Recent Victories and 2019 Priorities
The American Ambulance Association has worked diligently to achieve many legislative and regulatory wins for the industry in the 115th Congress. Thanks to AAA board, volunteer leaders, and members alike, we were able to accomplish many of our goals to improve payment and overall regulations that will benefit AAA members and the industry as a whole. The accomplishments of the 115th Congress include:
- Ensuring inclusion and passage of a 5-year extension of the ambulance Medicare add-on payments through December 31, 2022 in the Bipartisan Budget Act (BBA) of 2018. Also included in the BBA of 2018 was the AAA preferred method for data cost collection using a survey which is the most likely to provide useful data as well as the least burdensome on the industry.
- Following passage of the extension of the Medicare ambulance add-on payments AAA has successfully worked with CMS and the RAND corporation in the development of the cost collection system in order to ensure that the end result is feasible for our industry. AAA has established itself and our members as a main stakeholder throughout the cost collection development process and look forward to remaining involved.
- Introduce legislation to restructure the offset included in the Bipartisan Budget Act of 2018 for the 5-year extension of Medicare add-on payments. This restructuring would allow for the additional 13% reduction included in the BBA 2018 to only be applied those ambulance service agencies in which 50% or more of their volume are repetitive BLS nonemergency transports to and from dialysis centers rather than the industry as a whole.
- Supporting the efforts of the IAFC and NAEMT in passage of language from the SIREN Act (2830, H.R. 5429) that reauthorizes the Rural EMS Grant program. These grants will now provide funds up to $200,000 for training, equipment, and personnel retention in rural areas. The grants also require a 10% contribution by the grant recipient. While the AAA had advocated that language be revised to ensure small rural for-profit providers would still be able to apply for grants, we are pleased to see this program reauthorized.
- Through AAA members, working with Senator Collins to include report language to accompany the FY2019 Senate VA Appropriations bill which directs the VA to use the prudent layperson standard for determining emergency ambulance services coverage.
While we are very pleased with our accomplishments during the 115th Congress, we are eager for the year ahead and will work hard to see all of these priorities come to fruition. The AAA’s priorities for 2019 include:
- Cost Collection
The 116th Congress will be an important year in the development and implementation of the cost collection system within CMS and its work with the RAND corporation. AAA intends to remain very involved in this process in working with CMS, HHS, and Congress in order to ensure that the cost collection system end result is something with which our industry is able to comply. The AAA is also working to create comprehensive education resources on the new cost collection system. This information can be found at ambulancereports.org.
- 2019 Medicare Priorities Bill
AAA is eager to introduce a larger piece of legislation that will contribute to the long-term sustainability of the industry. This legislation will address issues such as inadequate reimbursement, the need for innovative payment models, a lack of equitable polices and more.
- Public Safety Officers Benefit
AAA will pursue efforts to include paramedics, EMTs and other first responders who work for a private for-profit EMS organization and who die in the line of duty as part of the Public Safety Offers Benefit program so that their family members will receive death benefits.
We will continue to pursue the Veterans Reimbursement for Emergency Ambulance Services Act (VREASA) which would provide veterans with reimbursement for emergency ambulance services when a prudent layperson would have a reasonable expectation that a delay in seeking immediate medical attention will jeopardize the life or health of the veteran.
- NEATSA Bill – Restructure of Medicare Payment for Non-Emergency ESRD transport
AAA will continue to push for policies that will help our industry target bad actors rather than harshly penalizing the entire ambulance industry for the fraudulent behavior of a few. We will continue to push to restructure the offset of additional cuts on ESRD transports to specifically target this additional cut to only those with 50% or more of their volume as repetitive BLS nonemergency transports to and from dialysis centers.
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.
