THE PROJECT SUMMARY.

#The Petition serves as a robust legal instrument, meticulously crafted not only to guarantee a favorable outcome by systematically eliminating all potential avenues of denial, but also to prevent the emergence of irrational or unfounded opinions proactively. This is achieved by strategically addressing and effectively neutralizing the impact of six critical, previously unanswered questions, thereby closing off any potential pathways for dissent or misinterpretation.

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The legal foundation herein presented aligns with the legal framework established in the accompanying Medicaid document.   “The legal arguments demonstrate that Non-Emergency Medical Transportation (NEMT) constitutes an Essential Healthcare Product from all perspectives, and its necessity has been substantiated. Under the United States Constitution, as a Nation of Common Law, the current treatment of NEMT in the fault category has resulted in the creation of a two-tiered system, thereby violating the United States Constitution Law, The Fourteenth Amendment, Equal Protection, “Equal protection means that a government must apply its laws fairly and cannot treat people differently without a valid reason. Individuals in similar situations should be treated alike under the law, as mandated by the Principle of Equality 

This Proposal utilizes the legal grounds from the document created by Medicaid “  ( Attached in Appendix A). The Demonstration Non-Emergency Medical Transportation(NEMT) is an Essential Healthcare Product. However, it was misclassified into the wrong category.  EMT AMBULANCE and NEMT COVERAGE DENIAL IS INSURANCE PROVIDERS’ PROHIBITED.

The claim of EMT Ambulance Denial by Insurance Providers. In this transaction, the petitioner must claim that the issue happened before the petition's goal of adding NEMT into the National Coverage Determination. However, the issue must be addressed simultaneously with the implementation of the new law. In the petitioner’s opinion, if any product passes the burden of proof to confirm the status under NCD, the insurance provider should not still deny. When the petitioner reviewed the insurance provider’s reason for denial, it was likely that the EMT Transaction lacked medical necessity. The petition needs to ensure that all parties involved adhere to the same standard, the judgment below its fair value, and eliminate any game-playing, as in this petition. Two sources can dispatch the Ambulance: 

1. 911 Emergency Dispatch:

This scenario commences when a client initiates a call to 911. A trained 911 agent answers the call and, in collaboration with a 911 dispatcher, conducts an initial assessment to determine the immediacy and severity of the situation. This assessment is critical in establishing whether the case constitutes a genuine emergency, warranting the immediate dispatch of Emergency Medical Services. The information gathered during this initial contact, including the caller's description of the symptoms, the perceived urgency, and any pre-existing conditions disclosed, forms the foundational documentation for the emergency response. While the 911 system is designed to provide immediate assistance in critical situations, even dispatches from this source have faced unwarranted denials, resulting in significant financial burdens for patients and their families.

2. Physician-Initiated Dispatch (Inter-facility Transfer):

The second common scenario for EMT ambulance dispatch arises from a medical professional, typically a doctor, initiating the transfer of a patient. This most frequently occurs when a patient needs to be transferred from one hospital or medical facility to an emergency unit at another facility. This type of transfer almost always occurs while the patient is under a doctor's care, indicating a deliberate medical decision made for the patient's well-being. Consequently, all relevant medical documents, including physician orders, transfer summaries, and any diagnostic results, are issued by the attending physician and are meticulously attached to the case for claims processing.  However, most of the EMT Ambulance's transactions were denied by the source, 911 dispatching, due to unnecessary medical-related issues. Denying this reason in the situation suggests that the insurance provider is playing a game to deny coverage for its own profitability. Although the EMT Ambulance confirmed that it was an investment to increase the insurance provider's profitability, the same rationale applies to NEMT as well. By law, no one shall be allowed to refuse to pay the expenses from their investment. We must make it clear that if this is not done, the insurance provider will continue to deny NEMT transactions. 

In accordance with legal principles, no entity should be permitted to deny legitimate expenses incurred from profitable investments arbitrarily. Such denials must be predicated on verifiable facts and justifiable reasoning. A notable instance of this principle being violated involves insurance providers who rejected claims from EMT Ambulance and their associated clients in 911 emergencies. This rejection occurred despite the absence of a doctor on the scene, yet the insurance providers paradoxically imposed a requirement for documentation to be issued by a physician.

It is a well-established fact that individuals and organizations, including insurance providers, are expected to assume responsibility for scenarios in which they are directly involved. This petition aims to clarify the concept of fairness and establish a factual basis within the realm of policy, thereby eliminating any undue manipulation or "games" played by parties related to insurance policies.

Specifically, an insurance company's ability to deny transactions from EMT Ambulance and Non-Emergency Medical Transportation (NEMT) services, after both have been confirmed under the National Coverage Determination (NCD), should be strictly limited. Such denials would only be permissible if the submitted proof demonstrably fails to align with NCD guidelines or if the services demonstrably do not generate a profit for the insurance company. 

Crucially, both EMT Ambulance and NEMT products are eligible for confirmation under NCD status, having successfully navigated the pathway to demonstrate their efficacy as methods to enhance insurance providers' profitability. Furthermore, under new legislative provisions, the system is set to benefit from a 25% discount offered by this petition, thereby providing an additional layer of security and financial advantage to insurance providers, as it has never been enacted within the previous law. It highlights the mutually beneficial nature of these services when they are appropriately recognized and reimbursed.# RCM VS Insurance Provider.  All parties related to the Healthcare System must realize and understand that the 25% discount isn’t a punishment from the system; it is part of sharing our unintentional mistake, which we must all share as a fair solution. We can’t ignore the error; we all have a part in it, and we will hold the healthcare system accountable as we have previously. We will succeed together as a team.                      

The United States is a nation of Common Law; similarly. The judge must decide the cases under the same part or section of law in the same direction. However, much confusion is brewing within this part of Non-Emergency Medical Transportation (NEMT) that needs to be addressed by the honorable MEDCAC committees.

The proposal provides a comprehensive outline of clear and concise facts for the esteemed MEDCAC committee's understanding, aiming to secure their concurrence regarding the use of legal authority to guide the U.S. healthcare system. This approach seeks to harmonize efforts and optimize services or products, a rare but achievable objective. Should a superior market offering, distinguished by its exemplary quality, present itself as a suitable replacement for established methods—provided it aligns with the most economical cost, as mandated by law—then this ideal item warrants consideration and approval by the honorable MEDCAC committee as an "essential healthcare product" covered under healthcare law and it‘s NEMT( Non-Emergency Medical Transportation ).

Lastly, if any party related to the Healthcare System is involved in this Petition, the person or Organization must answer the questions below. If they do not answer these questions correctly, they must agree to the terms and conditions of the agreement.

Question #1: As legal professionals, is it not established that the United States operates under a common law or case law system? If so, given that Medicaid, as an insurance provider, has historically covered Non-Emergency Medical Transportation (NEMT), why has this coverage not been extended to other instancesoutcome, as the world leader must be?     

Question #2: Do Medicaid's clients differ from those of other insurance providers? If not, why is this particular individual being treated disparately? This constitutes a violation of the Constitution, specifically the Fourteenth Amendment and the Equal Protection Clause.

Question #3: Are there other healthcare systems in the United States? If not, both Medicaid clients and clients of all other insurance providers utilize the same high-cost healthcare system. However, given that Medicaid covers Non-Emergency Medical Transportation (NEMT) for its clients, why do other insurance providers not offer similar coverage?

Question #4: If the world leader should carry a political will even though it’s outdated and leads to adverse outcomes, isn't it better to update the political will to get to a better, smarter outcome, as the world leader must be?                                                                                        

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Question #5: The EMT Ambulance was added to the National Coverage Determination because it was considered a return investment for the Insurance Provider to increase profitability. This was particularly important, as the NEMT journey was a long and ongoing process, which continues to this day. And if that confirmed theory is incorrect, the EMT Ambulance wasn’t returning any profit to the insurance Company, so why aren't the companies taking any action to revoke the theory? However, if the theory is confirmed, then why do insurance providers continue to deny the company's costs to achieve higher profits? Honorable Submitting for Consideration   

Question #6: Based on the fact and assuming could be “The EMT Ambulance that Wrongly If the Ambulance provider companies didn’t agree with the 25% discount for each wrongly-dispatched call, must they prove  both the wrongly calls and the unintentional mistaken dispatches, spending the same amounts of time and resources? dispatched from the fault determination from the critical decision-making, and it's unintentional  from the 911 dispatcher, anyone could make a mistake under this criteria, but to analyze the deeper outcomes after that unintentional mistake is the key to this question. The petitioner found that the time the ambulance spent on each incorrect dispatch was shorter than the time spent on the correctly dispatched trip.That will free the ambulance from those trip sooner with empty vehicles open the Ambulance for the next trip to generate other revenue and full amount if it’s the corrected determined trip. If the Ambulance providers companies didn’t agree with the 25% discount in each wrongly-dispatching they  must prove both of the wrongly dispatching and the unintentional mistaken dispatching spending the same amount of time and resources? So your company can still issue the full amount of charge to the system if can’t prove or quiet by law it legally admissible.