Advocacy

Congressman Greg Walden

The AAA continues to press the Congress and federal agencies for help to ensure ambulance service organizations and our paramedics and EMTs serving on the front lines of the COVID-19 pandemic have the necessary resources and financial assistance to serve their communities.

Help support the AAA’s efforts by contacting your members of Congress today asking them to support the ambulance industry in upcoming COVID-19 relief legislation:

Contact your Members of Congress

 

2022 AAA Advocacy Priorities

The continuing dynamics of the COVID-19 Public Health Emergency (PHE) and corresponding challenges facing ground ambulance service organizations has shifted our view of the current prioritization of the legislative objectives of the AAA. Below you will find a list of the top advocacy priorities and objectives the AAA is pursing in 2022.

Balance Billing –Ground Ambulance Patient Billing (GAPB) Advisory Committee

The American Ambulance Association, International Association of Fire Chiefs, International Association of Fire Fighters, National Association of Emergency Medical Technicians, and the National Volunteer Fire Council successfully advocated that the Congress take into consideration the unique characteristics of ground ambulance services when determining balance billing policy for our services. Because of these efforts, Congress excluded ground ambulance services from the provisions of The No Surprises Act and created the Ground Ambulance Patient Billing Advisory Committee to address balance billing for ground ambulance.

On November 23rd the Centers for Medicare and Medicaid Services (CMS) filed the Solicitation of Nominations Notice for the Ground Ambulance Patient Billing Advisory Committee in the Federal Register. The AAA has identified candidates, including AAA President Baird, who we will be supporting for inclusion on the Advisory Committee who we believe are well-positioned to represent the AAA membership. Once formed, the Advisory Committee has 180 days in which to report its recommendations to the Congress. The directive of the Committee is to review options to “improve the disclosure of charges and fees for ground ambulance services, better inform consumers of insurance options for such services, and protect consumers from balance billing.” We will continue to keep the membership informed of the actions and deliberations of the GAPB Advisory Committee.

EMS Workforce Shortage

As the shortage of ground ambulance service field personnel continues to grow to crisis levels, the AAA is developing a long-term strategic plan to address this issue. While some of the action items will take time to implement, staff and volunteers have identified several immediate action steps.

The AAA is working with the Health Resourced Service Administration (HRSA), the Assistant Secretary for Preparedness and Response (ASPR), and other key agencies of jurisdiction to actively seek a ground ambulance service only revenue stream to provide fund 1) increased pay for the current workforce, 2) grants and scholarships for EMTs and paramedics, 3) activities to promote the profession, and 4) pilot or demonstration projects related to recruitment and retention. These earmarked funds could be distributed to each state with specific guidance that the State Offices of EMS distribute the funds to all ground ambulance services using a proportional formula (per field medic). In addition, funds would be appropriated to HRSA specially for the support of training field personnel. The AAA sent a joint letter with NAEMT requesting HRSA EMS Training Funding, a Paramedic and EMT Direct Pay Bump, a COVID-19 Medicare Reimbursement Increase, and a Congressional Hearing on the EMS Workforce Shortage.

Sequestration

The AAA successfully advocated for a further delay of the long-standing 2% cut in Medicare reimbursement and the additional 4% cut to providers and suppliers resulting from Sequestration. On December 9th Congress passed S. 610, the Protecting Medicare and American Farmers from Sequester Cuts Act.

Under S. 610, the Congress waived the PAYGO rules for one year to 2023. The cuts were scheduled to occur early in 2022 if the Congress did not act by the end of the current congressional session. The Congress also extended the current freeze on the long-standing 2% sequestration reduction in Medicare reimbursement. The Congress had deferred the cuts during the COVID-19 public health emergency, but the deferral was scheduled to expire at the end of this year. S. 610 extends the 2% freeze until March 31, 2022, and then reduces the freeze to 1% from April 1, 2022, to June 30, 2022. To offset the cost of the deferral, S. 610 increases the reductions in 2030.

The AAA will be advocating for the further delay of the 2% sequestration and the additional 4% cut which is set to take place on January 1, 2023.

Data Collection

With the two-year delay of data collection due to the PHE, CMS has proposed that those ambulance service providers and suppliers selected to provide data in years 1, 2 and 3 or 75% of the industry do so for their 2022 budget year and the remaining 25% service providers and suppliers provide their 2023 data. Having 75% of the industry report their data in the first year of collection when CMS did not do a field test of the survey would significantly increase the chances of MedPAC using bad data for their report. In addition, the two-year delay of data collection means MedPAC would issue an initial report without any actual new data. It is therefore critical that the MedPAC report be delayed until the second batch of data is available to be analyzed.

The AAA submitted comments to the proposed rule on changes to the FY2022 Medicare ambulance fee schedule requesting that CMS follow congressional intent of collecting data over four years. However, it will likely require a technical fix by the Congress to direct CMS and MedPAC to make the adjustments. We are currently exploring legislative vehicles in which to address those fixes.

Provider Relief Fund

The AAA and our members with public relations support from the Mercury Group were instrumental in the effort by health care providers to press the Department of Health and Human Services (HHS) to distribute unallocated monies under the Provider Relief Fund. The

AAA had determined that the Provider Relief Fund was the likely source of the most immediate financial relief for our members. As a direct result of those efforts, on September 10 the Department announced a Phase 4 distribution of $25.5 billion in funds to health care providers. Phase 4 funds were distributed in late 2022 and HHS has also indicated there are additional unallocated funds. The AAA will be advocating for additional funds to be allocated to EMS providers as part of the potential 5th tranche.

Temporary Medicare Ambulance Relief

Since the temporary Medicare ambulance increases of 2% urban, 3% rural and the super rural bonus payment do not expire until December 31, 2022, we are focusing on efforts to proactively look for opportunities to pass the Preserving Access to Ground Ambulance Medical Services Act (S. 2037, H.R. 2454). We will need to continue to monitor the timing of when we believe CMS will issue a proposed rule on changes to the urban, rural or super rural designation of zip codes under the Medicare fee schedule based on 2020 census data. Should we believe CMS will issue the change in the FY2023 proposed rule, we will need to advocate for passage of the provision sooner as CMS issues proposed rules in the summer but begins drafting them early in the year.

 

We will keep you posted of new developments. Thank you for your continued support of the American Ambulance Association.

The American Ambulance Association invites you to become involved with our efforts on Capitol Hill.  It is thanks to our member’s contributions, both time and resources, that we are able to have such a strong influence with federal legislators. The efforts of the AAA’s legislative team and our members have given our industry nearly $2 billion in desperately needed Medicare relief over the last 12 years. Become a member today and join this important work.