CMS Lifts Ambulance Claims Hold
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Author: Tristan North
Congressional Letter on Updating Medicare Zip Codes
On September 18, Congresswoman Carol Miller (R-WV) was joined by 13 members of Congress in a letter to CMS requesting that the agency update the zip code designations under the Medicare ambulance fee schedule based on the 2020 census.
According to an analysis by AAA data firm of Health Management Associates, the update would result in a net of 1,490 zip codes being redesigned as super rural instead of rural and 782 zip codes being rural instead of urban. Ground ambulance service organizations that serve these rural and super rural areas would thus benefit from the additional reimbursement for rural and super rural areas.
CMS is overdue in automatically updating the zip codes based on the 2020 census data.
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AAA Letter to CMS- Reducing Regulatory Burdens on Ground Ambulance Providers
On June 9, the AAA submitted to CMS a letter on ways the Administration can reduce regulatory burdens on ground ambulance service organizations. The AAA requested that CMS eliminate the requirement to obtain a Physician Certification Statement (PCS), remove the vehicle section from the 855 form and eliminate the patient signature requirement. The letter was in response to a request for information (RFI) issued by CMS.
House Reintroduces Vital Medicare Extender and EMS Workforce Bills
Medicare Ambulance Extender Bill Introduced in House
Yesterday, March 18, Representatives Claudia Tenney (R-NY), Terry Sewell (D-AL), Cliff Bentz (R-OR), Paul Tonko (D-NY), Mike Carey (R-OH), Danny Davis (D-IL), Carol Miller (R-WV) and Marie Gluesenkamp Perez (D-WA) reintroduced the Protecting Access to Ground Ambulance Medical Services Act (H.R. 2232). This legislation would extend the temporary Medicare ambulance add-on payments at their current levels of 2% urban, 3% rural and 22.6% super rural until January 1, 2028.
The AAA and our partners at the International Association of Fire Chiefs (IAFC), International Association of Fire Fighters (IAFF), National Association of Emergency Medical Technicians (NAEMT) and National Rural Health Association (NRHA) have spearheaded efforts to extend and increase the levels of the Medicare ambulance add-on payments. We expect to see a Senate bill with the higher levels of 3.4% urban, 4.3% rural and 26.7% super rural introduced in the near future.
EMS Workforce Shortage Bill Introduced in House
Additionally, yesterday Representatives Marie Gluesenkamp Perez (D-WA), Brad Finstad (R-MN), Randy Feenstra (R-IA), Suzanne Bonamici (D-OR), Michael Lawler (R-NY), Josh Harder (D-CA) reintroduced the Preserve Access to Rapid Ambulance Emergency Medical Treatment Act (PARA-EMT Act). H.R. 2220 would provide funding for grants to help recruit and train paramedics and EMTs, reduce barriers that prevent veteran medics transitioning to civilian paramedics and EMTs, and request the Secretary of Labor to conduct a study on the EMS workforce shortage and report their findings.
The legislation is supported by the AAA, NAEMT and NRHA. A copy of the press release on the introduction of H.R. 2220 can be found here.
Congress Extends Ambulance Add-On Payments Through September 30
Yesterday evening, March 14, the United States Senate by a vote of 54 to 46 passed the Full-Year Continuining Appropriations and Extensions Act, 2025 (H.R. 1968) to fund the federal government through the end of the 2025 fiscal year ending September 30. An extension of the current levels of the temporary Medicare ambulance add-on payments was included in H.R. 1968 with an expiration date of also September 30. President Trump is expected to sign H.R. 1968 into law shortly.
The AAA, our champions and supporters on Capitol Hill, and EMS partner organizations fought hard to ensure the ambulance extension was included in the lean bill of just 99 pages. We greatly appreciate the outreach by the AAA membership and state EMS associations to their members of Congress in support of the extension of the ambulance add-on payments. The AAA will continue to advocate for a long-term extension of the add-on payments at the higher levels of 3.4% urban, 4.3% rural and 26.7% super rural.
