EMS Balance Billing Quick Take—July 7, 2021

Webinar July 7, 2021 | 13:00–13:30 ET | Free to AAA Members
Speakers: Kathy Lester, Esq. & Asbel Montes

On July 1, CMS issued a proposed rule on Surprise Billing which applies to those providers and physicians identified in the No Surprises Act. This statute subjected ground ambulance suppliers to an HHS Advisory Committee process prior to any rulemaking addressing these services.

The consultants and staff of the American Ambulance Association are doing a deep dive into the 400+ page rule and evaluating its nuances. We continue to understand from our conversations that ground ambulances are not included and instead are subjected to the Advisory Committee.

The American Ambulance Association will soon provide a summary to members, and will address any confusion with the Administration. Join AAA for a quick take live webinar on July 7 at 13:00 ET to learn more!

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Medicare Ambulance Relief Bill introduced in Senate

Yesterday, Senators Catherine Cortez Masto (D-NV) and Susan Collins (R-ME) introduced the Protecting Access to Ground Ambulance Medical Services Act of 2021 (S. 2037). Senators Cortez Masto and Collins were joined by Senators Debbie Stabenow (D-MI), Bill Cassidy (R-LA), Patrick Leahy (D-VT) and Bernie Sanders (D-VT) as primary cosponsors and leads on the legislation.

S. 2037 is identical to H.R. 2454 by Representatives Terri Sewell (D-AL), Devin Nunes (R-CA), Peter Welch (D-VT) and Markwayne Mullin (R-OK) and would extend the temporary Medicare ground ambulance increases of 2% urban, 3% rural and the super rural bonus payment for five years. The increases are currently scheduled to expire on December 31, 2022. The five-year extension would allow for the increases to remain in place during the two-year delay on ambulance data collection due to the COVID-19 public health emergency, an analysis of the data by MedPAC and subsequent action by the Congress to reform the Medicare ambulance fee schedule.

The legislation would also help ensure that rural zip codes in large urban counties remain rural following geographical changes under the fee schedule as a result of the 2020 census data. The current definition using rural urban commuting areas (RUCA) in Goldsmith Modification areas would be modified for zip codes with 1,000 people or less per square mile would also be rural. Ground ambulance service providers and suppliers could also petition the Centers for Medicare and Medicaid Services (CMS) to make the argument that a specific zip code should be rural. It is vital that this provision be implemented before CMS makes changes from the 2020 census data which will likely occur in 2023.

The AAA has been leading the effort on the legislation with the support of the International Association of Fire Chiefs, International Association of Fire Fighters, National Association of EMTs, National Rural Health Association and the National Volunteer Fire Council.

The AAA will be launching a Call to Action shortly requesting AAA members to ask their Senators to cosponsor S. 2037, and reach out to their Representatives to cosponsor H.R. 2454 if they have not already done so.

We greatly appreciate the leadership of Senators Cortez Masto, Collins, Stabenow, Cassidy, Leahy, and Sanders on this vitally important legislation.

CNN | Rural ambulance crews are running out of money and volunteers

From CNN on May 22, 2021

Rural ambulance crews are running out of money and volunteers. In some places, the fallout could be nobody responding to a 911 call

America’s rural ambulance services, often sustained by volunteers, are fighting for their survival — a crisis hastened by the impact of Covid-19.

More than one-third of all rural EMS are in danger of closing, according to Alan Morgan, CEO of the National Rural Health Association. “The pandemic has further stretched the resources of our nation’s rural EMS.”

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HR2454 | Protecting Access to Ground Ambulance Medical Services Act of 2021

From Representative Terri Sewell

Rep. Sewell Introduces Legislation to Protect Access to Ground Ambulance Medical Services for Rural and Underserved Communities

Washington, D.C. – This Congress, U.S. Rep. Terri Sewell (AL-07), along with Reps. Devin Nunes (CA-22), Peter Welch (VT-AL), and Markwayne Mullin (OK-02), introduced H.R. 2454, the Protecting Access to Ground Ambulance Medical Services Act of 2021. The bill would ensure that ambulance service providers, including rural providers and those in underserved communities, are able to continue delivering quality critical first responder and health care services.

