New Broker for Kentucky UHC Community Plan & Caresource Medicare

As of January 1st, Kentucky has a new Medicaid HMO, this is UHC Community Plan of KY. UHC Community Plan of KY requires prior authorization through ModivCare (formerly Logisticare). In addition to this, ModivCare is the broker for Caresource Medicare HMO. Without prior authorization for any non-emergency transport with UHC Community Plan of KY or Caresource Medicare HMO, there is no means for reimbursement.  To be eligible for reimbursement you MUST be a contracted transportation provider with ModivCare.

It is our understanding that KAPA is fighting this but that does not mean they will get this requirement changed. At this time, it is our opinion that you should become a contracted transportation provider with ModivCare to avoid interruption in reimbursement. We have contacted ModivCare and asked multiple questions to give you a feeling of what to expect.

The greatest downfall to their process that we see, is that it relies on the sending facility to arrange the transport through ModivCare directly. They will not be able to request the service directly from the provider. If they do, it will be the responsibility of the provider to decline transport without the prior authorization before transport.

The greatest advantage that we see, is the reimbursement structure that we have seen will result in payment much higher than the current Medicaid Non-Emergency transport fee schedule.

According to Laura Watkins at ModivCare, they have been reaching out to providers to provide education and to attempt to contract.

Attached is documentation that we have secured, which can be used for review of what their contract details. It is imperative however that you contact ModivCare directly to begin the contracting process and avoid lost reimbursement if you provide non-emergency transports to anyone with these Medicare and Medicaid components.

Thank you,

Shellie Beamer

Q&A with MCA and Laura Watkins at ModivCare (formerly Logisticare)

Q: The insurance plans that require authorization through Logisticare 

A: UHC Medicaid and Caresource Medicare 

Q: The population of Kentucky that this effects geographically 

A: This is not a large plan. We do not have exact counts but the trip volume is expected to be low.  

Q: The plan for education to the facilities 

A: Outreach was done through UHC  

Q: Standard contract conditions 

A: I have attached a contract for you to review 

Q: Are you accepting the companies State License in placement of inspections for credentialing 

A: Yes 

Q: Rate structure (is there one for Medicare components and one for Medicaid, a blend, and is the rate negotiable) 

A: Rates are based on Medicaid and Medicare allowable rates 

Q: Documentation requirements 

A: Full contract, certificate of insurance to meet LogistiCare requirements, Workers’ compensation  

Q: Billing requirements 

A: Providers cannot bill without an executed contract 

Q: Process for billing when insurance discovery takes place after transport happens 

A: See above  

Q: Notification of trips, how does this take place, some of the providers have contracts with facilities, will they remain the preferred provider 

A1: Trip Notification

  • Members/Facilities must call ModivCare to schedule a reservation with proper notice
  • ModivCare’s customer advocate team will reach out to the providers to schedule the trip  
  • Hospital discharges/urgent appointments are handled same day

A2: Facility contracts – There is a questionnaire included with the contract documents where the providers can list the facilities they are contracted with – these will be first calls

Q: We also have clients in bordering states, how will this affect them? Will they need to contract as well?

 A: If they provide transport to covered NEMT services to members with UHC Medicaid or Caresource Medicare in Kentucky then they will need to be contracted to receive payment   

Q: Will an authorization be required on hospital to hospital transfers? 

A: Hospital to hospital transfers are generally a non-covered service  

Q: We also have some clients that provide wheelchair van services in addition to ambulance transportation. Will it be the same requirements for the wheelchair van services?

A: Providers with wheelchair van service would go through the same process – we would need to add wheelchair rates to their contract 

Q: Anytime there is change there is concern. The largest concern that providers should have, even once contracted, is that they will need to rely on the facility owning the process. By this I mean, in a perfect scenario, when a patient has “x” plan, the facility would contact Logisticare, who then would arrange transportation with a contracted provider. When currently what they know is that they need to free up the bed in the ER ASAP, or someone forgot to arrange transportation and the patient has been discharged so they need someone right now, or the person trying to clear the bed has no clue who the insurance provider is, in each of these scenarios they call who they know and as the ems provider they show up and do the transport. The difference now will be that they will not be reimbursed for their services. Right now providers are taking such a hit financially and have been since the whole pandemic began. They can not afford to absorb an additional loss on top of it. What is the recourse when this happens? Who is responsible for the facility outreach? Is there any backing in place in the form of legislation to hold facilities responsible?  I understand that this may be something that you are unable to answer yourself but maybe you could let me know who we may be able to talk to regarding those concerns. 

