Ground Ambulance Upper Payment Limit (UPL)

Government-Owned

The Department of Community Health (DCH) recently received approval from the Centers for Medicare & Medicaid Services (CMS) to provide a supplemental payment adjustment to government-owned (hospital affiliated or free-standing) ground ambulance providers in Georgia. Effective with dates of service beginning on January 1, 2020 and thereafter, the Fee-for-Service (FFS) Ground Ambulance Upper Payment Limit (UPL) Program will compensate eligible ambulance providers for ambulance services provided to Medicaid FFS members. DCH has determined the UPL will be based on commercial rate information through the calculation of an average commercial rate (ACR) for each applicable ambulance service.

To participate in the program, eligible government-owned (hospital affiliated or free-standing) ground ambulance providers must submit to Myers and Stauffer the documentation listed in this notice. All documentation below must be submitted electronically through the Myers and Stauffer secure FTP portal.

  • Completed Average Commercial Rate survey
  • Signed Schedule 1 (attestation) of the ACR survey
  • Supporting documentation of commercial payment rates
  • Government Ownership Checklist

An online provider training was held on Thursday, March 18, 2021 at 10:00 AM EST for instruction on completing and submitting the ACR survey and supporting documentation. A video from the webinar can be viewed at this link.

Download this pdf file. UPDATED TIMELINE

July 1, 2020 – December 31, 2020 – Period 2 Notices:

January 1, 2020 – June 30, 2020 – Period 1 Notices:

Download this pdf file. Ground Ambulance UPL Frequently Asked Questions  

 

Privately Owned

House Bill 271 of the 2021-2022 regular session of the Georgia Assembly authorized the Department of Community Health (DCH) to develop an assessment program for the purpose of funding the state share of Medicaid supplemental payments for ambulance providers. The legislation authorizes DCH to implement the assessment program on a subset of ambulance services, and DCH intends to implement the assessment program for privately owned (private) ground ambulance providers. Participation in the assessment program by private ground ambulance providers is mandatory in accordance with House Bill 271.

To participate in the program, eligible ground ambulance providers must submit to Myers and Stauffer the documentation listed in this notice. All documentation below must be submitted electronically through the Myers and Stauffer secure FTP portal.

An online provider training was held on Tuesday, September 14, 2021 at 11:00 AM EST for instruction on completing and submitting the ACR survey and supporting documentation. A video from the webinar can be viewed at this link.