Ground Ambulance (Public/Private) Providers

Government-Owned UPL Payment Limit (UPL)

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.

Calendar Year 2023 Claims Period

The participation period is open for the January 1, 2023 – December 31, 2023 Survey Period for all Public Ground Ambulance Providers to complete the needed information to calculate a UPL payment. This opportunity is also available to all Public Ground Ambulance Providers even if they did not participate in the previous Survey Periods (July 1, 2020 – December 1, 2022).

Per CMS requirement, providers must submit Average Commercial Rates (ACR) every two (2) years. Please see the needed documents for submission electronically through Myers and Stauffer secure FTP portal.

• GA Public Ambulance UPL Cover Letter (dated June 10, 2024)  - Posted 06/07/24
• GA Ambulance ACR Survey CY2023  - Posted 06/07/24
• Georgia Ambulance Governmental Ownership Checklist CY2023  - Posted 06/07/24

Calendar Year 2022 Claims Period

Public Ground Ambulance Providers that completed the needed information to calculate a UPL payment have received the following payments:

January 1, 2022 - December 31, 2022 - Final payment made February 29, 2024.

• Public Ground Ambulance UPL Final Payment (2022 claims) - Posted 11/12/24

January 1, 2022 – December 31, 2022 – Interim payment made March 23, 2023.

• Public Ground Ambulance UPL Interim (2022 claims) - Posted 11/12/24

Calendar Year 2021 Claims Period

Public Ground Ambulance Providers that completed the needed information to calculate a UPL payment have received the following payments:

• January 1, 2021 – December 31, 2021 – Final Payment made July 27, 2023.
  • Public Ground Ambulance UPL Final Payment (2021 claims) - Posted 11/12/24
• January 1, 2021 – December 31, 2021 – Interim Payment made January 26, 2023.
  • Public Ground Ambulance UPL Interim (2021 claims) - Posted 11/12/24

Calendar Year 2020 Claims Period

• July 1, 2020 – December 31, 2020 – Period 2 paid on September 1, 2022 and September 29, 2022.  
  • Public Ground Ambulance UPL Payments (July December 2020 claims) - Posted 11/12/24
• January 1, 2020 – June 30, 2020 – Period 1 paid on February 24, 2022, and June 23, 2022.
  • Public Ground Ambulance UPL Payments (January – June 2020 (claims)  - Posted 11/12/24

Ground Ambulance UPL Frequently Asked Questions  - Updated 03/10/23

Privately Owned Provider Fee Payments

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.

• Announcement Letter
• Georgia Ambulance Ownership Checklist
• Financial Survey Jan - June
• GA Ambulance Survey Letter (dated 09/10/21)  
• GA Ambulance Provider Reminder (dated 10/01/21)
• GA Ambulance Provider Reminder (dated 11/19/21)

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.

• GA Medicaid Ambulance Financial Survey Training Presentation
• GA Ambulance Assessment and Payment Program FAQs

Calendar Year 2022 Claims Period

• January 1, 2022 – December 31, 2022 – Interim Payment made June 17, 2024.
  • Private 911 3rd Interim Timeline (2022 Claims) - Posted 11/12/24
• January 1, 2022 – December 31, 2022 – Interim Payment made December 28, 2023.
  • Private 911 2nd Interim Timeline (2022 Claims) - Posted 11/12/2024
• January 1, 2022 – December 31, 2022 – Interim Payment made September 28, 2023.
  • Private 911 1st Interim Timeline (2022 Claims) - Posted 11/12/24

Calendar Year 2021 Claims Period

• January 1, 2021 – December 31, 2021 – Payment made June 29, 2023.
  • Private 911 Final Timeline (2021 Claims) - Posted 11/12/24