2022 - Offered by Representative Loudenbeck.
1An Act to create
25.17 (1) (aj), 25.776, 49.45 (3) (em), 49.45 (15r) and 256.23 of 2
the statutes; relating to: emergency medical transportation services under
3Medical Assistance program.
Analysis by the Legislative Reference Bureau
This bill implements an ambulance service provider assessment on private
ambulance service providers for supplemental reimbursements under the Medical
Assistance program and a supplemental reimbursement under the Medical
Assistance program to public ambulance service providers though certified public
expenditures. Currently, the Department of Health Services administers the
Medical Assistance program, which is a joint federal and state program that provides
health services to individuals who have limited financial resources. Generally, under
the Medical Assistance program, the state provides its share of the funding for
benefits and the federal government then contributes its designated share of
funding, also known as federal financial participation.
The bill imposes on each private ambulance service provider a fee for the
privilege of doing business in Wisconsin. The fee, as established by DHS is a
percentage of the ambulance service provider's net patient revenues from ground
emergency ambulance transports such that the total fee for a fiscal year is no less
than one quarter of 1 percent lower than the maximum limit for a provider fee under
federal regulation. The bill prohibits those ambulance service providers from
increasing rates they charge for their services because of the imposition of the fee.
DHS must obtain approval from the federal government, if necessary, to obtain
matching funds, and if federal approval is required, is prohibited from collecting the
fee until DHS receives that approval. The bill requires DHS to expend the moneys
collected from the fee assessment to supplement reimbursements to ambulance
service providers for services provided on a fee-for-service basis and through
managed care to Medical Assistance program recipients.
The bill also requires DHS to submit a state plan amendment to the federal
government to allow supplemental reimbursements under the Medical Assistance
program to public ambulance service providers for ground emergency medical
transportation through certified public expenditures. In certain circumstances
under the certified public expenditure process under current federal law, a public
provider may certify its costs for providing services to Medical Assistance recipients
that are in excess of the usual Medical Assistance reimbursement for those services
and then receive a supplement to cover otherwise unreimbursed costs.
The people of the state of Wisconsin, represented in senate and assembly, do
enact as follows:
25.17 (1) (aj) of the statutes is created to read:
(aj) Ambulance service provider trust fund (s. 25.776);
25.776 of the statutes is created to read:
425.776 Ambulance service provider trust fund.
There is created a 5
separate nonlapsible trust fund designated as the ambulance service provider trust 6
fund, consisting of all moneys received from fees from ambulance service providers 7
under s. 256.23 (2).
49.45 (3) (em) of the statutes is created to read:
(em) The department shall expend moneys collected under s. 256.23 10
(2) to supplement reimbursement for eligible ambulance service providers, as 11
defined in s. 256.23 (1) (a), for services provided under the Medical Assistance 12
program under this subchapter, including services reimbursed on a fee-for-service 13
basis and provided under managed care, by eligible ambulance service providers. 14
Health plans shall be indemnified and held harmless for any errors made by the
department or its agents in calculation of any supplemental reimbursement made 2
under this paragraph.
49.45 (15r) of the statutes is created to read:
49.45 (15r) Emergency medical transportation reimbursement.
department shall submit a state plan amendment to the federal department of 6
health and human services to allow payment of supplemental reimbursements 7
under the Medical Assistance program under this subchapter to public ambulance 8
service providers, as defined in s. 256.01 (3), for ground emergency medical 9
transportation through certified public expenditures. For purposes of this 10
subsection, any ambulance service provider that is owned by any municipality or 11
group of municipalities, regardless of whether or not the ambulance service provider 12
is organized as a nonprofit corporation, is considered a public ambulance service 13
provider. If the state plan amendment under this subsection is approved, the 14
department shall pay to an ambulance service provider that complies with a certified 15
public expenditure arrangement, as established by the department, a supplemental 16
reimbursement equal to the amount of federal financial participation for ground 17
emergency medical transportation services in accordance with state and federal law 18
and regulations, except that the total reimbursement under the Medical Assistance 19
program for the transportation may not exceed the actual cost to the ambulance 20
service provider of providing the transportation. If the federal department of health 21
and human services disapproves the state plan amendment, the department may not 22
pay the supplement under this subsection.
256.23 of the statutes is created to read:
24256.23 Ambulance service provider fee. (1)
In this section:
(a) “Eligible ambulance service provider” means any privately owned 2
ambulance service provider. “Eligible ambulance service provider” does not include 3
any ambulance service provider that is owned by any municipality or group of 4
municipalities regardless of whether or not the ambulance service provider is 5
organized as a nonprofit corporation.
(b) “Emergency ambulance transport” means all of the following:
1. Each ground emergency ambulance transport that requires the delivery of 8
life support services, including basic life support or advanced life support, by an 9
emergency medical responder or emergency medical services practitioner at any 10
2. Any other ambulance transport that is designated by the department to be 12
subject to the fee under sub. (2).
For the privilege of doing business in this state, there is imposed on each 14
eligible ambulance service provider a fee that is equal to a uniform percentage, as 15
determined under sub. (3), of the eligible ambulance service provider's net patient 16
revenues from emergency ambulance transports. Except as provided in sub. (4), each 17
eligible ambulance service provider shall pay the fee under this subsection in a 18
manner determined by the department acting in collaboration with the Professional 19
Ambulance Association of Wisconsin, or its successor organization, no more 20
frequently than quarterly. An eligible ambulance service provider cannot increase 21
rates it charges for its services because of the imposition of the fee under this 22
The department shall establish the uniform percentage of the eligible 24
ambulance service provider's net patient revenues so that the total amount of fees 25
collected from an eligible ambulance service provider under sub. (2) in a state fiscal
year is an amount not less than one quarter of 1 percent lower than the maximum 2
limit for a provider fee under 42 CFR 433.68
(f) but does not exceed the maximum 3
The department may allow an eligible ambulance service provider that is 5
unable to make a payment of the fee by the date specified under sub. (2) to make a 6
In accordance with s. 20.940, the department shall submit to the federal 8
department of health and human services a request for any state plan amendment, 9
waiver or other approval that is required to implement this section and s. 49.45 (3) 10
(em). If federal approval is required, the department may not implement the 11
collection of the fee under sub. (2) until it receives approval from the federal 12
government to obtain federal matching funds.
(1) Budget request; administrative costs.
The department of health services 15
shall include in its 2023-25 biennial budget request an appropriation to expend the 16
moneys in the ambulance service provider trust fund for the purposes under s. 49.45 17
(3) (em), including any request to expend the ambulance service provider trust fund 18
moneys for the department's costs in administering s. 256.23. Before the passage of 19
the 2023-25 biennial budget act, the department of health services may submit to 20
the joint committee on finance a request to supplement one of the department's 21
appropriation for the purposes of paying administrative costs of s. 256.23.