Government Affairs Update

Written by Tristan North on . Posted in Advocacy Priorities, Government Affairs, Member-Only, News, Regulatory.

Government Affairs Update: What We’re Working On

The AAA continues to press policy initiatives with Congress and the Administration that are important to our members. While not as high-profile as our successful efforts earlier this year on the five-year extension of the Medicare ambulance add-ons, the AAA is working hard on ambulance legislation and regulations that impact the EMS industry and ambulance services across the country. Here is a snapshot of those current efforts. Over the next month, we will be providing weekly in-depth updates highlighting these issues.

Ambulance Cost Data Collection System

The AAA was successful in getting our preferred language of an ambulance cost data collection system using a survey and random sample methodology included with the extension of the add-ons in the Bipartisan Budget Act of 2018. However, that was just the first key step in the process. We now need to ensure that CMS gets the details right as the agency develops the structural specifics and data elements for the system. It is critical that the system is designed in a way that ambulance service suppliers and providers will submit the most accurate data possible.

The data will ultimately provide the information necessary for Congress, the Centers for Medicare and Medicaid Services (CMS) as well as the AAA and other stakeholders to reform the Medicare ambulance fee schedule. Reform will include potential reimbursement for services such as community paramedicine, treat and refer, and other items that don’t involve transporting the patient.  However, in order to determine the reimbursement levels, we first need the data on what it could cost for these additional services. The AAA therefore has been working closely with officials at CMS on the development of the data collection system.

Medicare Community Bill

The five-year extension of the add-ons and authorization of data cost collection system were the first steps needed in the long-term goal of reforming the Medicare ambulance fee schedule. The AAA is now developing the next piece of legislation as step two of the process. The “Community Bill” would make the Medicare ambulance add-ons permanent, treat ambulance service suppliers like providers in three specific instances, direct the Centers for Medicare and Medicaid Services (CMMI) to do additional pilot programs on innovative services being done by ambulance agencies, reduce regulatory burdens, and implement a more accurate definition of what Goldsmith Modification zip codes should remain as rural. The AAA is currently developing the draft bill and reaching out to congressional offices regarding the introduction of the bill which will likely occur early next Congress.

Restructuring of Dialysis Offset

The AAA is supporting the efforts of our members who would be significantly adversely affected by the upcoming reduction in dialysis transport reimbursement to restructure the cut. Congress included in the Bipartisan Budget Act of 2018 an offset to go along with the extension of the add-ons that will cut reimbursement for BLS nonemergency transports to and from dialysis centers by an additional 13%. This will be on top of the existing 10% reduction.  The NEATSA Act (H.R.6269) by Congressman LaHood (R-IL) and Congresswoman Sewell (D-AL) 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 nonemergency transports. The cut is currently scheduled to be implemented on October 1 and impacted AAA members and the AAA are working to get a Senate companion bill introduced shortly.

Rural EMS Grant Program

As an amendment to the Farm Bill (S. 3042) that passed the Senate, Senator Dick Durbin (D-IL) included language similar to the SIREN Act (S. 2830, H.R. 5429) to reauthorize the Rural EMS Grant program. However, in an effort to ensure the funding would go to the most needy, small, and rural EMS providers, the language of the amendment and SIREN Act would change the eligibility to just governmental and non-profit EMS agencies. Therefore, small rural for-profit ambulance service providers would no longer be eligible to apply for grants.

The AAA is pressing Senator Durbin as well as other members supportive of the reauthorization to revise the language to ensure small rural for-profit providers would still be able to apply for grants. In the next few weeks, the AAA will be asking AAA members to reach out to their members of Congress in support of the final Farm Bill including the reauthorization language and that it continues to also apply to for-profit providers as well.

Easing Regulatory Burdens

Over the last year, the AAA has responded to several requests for information from CMS as well as Congress on how to ease regulatory burdens for Medicare providers and suppliers. In addition to these broader opportunities, representatives of the AAA and our members have been meeting with CMS officials to reduce burdens for our industry. As a specific example, we are pushing for the elimination of the PCS for interfacility transports and to expand the categories of facility personnel eligible to sign the form.

Protecting Non-Emergency Ambulance Services

The AAA continues to educate members of Congress and congressional staff about the importance of non-emergency ambulance services. We are providing congressional offices with a clearer picture as to the vital role of these transports as part of the overall health care system. We are also looking to ensure that changes in federal payor policies strengthen the role and distinction of non-emergency ambulance transports from non-medical transportation services to health care facilities.

Zip Code Changes

The current use of Rural-Urban Commuting Areas (RUCA) as the basis of the Goldsmith Modification for determining rural areas in larger urban counties needs to be reformed. There are numerous examples of zip codes that are designated as urban under the Medicare ambulance fee schedule that are clearly rural. The AAA Rural Task Force is leading the way on both short-term and long-term efforts to more accurately capture rural zip codes in large urban counties. The AAA will include the ultimate reform provision crafted by the Task Force within the Community Bill as well as look at other legislative opportunities to make the changes.

Questions?: Contact Us

If you have questions about the legislation or regulatory initiatives being undertaken by the AAA, please do not hesitate to contact a member of the AAA Government Affairs Team.