“When tragedy strikes and medical emergencies happen, we should feel confident that our first responders have the resources they need to deliver life-saving care,” said Rep. Sewell. “Unfortunately, inadequate Medicare reimbursement rates are putting a strain on ambulance service providers in the most vulnerable communities across the country and making it harder for them to care for our neighbors.”

“The problem is particularly severe for rural communities and has been worsened by the demands of the COVID-19 pandemic,” continued Sewell. “That is why I am proud to introduce the Protecting Access to Ground Ambulance Medical Services Act of 2021. This bill would permanently adjust Medicare reimbursement practices so that vital ambulance services remain vibrant and available to all Americans.”

“This bipartisan bill includes key reforms to ensure that rural Americans are not harmed by the delay in updating the Medicare ground ambulance fee schedule due to the COVID-19 pandemic,” said Rep. Nunes, Lead Republican Co-Sponsor. “Extending these temporary Medicare ground ambulance add-on payments for another five years and expanding coverage for those who live in zip codes with fewer than 1,000 people per square mile will keep ambulance costs affordable for Americans when they need ground ambulance transportation.”

“Rural ambulance services save lives and provide needed care in underserved areas every day,” said Rep. Peter Welch, Lead Democratic Co-Sponsor. “This bipartisan bill will ensure that patients in rural areas have access to critical ambulance services and that the providers of these services receive fair, consistent reimbursement for their important work. It’s time for Congress to pass this bill and give ambulance services the certainty they need to continue serving all Americans.”

“Ambulance services are critically important to rural Americans who may live close to an hour away from the nearest emergency room,” said Rep. Mullin, Lead Republican Co-Sponsor. “Providing this care literally means the difference between life and death for many people. As we continue to battle the closures of critical access hospitals across Oklahoma, ambulance services are more important now than ever before. We must ensure that rural Americans receive the care they need. I’m proud to join my colleagues in support of this bill which would enhance and increase resources for first responders in Oklahoma.”

Currently, ambulance service providers across the country are reimbursed by Medicare at rates below the cost of providing services, as determined by the Government Accountability Office (GAO). Consequently, providers rely on “add-on” payments to continue providing services. Add-on payments vary depending on whether a provider is located in an urban, rural, or “super rural” ZIP Code.

Congress has extended current add-on payment rates through December 31, 2022, and planned to review Medicare cost data in considering whether they should be made permanent. However, due to the upcoming ZIP Code reclassification which will occur following the 2020 Census, providers are faced with uncertainty regarding the future of these payments. Additionally, the COVID-19 pandemic forced the Centers for Medicare and Medicaid Services (CMS) to delay the first two rounds of data collection, compounding this uncertainty.

Background on the Protecting Access to Ground Ambulance Medical Services Act of 2021

H.R. 2454, the Protecting Access to Ground Ambulance Medical Services Act of 2021, would end the band-aid approach and make permanent adjustments to the reimbursement methodology for services in urban, rural, and “super rural” areas by building the temporary add-ons into the base rate fee. Specifically, it would extend the current temporary Medicare ground ambulance increases of 2% urban, 3% rural, and the super rural bonus payments for five years and would ensure that rural zip codes continue to be classified as rural following the ZIP Code reclassification.

These payments are vital to the financial viability of the ambulance community and have been extended numerous times on a bipartisan basis, most recently for 5 years. This five-year extension would allow a new data cost collection system time to be put into place and collect meaningful data following the delays caused by the COVID-19 pandemic.

“NRHA applauds Representative Terri Sewell for her leadership in working to preserve ground ambulance services in rural America. Throughout the pandemic ambulance services have provided critical first responder services in our most rural communities. Passing H.R. 2454, the Protecting Access to Ground Ambulance Medical Services Act of 2021, is critical to ensuring that these important services remain in their communities long after the public health emergency,” said Alan Morgan, Chief Executive Officer of the National Rural Health Association.

“The Alabama Rural Health Association lends its full support behind the ‘Protecting Access to Ground Ambulance Medical Services Act of 2021’ (H.R. 2454).  As rural EMS transportation is one of the greatest challenges for quality access to care in rural Alabama, support is greatly needed to reinforce the existing emergency transportation system.  With additional funding and flexibility created in the system, states like Alabama will have the ability to provide improved emergency transportation in critically rural and underserved areas and allow patients to receive the care that they need in a timely manner.  We are thankful for Rep. Sewell’s introduction of this language, and we encourage support for H.R. 2454,” said Ryan Kelly, Administrator of the Alabama Rural Health Association. 

