SB1254 Summary: Ground Ambulance Services Payments

• Establishes payment system for ground ambulance services under Illinois Medicaid effective January 1, 2016, based on 80% of Medicare Ambulance Fee Schedule rates as of July 1, 2013, adjusted by the 4 Medicare localities in Illinois.

• Requires Department of Healthcare and Family Services to pay ground ambulance providers the lesser of the provider's charge or the Illinois Medicaid Ambulance Fee Schedule rate for both base and mileage charges.

• Provides enhanced payment for rural county pickups: 1.5 times the ground mileage rate for the first 17 miles, then standard mileage rate for remaining distance.

• Requires mileage payment per loaded mile with no loaded mileage included in base rate; allows payment based on actual distance traveled when natural disasters, weather, or road conditions necessitate alternate routes.

• Establishes payment provisions for emergency ground ambulance services and managed care plan payments, with all payments subject to appropriation availability; permits Department to set rates by administrative rule pending appropriations.