Tristan North – Senior Vice President of Government Affairs
tnorth@ambulance.org | (703) 610-0216

Ruth Hazdovac – AAA Senior Manager of Federal Government Affairs
rhazdovac@ambulance.org | (703) 610-5821

Aidan Camas – Manager of State & Federal Government Affairs
acamas@ambulance.org | (703) 610-9039

Thank you for your continued membership and support.

Add-Ons Update & Impact of Partial Government Shutdown

Written by AAA Staff on . Posted in Advocacy Priorities, Government Affairs, Member Advisories, News.

Call To Action:  Ambulance Add-Ons Update &
Impact of Partial Government Shutdown

Congress is heading toward a possible partial shutdown of the federal government without taking action on our expired Medicare add-on payments. While the AAA and other industry stakeholders have pressed hard for Congress to immediately pass a five-year extension of the ambulance add-ons, our message is not being heard loud enough amongst all the other noise. We need you to contact your members of Congress today in support of extending the 2% urban, 3% rural and 22.6% super rural increases!

Write to Your Member of Congress

Last night, the House of Representatives mostly along party lines passed a Continuing Resolution to fund the federal government through February 16. The fate of the bill in the Senate is uncertain. If Congress does not pass by midnight tonight a measure extending funding for the federal government, there will be a partial government shutdown.

The AAA had pushed for Congress to attach a Medicare provider extender package including a five-year extension of the ambulance add-ons to the Continuing Resolution.  Since the extender package was not included in the Resolution, we are pressing Congress to consider a separate extenders only package including the five-year ambulance extension or attach the package to another moving legislative vehicle.  We are also pushing Congress to at the very least pass a short-term extension retroactive to January 1 until a Medicare extender package can move.

It is critical that we get the Medicare ambulance add-ons reinstated as soon as possible.
So please write your members of Congress today!

In the meantime, here are answers to questions about whether you should continue to hold claims and what a partial government shutdown would mean for Medicare and Medicaid payments.

Should my organization still hold Medicare claims?

CMS has not formally stated whether it is holding claims beyond the requirement for contractors to not pay claims until two weeks after receiving them.  AAA members may want to consider holding claims until the issue is resolved, assuming their financial position permits.  Holding claims would potentially allow members to avoid the need to have claims subsequently adjusted at a later date.

Will CMS pay claims during a partial government shutdown?

Yes. CMS has issued the following:  CMS would continue key Federal Exchange activities, such as open enrollment eligibility verification, using Federal Exchange user fee carryover. In the short term, the Medicare Program will continue largely without disruption during a lapse in appropriations. Additionally, other non-discretionary activities including Health Care Fraud and Abuse Control, and Center for Medicare & Medicaid Innovation activities would continue. States will have sufficient funding for Medicaid through the second quarter, due to the continuation of authority under the CR for appropriated entitlements, and CMS will maintain the staff necessary to make payments to eligible states from remaining Children’s Health Insurance Program (CHIP) carryover balances.

AAA Spearheads Medicare Provider Extension Letter

Written by AAA Staff on . Posted in Advocacy Priorities, Government Affairs, Medicare, News.

AAA Spearheads Medicare Provider Letter
Supporting Add-ons Extension

The AAA spearheaded a letter by a coalition of Medicare providers urging congressional leaders to pass a Medicare provider extender package by January 19. This is part of the AAA’s ongoing efforts to ensure that the Medicare ambulance add-ons are extended as soon as possible.

Many thanks to John Jonas and the team at Akin Gump for taking the lead on reaching out to other Medicare provider organizations. The AAA was able to secure the support of twenty organizations on the letter and the letter has been to congressional leaders as well as all congressional offices.

Read the Letter

The organizations that singed on to the letter are:

American Ambulance Association (AAA)
American Health Care Association (AHCA)
American Medical Rehabilitation Providers Association (AMRPA)
American Physical Therapy Association (APTA)
American Occupational Therapy Association (AOTA)
Association of Critical Care Transport (ACCT)
Brain Injury Association of America
Christopher & Dana Reeve Foundation
Emergency Department Practice Management Association
Falling Forward Foundation
Focus on Therapeutic Outcomes, Inc. (FOTO)
National Association for Home Care & Hospice
National Association for the Support of Long Term Care (NASL)
National Association of Emergency Medical Service Physicians
National Center for Assisted Living
National Rural Health Association (NRHA)
Partnership for Quality Home Healthcare
Private Practice Section of the American Physical Therapy Association
Texas Association for Home Care and Hospice
United Spinal Association

While we believe we may be approaching the endzone on the extender renewals, we must continue to push Congress to do what is right for EMS. Now, more than ever, we need you to add your voice to those of AAA, state-level ambulance associations, and thousands of your peers. Please take a moment today to send Congress your message of support for the Medicare ambulance add-ons—it takes just two clicks. Write a letter now

 

Alert: Medicare Increases Will Expire For Now: What You Need to Know

Written by Kathy Lester on . Posted in Advocacy Priorities, Government Affairs, Member Advisories, News, Reimbursement.