The legislation is also supported by the following organizations:

  • American Ambulance Association (AAA)
  • International Association of Fire Chiefs (IAFC)
  • International Association of Fire Fighters (IAFF)
  • National Association of Emergency Medical Technicians (NAEMT)
  • National Volunteer Fire Council (NVFC)

H.R. 2454 can be found here.

Thank you to Representatives Rep. Terri Sewell, Congressman Devin Nunes, Peter Welch, and Congressman Markwayne Mullin…

May 6, 2021
Press Release

 

NYT | Rural Ambulance Crews Have Run Out of Money and Volunteers

From the New York Times by Ali Watkins on April 25, 2021

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Strained by pandemic-era budget cuts, stress and a lack of revenue, at least 10 ambulance companies in Wyoming are in danger of shuttering — some imminently.

Washakie County’s conundrum is reflective of a troubling trend in Wyoming and states like it: The ambulance crews that service much of rural America have run out of money and volunteers, a crisis exacerbated by the demands of the pandemic and a neglected, patchwork 911 system. The problem transcends geography: In rural, upstate New York, crews are struggling to pay bills. In Wisconsin, older volunteers are retiring, and no one is taking their place.

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Medicare Ambulance Relief Bill Introduced in House

Yesterday, Congresswoman Terri Sewell (D-AL) introduced the Protecting Access to Ground Ambulance Medical Services Act of 2021 (H.R. 2454). Congresswoman Sewell was joined by Congressmen Devin Nunes (R-CA), Peter Welch (D-VT) and Markwayne Mullin (R-OK) as primary cosponsors and leads on the legislation.

H.R. 2454 would extend the temporary Medicare ground ambulance increases of 2% urban, 3% rural and the super rural bonus payment for five years. The increases are currently scheduled to expire on December 31, 2022. The five-year extension would allow for the increases to remain in place during the two-year delay on ambulance data collection period due to the COVID-19 public health emergency.  It would also permit the cost collection program to move forward so that the statutorily mandated MedPAC analysis could be completed before the Congress would have to act to either further extend the add-ons or make them permanent through reforming the Medicare ambulance fee schedule.

The legislation would help address potential problems that rural zip codes in large urban counties could face as a result of the 2020 census data.  As we saw after the 2010 Census, the new Census data collection methodology resulted in geographical changes under the fee schedule that shifted rural ZIP codes to urban, despite there being no significant change in their population. The current definition using rural urban commuting areas (RUCA) in Goldsmith Modification areas would be modified to ensure ZIP codes with 1,000 people or less per square mile would remain rural. Ground ambulance service providers and suppliers could also petition the Centers for Medicare and Medicaid Services (CMS) to make the argument that a specific ZIP code should remain rural. It is vital that this provision be implemented before CMS makes changes from the 2020 Census data which will likely occur in 2023.

The AAA has been leading the effort on the legislation with the support of the Congressional Fire Services Institute, International Association of Fire Chiefs, International Association of Fire Fighters, National Association of EMTs and the National Volunteer Fire Council.

The AAA is working with champions of the effort in the Senate on introduction of a companion bill. We expect the bill to be introducing in the coming weeks.

The legislation is one of the policy issues being raised as part of EMS on the Hill Day and the AAA will be launching a Call To Action shortly requesting AAA members to ask their members of Congress to cosponsor the bill.

We greatly appreciate the leadership of Representatives Sewell, Nunes, Welch and Mullin on this vital issue.

CMS | Repayment of COVID-19 Accelerated & Advance Payments Began 3/30

Repayment of COVID-19 Accelerated and Advance Payments Began on March 30, 2021

CMS issued information about repayment of COVID-19 accelerated and advance payments. If you requested these payments, learn how and when we’ll recoup them:

  • Identify payments we recovered
  • Prepare your billing staff

More Information:

Joint Letter on Sequestration Delay

On March 15, the AAA, IAFC, IAFF, NFVC, NAEMT, and the Congressional Fire Services Institute sent a letter to congressional leaders in support of legislation (H.R. 1868) to extend the current moratorium on the 2% Medicare sequestration cut. The moratorium is currently scheduled to expire on March 31 and H.R. 1868 would extend the moratorium until December 31. Below is a copy of the letter.

