The American Ambulance Association is proud to announce the winners of the 2024 AAA Legislative Awards. Each Member of Congress is being recognized for their strong advocacy for emergency medical services and their ongoing dedication to ambulance services across the United States. In addition to our two Legislator of the Year Awards and 25 Legislative Recognition Awards, the American Ambulance Association has named their first-ever EMS Legacy Award Winner. This award is reserved for a Members of Congress who made a substantial impact on the EMS industry during their tenure in the U.S. Congress.
2024 EMS Legacy Award
Senator Debbie Stabenow (MI)
2024 AAA Legislators of the Year
Congresswoman Marie Gluesenkamp Perez (WA-3)
Congressman Brad Finstad (MN-1)
Contact:
Tristan North
tnorth@ambulance.org
October 10, 2024
Senator Debbie Stabenow Receives Inaugural EMS Legacy Award from the American Ambulance Association
Washington, D.C. — Senator Debbie Stabenow has been honored with the first-ever annual EMS Legacy Award by the American Ambulance Association (AAA) for her exemplary leadership and unwavering commitment to emergency medical services (EMS) during her distinguished tenure in the United States Senate.
The award recognizes Senator Stabenow’s significant contributions to the EMS community, particularly her role in introducing and championing critical legislation. Notably, she was instrumental in the creation of the Ground Ambulance Cost Data Collection System, which enhances transparency and supports the sustainability of ground ambulance services across the nation. Additionally, Senator Stabenow’s efforts led to the successful extension of Medicare Ambulance Add-On payments for five years, a vital support mechanism that helps ensure reliable emergency medical care for Medicare beneficiaries.
The EMS Legacy Award underscores the critical importance of legislative support for emergency medical services, highlighting Senator Stabenow’s role in elevating these issues on the national stage. Her advocacy ensures that EMS providers have the resources and support needed to deliver high-quality care.
About the American Ambulance Association:
The American Ambulance Association is a nonprofit organization that advocates for the interests of ambulance service providers and the patients they serve. With a mission to advance the profession and improve patient care, the AAA provides resources, education, and support to its members and the EMS community.
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.
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.
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.
NHTSA is soliciting applications for appointment to the DOT’s NEMSAC. The purpose of NEMSAC is to serve as a nationally recognized council of Emergency Medical Services (EMS) representatives and consumers to provide advice and recommendations regarding EMS to DOT. Through NHTSA, NEMSAC’s advice is provided to the Federal Interagency Committee on EMS (FICEMS). Deadline: November 1, 2024
National data shows delayed EMS crews frequently wait an hour or more before returning to service
“To look at the scope and severity of wall times nationwide, InvestigateTV obtained data from the National Emergency Medical Services Information System (NEMSIS), a program run through the National Highway Traffic Safety Administration and the University of Utah that provides a standardized method of recording and reporting information about 911 calls involving EMS.
The data, which local EMS agencies report to their respective states that in turn submit it to the national database, documents all aspects of the call, including if the ambulance crew experienced any kind of delay.”
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.
On August 22, 2024, the Department of Veterans Affairs (VA) published a notice in the Federal Register announcing an extension of the timely filing limits for claims impacted by the Change Healthcare cyberattack.
In February, Change Healthcare announced that it was the victim of a massive cyberattack. In response, Change Healthcare proactively took down several of its online platforms, including its online claim submission platform. This platform is used by the VA to receive electronic claims. The VA indicated that this resulted in what it calls “limited or no ability” to receive electronic claims between February 21, 2024 and May 8, 2024 (referred to hereinafter as the “Limited Access Period”).
The current notice is intended to address problems with timely filing that resulted from that Limited Access Period. Specifically, the VA is announcing that claims that would have been considered timely had they been submitted during the Limited Access Period will continue to be treated as timely filed to the extent they are submitted on or before October 31, 2024.
Claims submitted after that date will not be considered timely filed, and will be denied.
Thus, the VA is effectively extending the timely filing period for VA claims through October 31, 2024. The VA expressly noted that this would include claims for transportation furnished to veterans with dates of service between February 21, 2022 and March 23, 2024. Note: the specific program under which ambulance transportation claims are being paid will determine the actual timely filing limits. The VA was simply noting the earliest and latest possible qualifying dates.
Therefore, if you have claims for ambulance services that were recently denied by the VA for lack of timely filing, the AAA encourages you to resubmit those claims to the VA under this extending timely filing period.
A Message from GAPBAC Committee Member Shawn Baird
Please see below for a video message from former American Ambulance Association President Shawn Baird, who participated on the Ground Ambulance Patient and Billing Advisory Committee. A formal analysis of the complete report to Congress is forthcoming.
Video Transcript
Hello, I’m Shawn Baird, past president of the American Ambulance Association.
Together with my fellow ambulance profession representatives Ted Van Horne, Regina Crawford, and Rhonda Holden, I was privileged to speak on behalf of AAA members and the EMS profession as a whole during the deliberations of the Ground Ambulance and Patient Billing Advisory Committee, also known as GAPBAC.
