Congressman Greg Walden

Congress Passes 5 Year Extension of Medicare Add-Ons

On February 9, 2018 the Congress passed the 5 year extension of the Medicare ambulance add-ons. The extension was part of the two-year budget deal reached by congressional leaders. The Bipartisan Budget Act was signed into law by President Trump shortly after passage.

The ambulance provisions in the Bill include the following:

  • 5 year extension of the ambulance Medicare add-ons through December 31, 2022, retroactive to January 1, 2018.
  • AAA’s preferred method of Cost data collection that provides flexibility to the Secretary of HHS in developing the system. Consultation with the industry is required so that it strikes the appropriate balance between obtaining meaningful data while not overly burdening or onerously penalizing the ambulance services.
  • The penalty for failing to report required data would be a reduction in payment up to 10% for the year following the year in which the data should have been submitted. AAA objected to the house proposed penalty of up to a year of Medicare payments clawback or withholding of payments. A clause is included to wave the penalty in cases of hardship.
  • A “pay-for” for the 5-year extension of the add-ons with a 13% cut to non-emergent dialysis transports – the AAA had objected to the offset and pushed for a cut targeted to just those entities which abuse the dialysis transport benefit. We were successful in reducing the initial cut from 22% to 13%. The AAA is actively working on other pay-for options that would replace the 13% cut with something targeting dialysis fraud and abuse.

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.

Below, you will find a list of several of the ambulance industry’s and the AAA’s legislative priorities for 2018. Each priority goes over the current climate, the priority itself and provides valuable resources to help you join our efforts.

AAA Advocacy Priorities

Talking Medicare: CMS Implements Further Dialysis Cuts

Talking Medicare: CMS Implements Further Cuts in Reimbursement for Dialysis Services; Medicare Payment Data Shows Continued Reduction in Overall Spending on Dialysis Transports, but Net Increase in Dialysis Payments in Prior Authorization States On October 1, 2018, CMS implemented an additional thirteen (13%) cut in reimbursement for non-emergency BLS transports to and from dialysis. This cut in reimbursement was mandated by Section 53108 of the Bipartisan Budget Act of 2018. This on top of a ten (10%) cut in reimbursement for dialysis transports that went into effect on October 1, 2013. As a result, BLS non-emergency ambulance transports to and from dialysis that occur on or after October 1, 2018 will be reimbursed at 77% of the applicable Medicare allowable. The payment reduction is partially the result of the reduction in the amounts paid for dialysis services. However, it is also reflective of an overall decline in the number of approved dialysis transports. For this, we can look primarily to the impact of a four-year demonstration project that requires prior authorization of dialysis transports in 8 states and the District of Columbia. As a reminder, the original prior authorization states were selected based on higher-than-average utilization rates and high rates of…

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Update on Opioid Legislation & Rural EMS Grant Program

The AAA continues to push on policy issues important to our members we are happy to provide an update on two pieces of legislation that we have been actively monitoring. Congress is proceeding with consideration of several legislative vehicles as they address key topics prior to the November elections. First Responder Opioid Grant Program The AAA is pleased to report that language we supported on grant funding for opioid protection training for first responders has passed the Senate. Based on an analysis by counsel, we believe all ambulance service agencies would be eligible to apply for the grants. In 2017, the Administration officially labeled the Opioid Crisis as a public health emergency, and in response Congress has finally taken action. On Monday, the Senate overwhelmingly passed the Opioid Crisis Response Act with a bipartisan vote of 99-1. The impact of this legislation on the ambulance industry includes providing resources and training so that first responders and other key community sectors, including emergency medical services agencies, can appropriately protect themselves from exposure to drugs such as fentanyl, carfentanil and other dangerous licit and illicit drugs. $36,000,000 will be given annually for each fiscal year from 2019 through 2023. The bill also (more…)

