Greene County-Greeneville Emergency Medical Services (EMS), which provides ambulance service to Greene County and its municipalities, is facing a $175,000 revenue shortfall because of an unanticipated change in the state's Medicaid program.

Greene County-Greeneville EMS Director Robert Sayne said on Monday that he learned last month that the state Medicaid program is no longer reimbursing ambulances services for part of the cost of transporting patients whose primary health insurance is the federal Medicare program.

Traditionally, he said, Medicare had covered 80 percent of the cost of ambulance transportation of patients who are covered by Medicare, while the state's Medicaid program had chipped in the other 20 percent of the cost.

But that changed, EMS Director Sayne said, when state officials, at the outset of the budget year that began July 1, reallocated to other programs the Medicaid funds that previously were used to reimburse ambulances services for 20 percent of the cost of transporting Medicare patients.

He said he learned of the change, after the fact, while attending a meeting in Nashville about another subject.

Neither he, nor any of the directors of other Northeast Tennessee ambulance services, received notification of the change in state policy regarding reimbursement of ambulance services before it took effect, Sayne said.

He noted that "about 60 percent" of the patients Greene County-Greeneville EMS transports on a non-emergency basis are covered by the federal Medicare program.

"This could cost lives," Sayne said, noting that his agency could be forced to cut service to make up for the anticipated revenue short-fall.

But during a Monday interview, Sayne said cutting service to the public will be a last resort as far as he is concerned.

Asked what a service cut might look like, Sayne said that unless the Medicaid funds are restored Greene County-Greeneville EMS could eventually be forced to take steps as drastic as operating only five ambulances per day instead of the present six and laying off personnel.

"I'm not going to do it [cut service] unless someone tells me directly that I have to do it," Sayne said. "I can't tell people in Baileyton or Tusculum or western Greene County that they're not going to have an ambulance."

Sayne noted that Greene County-Greeneville Emergency Medical Service's 2008-09 budget is $3,138,342, of which $3,083,843 is expected to be covered by patient charges.

The remainder of the EMS budget, Sayne said, is to be funded by a $38,149.30 allocation from the Greene County Commission and a $16,349.70 contribution from the Town of Greeneville.

Sayne noted that the $175,000 in funding that Greene County-Greeneville EMS apparently will lose unless the change in state policy is reversed, is actually among the smaller amounts among Northeast Tennessee ambulance services.

For example, Washington County-Johnson City EMS is facing a revenue decrease of about $400,000 as a result in the Medicaid reimbursement change, while Sullivan County EMS is facing the loss of some $276,000 and Carter County EMS is facing a shortfall of some $201,000, Sayne said.

Sayne pointed out that area state legislators were unaware of the change in state Medicaid reimbursement policy for ambulance services before it took effect.

He noted that he had spoken personally to state Rep. David Hawk, R-5th, of Greeneville, about the situation.

Sayne said that Greene County Budget Director David Lawing also had spoken to state Rep. Eddie Yokley, D-11th, of Greene County, and state Sen. Steve Southerland, R-1st, of Morristown.

Nashville Meeting Sept. 17

A meeting between state legislators and state officials to discuss the problem is planned for Sept. 17 in Nashville, Sayne said.

State Rep. Hawk said members of the Northeast Tennessee legislative delegation plan to meet with representatives of the state Department of Finance and Administration on that date.

"We're going to express our concerns about these cuts and our desire to see them reinstated," Hawk said. "And we're going to let them know how deep the cuts in our community budgets will be."

Hawk noted that in the reimbursement policy change was one of the "surprises" in the state's $28-billion budget our which legislators were not aware at the time the budget was approved.

"In a $28 billion budget, some things don't always get brought to light," Hawk said.

EMS Director Sayne said area ambulance service directors hope legislators can bring about a reversal of the policy change. But he said that likely won't happen before the legislature returns to session next January.

"A lot of money is going to be lost by then," Sayne said.

State Official Comments

A telephone message left for Marilyn Wilson, a spokesman for the TennCare program, on Monday afternoon was not immediately returned.

However, Wilson had confirmed to the Bristol Herald-Courier in late August that the policy change had taken place

"Medicare reimburses 80 percent, and for most providers that's all they receive," Wilson was quoted by the Herald-Courier as having said on Aug. 29. "What's changing is that providers that had been reimbursed by both Medicare, as well as getting a 20 percent co-pay from TennCare (Tennessee's version of Medicaid) has changed. Our policy is we no longer pick up the 20 percent."

Wilson said the agency sent notices of the change after July 1, when the policy change was officially set in the state's budget.

"When we do have to tighten our belts, we have to make a change," she said. "When we looked at all the things we could tighten up in our budget, we did find this inequity where the majority of providers were not receiving this extra check."

Wilson conceded that TennCare had followed the ambulance service reimbursement policy for years.

"It was a reimbursement policy used by TennCare for a long time, and quite frankly, we found that a reimbursement to a handful of providers was not very efficient," she said.