Revised versions of the Protecting Access to Ground Ambulance Medical Services Act with a long-term extension of the add-on payments, and at the higher levels in the Senate bill, will be reintroduced in the near future. Once introduced, we will be launching a new Call To Action asking you to contact your members of Congress to cosponsor the legislation
Congress Extends Medicare Ambulance Add-On Payments
On Saturday, December 21, the American Relief Act of 2025 (H.R. 10545) became law and thereby averted a partial federal government shutdown. Of critical importance to ground ambulance service organizations, H.R. 10545 also extends the temporary Medicare ambulance add-on payments of 2% urban, 3% rural and 22.6% super rural through March 31, 2025. In addition, the new law wipes clean the PAYGO scorecard preventing a potential 4% cut in Medicare reimbursement for ground ambulance and other Medicare services.
The House of Representatives passed by a vote of 366 to 34 the Continuing Resolution (H.R. 10545) to extend funding for the federal government just hours before reaching the previous funding deadline of midnight on December 20th. The Senate then passed H.R. 10545 by a vote of 85 to 11 late that evening. The CR funds the federal government primarily at current funding levels through March 14, 2025.
The negotiations on the American Relief Act were extremely tense with a more robust initial legislative package, which would have extended the Medicare ambulance add-ons for two years, being replaced with a slimmer bill with fewer and shorter health care provisions. The extension of ground ambulance service payments ended up being just one of twenty-five provisions in the final 118-page Continuing Resolution, which was originally over 1,600 pages.
The AAA greatly appreciates the advocacy of our champions and supporters on Capitol Hill to ensure that the temporary ambulance payments extension was included in the final CR. We also want to thank our AAA members for reaching out to their members of Congress to request their help with the add-on payments. We will continue to push for a longer extension of the ambulance payments at percentages higher than the current levels upon the expiration of the CR.
Congressman Mike Bost Honored with Legislative Recognition Award
FOR IMMEDIATE RELEASE
Contact:
Tristan North
tnorth@ambulance.org
October 10, 2024
Congressman Mike Bost Honored with Legislative Recognition Award
from the American Ambulance Association
Washington, D.C. — The American Ambulance Association (AAA) has awarded Mike Bost (IL) a 2024 AAA Legislative Recognition Award in recognition of his leadership in ensuring veterans continue to have access to emergency 9-1-1 and interfacility ground ambulance services.
Congressman Bost introduced the bipartisan VA Emergency Transportation Access Act (S. 2757, H.R. 6433) to direct the Department of Veterans Affairs (VA) to further analyze the impact of the VA Final Rule on Special Modes of Transportation and create an advisory committee to evaluate future reimbursement rates for ambulance services.
The Rule as it stands would reimburse ambulance service providers below the costs of providing medical and transport services. S. 2757 would help ensure that ambulance service providers throughout Kansas and the country do not face further cuts to VA reimbursement which would limit their ability to provide lifesaving emergency medical services to our nation’s veterans.
Due to the efforts of Congressman Bost and a bipartisan group of Senators and Representatives, the VA has recently stated it will delay implementation of the Final Rule for four years which would provide time to determine more fair and adequate payment rates for ambulance services.
“We greatly appreciate the leadership of Congressman Moran in ensuring that our veterans and entire communities will continue to have access to vital ground ambulance service,” said AAA President, Randy Strozyk. “His perseverance paid off with the VA recognizing the need to delay implementation of the final rule to provide more time to address concerns that the new payment system could adversely affect ambulance access for veterans.”
The American Ambulance Association will be presenting Congressman Bost with his Legislative Recognition Award this November at the AAA Annual Stars of Life Event, which honors emergency medical services professionals from around the nation who have gone above and beyond in service to their communities.
