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Medicaid Supplemental Payment Programs for EMS Providers

The Wisconsin Department of Health Services (DHS) has created supplemental payment programs for public and private emergency medical services (EMS) providers. These programs help get money to EMS providers for transporting Wisconsin Medicaid members. They apply to costs for services going back to 2023.

Key information

Wisconsin has two supplemental Medicaid payment programs for public and private EMS providers:

  • The Certified Public Expenditure Program provides supplemental Medicaid reimbursement to public EMS providers.
  • The Provider Assessment Program provides supplemental payments to private and nonprofit EMS providers (not owned or operated by a municipality). This program uses matching federal funds for quarterly assessments.

Supplemental payments for public EMS providers

The Certified Public Expenditure Program offers enhanced federal funding to “make up” the difference between the true cost of providing emergency ambulance transportation services and current Medicaid reimbursement rates. This program operates with no extra cost to the state. It’s only for public EMS providers.

Who can get payments?

To get payments through the Certified Public Expenditure Program, you must:

  • Provide ground emergency transportation services to Wisconsin Medicaid members.
  • Be licensed in Wisconsin.
  • Be enrolled as an active Wisconsin Medicaid provider for the period being claimed.
  • Be classified as a public EMS provider. A public EMS provider is an ambulance service provider owned and operated by a municipality or group of municipalities, even if it is organized as a nonprofit corporation.

How do payments work?

This program is voluntary. Public EMS providers can submit an annual cost report to DHS. DHS calculates supplemental payment amounts based on reported costs. All eligible providers who submit a cost report can expect a payment representing a share of their reported costs.

Step 1

 

Bill Medicaid interim payments throughout the fiscal year

Step 2

 

Get interim Medicaid payments throughout the fiscal year

Step 3

 

Complete an annual cost report after the close of the fiscal year to report the cost of EMS services

Step 4

 

Get supplemental payments through fee-for-service (FFS) cost settlement

January–April

Provider training and tool access (more information is coming soon)

April–May

Submission and review of calendar year (CY) 2023 cost reports

May–June

Submission and review of CY 2024 cost reports

Supplemental payments for private EMS providers

The Provider Assessment Program enhances Medicaid reimbursement rates for emergency ambulance transportation services by accessing extra federal funds. The program is mandatory for private EMS providers, who are required to pay a quarterly assessment fee to operate as an EMS provider in Wisconsin.

Who gets payments?

You get payments from the Provider Assessment Program if you are a privately owned or private nonprofit EMS provider (not owned or operated by a municipality).

How do payments work?

Each quarter, private EMS providers pay their assessment fee on the DLTC ePay System. DHS then draws matching federal funds on those collected fees. DHS then redistributes the total as supplemental payments to providers for transporting Medicaid members. The supplemental payment amounts are calculated for each provider based on the volume of trips they make for Medicaid members compared to other private providers in Wisconsin.

Step 1

 

Report organization data annually

Step 2

 

Pay quarterly assessments received on the DLTC ePay System

Step 3

 

DHS accesses additional federal match funding

Step 4

 

Get supplemental reimbursement payments throughout the year

Schedules of private Provider Assessment invoices and payments for FFS transports

Program date rangeProgram quarter (Q)Invoice issue dateInvoice due dateTarget payment dateAnticipated receipt date
Jul. 1, 2023–Dec. 31, 20232023 Q1 and Q2Jan. 15, 2025Feb. 5, 2025Feb. 13, 2025Feb. 19, 2025
Jan. 1, 2024–Jun. 30, 20242024 Q1 and Q2Jan. 15, 2025Mar. 7, 2025Mar. 13, 2025Mar. 19, 2025
Jul. 1, 2024–Dec. 31, 20242024 Q3 and Q4Jan. 15, 2025Apr. 6, 2025Apr. 10, 2025Apr. 16, 2025

Program date rangeProgram quarter (Q)Invoice issue dateInvoice due dateTarget payment dateAnticipated receipt date
Jan. 1, 2025–Mar. 31, 20252025 Q1Jan. 15, 2025Mar. 1, 2025Apr. 10, 2025Apr. 16, 2025
Apr. 1, 2025–Jun. 30, 20252025 Q2Jan. 15, 2025Apr. 1, 2025Jul. 10, 2025Jul. 16, 2025
Jul. 1, 2025–Sept. 30, 20252025 Q3Jan. 15, 2025Jul. 1, 2025Oct. 9, 2025Oct. 15, 2025
Oct. 1, 2025–Dec. 31, 20252025 Q4Jan. 15, 2025Oct. 1, 2025Jan. 15, 2026Jan. 21, 2026

Background

DHS created these supplemental payment programs in response to 2021 Wisconsin ACT 228. The federal Centers for Medicare & Medicaid Services approved the programs on January 14, 2025.

Resources

Contact

WIGEMT@pcgus.com

Glossary

 
Last revised February 26, 2025