Government Affairs Update

Government Affairs Update: What We’re Working On The AAA continues to press policy initiatives with Congress and the Administration that are important to our members. While not as high-profile as our successful efforts earlier this year on the five-year extension of the Medicare ambulance add-ons, the AAA is working hard on ambulance legislation and regulations that impact the EMS industry and ambulance services across the country. Here is a snapshot of those current efforts. Over the next month, we will be providing weekly in-depth updates highlighting these issues. Ambulance Cost Data Collection System The AAA was successful in getting our preferred language of an ambulance cost data collection system using a survey and random sample methodology included with the extension of the add-ons in the Bipartisan Budget Act of 2018. However, that was just the first key step in the process. We now need to ensure that CMS gets the details right as the agency develops the structural specifics and data elements for the system. It is critical that the system is designed in a way that ambulance service suppliers and providers will submit the most accurate data possible. The data will ultimately provide the information necessary for Congress, the…

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Add-Ons Update & Impact of Partial Government Shutdown

Call To Action:  Ambulance Add-Ons Update & Impact of Partial Government Shutdown Congress is heading toward a possible partial shutdown of the federal government without taking action on our expired Medicare add-on payments. While the AAA and other industry stakeholders have pressed hard for Congress to immediately pass a five-year extension of the ambulance add-ons, our message is not being heard loud enough amongst all the other noise. We need you to contact your members of Congress today in support of extending the 2% urban, 3% rural and 22.6% super rural increases! Last night, the House of Representatives mostly along party lines passed a Continuing Resolution to fund the federal government through February 16. The fate of the bill in the Senate is uncertain. If Congress does not pass by midnight tonight a measure extending funding for the federal government, there will be a partial government shutdown. The AAA had pushed for Congress to attach a Medicare provider extender package including a five-year extension of the ambulance add-ons to the Continuing Resolution.  Since the extender package was not included in the Resolution, we are pressing Congress to consider a separate extenders only package including the five-year ambulance extension or attach (more…)

AAA Spearheads Medicare Provider Extension Letter

AAA Spearheads Medicare Provider Letter Supporting Add-ons Extension The AAA spearheaded a letter by a coalition of Medicare providers urging congressional leaders to pass a Medicare provider extender package by January 19. This is part of the AAA’s ongoing efforts to ensure that the Medicare ambulance add-ons are extended as soon as possible. Many thanks to John Jonas and the team at Akin Gump for taking the lead on reaching out to other Medicare provider organizations. The AAA was able to secure the support of twenty organizations on the letter and the letter has been to congressional leaders as well as all congressional offices. The organizations that singed on to the letter are: American Ambulance Association (AAA) American Health Care Association (AHCA) American Medical Rehabilitation Providers Association (AMRPA) American Physical Therapy Association (APTA) American Occupational Therapy Association (AOTA) Association of Critical Care Transport (ACCT) Brain Injury Association of America Christopher & Dana Reeve Foundation Emergency Department Practice Management Association Falling Forward Foundation Focus on Therapeutic Outcomes, Inc. (FOTO) National Association for Home Care & Hospice National Association for the Support of Long Term Care (NASL) National Association of Emergency Medical Service Physicians National Center for Assisted Living National Rural Health Association (NRHA) (more…)

Alert: Medicare Increases Will Expire For Now: What You Need to Know

While the Congress succeeded in passing the Republican tax bill and keeping the federal government open with a short-term continuing resolution that included a temporary extension for the State Children’s Health Insurance Program (CHIP), it did not act upon the several Medicare extenders that expire on December 31, 2017. This extenders package includes the ambulance add-ons for urban, rural, and super-rural areas, as well as a moratorium on therapy caps, extenders for hospitals, and several other extenders important to other Medicare providers. Despite the fact that the Congress left town, there is still strong bipartisan support for reinstating these extenders – including the ambulance extenders – early in January 2018. The most likely time frame will be for the extenders to be added to the next government funding legislation, which must be passed by January 19. First, do not panic. As you may have already heard, CMS is telling providers and suppliers that the add-ons will expire at the end of the month. Technically that is true. The Agency is simply stating the obvious; but no one should imply from such statements that the Congress will not fix them or not make them retroactive. Historically, CMS has followed this pattern of indicating the add-ons have expired (more…)