Wyoming Health Department looks to regulate air ambulance providers

JACKSON — The Wyoming Department of Health wants to make air ambulance travel cheaper for everyone.

Officials have drafted a waiver application to send to the Centers for Medicare and Medicaid Services asking to change air ambulance travel regulations. Essentially they want to treat air ambulance service like a utility, extending the service at Medicaid prices to everyone, regardless of age, income level or location by creating a type of regulated monopoly.

“We’re trying to fix the free market,” said Franz Fuchs, a Health Department policy advisor.

The idea behind it is simple: The state would choose air ambulance providers based on a public proposal process, set up a dispatch center that would field calls for the services and then assign providers to emergencies and hospitals based on their proximity. For instance, in a crash like the fatal one that occurred in July in Grand Teton National Park, the central call center would find the closest base in Wyoming with a helicopter ready and dispatch it to the crash site.

The goal is to decrease the cost of air ambulance travel, which can run tens of thousands of dollars and is often not completely covered by insurance companies. Sometimes the air ambulance provider that responds to a call isn’t in-network with a patient’s insurance company, so much of the cost falls to the patient.

The waiver would allow the state to retroactively expand Medicaid coverage to everyone who takes an air ambulance ride. Under the proposed program the state would pay providers a flat fee — the public notice likened it to a “gym membership” payment — then recoup costs from insurance companies and other payers.

As of Monday, the state is accepting public comment on the proposed waiver, which is one of the last steps in the process. Fuchs said the state will send the waiver application to the Centers for Medicare and Medicaid Service after the public comment period closes, then the federal agency will have 45 days to respond.

The Centers for Medicare and Medicaid Services can extend the process, however, if it has questions or wants to see changes to the application. Fuchs said if that happens the application could end up in a sort of bureaucratic limbo that could extend for years, which is the last thing the department wants.

The proposal faces a tough road, Fuchs said. The change would be a seismic shift in how the life-saving health care service is regulated. Though it would inject a high level of regulation into private enterprise, it is meant to quell some of the forces that saddle customers with big bills.

Because of the nature of air ambulance travel, customers don’t have the choice to ask for an in-network provider. Since Medicare and Medicaid pay less for an air ambulance flight than Wyoming providers say it costs, the difference in cost is passed on to insurance companies and patients. Many insurance companies have failed to reach agreements with providers to bring them into their networks, sometimes leaving patients with staggering bills.

Wyoming’s plan would eliminate the surprise of receiving a big bill by mandating that patients’ out-of-pocket costs would either be $5,000 or 2 percent of their annual income, whichever is lower. The Health Department labels it as a check on rampant economic forces that hurt consumers.

Fuchs called it a free-market solution because the state is still allowing market forces, namely how much companies charge, to dictate which providers fit into the proposed system. Call center dispatchers would receive calls and send them to approved companies. Other companies wouldn’t be excluded from the market, though the proposal would make it difficult for them to compete.

“There’s no legal reason we would stop them,” Fuchs said, “But if we are controlling the volume, they would get no calls.”

To comment or view materials related to the application go to AirAmbulanceWaiver.Wyo.gov. Fuchs will also take comments at [email protected]. The public comment period ends Sept. 29.

The Health Department will also hold a pair of public meetings, one at 11 a.m. Sept. 3 in Torrington and another at 5 p.m. Sept. 5 in Laramie. Call in information is on the same website as the application.