AAA Advocacy Priorities
Moments ago, Congresswoman Terri Sewell (D-AL) and Congressman Devin Nunes (R-CA) introduced the Medicare Ambulance Access, Fraud Prevention, and Reform Act of 2019 (H.R. 4938). Congressmen Peter Welch, (D-VT), Markwayne Mullin (R-OK), and Earl Blumenauer (D-OR) are original cosponsors of the legislation. Thank you to the bill sponsors for their continued support! H.R. 4938 would help stabilize current and future Medicare reimbursement of ambulance services and set the stage for future reform of the Medicare ambulance fee schedule. If passed, this bill would: Make Medicare Add-ons Permanent – Current temporary 2 percent urban, 3 percent rural, and super rural bonus payments would be made permanent. Expand Prior Authorization Pilot Program Nationwide – To address fraud and abuse with the transportation of dialysis patients by ambulance, the bill expands the Centers for Medicare & Medicaid Services (CMS) national prior authorization program for repetitive non-emergency basic life support (BLS) dialysis transports. CMS has not yet exercised its authority to expand this successful pilot program nationwide. While CMS is considering exercising its authority to extend the program nationwide in a recent proposed rule, it has not made a final determination yet. Provide Regulatory Relief – Amend requirements under the 855 form to make (more…)
The American Ambulance Association has been working hard to accomplish the legislative goals of the membership in the 116th Congress. The AAA would like to take this opportunity to provide an update on what we have accomplished thus far in the 116th Congress. Balance/Surprise Billing Balance/surprise billing is a hot button issue that recently came into the spotlight at the start of the 116th Congress. With the President’s announcement calling for Congress to pass legislation that would end surprise billing for patients, there has been an increase in Congressional action on the issue including introduced legislation, discussion drafts and hearings in all committees of jurisdiction. The AAA has been working tirelessly with the Congressional committees of jurisdiction to educate Members and staff on the unique characteristics of EMS systems and that it would be inappropriate to apply the same restrictions on balanced billing to ground ambulance services. The AAA has formed a working group comprised of AAA member volunteers that have worked on policy and messaging on balance billing. The working group has submitted comments to the Energy and Commerce Committee and Senate HELP committees advocating that the ambulance industry is unique from other stakeholders, and as such, should be looked (more…)
House Introduces NEATSA Act Companion Bill (H.R. 3021) The American Ambulance Association (AAA) is pleased to announce that, Congressman Darin LaHood (R-IL) and Congresswoman Terri Sewell (D-AL) have introduced H.R. 3021 the “Non-Emergency Ambulance Transportation Sustainability and Accountability Act of 2019” or “NEATSA Act.” Last year, Congress included in the Bipartisan Budget Act of 2018 an offset to cover the cost of the 5 year extension of the add-ons. The offset cuts reimbursement for BLS non-emergency transports to and from dialysis centers by an additional 13%. This is on top of the preexisting 10% reduction. This legislation would restructure the offset so that a majority of the additional reduction would be focused on those ambulance service agencies in which 50% or more of their volume are repetitive BLS non-emergency transports to and from dialysis centers. H.R. 3021 is the reintroduction of H.R.6269 from last Congress. This legislation serves as a companion bill to the Senate version, S. 228 by Senator Cassidy (R-LA) and Senator Jones (D-AL) which was introduced in January 2019. The additional cut went into effect on October 1, 2018 and has since negatively impacted AAA members. As such, the AAA is grateful for the support of Congressman LaHood…
The American Ambulance Association (AAA) is pleased to announce that Congressman Lee Zeldin (R-NY-01) and Congressman Thomas Suozzi (D-NY-03) have introduced H.R. 2887, the “Emergency Medical Services Providers Protection Act.” This piece of legislation would extend the Public Safety Officers’ Benefit (PSOB) to cover first responders who work for private providers. The PSOB Program provides death and education benefits to survivors of fallen law enforcement officers, firefighters, and other first responders, and disability benefits to officers catastrophically injured in the line of duty. The AAA has advocated tirelessly for years that all first responders killed in the line of duty, should be eligible for this benefit regardless of who their employer is. Many of the nation’s first responders work for more than one EMS Agency. Local communities throughout the country decide which organization is best fit to provide high quality mobile healthcare to their community. For large parts of the country, privately run ambulance services have been providing high quality health care, and responding to the same natural disasters, incidents, etc. as their peers for decades. It is common for Paramedics and EMTs to also work/volunteer as firefighters and vice versa. Currently, if a line of duty death occurs, whether (more…)
This morning Ruth Hazdovac and Aidan Camas of AAA staff and Kathy Lester, Esq, Healthcare Consultant to the AAA attended a briefing held by the House Energy & Commerce Committee on the issue of surprise/balance billing. At the briefing, staff for Chairman Frank Pallone (D-NJ) and Ranking Member Greg Walden (R-OR) announced that they would be releasing a bipartisan discussion draft, the No Surprises Act, which would “protect consumers from surprise medical bills and increase transparency in our health care system.” As of now, ground and air ambulances are NOT included in the discussion draft. However, the committee is asking for comments on ground and air ambulance and recommendations on how to provide relief to the consumer in this area. The AAA has a Balance Billing Work Group that is hard at work developing a policy recommendation that will work for our members. The House Ways and Means Health Subcommittee Chairman Lloyd Doggett also announced today that the Health Subcommittee will hold a hearing next week entitled “Hearing on Protecting Patients from Surprise Medical Bills.” AAA Staff will be at the briefing and provide a timely update to membership on any developments. The AAA team will be submitting comments and (more…)
February 14, 2019 For Immediate Release Contact Maria Bianchi American Ambulance Association 202-802-9020 email@example.com CMMI Announces Ambulance Innovative Payment Pilot Program Washington, DC – Today, the Centers for Medicare & Medicaid Services (CMS) Center for Medicare and Medicaid Innovation (CMMI) announced the launch of the Emergency Triage, Treat and Transport (ET3) Model. During the next five years, this model will test paying ambulance providers and suppliers when they transport beneficiaries to locations other than an emergency department, if the alternative location is more appropriate medically for the patient. It will also test paying for health care services provided by qualified health care professionals or through telehealth at the scene even if the ambulance does not transport the patient. While there are several important details yet to be released, this model appears to track the recommendations the American Ambulance Association, our members, and other industry partners have been working with CMS to implement. “Over the last 7 years, the AAA and our members have been working to develop an innovative payment framework to modernize the Medicare ambulance benefit,” said AAA President Aarron Reinert. “We are pleased that CMS is taking this important step and look forward to working closely with Administrator (more…)