Today, I’m excited to share with you the culmination of our efforts—the release of a report to Congress that could transform how ground ambulance services are reimbursed, ensuring better protection for patients against surprise medical bills as well as fair compensation for the essential mobile healthcare we deliver daily.
We know that the patient care and transport we provide every day, 24/7, is vital to the health and welfare of our communities. In many parts of the country, we are the only healthcare available within hours. I am excited that if Congress acts on these recommendations, patients can not only continue to depend on our vital care, but also be relieved of the financial stress of the unknown bill when insurance falls short of appropriate payment. Quite frankly, if adopted by Congress, these recommendations would take patients out of the middle between providers and insurers, and free us to remain focused on what we do best; taking care of patients, 24/7.
Let me rewind a bit and give you the full context for this report.
GAPBAC was formed following the American Ambulance Association’s successful advocacy efforts to carve ground ambulance services out of the No Surprises Act. Through the dedication of AAA volunteer leaders made possible by your dues investment, we were able to successfully educate legislators about the unique nature of EMS. We effectively highlighted our inability to pick and choose patients, our role as the safety net provider in rural and medically underserved urban areas, as well as our sky-high costs of readiness. Instead of rolling ambulance services into a one-size-fits-all healthcare billing scheme that wouldn’t work for EMS, legislators had the vision and foresight to create the GAPBAC committee.
The group’s charter was signed in November 2021, and the roster was announced in December 2022. We are proud that former American Ambulance Association board member Asbel Montes was selected to take the helm as Chair.
Since then, our committee, composed of patient advocates, physicians, EMS experts, government officials, and insurance industry representatives, has worked collaboratively to address a critical issue—out-of-network billing for ground ambulance patients covered by non-ERISA health plans.
This discussion presented an extraordinary challenge as ambulance services face skyrocketing costs, flat reimbursement from Medicare, and an unprecedented workforce shortage. At the same time, our patients were sometimes confused by the complex health insurance landscape including copays, deductibles, and policy limitations.
But the GAPBAC panel, with the help of experts including AAA’s own Kathy Lester, persevered. Through research, dialogue, and compromise, GAPBAC’s team members developed 14 key recommendations that, if adopted by Congress, would protect patients, financially sustain EMS, enhance transparency, and empower state and local governments to determine fair reimbursement rates for their residents.
While I urge you to read the report to Congress in its entirety, rest assured that the AAA advocacy team will soon share a concise summary with our membership.
As I mentioned, the release of this report has been no small task. The collaboration across various stakeholder groups was unprecedented in EMS history, and every voice brought valuable insights, driving us toward solutions that consider all perspectives on the complex mobile healthcare reimbursement landscape. Together, we’ve laid down a framework that I believe will lead to significant improvements, ensuring that millions more Americans are fully covered during some of the most critical moments of their lives.
As we present our final findings, I hope that the recommendations will be met with thoughtful consideration by Congress and regulators—the well-being of our patients and the integrity of our out-of-hospital healthcare system depend on it. Thank you to American Ambulance Association President Strozyk, the AAA board and committee chairs, and you, the AAA membership, for the overwhelming support through this journey. Together, we will continue to advocate for a sustainable future for EMS!
Shawn Baird
Immediate Past President
American Ambulance Association
The AAA is projecting that the 2025 Medicare Ambulance Inflation Factor will likely be 2.6%, plus or minus 0.1%.
Section 1834(l)(3)(B) of the Social Security Act mandates that the Medicare Ambulance Fee Schedule be updated each year to reflect inflation. This update is referred to as the “Ambulance Inflation Factor” or “AIF”.
The AIF is calculated by measuring the increase in the consumer price index for all urban consumers (CPI-U) for the 12-month period ending with June of the previous year. Starting in calendar year 2011, the change in the CPI-U is now reduced by a so-called “productivity adjustment”, which is equal to the 10-year moving average of changes in the economy-wide private nonfarm business multi factor productivity index (MFP). The MFP reduction may result in a negative AIF for any calendar year. The resulting AIF is then added to the conversion factor used to calculate Medicare payments under the Ambulance Fee Schedule.
For the 12-month period ending in June 2024, the federal Bureau of Labor Statistics (BLS) has calculated that the CPI-U has increased by 3.0%.
CMS has yet to release its estimate for the MFP for calendar year 2024. Since its inception, this number has fluctuated between 0.3% and 1.2%. For calendar year 2024, the MFP was 0.4%.
Under normal circumstances, it would be reasonable to expect the 2025 MFP to be within a tenth of a percentage point or two of the 2024 MFP.
Accordingly, the AAA is projecting that the 2025 Ambulance Inflation Factor will likely be 2.6%, plus or minus 0.1%.
The AAA will notify members once CMS issues a transmittal setting forth the official 2025 Ambulance Inflation Factor.