A: Facility outreach was done by UHC. We are working to adopt policies used in other networks if there is pushback with facilities about scheduling for discharges and we will have more info to come soon. 

Contacts at ModivCare:  

Laura Watkins

Manager, Provider Relations

ModivCare(formerly LogistiCare) 

Mobile: 859.415.8376 

Email:  | 

LinkedIn: ModivCare  | Facebook: ModivCare | Twitter: @ModivCare 

Gerald Trowbridge


Phone 515-202-4951

Announcements Blog

Updated Contracts

**Notice to all groups whose MCA Billing Agreements expire on 12/31/2015.


We are diligently working on the new contracts to get them out as soon as possible.  It may be that you do not receive yours before the end of the year.  Not to worry.  You will still be under the current contract.  There is a clause in the contract that states it will automatically renew unless either party terminates the Agreement.  We promise that we will get them sent out as quickly as possible.  Thank you for your patience.


Merry Christmas and Happy New Year!


Mike Wheeler

Provider Relations Specialist



Updated Signature Requirements

Click on the link below to see updated signature requirements for Medicare


Blog Re-post

A Request from KAPA

Tonya Chang with the American Heart Association is looking for personal stories and known instances where individuals in their communities have been saved by bystander CPR (before EMS arrived on the scene). They are looking for individuals who would be willing to share their story in support of their CPR-in-schools legislative initiative, which the Kentucky Ambulance Providers Association is supporting.

If you have a personal story or know of someone who would be willing to share their story, please forward that information to Tonya Chang ( or Tom Adams (

Blog Re-post

REPOST: Are Aging Ambulances Putting You At Risk?

You can find this story here… Aging Ambulances

Blog Re-post

Community Paramedicine in Washington state

Community paramedic visits people before they need 911 again

REPOSTED from, Thursday, September 18, 2014

By Eric Stevick, Herald Writer

EDMONDS – At 89, Rosemary Walters looks forward to Shane Cooper’s visits.

Their banter is rapid-fire and frequently funny.

Her mind is sharp.  It is her body that is wearing down.

Walters walks with the aid of two canes.  She has osteoarthritis of the spine and arthritis in her hands, an irregular heartbeat and diabetes.  Her morning routine includes swallowing 16 pills that are lined up on the arm of her easy chair.  More are taken throughout the day.

Senorita Nena, her slightly chubby chihuahua, trained to use scent to detect dangerous changes in Walters’ blood chemistry, stays close by.

The World War II British Army veteran likes it when the man in the dark blue uniform stops by her first-floor Edmonds condominium to check on her.

“He knows how to talk to the old folks,” she said.  “He doesn’t talk down to us.”

Cooper has an unusual job:  He is a community-based paramedic.  Unlike his peers at Snohomish County Fire District 1, he doesn’t respond to emergencies.  Instead, he roams south Snohomish County visiting people with serious medical problems before they need to call 911 again.

He has been at it for eight months now.  His boss thinks Cooper is the first community paramedic working for a fire department in the state.

What Cooper has is the luxury of taking time.  That’s not an option during a typical emergency call, when patients are panicked and seconds count.

“Now there is a conversation,” he said.

With Walters, he discusses a three-hour visit and assessment she had with a social worker.  He asks her daughter, Bryce Durst, if she is making progress with paperwork that will enable Durst to get paid for the around-the-clock care she’s providing.

Cooper checks the swelling in Walters’ legs and ankles.  They talk about the many medicines she is taking, her blood sugar levels and the time of day those levels are being recorded.

Mainly, he’s making sure she’s following her doctor’s orders.

Walters desperately wants to stay put in her cozy home, which has a bookshelf bulging with hard-bound classics.  Too many of her friends have died in nursing homes, she said.

“You want to keep your independence for as long as you can,” she said.

Walters also doesn’t want to be perceived as a chronic complainer.

That’s the beauty of the paramedic who makes house calls before there is a problem, her daughter said.

“It really has been a godsend,” Durst said.  “Mom tends to downplay a lot of the issues.”

Walters is one of an ever-changing number of people on Cooper’s case load.  Earlier this week, the list totaled 155.  Each is designated a row on a 38-column spreadsheet he maintains.

Initially, most of his stops were at homes with the district’s most frequent 911 callers.  That has changed.  Now the lion’s share are referrals from other paramedics and firefighters who have identified people in need of follow-up.

There’s a mix of patients.  Many have fallen.  Some have dementia or mental illness.  Others report weakness, breathing problems, or seizures.

Ideally, Cooper’s roster will be in constant flux.  A big part of his job is to connect patients to other professionals, including nurses and social workers.