Congressman Ryan Zinke Honored with Legislative Recognition Award
FOR IMMEDIATE RELEASE
Contact:
Tristan North
tnorth@ambulance.org
October 10, 2024
Congressman Ryan Zinke Honored with Legislative Recognition Award
from the American Ambulance Association
Washington, D.C. — The American Ambulance Association (AAA) has awarded Congressman Ryan Zinke (MT) a 2024 AAA Legislative Recognition Award in recognition of his leadership in ensuring veterans continue to have access to emergency 9-1-1 and interfacility ground ambulance services.
Congressman Zinke has led efforts to restrict the ability of the Department of Veterans Affairs to implement its Final Rule on Special Modes of Transportation which would reimburse ambulance service providers below the costs of providing medical and transport services to our veterans. Congressman Zinke has supported efforts to instead create an advisory committee to evaluate future VA reimbursement rates for ambulance services.
Due to the efforts of Congressman Zinke and a bipartisan group of Senators and Representatives, the VA has recently stated it will delay implementation of the Final Rule for four years which would provide time to determine more fair and adequate payment rates for ambulance services.
“We thank Congressman Zinke for his dedication and perseverance to ensuring that our veterans and entire communities will continue to have access to vital ground ambulance service,” said AAA President, Randy Strozyk.
The American Ambulance Association will be presenting Congressman Zinke with his Legislative Recognition Award this November at the AAA Annual Stars of Life Event, which honors emergency medical services professionals from around the nation who have gone above and beyond in service to their communities.
Senator Jerry Moran Honored with Legislative Recognition Award
FOR IMMEDIATE RELEASE
Contact:
Tristan North
tnorth@ambulance.org
October 8, 2024
Senator Jerry Moran Honored with Legislative Recognition Award
from the American Ambulance Association
Washington, D.C. — The American Ambulance Association (AAA) has awarded Jerry Moran (KS) a 2024 AAA Legislative Recognition Award in recognition of his leadership in ensuring veterans continue to have access to emergency 9-1-1 and interfacility ground ambulance services.
Senator Moran introduced with a bipartisan group of Senators the VA Emergency Transportation Access Act (S. 2757, H.R. 6433) to direct the Department of Veterans Affairs (VA) to further analyze the impact of the VA Final Rule on Special Modes of Transportation and create an advisory committee to evaluate future reimbursement rates for ambulance services.
The Rule as it stands would reimburse ambulance service providers below the costs of providing medical and transport services. S. 2757 would help ensure that ambulance service providers throughout Kansas and the country do not face further cuts to VA reimbursement which would limit their ability to provide lifesaving emergency medical services to our nation’s veterans.
Due to the efforts of Senator Moran and a bipartisan group of Senators and Representatives, the VA has recently stated it will delay implementation of the Final Rule for four years which would provide time to determine more fair and adequate payment rates for ambulance services.
“We greatly appreciate the leadership of Senator Moran in ensuring that our veterans and entire communities will continue to have access to vital ground ambulance service,” said AAA President, Randy Strozyk. “His perseverance paid off with the VA recognizing the need to delay implementation of the final rule to provide more time to address concerns that the new payment system could adversely affect ambulance access for veterans.”
The American Ambulance Association will be presenting Senator Moran with his Legislative Recognition Award this November at the AAA Annual Stars of Life Event, which honors emergency medical services professionals from around the nation who have gone above and beyond in service to their communities.
Senator Jon Tester Honored with Legislative Recognition Award
FOR IMMEDIATE RELEASE
Contact:
Tristan North
tnorth@ambulance.org
October 7, 2024
Senator Jon Tester Honored with Legislative Recognition Award
from the American Ambulance Association
Washington, D.C. — The American Ambulance Association (AAA) has awarded Senator Jon Tester (MT) a 2024 AAA Legislative Recognition Award in recognition of his leadership in ensuring veterans continue to have access to emergency 9-1-1 and interfacility ground ambulance services.
Senator Tester introduced with a bipartisan group of Senators the VA Emergency Transportation Access Act (S. 2757, H.R. 6433) to direct the Department of Veterans Affairs (VA) to further analyze the impact of the VA Final Rule on Special Modes of Transportation and create an advisory committee to evaluate future reimbursement rates for ambulance services.