While the Congress succeeded in passing the Republican tax bill and keeping the federal government open with a short-term continuing resolution that included a temporary extension for the State Children’s Health Insurance Program (CHIP), it did not act upon the several Medicare extenders that expire on December 31, 2017. This extenders package includes the ambulance add-ons for urban, rural, and super-rural areas, as well as a moratorium on therapy caps, extenders for hospitals, and several other extenders important to other Medicare providers.

Despite the fact that the Congress left town, there is still strong bipartisan support for reinstating these extenders – including the ambulance extenders – early in January 2018. The most likely time frame will be for the extenders to be added to the next government funding legislation, which must be passed by January 19.

First, do not panic. As you may have already heard, CMS is telling providers and suppliers that the add-ons will expire at the end of the month. Technically that is true. The Agency is simply stating the obvious; but no one should imply from such statements that the Congress will not fix them or not make them retroactive. Historically, CMS has followed this pattern of indicating the add-ons have expired until legislation extending the add-ons has passed both chambers of Congress and the President has signed the bill into law.  CMS will make similar statements relative to the other Medicare extenders as well.

Second, prepare. To the extent you are able to do so, you may hold your claims. Medicare requires providers to files claims no later than 12 months after the date when the services were provided. (See Medicare: File a Claim; see also section 6404 of the Affordable Care Act). While this may not work for all claims, holding claims will reduce the number that would have to be reprocessed once the add-ons become law. If CMS believes at some point the legislation will pass, it may also break with its own precedent and indicate that has asked the contractors to hold claims for a short period of time as well. It did this in 2014 when it discovered errors in a final fee schedule rule. Once the claims are processed, so long as the add-ons have been extended by law, the add-on dollars will appear in the reimbursement amounts sent to providers and suppliers.

Third, retroactivity can be expensive, but CMS can mitigate the costs. CMS did this most recently in May of 2017. Then, CMS announced that it would implement the retroactive extension of a transitional payment for durable medical equipment suppliers by having the contractors automatically reprocess claims from the period when the transitional payment was made retroactive. This approach reduced the burden on providers and suppliers by eliminating the need to resubmit claims.

Despite the fact that there are ways to mitigate the problem, the American Ambulance Association (AAA) remains deeply concerned that the Congress did not extend the add-ons before they left for the holidays. We understand that for ambulance services across the country receiving timely payments from Medicare can be the difference between being able to make payroll or not. Having the dollars from the add-ons is also crucial to ensuring adequate cash flow. Therefore, while we advise you to think through your options and take the steps that best meet your needs and the needs of your employees, patients, partners, and businesses, we also ask that you reach out to the Congress and let them know how important it is to get the add-ons extended as early in January as possible. Make your voice heard by going to the AAA’s grassroots page. There you can send an email or reach out through social media to your Members of Congress.  We need everyone, including your employees, patients, and others who support high quality ambulance services, to reach out today.

Write to Your Members of Congress

The AAA will continue our direct efforts on Capitol Hill to make sure these add-ons are extended and overly burdensome new requirements are not placed on ambulance services. With your help, we can get the add-ons extended. For more information please visit https://ambulance.org/advocacy/.

Act Now: Support 5 Year Medicare Add-on Extension

Written by AAA Staff on . Posted in Advocacy Priorities, Government Affairs, Medicare, Member Advisories, Reimbursement.

Take Action for Permanent Medicare Ambulance Relief

Ask your Senators and Representatives to Support Medicare Ambulance Relief!

The temporary Medicare ambulance increases of 2% urban, 3% rural and 22.6% to the base rate in super rural areas are scheduled to expire on December 31 of this year. That is just one month away! Please write your members of Congress today in support of a 5-year extension of the increases.

Writing to your members of Congress only takes 2 clicks, follow these simple steps:

1. Enter contact information below (required by Congressional offices) and click “Submit”
2. On the next page you’ll see the letter to your Representative (Message 1) and the letter(s) to your Senators  (Message 2) – click “Submit Messages”
Feel free to personalize your letter(s) before submitting them.

Over the past 15 years, the AAA has lead efforts on Capitol Hill to establish the increases and ensure they do not expire.  Thanks to the work of our champions and supporters on Capitol Hill, there are provisions in both the House and Senate for a five-year extension of the Medicare ambulance increases.  However, passage of these provisions is in no way certain.  Your members of Congress need to hear that the 5-year extension is important to you!

In addition, the Congress is considering ways to collect Medicare cost data from ambulance service suppliers and providers.  The Senate version, which the AAA prefers, would require a statistically significant sampling of ambulance service suppliers and providers and would provide CMS with significant flexibility on how the system would be designed.  The House version would require all ambulance service suppliers and providers to submit an annual “cost report” which would be subject to a strict financial penalty for not providing timely as well as full data.  We continue to push for changes to the House version and there has been some confusion in the industry about these two provisions.  The bottom-line is that any collection of cost data needs to be tailored to meet the unique needs of ambulance services.

Members of Congress need to hear from you today!  Tell your Senators to support a five-year extension of the Medicare ambulance increases and to cosponsor S. 967.  Tell your Representatives to support a five-year extension of the Medicare ambulance increases and request revisions to cost reporting requirements.

 

POTUS Signs DEA Standing Orders Bill into Law

Written by AAA Staff on . Posted in Advocacy Priorities, Government Affairs, Legislative, Member Advisories, News.

