A change in the Managed Care Organization which handles TennCare claims threatens to cut the amount that county-owned Bedford County Emergency Medical Services is paid for transporting TennCare patients.

Under the state's old MCO, TennCare Select, BCEMS was paid about $140 for a basic life support ambulance run, plus $4 per mile. Those rates were part of a contract between TennCare Select / BlueCare and BCEMS and had been in place since 1994, ignoring increases in gas prices, salaries and other operating costs since that time.

But now TennCare Select has been replaced by two other MCOs, AmeriChoice and AmeriGroup. And they want to pay BCEMS even less -- $120 for a basic life support run and only $2 per mile. The companies have refused to negotiate, according to BCEMS Director Chad Graham, and say that if BCEMS does not sign a contract accepting the new, lower rates, they will pay even less than that for non-contract service.

By comparison, said Graham, Medicare pays BCEMS $174 plus $9 per mile for a basic life support run.

Graham told his board members Monday night that TennCare accounted for about 13 percent of the ambulance service's annual billing in 2006. If the decreased compensation is allowed to stand, it will cost his department the equivalent of a half cent on the county property tax rate.

Graham said he's been working with the Tennessee Ambulance Services Association to try to rally its membership to try to protest the new, lower rates. TASA wants TennCare to pay the same as Medicare for ambulance runs. Graham has also contacted state Rep. Curt Cobb and state Sen. Jim Tracy to ask for their support.

If BCEMS cannot come to an agreement with AmeriChoice and AmeriGroup, it's possible that the MCOs would try to encourage a privately-owned ambulance service to set up shop here and handle non-emergency runs. The danger, Graham said, is that such a firm could skim the more profitable non-emergency ambulance runs while leaving BCEMS to handle emergency traffic, uninsured patients and so on. Or a private firm could cut its costs by providing a lower standard of care.

Graham said the county should adopt "fair practice rules" setting standards of care for non-emergency ambulance runs. If such standards are adopted, they would apply both to BCEMS and to any other ambulance service which set up shop in Bedford County. The county already has some standards in place, but they apply to emergency runs. He presented a draft of a resolution approved by Union County setting up standards for both emergency and non-emergency runs. The BCEMS board voted to submit the model resolution to the county commission's rules and legislative committee and ask for it to be adopted.

Meanwhile, Graham presented his 2007 budget request to the board. He proposed a 3 percent across-the-board raise plus 1 percent for longevity or career ladder raises for employees. The budget as approved by the board would total $1,694,452, with $1,075,000 in projected revenue, for a net cost to the taxpayer of $620,452, an increase of about $35,000 over the 2006-2007 budget. Graham raised the projected revenue by only $25,000 over 2006-2007 numbers because of uncertainty over the TennCare issue.

Graham also reported to the board that BCEMS should be ready to relocate from its Academy station to the new Unionville station on April 15.

BCEMS is still working out the details of receiving a donation of property in Airport Industrial Park from Wal-Mart Distribution Center. That site, near the construction site for the new Bedford County Medical Center, will become the ambulance service's new headquarters as well as an ambulance station. BCEMS also plans a new station in the Cascade School area on property owned by the school system.

The original plan was to build the airport station first and then the Cascade station after that. BCEMS doesn't want to open them both at the same time because new staffing will be required, and the goal is not to add the new staff until the 2008-2009 fiscal year. But because of the slow approval process for the Wal-Mart donation, Graham said BCEMS may need to flip the two projects. No decision was made on that, but the board did recommend going ahead and working with the school system to finalize details about where on the Cascade property the station should be located.