“I think it’s going to take all three of us working together,” Fire District Capt. Shaughn Maxwell said.  “There is obviously a gap we are filling.  We want to route them to the right professionals.”

“Our challenge is how to keep up with the demand,” he added.  “How do we sustain this?”

Fire District 1 spent years researching successful community paramedic programs in Australia, Europe, and Canada.

The Verdant Health Commission, an offshoot of the Snohomish County Public Hospital District No. 2, found merit in the fire district’s vision.  It’s providing $144,426 annually over two years to get the program off the ground.

“It certainly seems to be reaching the goals of providing direct support to people with high needs,” said George Kosovich, Verdant’s director of programs and community investments.

It also is highlighting unmet medical needs in the community, which is important for Verdant so it can better understand where it fits in and how it can help, he said.

The job of monitoring the effectiveness of the community paramedic program falls to Robin Fenn, research manager with Snohomish County Human Services.

Initial results – though taken from a small sample of cases – are promising, she said.

She compared 13 patients who could be tracked for three months before and after the community paramedic began in January.  They accounted for 61 emergency medical calls beforehand and 23 after – a 62 percent reduction.  The patients’ emergency room visits also dropped by 54 percent.

“It is hard to track saved dollars,” Maxwell said.

Other fire departments in Snohomish County and beyond are now asking about the Fire District 1 experience.

“There is a lot of interest, a lot of passion, but not much money,” Fenn said.

A key factor in the success of the program is the personality of the paramedic, Maxwell said.

The bottom line is they must be patient and good listeners.

After visiting with Walters last Thursday afternoon, Cooper dropped in on Julia Williams in north Edmonds.

The fire district first began visiting the two-story home when Williams’ mom, who has dementia, took a fall.  She eventually was placed in a Shoreline rehab center.

It became apparent that Williams, 71, also needed help.

That afternoon, she asked Cooper to interpret one of her mother’s medical bills.

They talked about the need to sell the house and what could be done with its contents.

Making house payments has become increasingly stressful – “like keeping the Titanic floating,” Williams said.

Williams reported that she had an assessment scheduled with a psychologist the next day.

As he was preparing to leave, Cooper reviewed his notes.

“So I’m going to give you a buzz in the morning,” Cooper said.

“To keep me from going off the deep end,” she replied, with a smile.

Cooper did call to remind her of her appointment and later followed up to make sure she went.

He makes a lot of follow-up calls.

If patterns continue, his list of patients will grow.

There’s plenty of hidden need in a fire district of 225,000 people.

“It would be nice to replicate me by three,” he said.

Eric Stevick:  425-339-3446;

©2014 The Daily Herald Co., Everett, WA

Repost of original article located here

Announcements Blog

Call to action from AAA

The American Ambulance Association submitted this request to all members (related to previous KAPA post)…

Ask Your Congressperson to Co-Sponsor Medicare Relief and Reform (HR 5460) 

September 16, 2014


To: AAA Membership

From:  Jimmy Johnson, AAA President

Re: Ask your Congressperson to Co-Sponsor Medicare Relief and Reform (HR 5460)

This week, several Members of Congress introduced legislation critical to all of those in the ambulance industry. But we NEED YOUR HELP to ensure this bill gets the attention it deserves. Will you please ask your U.S. Representative to co-sponsor H.R. 5460?

H.R. 5460, the Medicare Ambulance Access, Fraud Prevention, and Reform Act of 2014, will modernize Medicare ambulance policies, address fraudulent conduct, and make critical stopgap funding a permanent part of the payment system.

Click here to learn more about the legislation and to send an email to your elected official. While we have provided a sample email that you can use, I highly recommend that you edit it by personalizing your message with an example of why you think the legislation is necessary.

Please Note: If you are represented by any of the following members of Congress, please thank him for his leadership on this critical industry issue: Greg Walden (OR-02), Peter Welch (VT-01), Devin Nunes (CA-22) and Richard Neal (MA-01).

Please send your co-sponsor request now. It only takes two minutes of your time. Thank you in advance for making sure our voices are heard on Capitol Hill.

Jimmy Johnson

Announcements Blog

Important request from KAPA

From Kentucky Ambulance Providers Association…

H.R. 5460, the Medicare Ambulance Access, Fraud Prevention, and Reform Act  was introduced in the House yesterday afternoon by Congressmen Walden, Neal, Nunes and Welch.

The American Ambulance Association has been meeting with Congressman Walden and members of the House Ways and Means Committee, and they have also met with the offices of Congressmen Roskam, Blumenauer, and Becerra. They are receiving very positive feedback about the bill and hope to secure several key sponsors.