This week, the House passed House Resolution 233 with the rules for debate and consideration of H.R. 1868. Congressmen Schneider (D-IL) and McKinley (R-WV) introduced H.R. 315 and Senators Sheehan (D-NH) and Collins (R-ME) introduced S. 748 which would extend the moratorium through the end of the public health emergency.

March 16, 2021

The Honorable Nancy Pelosi Speaker
U.S. House of Representatives
Washington, DC 20515

The Honorable Kevin McCarthy Minority Leader
U.S. House of Representatives
Washington, DC 20515

The Honorable Charles Schumer Majority Leader
United States Senate
Washington, DC 20510

The Honorable Mitch McConnell Minority Leader
United States Senate
Washington, DC 20510

Dear Speaker Pelosi, Majority Leader Schumer, Minority Leader McConnell and Minority Leader McCarthy:

Thank you for your continued support of front-line medical workers throughout the COVID-19 pandemic. Our paramedics, emergency medical technicians (EMTs) and firefighters, as well as the organizations that they serve, take on substantial risk every day to treat, transport and test potential COVID-19 patients. We write today to express our deep concern with the impending 2% Medicare sequestration cut scheduled to take effect on April 1, 2021.

The American Ambulance Association (AAA), International Association of Fire Chiefs (IAFC), International Association of Fire Fighters (IAFF), National Association of Emergency Medical Technicians (NAEMT), National Volunteer Fire Council (NVFC) along with the Congressional Fire Services Institute (CFSI) represent the providers of vital emergency and non-emergency ground ambulance services and the paramedics, EMTs and firefighters who deliver the direct medical care and transport for every community across the United States. We have all experienced the strain on our services, and need financial assistance and support as we remain the frontline responders to our nation’s coronavirus patients. The sequestered cuts, if implemented, would further strain the provision of these critical services.

Our costs of operating have increased exponentially in response to COVID-19, as we maintain full readiness to combat the pandemic and continue to provide 24-hour vital non-COVID-19- related services. Our costs for personal protective equipment (PPE), overtime pay, and other expenses directly related to COVID-19 remain high. At a time when we are facing considerable economic strain due to the COVID-19 pandemic, we respectfully urge Congress take action before April 1, 2021 to extend the 2% Medicare sequestration moratorium. We would like to voice our strong support for bipartisan legislation, H.R. 1868, to prevent the 2% sequester cut.

Our organizations greatly appreciate both the financial support provided through congressionally enacted COVID-19 relief legislation, as well as the recognition of the dangers of providing these critical services on a daily basis. However, the impact of the pandemic on our resources and services remains and the implementation of additional Medicare cuts at this time would be harmful to our members.

We thank you in advance for your consideration and helping ensure that EMS agencies and personnel have the resources they need to continue to respond to the COVID-19 pandemic and the funding to maintain the short and long-term viability of our operations.

Sincerely,

American Ambulance Association

Congressional Fire Services Institute

International Association of Fire Chiefs

International Association of Fire Fighters

National Association of Emergency Medical Technicians

National Volunteer Fire Council

CDC ACIP | Reccs for Allocating Initial COVID-19 Vaccines

From the CDC’s Morbidity and Mortality Weekly Report

The Advisory Committee on Immunization Practices’ Interim Recommendation for Allocating Initial Supplies of COVID-19 Vaccine — United States, 2020

What is already known about this topic?

Demand is expected to exceed supply during the first months of the national COVID-19 vaccination program.

What is added by this report?

The Advisory Committee on Immunization Practices (ACIP) recommended, as interim guidance, that both 1) health care personnel and 2) residents of long-term care facilities be offered COVID-19 vaccine in the initial phase of the vaccination program.

What are the implications for public health practice?

Federal, state, and local jurisdictions should use this guidance for COVID-19 vaccination program planning and implementation. ACIP will consider vaccine-specific recommendations and additional populations when a Food and Drug Administration–authorized vaccine is available.

Continue Reading

Dooling K, McClung N, Chamberland M, et al. The Advisory Committee on Immunization Practices’ Interim Recommendation for Allocating Initial Supplies of COVID-19 Vaccine — United States, 2020. MMWR Morb Mortal Wkly Rep. ePub: 3 December 2020. DOI: http://dx.doi.org/10.15585/mmwr.mm6949e1