On Friday, President Trump signed H.R. 304, the Protecting Patient Access to Emergency Medications Act of 2017, into law. H.R. 304 also known as the DEA Standing Orders Bill is an issue that the AAA has been working on closely for over a year. This new law will “improve the Drug Enforcement Administration (DEA) registration process for emergency medical services (EMS) agencies, and clarify that EMS professionals are permitted to administer controlled substances pursuant to standing or verbal orders when certain conditions are met.”

On the passage of H.R. 304, AAA President Mark Postma stated: “the enactment of H.R. 304 ensures that paramedics, EMTs and other emergency medical professionals may continue to administer vital and often life-saving medications to patients. The AAA applauds Congressmen Hudson and Butterfield and Senators Cassidy and Bennet for their successful efforts on this critical issue.”

Special thanks to Rep. Hudson (R-NC-08) for authoring the Bill, and to Rep. Butterfield (D-NC-01), Sen. Bill Cassidy (R-LA) and Sen. Michael Bennet (D-CO) for sponsoring this legislation. Additional thanks to Chairman Greg Walden (R-OR-2) for his continued support. H.R. 304 will help to ensure that ambulance service providers are able to continue providing life saving services throughout the country. The AAA would like to thank NAEMSP for spearheading this effort as well as NAEMT, ACEP, ENA, IAFF, and the IAFC for their hard work and dedication to this issue.

View the full Energy & Commerce press release. Rep. Hudson’s statement on the Bill.

Senate Committee Draft Package with 5-year Ambulance Extender

Written by AAA Staff on . Posted in Advocacy Priorities, Government Affairs, Legislative, Member Advisories, News.

Senate Committee Releases Draft Package with 5-year Ambulance Extender

The Senate Finance Committee has released a discussion draft of its Medicare provider extender package. A five-year extension of the temporary Medicare ambulance add-ons and a modified version of the cost data collection provision from the Medicare Ambulance Access, Fraud Prevention and Reform Act (S. 967) are included in the package. The ambulance provisions being part of the package marks significant progress in the Senate toward a long-term extension of the add-ons and a model cost data collection system.
A five-year extension of the 2% urban and 3% increases and the super rural bonus payment would provide approximately $1 billion in desperately needed Medicare relief for our industry. Having the increases in place for five years would give ambulance service suppliers and providers greater funding stability and help with long-term budgeting. There are now proposals in both the House and Senate with Committee backing which reflect a five-year extension of the add-ons.

The five-year extension reflects the efforts of our champions in the Senate on S. 967. The cost data collection system is also from S. 967 with modifications. Instead of a random sampling of ambulance service providers and suppliers a minimum of every three years, the sampling would occur each year for three years than a minimum of every three years. Also, in place of a 5% penalty in Medicare reimbursement for not submitting cost data if selected to report data, the penalty would be 10%. There is a hardship clause within the draft for CMS to work with ambulance service suppliers to ensure they are not penalized. The provision is also streamlined from the version introduced in S. 967.

We greatly appreciate the efforts of Senators Debbie Stabenow (D-MI), Pat Roberts (R-KS), Chuck Schumer (D-NY), Susan Collins (R-ME) and Patrick Leahy (D-VT) as champions of S. 967 and Senator Bill Cassidy (R-LA) on getting the ambulance provisions into the draft. We also thank Senators Orrin Hatch (R-UT) and Ron Wyden (D-OR) as Chairman and Ranking Member respectively of the Senate Finance Committee for their support.

While the discussion draft includes the five-year extension of Medicare ambulance add-ons and cost data collection provisions, there is still a long way to go. If your Senators are not already cosponsors of S. 967, please reach out to them today and ask they cosponsor the bill. Write to your Senators using the AAA online letter writing tool below, or go to:  https://ambulance.org/advocacy/

Ask your Senators to Support S.967 – 2017 Medicare Ambulance Access, Fraud Prevention, and Reform Act

The current 33-month extension of the Medicare add-on payments is set to expire at the end of December 2017. Losing these add-on payments would be a devastating blow to ambulance services across the country. It is crucial that the payments be made permanent as we push for a long-term solution. More details about the Bill can be found below. Let your Senators know that you support S. 967 — Here are three quick and easy ways to get involved!

Writing to your members of Congress only takes 2 clicks, follow these simple steps:

1. Enter contact information below (required by Congressional offices) and click “Submit”
2. On the next page you’ll see the letter(s) to your Senators – click “Submit Messages”

House Committee Passes Medicare Ambulance Relief Bill

Written by AAA Staff on . Posted in Advocacy Priorities, Government Affairs, Legislative, Member Advisories, News, Reimbursement.

House Committee Passes Medicare Ambulance Relief Bill

On Wednesday, the House Ways and Means Committee voted out favorably an amendment in the nature of a substitute to the Comprehensive Operations, Sustainability, ant Transport Act of 2017 (HR 3729) by Congressman Nunes (R-CA) and Sewell (D-AL). H.R. 3729 would extend for five years the Medicare ambulance add-on payments of 2% urban, 3% rural and the super rural bonus. The legislation would also implement cost reporting for ambulance service suppliers.

