Nelson County Fiscal Court voted Dec. 2 to participate in an optional supplemental-payment program for ambulance Medicaid payments that county EMS staff said bases additional payments on actual local costs and capital depreciation.

Michael (EMS) told the court the program requires detailed documentation of vehicles, salaries and capital expenses and that a contractor would oversee the paperwork. He said the contractor would receive 10% of any additional payments the county receives under the program and that the county may opt out at any time. Michael described the program as federal, optional and quarterly in its payment cadence; staff said actual payments would be behind historical timing and that payments would begin after filing (payment activity could start around Jan. 27 under the schedule discussed).

County officials said they had been conservative in prior estimates and expected the program to help "close the gap" between actual costs and Medicaid payments. After discussion, a motion to approve participation carried.

Quote from the meeting: "So they would get 10% of whatever we were received in additional payment," an EMS representative said.

Next steps: staff will proceed with program enrollment, prepare the required documentation with finance staff, and monitor any audit or reconciliation requirements associated with the supplemental payments.