President’s Perspective: April 2018

Dear Fellow AAA Member, Spring has sprung, and the American Ambulance Association is busier than ever working on your behalf to build the future of EMS. The AAA is pleased to announce that since our last Response Times update, Congress has passed the 5-year extension of the Medicare ambulance add-ons. The extension included the 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 and avoiding overly burdening or onerously penalizing the ambulance services. This legislation was a true victory for the AAA and the entire industry. Learn more► This success would not have been possible without months of effort by AAA volunteer leaders, advocacy experts, and staff, as well as support from our key champions in Congress. In particular, the AAA would like to thank Senator Debbie Stabenow for spearheading our legislation and ensuring that the Senate language prevailed. In recognition of Senator Stabenow’s support, she has been named the AAA’s 2018 Legislator of the Year. The AAA would also like to thank Senators Schumer, Roberts, Collins, Leahy, Hatch, Wyden, Thune, and many (more…)

Congress Passes Ambulance Medicare Add-Ons

  It is my pleasure to share with you that—just minutes ago—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 and passed by the Senate early this morning and then shortly thereafter by the House. The ambulance provisions in the final deal differ from the provisions passed earlier this week by the House in one key area – the collection of ambulance cost data. This means that we are truly in the endzone of the add-on payment extension process. While we ask your continued patience as we jump through one last procedural hoop, I am confident that the add-ons will be back in effect as soon as the President signs the legislation. In today’s deeply divided political climate, I am proud of what we have accomplished through collaboration as an association and industry. Here are the specifics of the final package: 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 (more…)

House Passes Ambulance Medicare Add-Ons

Moments ago, the U.S. House of Representatives passed legislation which includes a five-year extension of the Medicare ambulance add-ons. The House voted 245 to 182 to pass a Continuing Resolution (CR) to fund the federal government beyond the current expiration date of February 8. The CR included a package of Medicare provider extenders including an extension of the temporary Medicare ambulance add-ons. The ambulance provisions in the CR include the following: A five-year extension of the temporary Medicare ambulance increases of 2% urban and 3% rural to base and mileage rates and 22.6% to the base rate in super rural areas. The extension would be retroactive to January 1, 2018 and expire on December 31, 2022. The requirement for ambulance service suppliers to submit cost reports. The language is based on H.R. 3729 as reported by the House Ways and Means Committee but with new language providing the CMS Administrator with the discretion to apply a payment suspension or overpayment as the penalty for suppliers that do not submit timely, accurate and complete data after the initial two years. To offset the cost of the add-ons extension, a further reduction of 13% in Medicare reimbursement for BLS non-emergency transports to (more…)

President’s Perspective: January 2018

Dear Fellow AAA Members, Happy New Year from the American Ambulance Association! This year promises to bring new challenges and opportunities for ambulance services. As your association, AAA, its experts, and the whole member community will be there to support you every step of the way. Advocacy Update If you’ve missed your recent member advocacy emails, you may be wondering “What is going on with the add-ons?!” I’d like to address this first and foremost. Despite the best efforts of the American Ambulance Association and other industry stakeholders, the temporary Medicare ambulance increases expired December 31. However, please rest assured that the AAA lobbying team, volunteer leadership, and staff are working tirelessly around-the-clock to advocate for this critical EMS revenue. The good news is that the end may be in sight. However, we must remain engaged, active, and unified as an industry to carry this effort through in the face of the today’s contentious and unpredictable political climate. Republicans and Democrats in the House and Senate are working toward a long-term extension of the Children’s Health Insurance Program (CHIP).  As part of these negotiations, the House and Senate are working through the details of a Medicare provider extender package. Thanks...

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Medicare Extender Update

As president of your association, keeping you informed of our advocacy efforts is one of my top priorities. In keeping with this approach, I would like to share with you an update on the American Ambulance Association’s latest efforts on Capitol Hill. The temporary Medicare ambulance increases are currently scheduled to expire on December 31, 2017. And once again, Congress is waiting until the last minute to extend them. Thankfully, a long-term solution is on the horizon. The House and Senate are in the process of negotiating the details of a Medicare provider extender package including our ambulance provisions. The House and Senate positions both include a five-year extension of the 2% urban, 3% rural, and super rural increases. Where their positions differ reflects the respective preferences of the Senate Finance and House Ways and Means Committees on how best to collect cost data from ambulance services suppliers and providers. The Senate position is based on a Senate Finance Committee Discussion Draft from October 26 which includes the five-year extension of the increases as well as a data collection system based on the one from the Medicare Ambulance Access, Fraud Prevention and Reform Act (S. 967). The provision would direct...

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AETNA/CVS Deal Along with Uber Concepts May Finally Change Ambulance Industry

Mark Postma, AAA President & Asbel Montes, AAA Payment Reform Chair The recent merger of Aetna/CVS may be the catalyst that finally brings the change that the ambulance industry has been advocating for over the past several years. This new healthcare strategy supports the ambulance industry’s ideas that alternative patient destinations are needed in EMS. To explain this better, one must understand the current state of ambulance reimbursement via the 911 system or equivalent. At this point in time most commercial payers of healthcare (Insurance) as well as Medicare will not pay for 911 ambulance transportation to any destination other than the “nearest appropriate” hospital based emergency room; arguably, the most expensive and least efficient form of healthcare. The continuation of this policy discounts the advanced capabilities of both EMS and new clinical settings and the savings that can be achieved through innovative change. In addition, at the same time that the cost of healthcare in general is increasing, reimbursement from all payers is decreasing, creating a significant challenge for providers. Medicare consistently pays providers below cost for providing life-saving services and state Medicaid agencies are consistently underfunding the critical services to the un- and under-insured populations that have allowed (more…)

Response to Kaiser Health News Ambulance Billing Article

To the Editor: I write today in response to Melissa Bailey’s November 20 piece about ambulance balance (“surprise”) billing. While we disagree with the characterization of ambulance services in the article, we welcome the ongoing public dialogue about how unsustainable reimbursement for emergency medical services results in cost-shifting to patients. Missing from the article is a true understanding of the sky-high cost of readiness for emergency medical services. Ambulance service providers offer their communities 24/7/365 on-demand mobile healthcare. Skilled staff and ambulances—high-tech emergency rooms on wheels—are ready to respond to a 9-1-1 call at a moment’s notice to help patients with issues ranging from stroke to heart attack to trauma to childbirth. EMS is also on the very front lines of the surge in opioid overdoses, providing naloxone (Narcan) to hundreds of patients each day. Keeping supplies, medications, equipment, and personnel at-the-ready requires a significant ongoing investment, regardless of whether or not an ambulance is out responding to a call. Cost comparisons between EMS and the rideshare app Uber may make for catchy sound bites, but they are misleading and misguided. The piece states that our nation’s 14,000 ambulance service providers received 1,200 Better Business Bureau complaints spread over three (more…)

President’s Perspective: July 2017

Dear Fellow AAA Member, I am proud to share with you that just yesterday legislation was introduced in the House on a long-term extension of Medicare ambulance add-ons. The House bill follows introduction of the Medicare Ambulance Access, Fraud Prevention and Reform Act (S. 967) in the Senate, giving us a bill in both houses of Congress. The Ambulance Medicare Budget and Operations Act (H.R. 3236) would extend for five years the 2% urban, 3% rural, and super rural bonus increases. The bill would also direct CMS to collect cost data from ambulance service suppliers. The AAA has been working with Congressman Nunes (R-CA) and Upton (R-MI) as well as the House Ways and Means and Energy and Commerce Committees on the bill language. You will soon receive a Call to Action to reach out to your Representatives to cosponsor the new House bill. 967 would make the add-on payments permanent and direct CMS to collect cost data from ambulance service suppliers using a survey methodology. Since its introduction, four additional Senators have signed on to co-sponsor S. 967, Senators Sanders (VT), Cochran (MS), Tester (MT) and Gillibrand (NY), bringing the total number of cosponsors to nine. While this is (more…)

Support AAA’s Medicare Relief Legislation, S. 967

Dear Fellow Members, As you know, the Medicare ambulance add-on payments are set to expire on December 31, 2017. I’m proud to share with you that today, due to AAA advocacy efforts, permanent ambulance relief legislation was introduced by Senators Stabenow, Roberts, Schumer, Collins, and Leahy. This bill, S.967, “Medicare Ambulance Access, Fraud Prevention, and Reform Act” would make permanent the vital urban and rural Medicare add-ons and super-rural bonus payments. Although some changes are likely during the committee markup process, we are cautiously optimistic that it will also carry through proposals to reclassify ambulance organizations as providers of health care (not suppliers of transportation), as well as a cost data collection system that does not place undue burden on ambulance services. On behalf of the AAA, I’d like to extend my deepest thanks to Senators Stabenow, Roberts, Schumer, Collins, and Leahy for sponsoring the legislation, as well as the AAA Board, Government Affairs Committee, advocacy consultants, and staff who worked so diligently to build support on Capitol Hill. Over the coming months, AAA will continue to connect with policymakers to build support for sustainable ambulance Medicare reimbursement. However, we need your help to ensure that this critical revenue remains (more…)