H.R. 3729 is a revised version of the Ambulance Medicare Budget and Operations Act  (HR 3236)introduced by Congressmen Nunes (R-CA), Upton (R-MI) and Welch (D-VT). While the AAA supports H.R. 3236, there were several changes made in H.R. 3729  that are concerning to the AAA. In particular, the addition of an offset which would implement an additional 13%* cut to BLS nonemergency transports to and from dialysis centers and a change in the penalty for not filing a time, complete and accurate cost report.  The AAA has therefore taken a neutral position on H.R. 3729 as we work with the House Ways and Means Committee and Congressmen Nunes and Sewell on modifications to the bill.

This week, AAA Board Members and Volunteer Leaders were in DC and met with both sponsors of the bill and other key offices to express our concerns over these new provisions. The AAA was able to secure the commitment of House Ways and Means Chairman Kevin Brady (R-TX) and Congressmen Nunes and Sewell to work with us on those two key provisions.

The inclusion of an offset in the bill was necessary for its consideration by the Committee and the AAA is pushing for the language from S. 967 on prior authorization or similar approach just targeting dialysis transport fraud and abuse to replace the current cut. The AAA is also pushing for the Senate to consider S. 967which would make the add-ons permanent and require a random sampling of ambulance services to collect data instead of mandatory annual cost reporting by all ambulance services suppliers.

The AAA encourages its members to write their Senators to cosponsor S. 967.

* This figure was previously 22%.  The AAA worked with the House Ways and Means Committee and Congressional Budget Office (CBO) on the cost estimate for a five-year extension of the add-ons. As a result, CBO lowered its estimate to $1 billion over ten years instead of approximately $1.8 billion. The cut to dialysis as the offset was therefore lowered from 22% to 13%.

Ask your Senators to Support S.967 – 2017 Medicare Ambulance Access, Fraud Prevention, and Reform Act

The current 33-month extension of the Medicare add-on payments is set to expire at the end of December 2017. Losing these add-on payments would be a devastating blow to ambulance services across the country. It is crucial that the payments be made permanent as we push for a long-term solution. More details about the Bill can be found below. Let your Senators know that you support S. 967 — Here are three quick and easy ways to get involved!

Writing to your members of Congress only takes 2 clicks, follow these simple steps:

1. Enter contact information below (required by Congressional offices) and click “Submit”
2. On the next page you’ll see the letter(s) to your Senators – click “Submit Messages”

House Introduces H.R. 3236 – Write to Your Reps!

Written by Aidan Camas on . Posted in Advocacy Priorities, Government Affairs, Legislative, Member Advisories, News, Reimbursement.

Take Action for Extending Medicare Ambulance Relief

Ask your Representatives to Support H.R. 3236 – The Ambulance Medicare Budget and Operations Act of 2017

The current 33-month extension of the Medicare add-on payments is set to expire at the end of December 2017. Losing these add-on payments would be a devastating blow to ambulance services across the country. It is crucial that the payments be extended as we push for a long-term solution. H.R. 3236 introduced by Reps. Nunes, Upton, and Welch would extend the current temporary Medicare add-ons for five years. More details about the Bill can be found below. Let your Representative know that you support H.R. 3236 — Here are three quick and easy ways to get involved!

Writing to your members of Congress only takes 2 clicks, follow these simple steps:

1. Enter contact information below (required by Congressional offices) and click “Submit”
2. On the next page you’ll see the letter to your Representative (Message 1) and the letter(s) to your Senators  (Message 2) – click “Submit Messages”
Feel free to personalize your letter(s) before submitting them.

Active on Social Media? Tweet at your Representative asking for their support of H.R. 3236!

  • Authorize Your Account
  • Enter Contact Information
  • Tweet! (Tweet will be auto-generated with your Senators tagged)
Know your Senators’ Twitter accounts already? Tweet:
“#ambulance svs in your district need you, @[your Representative]! Please co-sponsor HR 3236  to help us continue to provide quality #EMS!”

Post on Facebook why H.R. 3236  is important! Be sure to tag your Representative and encourage others to share your post! Ask others to write letters of support as well! http://bit.ly/AAAbill

More About Our Bill H.R. 3236, the Ambulance Medicare Budget and Operations Act of 2017:
Legislation to extend the Medicare ambulance add-on payments for five years has been introduced by Representatives Nunes, Upton, and Welch (H.R. 3236).
Specifically, the bill:

  • Provides Medicare Ambulance Relief, by extending for five years the current temporary 2 percent urban, 3 percent rural, and super rural bonus payments.
  • Requires the Medicare Payment Advisory Commission (MedPAC) to submit a report to Congress detailing the burden of cost reports on the ambulance industry and accuracy of the data received through ambulance cost reports and making recommendations on whether the system should be modified no later than July 1, 2019.
  • Requires CMS to work with stakeholders in the development of an ambulance cost report.

Write to Your Senators! Support S.967

Written by Aidan Camas on . Posted in Advocacy Priorities, Government Affairs, Legislative, Member Advisories, News, Reimbursement.