The Rule as it stands would reimburse ambulance service providers below the costs of providing medical and transport services. S. 2757 would help ensure that ambulance service providers throughout Montana and the country do not face further cuts to VA reimbursement which would limit their ability to provide lifesaving emergency medical services to our nation’s veterans.
Due to the efforts of Senator Tester and a bipartisan group of Senators and Representatives, the VA has recently stated it will delay implementation of the Final Rule for four years which would provide time to determine more fair and adequate payment rates for ambulance services.
“Senator Tester’s leadership on this issue has been instrumental in advancing our mission to preserve emergency medical services for veterans and entire communities,” said AAA President, Randy Strozyk. “His dedication to supporting our nation’s heroes exemplifies the kind of leadership we need to ensure that all veterans have access to timely and efficient emergency care.”
The American Ambulance Association will be presenting Senator Jon Tester with his Legislative Recognition Award this November at the AAA Annual Stars of Life Event, which honors emergency medical services professionals from around the nation who have gone above and beyond in service to their communitie
VA Notifies Tester/Moran of Delay of Final Rule until 2029
The Department of Veterans Affairs (VA) has notified Senate Committee on Veterans Affairs Chairman Jon Tester (D-MT) and Ranking Member Jerry Moran (R-KS) that the Department will be delaying implementation of the Final Rule on Special Modes of Transportation until February 16, 2029. The Committee has released a statement on the delay and the VA should be issuing a formal notification of the delay shortly in the Federal Register.
“I appreciate the VA providing the additional time to ensure a process for proper reimbursement of critical ambulance services for veterans and wholeheartedly thank Chairman Tester and Ranking Member Moran for their successful and tireless efforts in advocating for the delay,” stated AAA President Randy Strozyk. “Reimbursing ground ambulance services at Medicare rates would have a devasting impact on our members who are already struggling financially.”
The delay will allow time for a framework like the one outlined in the VA Emergency Transportation Access Act (S. 2757, H.R. 5530) to allow stakeholder input on future rates. “Our members appreciate the efforts of Senators Tester, Moran, Patty Murray, John Boozman and Susan Collins and Representatives Mike Bost and Ryan Zinke and the dozens of other members of Congress who helped push for the delay.”
The Final Rule on Special Modes of Transportation was originally scheduled to take effect on February 16, 2024, but in December 2023 the VA announced a one-year delay with the latest announcement delaying implementation for an additional four years. Under the final rule, the VA would reimburse for ambulance services provided through its beneficiary travel program at the lesser of the actual charges or Medicare rates.
We will provide more details about the delay when the VA issues its formal notice.
Treatment In Place Bill Introduced in House
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Updates on the VA Final Rule and NDAA Workforce Amendment
House Passes Language to Stop FY2025 Start of VA Final Rule
On June 5, the U.S. House of Representatives passed the FY2025 MilCon-VA-Related Agencies Appropriations bill. Included in the bill was language championed by Subcommittee Chair John Carter (R-TX) and Representatives Ryan Zinke (R-MT), Michael Guest (R-MS), Val Hoyle (D-OR), Brad Finstad (R-MN) and John Rutherford (R-FL) amongst numerous others that would prohibit the Department of Veterans Affairs from using funding during FY2025 (October 1, 2024 through September 20, 2025) to implement the Final Rule on Special Modes of Transportation. The Rule would reduce reimbursement under the VA travel pay program to Medicare rates for noncontracted ambulance services.
The Association of Air Medical Services, and several air and ground ambulance service organizations, as well as the AAA had submitted requests to several of the offices on language. In addition, the Committee included report language directing the VA to work with stakeholders to identify appropriate levels of reimbursement and to report to Congress on those efforts.