President’s Perspective April 2017

Dear Fellow AAA Member, As you know, the Medicare ambulance add-on payments are set to expire on December 31, 2017. The AAA Board, Government Affairs Committee, advocacy consultants, and staff have been working diligently to build support on Capitol Hill to ensure that this critical revenue remains in place. As we continue to connect with policymakers in preparation for the introduction of our legislation, I ask that you pay special attention to the requests for advocacy action you receive from the AAA. Now, more than ever, we need the active participation of each member organization to ensure our collective future! Capital Campaign and Financial Status In addition to representing our members’ current interests in Washington, AAA strives to serve ambulance providers over the longer term. It is key that the Association build a pool of capital for use in case of an unexpected legislative or regulatory threat, or once-in-a-blue-moon strategic opportunity. For these reasons, I announced the creation of a Capital Campaign the day I assumed the office of President. Funds contributed to this campaign are managed separately from other assets, and can only be accessed after a full AAA Board vote. To date, we have raised more than $250,000 of our $1mm goal through the generous contributions of our fellow members. My deepest thanks to all who have given. If you have (more…)

HHS Letter to Governors on Medicaid Changes

On Monday evening, the Senate confirmed Seema Verma, MPH, as the new Administrator of the Centers for Medicare and Medicaid Services (CMS). She has a strong background in Medicaid, and prior to her appointment worked as a consultant to several States seeking Medicaid waivers. One of her first acts was to issue a letter to governors with Secretary Tom Price, MD, regarding the Medicaid program. The letter highlights several initiatives on which they are focusing with regard to Medicaid. Perhaps of most importance to the ambulance community is the section on “Aligning Medicaid and Private Insurance Policies for Non-Disabled Adults.” In this section, the Secretary and Administrator suggest that States: may consider creating greater alignment between Medicaid’s design and benefit structure with common features of commercial health insurance, to help working age, non-pregnant, non-disabled adults prepare for private coverage. These state-led reforms could include, as allowed by law: …waivers of non-emergency transportation benefit requirements. While it may be meaningful that the reference does not include “medical,” before transport, it is critically important that the AAA work to protect Medicaid beneficiary access to medically necessary non-emergency medical transports. Thus, the Medicare Regulatory Committee is developing a letter and considering additional engagement...

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Medicare Relief and Reform Letter by President Postma

This is a critical year for the legislative efforts of the American Ambulance Association and our members.  First and foremost, our temporary Medicare ambulance increases expire at the end of the year.  It is vital that we ensure the new 115th Congress makes these increases permanent, or at the very least approves another long-term extension.  To be successful, we will need all of your help in reaching out to your members of Congress in support of the increases. The AAA and our partners have been also working to further the reform of the Medicare ambulance fee schedule.  To accomplish the first steps in this process, ambulance services need to be treated as providers of health care services rather than only suppliers of medical transportation.  In addition, we will need the cost data necessary for Congress, Centers for Medicare and Medicaid Services and the AAA to make data-driven decisions regarding the reform. To achieve these goals, we are working with our champions in Congress to reintroduce a version of the Medicare Ambulance Access, Fraud Prevention and Reform Act (HR 745, S. 332 – 114th Congress).  We hope to have a bill reintroduced in the House and Senate in the coming weeks. ...

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President’s Perspective January 2017

Happy New Year from the American Ambulance Association. 2017 promises to bring many changes to the health care landscape, and AAA will be there with you and your ambulance service the whole way. As we launch our 2017 initiatives, I wanted to share the updates below from AAA’s board and headquarters. Advocacy Priorities In 2017, we will continue to work tirelessly toward our primary advocacy goal: making the CMS temporary ambulance add-on payments permanent. This effort fits seamlessly into our longer-term payment reform plan, which includes seeking a change in our CMS status from “Supplier” of services to “Provider” of health care. We plan to back this effort with cost data obtained through a rotating, statistically valid survey of ambulance providers, rather than burdensome universal annual reporting. This Provider status would open the door for future innovations in our field, including mobile integrated health (MIH). Our Government Affairs, Medicare Regulatory, and Payment Reform Committees, along with our paid staff and consultants, have been extremely engaged and active on these issues. To add your voice to AAA’s, please visit our advocacy page to quickly and easily contact your elected officials. Capital Campaign I am proud to share that the $1 million (more…)