Take Action for Permanent Medicare Ambulance Relief

Ask your Senators to Support S.967 – 2017 Medicare Ambulance Access, Fraud Prevention, and Reform Act

The current 33-month extension of the Medicare add-on payments is set to expire at the end of December 2017. Losing these add-on payments would be a devastating blow to ambulance services across the country. It is crucial that the payments be made permanent as we push for a long-term solution. More details about the Bill can be found below. Let your Senators know that you support S. 967 — Here are three quick and easy ways to get involved!

Writing to your members of Congress only takes 2 clicks, follow these simple steps:

1. Enter contact information below (required by Congressional offices) and click “Submit”
2. On the next page you’ll see the letter(s) to your Senators – click “Submit Messages”

Active on Social Media? Tweet at your Senators asking for their support of S. 967!

  • Authorize Your Account
  • Enter Contact Information
  • Tweet! (Tweet will be auto-generated with your Senators tagged)
Know your Senators’ Twitter accounts already? Tweet:
“#ambulance svs in your state need you, @[your Senators]! Please co-sponsor S. 967 to help us continue to provide quality #EMS!”


Post on Facebook why S. 967 is important! Be sure to tag your Senators and encourage others to share your post! Ask others to write letters of support as well! http://bit.ly/AAAbill

More About Our Bill S. 967, the 2017 Medicare Ambulance Access, Fraud Prevention, and Reform Act:
Permanent ambulance relief legislation has been introduced by Senators Stabenow, Roberts, Schumer, Collins, and Leahy (S. 967). This legislation will allow ambulance service providers to maintain high quality ambulance services and budget for the future.
Specifically, the bill:

  • Provides Medicare Ambulance Relief, by permanently incorporating the current temporary 2 percent urban, 3 percent rural, and super rural bonus payments into the Medicare ambulance fee schedule rates.
  • Requires the Centers for Medicare and Medicaid Services (CMS) to submit a report to Congress detailing the features of a reformed payment system for ambulance services under the Medicare program no later than July 1, 2019.
  • Modifies the process for the transport of dialysis patients by requiring the Department of Health and Human Services to establish a process for the prior authorization of coverage for such patients.
  • Treat ambulance services designated as “suppliers” as “providers” for certain purposes under Medicare.
  • Specifies CMS to work with stakeholders in the development of a data collection system for ambulance entities that defines the various types of ambulance entities as well as the relevant cost and data elements required for submission.

Government Affairs Update: Protecting the Ambulance Add-ons

Written by Tristan North on . Posted in Advocacy Priorities, Government Affairs, Legislative, Member Advisories, Member-Only, Reimbursement.

Medicare Ambulance Relief and Reform

The top legislative priority this year for the American Ambulance Association is to extend, or hopefully make permanent, the temporary Medicare ambulance add-on payments. The temporary increases of 2% urban, 3% rural and the super rural bonus expire at the end of this year. The 2% urban and 3% rural increases have been in place since 2008 and the super rural bonus payment since 2004. While the AAA and our members have been successful in getting the payments extended numerous times, 2017 is not a typical year and we need everyone to be prepared to help push to make the increases permanent or extended for the longest possible duration.

The other top priorities for the AAA are for the Centers for Medicare and Medicaid Services (CMS) to recognize ambulance services more like providers of medical services instead of merely suppliers of transportation. In addition, it is critical that Congress direct CMS to collect cost data from ambulance service providers using a method, which will result in usable and meaningful data from everyone, but also not be overly burdensome on extremely low volume providers. Finally, Congress needs to target fraud and abuse with the transport of dialysis patients through a prior authorization program instead an arbitrary payment cut that impacts all providers.

The AAA is pushing its agenda again through a version of the Medicare Ambulance Access, Fraud Prevention and Reform Act which we hope to have introduced in the next few weeks. We are working with our champions on Capitol Hill on a different approach to being treated more like providers to mitigate issues raised about the provision last Congress. Instead of being listed in the Social Security Act as having provider status, we are looking to a hybrid model similar to dialysis facilities. This will clarify that we are not seeking to be treated like providers to achieve Medicare coverage because we are already reimbursed under the Medicare program. It will however still set the foundation for future legislative and regulatory changes to the Medicare fee schedule such as reimbursement for transporting to an alternate destination or treat and referral.

We are also making potential modifications to the House bill on our proposed data collection system. These changes would help with possible Committee consideration of the provision but still hopefully achieve or goal of obtaining useable data that is not overly burdensome to 73% of our industry which is composed of providers that do less than 1,000 Medicare transports a year of less. It is vital that we have meaningful data to make data-driven decisions as to changes to the Medicare ambulance fee schedule.

Ambulance Advocacy Webinar

We will let you know as soon as the revised legislation is introduced for the new Congress. In the meantime, we encourage you to register for the upcoming AAA webinar on the Ambulance Advocacy Action Plan with AAA Senior Vice President of Government Affairs Tristan North and AAA Government Affairs Coordinator Aidan Camas. Tristan and Aidan will provide you the latest information on our advocacy efforts and let you know how you can help. To register for the webinar which is free to AAA members, please go to: https://ambulance.org/product/ambulance-advocacy-action-plan/.