Congressional offices need to hear from their constituents before they agree to cosponsor.

We are asking our KAPA members to contact your member of Congress and ask them to cosponsor this bill. There is a very small window for adding cosponsors before Congress adjourns again for the November elections. Currently, September 23 is the estimate for when Congress will adjourn.

Please visit for help identifying your Congressmen and ways to contact them.

Thank you!

Blog Re-post

How EMS can clear community paramedicine roadblocks (re-post)

State-specific restrictions, Medicare reimbursement, turf battles and public and patient acceptance must be tackled for any program to be successful

By Cate Lecuyer, EMS1 Editor

EMS may sit at the kids’ table of health care, but the industry still gets to eat.

“We may not be the biggest player, but we’re a substantial player,” Page, Wolfberg & Wirth attorney Stephen R. Wirth said Wednesday during his session “Shedding Light on the Dark Side of Community Paramedicine” at the ZOLL Summit 2014 tradeshow in Denver.

“There needs to be an ‘us’ mentality,” he added.

As EMS agencies nationwide are gearing up to deliver mobile integrated health care through a community paramedicine model, roadblocks such as state-specific restrictions, Medicare reimbursement, turf battles and public and patient acceptance have emerged as critical aspects that must be tackled in order for any program to be successful, he said.

The good news is that under the Affordable Care Act, there’s a federal incentive and support from the Inspector General for hospitals to reduce readmission rates to avoid being penalized, and it opens the door to experimental community paramedicine programs with that aim.

Getting around the red tape

In 2011, Minnesota was the first state to pass a community paramedicine statute that includes Medicaide coverage and offer an EMT-CP certification a year later.

“It did not come easy,” Wirth said. The law allows CP services to be included in a patient’s care plan and billing — with approval from the patient’s primary-care provider.

Authorized coverage includes everything from health assessments and chronic disease monitoring and education, to medication compliance, minor medical procedures, vaccinations and hospital discharge follow-up care.

When it comes to dealing with your own state, there’s no need to reinvent the wheel.

“Show them the Minnesota law,” Wirth said.

He admits that although we’re starting to see some changes, pursuing legislation to get Medicare to go beyond non-transports is not going to happen overnight. Many states also limit EMS providers to ambulance service operations, and require that ambulances go to the ER.

In this case, partnerships are the key. It may be possible to implement community paramedicine programs through medical practice associations, physician groups and hospitals rather than going through the state.

Now that hospitals will soon be penalized for excessive readmissions under the Affordable Care Act’s Hospital Readmissions Reduction Program (HRRP), it makes sense to start an initiative focused on acute myocardial infarction (heart attacks), heart failure, and pneumonia — which are the readmissions HRRP has identified as those that hospitals need to reduce in order to avoid penalties.

“The money,” Wirth said, “that’s where this is going to benefit.”

Collaborate on a fundamental change

Of course, it helps if your hospital is supportive of a proposed community paramedicine program from the start — along with doctors, health agencies, nursing groups, assisted living facilities and other organizations in the health care field.

These groups should see community paramedicine not as a threat, but rather a way for everyone to work together to meet a common goal of increasing patient access to health care, increasing patient outcomes to health care, and reducing costs.

“It really comes down to collaboration in overcoming these obstacles,” Wirth said.

Meeting with hospital administrators before proposing a community paramedicne plan, and coming up with one together, can go a long way in making sure the plan is successful, he said. “It’s also about showing other health care providers how EMS can add value to its piece of the pie. Taking the lead in the coordination of patient services and care can also lead to public education and acceptance.

“We need to demonstrate we’re not just a bunch of ambulance jockeys,” Wirth said.

And it’s important to present community paramedicne programs as an expansion of existing services and skills.

“Don’t paint a picture that this is a big new thing,” he said. At the end of the day, it really comes down to the changing the “if you’re sick, call 911″ mentality, and getting EMS in at the ground level.

“There are some really cool opportunities for us to get on board a fundamental change,” Wirth said. “And those who get on the train early will benefit the most.”

Announcements Blog

An Urgent Request For Kentucky EMS Squads

This is from John Hultgren with KAPA…

The Kentucky Army National Guard is seeking information as to the availability of employment for its returning military medics in the civilian sector as Advanced EMTs.

They have contracted with Eastern Kentucky University to develop a survey that will gather this information.

Please take a moment and complete the short, three question survey.  Completion time is less than one minute and will provide valuable data for the National Guard.  This survey will be active until July 14, 2014.

Visit the survey at: