It is hard to fathom any acceptable excuse for the state’s prolonged delay regarding Medicaid-related payments to eligible ambulance services operating in the commonwealth.

Act 15 of 2023, which increased reimbursement for transporting Medicaid patients, took effect Jan. 1 of this year. This is September, and as of late last month, many ambulance services across the commonwealth still were waiting for release of the additional money authorized by the 2023 legislative measure.

One of the ambulance units in question is Altoona’s AMED, which, as of late last month, was due $200,000 — and experiencing a cash-flow crunch because of not having that money in hand.

Other Keystone State ambulance services reportedly were dealing with similar financial challenges of varying degrees, and lodging complaints with the Ambulance Association of Pennsylvania about the money holdup that never should have been.

Even if the money issue is being addressed to some degree now, as a result of news reports exposing the problem, or even if most of the money has been distributed by now, it is right that the problem undergo a complete airing, because of the message that needs to be delivered to all applicable state officials — that the financial hardship imposed must never be repeated.

“It’s a mess” was the way AMED Executive Director Gary Watters characterized the situation in an Aug. 23 Mirror article. However, the way the proverbial ball was dropped should be construed as a significant embarrassment as well.

According to the Aug. 23 Mirror article, the new law “now requires payment of $13.20 for every loaded mile for ambulance transports, rather than the old $4-per-loaded-mile, starting at mile 21.”

That information is included in a Pennsylvania Department of Human Services Medical Assistance Bulletin published in April.

The new law also requires higher payments than before for Advanced Life Support, Emergency Advanced Life Support, Basic Life Support, Emergency Basic Life Support and helicopter transport.

Of course, managed care plans that cover Medicaid patients have been caught up in the mess.

Actually, the reimbursement problem began about a month before the updated reimbursements law was to take effect, because incorrect rates were published in the Pennsylvania Bulletin. The troubling situation was compounded when there were problems with the plan amendment that the state Human Services Department had to file with the federal Center for Medicare and Medicaid Services.

The plan amendment could not be filed earlier than Jan. 1, the first day of the month that the new rates went into effect. However, that plan was not filed with the Medicare-Medicaid Center until Feb. 5, and the federal center did not approve the plan until April 17.

Although the federal center’s approval authorized retroactive payments back to Jan. 1 and made the managed care organizations responsible for reprocessing claims to ensure that the higher rates would be paid, delay has persisted and cash-flow problems within many of the ambulance units, including Altoona’s AMED, have continued to become more challenging.

Too bad something built upon such good intentions was allowed to go so awry and create unintended hardship, when “burning the midnight oil” to fix what was wrong was clearly necessary.

Also, what is now clearly necessary is a thorough examination of what occurred and a pinpointing of who and what were responsible.

A “fumble” of this scope, with plenty of time on the proverbial clock, demands a better playbook.