Also read Tristan and Kathy Lester’s recent Member Advisory on ACA Repeal & Reform:

ACA Repeal & Reform – What It Means for Ambulance Services (Pt. 1)
ACA Repeal & Reform – What It Means for Ambulance Services (Pt. 2)

Fighting for the Future of Ambulance Organizations

Written by AAA Staff on . Posted in Advocacy Priorities, Government Affairs, News, Press, Reimbursement.

AAA Executive Vice President, Maria Bianchi, recently penned an Op-Ed for JEMS entitled: Join AAA in Fighting for the Future of Ambulance Organizations. Learn about the AAA’s work towards Payment Reform and join us in our fight for our future. Help ambulance organizations be identified as healthcare providers by those who have influence on our regulations and reimbursement rates.

Learn more about 2017 AAA Member Benefits!

New Rural Provider Task Force

Written by AAA Staff on . Posted in Advocacy Priorities, News, Reimbursement.

AAA President Mark Postma created the Rural Providers Task Force which is being chaired by Jim Finger of Regional Ambulance Service in Rutland, Vermont. The Task Force will bring the perspective of small providers to the AAA Payment Reform Committee as it develops recommendations on how best to reform Medicare reimbursement policies. We are specifically targeting as Task Force volunteers those AAA members who operate 10 or fewer ambulances and serve rural communities.

The Task Force will initially focus on three key policy areas which are:
1) Ensuring that a cost data collection system is not overly burdensome on rural providers;
2) Understanding the impact of changing from ambulance service suppliers to providers will have on rural operations; and,
3) Looking at potential different options for defining rural areas within large urban counties under the Goldsmith Modification.

Our industry is predominately small operations with rural areas often relying on ambulance services as the only form of emergency medical care. Approximately 73% of ambulance service providers bill less than 1,000 transports to Medicare each year. President Postma has adopted the tag line for the AAA of “Representing EMS in America” and it is important that rural providers are representing within the reform efforts.

If your organization is rural and operates 10 or fewer ambulances and you would like to provide input on how potential reimbursement policy changes could affect organizations such as yours, please consider volunteering for the Task Force. The Rural Providers Task Force will have a limited number of participants comprised of individuals representing a cross-section of provider types and geographical areas. If you are interested in being considered for a spot on the Task Force, please click on this INTEREST FORM and complete and submit it.

If you have any questions about the Task Force, please do not hesitate to contact Jim Finger at jfinger@rasvt.com or Tristan North at tnorth@ambulance.org.

Join the Task Force!

Ambulance Payment Reform Whiteboard Video

Written by AAA Staff on . Posted in Advocacy Priorities, Legislative, Member Advisories, Regulatory.

The American Ambulance Association needs your help to build the future of EMS—an innovative industry compensated fairly and recognized appropriately for the critical healthcare it provides. Learn more in the video below, then visit our Payment Reform page to get involved!

Ambulance services across the country are struggling to survive in the face of falling reimbursement, short-sighted regulations, and rising costs. EMS providers of all sizes must share critical cost data, meet with legislators, and speak with one voice as we work to surmount these obstacles and position ambulance services for success today and for many years to come.

Permanent Medicare Ambulance Relief

Written by AAA Staff on . Posted in Advocacy Priorities, Government Affairs, Legislative, Medicaid, Medicare, Reimbursement.

Ambulance services are an essential piece of our local and national health care and emergency response systems. The majority of ambulance services are small businesses that provide jobs and support to their local communities.  Unfortunately, services throughout the country are facing serious financial crisis due to below-cost Medicare Reimbursement.  In 2012, the Government Accountability Office (GAO) released a report which clearly showed that, in the absence of temporary Medicare relief, Medicare reimburses ambulance service providers below cost.

You can support the efforts of the AAA and push for permanent Medicare ambulance relief by contacting your members of Congress.  We urge you to use the AAA’s online writing tool to write your members of Congress in less than 2 minutes.

Ask your members of Congress to Co-sponsor S. 377 and H.R. 745!

Take Action Now

Currently, as part of temporary Medicare relief, ambulance services receive a 2% urban, 3% rural or super rural add-on payment for each transport. The 2012 GAO report found that ambulance service providers are reimbursed 1% below cost when temporary Medicare relief is not taken into account.  The GAO report likely underestimates the financial difficulties facing ambulance service providers as the report did not take into account many other factors such as the expiration of a temporary GPCI add-on, productivity adjustments, a new fractional mileage policy, or increased fuel costs.

For these reasons, the American Ambulance Association is working tirelessly to win permanent Medicare relief for ambulance service providers.  Even with the current 33-month extension of ambulance Medicare relief, it is extremely difficult for ambulance services to budget and prepare for the uncertainties of the future.

Permanent Medicare Relief Bill

Early last year, the American Ambulance Association was successful in getting the Medicare Ambulance Access, Fraud Prevention and Reform Act of 2015 (S. 377, H.R. 745) introduced in both the Senate and the House of Representatives.  This critical legislation would help the ambulance industry move into the future by doing the following:

– Provides Medicare ambulance relief by permanently incorporating the current temporary 2% urban, 3% rural, and super rural bonus payments into the Medicare ambulance fee schedule rates.

– Requires the Centers for Medicare and Medicaid Services (CMS) to submit a report to Congress detailing the features of a reformed payment system for ambulance services under the Medicare program.