FY25 VA Approps Special Modes Language
Perez/Finstad Offer NDAA EMS Workforce Amendment
Representatives Gluesenkamp Perez (D-WA) and Finstad (R-MN) have submitted a bipartisan amendment (No. 809) to the National Defense Authorization Act (NDAA) (H.R. 8070) that would provide states with funding to help cover the transition costs of a military medic becoming a civilian paramedic or EMT when leaving the Armed Services. The language of the amendment is a modified version of the provision included in the PARA-EMT bill (H.R. 6433) being championed by Gluesenkamp Perez and Finstad.
The AAA along with the National Association of EMTs and National Rural Health Association worked with the two congressional offices on the revised legislative text. The House Rules Committee is expected to meet the week of June 10 to determine the rule for floor consideration of H.R. 8070 and decide on allowed amendments.
Also, NAEMT working with the House Armed Services Committee was able to get report language to accompany the NDAA directing the Department of Defense to provide a report to the Committee on efforts to help ensure that EMTs and paramedics are better positioned to make the transition to the civilian workforce upon leaving the military
AAA Submits Paramedic Expedited Visa Comments in Line with PARA-EMT Act
On May 13, the AAA submitted a Comment Letter to the Department of Labor (DOL) in response to their Request for Information (RFI) on modernizing the process and updating the occupations that fall under the Schedule A program. Schedule A is a program administered by DOL which allows for expedited visa processing for occupations with a predetermined workforce shortage. The AAA advocated in our letter for the DOL to add paramedics and EMTs to Schedule A which currently includes nurses, physical therapists and individuals with exceptional abilities in the sciences and arts.
The comment letter by the AAA is in line with a provision of the PARA-EMT Act (H.R. 6433) by Congresswoman Gluesenkamp Perez (D-WA) and Congressman Brad Finstad that would direct DOL to conduct a study on the EMS workforce shortage and report to Congress on consideration by the Department to add paramedics and EMTs to the list of occupations under Schedule A.
VA Issues Notice on Delay of Special Modes of Transportation Final Rule
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2023 Year-End Government Affairs Update
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Gluesenkamp Perez and Finstad Introduce EMS Workforce Shortage Bill
Yesterday, November 15, Congresswoman Marie Gluesenkamp Perez (D-WA) and Congressman Brad Finstad (R-MN) introduced the Preserve Access to Rapid Ambulance Emergency Medical Treatment (PARA-EMT) Act (H.R. 6433). H.R. 6433 is the first broad, stand-alone piece of legislation specifically designed to focus solely on helping address the EMS workforce shortage.
“We greatly appreciate the leadership of Congresswoman Gluesenkamp Perez and Congressman Finstad on introducing this momentous legislation to assist with the hiring and retention of paramedics and EMTs,” stated AAA President Randy Strozyk. “We look forward to working with them on passage of the bill.”
H.R. 6433 would establish a pilot grant program under the Assistant Secretary for Preparedness and Response (ASPR) at the Department of Health and Human Services (HHS) for the recruitment and training of paramedics and EMTs. The grant program would be authorized from 2024 through 2028 with $50 million a year in funding.
The legislation would also provide states with funding to help facilitate and expedite the transition of medics coming out of military service with the requirements of becoming a civilian paramedic or EMT. The program would be authorized from 2024 through 2028 with $20 million a year in grant funding for states.
Lastly, H.R. 6433 would direct the Secretary of Labor to conduct a study on the EMS workforce shortage and issue a report to Congress. The report would include an analysis on potentially adding paramedics and EMTs to the list of health care occupations which benefit from an easier hiring process of professionals outside the U.S.
The American Ambulance Association, National Rural Health Association and Washington Ambulance Association have endorsed H.R. 6433. In the coming days, the AAA will be launching a Call to Action to encourage and assist our members in contacting their U.S. Representatives in support of cosponsoring H.R. 6433.
Thank you to all of the AAA members and volunteer leaders who worked tirelessly to push for the introduction of this important EMS legislation!
Welch, Sanders, & Balint Introduce Treatment in Place Bill
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Impact of Partial Government Shutdown on Healthcare
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VA Final Rule on Ambulance Services Update
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