Panel probes sharp jump in extra-large wheelchair payments; department pledges audits and review

Legislators pressed the department to explain how an NEMT transport rate for extra-large wheelchair services rose sharply and why utilization expanded after that change.

OSPB staff and department leaders told the Joint Budget and Technology Committees that the department had provided permissive guidance in 2020 to use an ambulance-rate code for certain transports that required additional equipment or personnel. That guidance was later benchmarked to Medicare-related indices through MPAC, which increased the higher rate to about $639 per pickup and coincided with a large increase in billed services.

Committee members said the department's earlier guidance may have encouraged broader use of the higher rate and questioned whether providers intentionally upcoded. Director Flores Brennan told the committee it will be difficult to definitively separate providers following guidance from those who intentionally upcoded, and that the department will not pursue providers who were following earlier direction; it will increase audits to identify potential fraud or unjustified billing and pursue recoupment where appropriate.

Senator Kirkmeyer and others asked how the department would make that determination given the guidance history; the department acknowledged the challenge and said it will prioritize audits and refine guidance to avoid repeated errors.

The committee asked for memos explaining the department’s analysis and for follow-up on rural provider effects, access impacts, and whether payment corrections had led to service disruptions.

The committee did not take final punitive action, but recorded a series of questions and requested staff follow-ups and data to support any future enforcement or policy changes.