The EMS community is increasingly tasked with responding to behavioral health emergencies. The 988 suicide and crisis lifeline and the emergence of dedicated behavioral health response teams have enhanced support for those in crisis, but also present unique challenges in building impactful, sustainable collaborations.
Hosted by Coalition Psychiatric Emergencies, APHA Medical Care Section, National Association of EMS Physicians and American College of Emergency Physicians, join your EMS colleagues for this important virtual symposium to help your EMS agency prepare for behavioral health emergencies.
Responding to Behavioral Health Emergencies
August 2, 2024
10 am – 4 pm ET
This free symposium will examine the call, the response and the destination for behavioral health emergencies and explore lessons learned regarding 988 and dedicated behavioral health response teams.
Key Topics Include:
988 Suicide and Crisis Lifeline: Learn how it supports those in crisis, including what help is available and how the EMS community can promote 988 for accessing care.
Behavioral Health Response Teams: Discover their success factors and differences from traditional EMS responses.
De-escalation Techniques: Understand the process of managing behavioral health crises and removing individuals from the scene.
Emergency Room Treatment: Explore treatment options, barriers to care, and assessments for ER versus dedicated behavioral health facilities.
Don’t miss this unique opportunity to help your agency prepare for behavioral health emergencies.
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Douglas F. Kupas*, Matt Zavadsky, Brooke Burton, Chip Decker, Robert Dunne, Peter Dworsky, Richard Ferron, DanielGerard, Joseph Grover, Joseph House, Jeffrey Jarvis, Sheree Murphy, Jerry Overton, Michael Redlener, George W.Solomon, Andrew Stephen, Randy Strozyk, Marv Trimble, Thomas Wieczorek, Kathryn Wire
Endorsed By:
Academy of International Mobile Healthcare Integration
American AmbulanceAssociation
American College of Emergency Physicians
American Paramedic Association
International Academies of Emergency Dispatch
International Association of EMS Chiefs
International City/County Management Association
National Association of EMS Physicians
National Association of Emergency Medical Technicians
It is essential to understand that EMS directly bills patients instead of insurers only as a last resort. Sadly, as a frequent entry point to healthcare, EMS often faces the unenviable task of educating people about their limited insurance coverage or high deductibles, both of which are out of our control. As mobile healthcare is entirely decentralized in the United States, it is often unfeasible for small or volunteer-staffed ambulance services to negotiate sustainable in-network rates with dozens of insurance plans. The GAPB Advisory Committee’s recommendations seek to remedy this foundational disconnect between patients, EMS providers, and health plans.
The article notes that some EMS providers are owned by private equity, but overlooks that the vast majority of ambulance services in the United States are small, often conducting only a few dozen patient transports per day. These community-based services—some of which are the sole healthcare provider for miles—face skyrocketing costs for wages, fuel, and medical supplies that threaten their ability to keep their doors open. The collaborative work of the GAPB Advisory Committee sought to address these challenges by proposing recommendations that, if adopted by Congress, would help alleviate these financial pressures while also enhancing patient protection from surprise insurance denials.
The article implies that Patricia Kelmar was the only representative of the public interest on the panel. In fact, another Committee participant was explicitly appointed to represent patient advocacy groups, and as healthcare providers, EMS professionals and physicians consistently advocate for our patients’ well-being. The committee’s composition, as established by Congress within the No Surprises Act, was intentionally diverse and included stakeholders ranging from physicians to elected officials to insurance providers to ensure balance.
Additionally, it is important to clarify that the Health Affairs research cited in the article does not provide data on actual balance bills received by patients. Rather, it roughly estimates only potential balance bills as calculated based on a flawed estimation process. Even if we were to accept Health Affairs estimates as fact, the average balance bill calculated according to their methods would be just a few hundred dollars. This is far from the sole and extreme outlier bill cited in the piece. This distinction is critical as it underscores the need for data-driven policy decisions based on real-world evidence rather than projections and one-off examples.
Finally, the piece misses entirely the largest challenge with the Committee’s recommendations and their potential adoption by Congress. Based on longstanding legal precedent, ERISA plans, which cover about half of Americans through their employers, would not be bound by any legislation drafted based on our report. In Washington state and elsewhere, innovative “opt-in” clauses enable ERISA plans to voluntarily comply with state regulation. We encourage this and hope to see it replicated throughout the nation.
People become first responders because they have a passion for caring for others, and our communities trust them to do just that—24/7. Our Committee’s report to Congress includes 14 key recommendations designed to improve transparency, ensure fair reimbursement rates, and ultimately protect patients by strengthening state and local control. If these recommendations are adopted, they will help remove patients from the middle of billing disputes, allowing EMS providers to focus on our primary mission: delivering life-saving and life-sustaining healthcare around the clock.
For a detailed understanding of our recommendations and the Committee’s work, I encourage reading the full GAPB Advisory Committee report when it becomes available later this summer.
Shawn Baird Immediate Past President, American Ambulance Association Member, Advisory Committee on Ground Ambulance and Patient Billing Portland, Oregon