– Modifies the process for the transport of dialysis patients by requiring the Department of Health and Human Services to establish a process for the prior authorization of coverage for patients.

– Defines all who provide ambulance services as “providers” under Medicare.

– Specifies CMS to work with stakeholders in the development of a data collection system for ambulance providers that defines the various types of ambulance entities as well as the relevant cost and data elements required for submission.

What You Can Do to Help

As is customary, Congress is scheduled to take an extended recess at the beginning of August through Labor Day in September.  That means that most Members of Congress will be spending a large portion of time in their states and districts.  This presents a great opportunity for members of the AAA and all ambulance service providers to meet with their legislators.

The AAA asks that you invite your members of Congress to participate in an Ambulance Ride-Along during the months of July, August and September.  Conducting a ride-along with legislators is one of the most effective ways to showcase all that you do for the community and what your legislator can do for you.  The American Ambulance Association recently released the 2015 version of the Ambulance Ride-Along toolkit to guide you through the process.

Permanent Medicare relief and the Medicare Ambulance Access, Fraud Prevention and Reform Act of 2015 will be critical for ambulance services moving into the future.  We invite you to join our push for permanent Medicare relief.

Contact your members of Congress today!

Take Action Now

The Fairness in Ambulance Reimbursement Act

Written by AAA Staff on . Posted in Advocacy Priorities, Government Affairs, Legislative.

On July 11, 2014, The Centers for Medicare and Medicaid Services (CMS) published a proposed rule for the 2015 Medicare Fee Schedule (PFS) that adjusted ZIP code classifications for ground ambulance reimbursement based on 2010 data. The proposed rule initially indicated that only 122 ZIP codes would be reclassified from rural to urban in 2015.  However, the final PFS rule, which was published on November 13, 2014, re-designated 3000 ZIP codes from rural to urban. Thanks to work by the AAA’s legislative team, champions on Capitol Hill, members and other organizations, on December 16, 2014, CMS once again revised the ZIP codes that would be adjusted from rural to urban to 1,599.

CMS’s error, which contributed to the drastic changes from the proposed rule in July to the final rule in December, effectively denied interested parties the opportunities to participate in the notice and comment process and did not give ambulance service providers enough time to process and adjust for their losses.

The Fairness in Ambulance Reimbursement Act of 2015

The Fairness in Ambulance Reimbursement Act of 2015 (H.R. 817) would delay implementation of the rural to urban ZIP code reclassification until January 1, 2016, which would provide ambulance services with the necessary time to evaluate and respond to recent changes made by CMS.  This legislation is critical to ensure that ambulance services have needed funding and that Medicare beneficiaries continue to have access to high quality medical care as they are transported to hospitals and other healthcare facilities.

What You Can Do to Help

Unlike the permanent Medicare relief bill, the changes in zip codes to do not affect every ambulance service in the country.  That being said, we invite AAA members, organizations, and individuals to support our efforts to delay implementation of the zip code reclassification.  Cosponsors and support for the bill are still needed.  Please reach out to your members of Congress and ask them to cosponsor and support this important piece of legislation.  If this issue will affect you and your service, raise the issue with your legislators during your ambulance ride-along

Public Safety Officers’ Benefits (PSOB)

Written by AAA Staff on . Posted in Advocacy Priorities, Legislative.

For many years, one of the top legislative priorities of the AAA has been the expansion of the Public Safety Officer’s Benefits (PSOB) to all private emergency medical services (EMS) professionals.  Originally, Congress established the PSOB program to provide assistance to police officers, firefighters, paramedics and emergency medical technicians (EMT) in the event of a death in the line of duty.  However, the benefits only apply to those public safety officers employed by a federal, state, or local government entity or a private non-profit emergency medical services agency or company.

Paramedics and EMTs employed by a private, for-profit EMS company provide identical services to their governmental and private non-profit counterparts and do so daily in the same dangerous environments. The Federal Emergency Management Agency (FEMA) is presently reviewing its guidelines on “active shooter” and may revise its policy of paramedics and EMTs waiting until a scene is secure before entering to provide urgent medical care to a victim. While paramedics and EMTs employed by private EMS companies already put the lives of others first, the review of the FEMA guidelines as federal policy puts a greater emphasis on the need to apply the federal PSOB program to all first responders.

The Dale Long Act, 2012

In 2012, our voice was heard when the Dale Long Act (S. 385, Public Law 112-239) was signed into legislation.  The act extends the PSOB program to employees and volunteer members of non-profit EMS organizations.  While we would have liked to see the benefits extended to all EMS professionals, both public and private, we celebrated the victory and continue to fight for complete coverage.

It is inequitable to penalize dedicated public safety officers and their families simply because of their employer type and it is now time for Congress to fully correct this disparity and legislate that the PSOB program cover those paramedics and EMTs employed by a private EMS company.

What You Can Do to Help

Currently, the AAA is continuing efforts to find House and Senate sponsors for expansion of the PSOB to for-profit service providers.  In the past, members of Congress have been motivated to act by specific examples of inequity within their states and districts.  If you have a strong relationship with your elected officials and feel that you can help with this issue, please contact Tristan North, Senior Vice President of Government Affairs, at tnorth@ambulance.org.

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