AAA’s 2015 Ambulance Ride-Along Toolkit

Written by on . Posted in Government Affairs, Legislative, Medicare, Reimbursement.

It is that time of year. With the summer heat, fireworks, baseball and barbecues comes your greatest opportunity to meet with and influence your federal legislators, the August Recess. This year, Congress is scheduled to begin recess early in August and return to normal business after the Labor Day Holiday. The recess means that many members of Congress will be in their districts and states. This will be a great opportunity for you to educate your members of Congress about current issues affecting our industry. In particular, it will give you the chance to talk about permanent Medicare ambulance relief.

The easiest and most effective way to discuss key issues with your members of Congress is to invite them and their staffs to participate in a tour of your operation and on an ambulance ride-along. This gives you the opportunity to show all of the valuable services that you provide to the community and how Congress can continue to help. The AAA has made the process of scheduling and arranging a ride-along easy for you with the release of our 2015 Congressional Ride-Along Toolkit.

In April of this year, Congress extended the temporary 2% urban, 3% rural and super rural bonus payment through December, 2017. While this was a great victory for the AAA and ambulance services nationwide, a permanent solution is still needed. With temporary extensions of Medicare ambulance relief, ambulance services are incapable of adequately preparing for their financial future and providing quality care to their patients. The AAA has worked hard to have legislation introduced in the both the U.S. House of Representatives and the Senate that would make the temporary relief become permanent. We are still seeking cosponsors for the bill (H.R. 745, S. 377) and hope that you will assist in our search.

We invite you to use the Ambulance Ride-Along toolkit as you prepare to meet with your members of Congress over the coming months.

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

Join Our Efforts to Receive Permanent Medicare Relief

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

After countless hours of work by the American Ambulance Association’s (AAA) legislative team, our champions on Capitol Hill, volunteer leaders, members and other organizations, we are pleased to once again announce the 33-month extension of Medicare ambulance relief.  This extension will continue the 2% bonus for urban areas, the 3% bonus for rural transports and the bonus payment for super rural areas.  This is a major victory for the AAA and its members as the extension will supply important funding to allow ambulance services to continue to provide essential medical care to their communities.

That being said, we can’t let the momentum stop!  The AAA is still fighting and pushing on Capitol Hill for a permanent extension of Medicare relief rather than a temporary fix.  With a short-term extension it remains difficult for ambulance services to properly budget for the future and prepare for the uncertainties of being a health care provider.  The AAA continues to seek support and cosponsors for the Medicare Ambulance, Access, Fraud Prevention, and reform Act of 2015 (S. 377, H.R. 745).  In addition to permanent Medicare ambulance relief, this bill includes several additional provisions that will help ambulance services to grow and provide critical care services to patients.  These additional provisions include:

–     Categorizing ambulance services as “providers” rather than “suppliers”. The AAA wants its members and all ambulance services to be recognized properly for the medical services they provide.  As you are aware, an ambulance is often the first place that a patient is provided critical care and service.  For this reason, the bill includes language that would recognize ambulance services as “providers” rather than “suppliers”.

–     Prior Authorization Program. The same bill that extended Medicare ambulance relief for 33 months also included a prior authorization program that would extend to several states on the East Coast in 2016 and nationwide in 2017.  The AAA is working with legislators on Capitol Hill, our Medicare Consultants, and AAA members to help with the roll-out of the prior authorization program.  Keep your eyes peeled for further information and resources that the AAA will be providing.

–     Ambulance Cost Data Collection. The bill directs the Centers for Medicare and Medicaid Services (CMS) to use a survey approach to collecting cost data from a statistically significant number of ambulance service providers.  It is critical that Congress have cost data from all the different types of providers to make future changes to the ambulance fee schedule.

With each of these significant provisions, the Medicare Ambulance Access, Fraud Prevention and Reform Act of 2015 will help position AAA members and ambulance services for the future.  It will provide critical funding as well as opportunities for recognition, growth and knowledge.

Shawn Baird, Co-Owner of Woodburn Ambulance Service and Co-Chair of the AAA’s Government Affairs Committee, said this about the Medicare Ambulance Access, Fraud Prevention and Reform Act of 2015…

“While the extension of our temporary ambulance relief provides hard earned breathing room, it is more essential than ever to get members of Congress signed on as co-sponsors of our permanent ambulance relief bills S. 377 and H.R. 745.  Using this precious time to secure permanent funding, data collection that works for the industry and provider status with CMS is the only way we will be able to keep our issue a priority on Congress’s busy agenda. In our ambulance services at home we all know how important it is to keep pushing our companies to be ready for that next emergency call.   We never say it’s time to sit back and relax now that we ran that last call. It is the same with our effort on Capitol Hill. We have been building success and let’s keep it rolling forward!”

The American Ambulance Association asks that you help in our efforts to make Medicare ambulance relief permanent!   Please contact your members of Congress using the AAA’s online letter writing tool and ask them to co-sponsor the Medicare Ambulance Access, Fraud Prevention, and Reform Acts (S. 377 and H.R. 745).

Each member of the AAA plays a critical role in helping to achieve success in our legislative efforts.  With your help and expertise, we look to continue to represent you and your interests on Capitol Hill.

Ask Your Members of Congress to Cosponsor Permanent Medicare Relief Legislation

Written by Michael Hall on . Posted in Government Affairs, Legislative, Medicare, Member Advisories, Reimbursement.

Yesterday morning, Congressmen Walden, Welch, Nunes and Neal sent a Dear Colleague to their fellow members of the House of Representatives asking them to cosponsor the Medicare Ambulance Access, Fraud Prevention and Reform Act of 2015 (S. 377, H.R. 745). This bill will make the current temporary ambulance add-on payments permanent for all ambulance services.

Even with our recent victory of a temporary 33-month extension of crucial Medicare ambulance relief, our Champions on Capitol Hill realize the importance of receiving permanent Medicare relief. They, like every ambulance service across the country, understand that a permanent solution is necessary to provide quality health care to individuals and our communities both today and tomorrow.

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Ask Your Members of Congress to Cosponsor Permanent Medicare Relief Legislation

Written by Michael Hall on . Posted in Government Affairs, Legislative, Medicare, Member Advisories, Reimbursement.

Yesterday morning, Congressmen Walden, Welch, Nunes and Neal sent a Dear Colleague to their fellow members of the House of Representatives asking them to cosponsor the Medicare Ambulance Access, Fraud Prevention and Reform Act of 2015 (S. 377, H.R. 745). This bill will make the current temporary ambulance add-on payments permanent for all ambulance services.

Even with our recent victory of a temporary 33-month extension of crucial Medicare ambulance relief, our Champions on Capitol Hill realize the importance of receiving permanent Medicare relief. They, like every ambulance service across the country, understand that a permanent solution is necessary to provide quality health care to individuals and our communities both today and tomorrow.

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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.

Ambulance Open Door Forum, April 22, H.R. 2

Written by David Werfel on . Posted in Government Affairs, Legislative, Medicare, Member Advisories, Regulatory, Reimbursement.

CMS held its latest Ambulance Open Door Forum on April 22. It started with the following two announcements:

– H.R. 2 was signed into law extending the temporary ambulance adjustments through December 31, 2017. The adjustments are 2% (urban pick-ups), 3% (rural) and 22.6% (super rural).

– For free standing facilities, use the “P” modifier if the facility is not part of the hospital and use “H” if it is hospital-based.
Following these announcements, there was a Question and Answer period. Most of the questions were not answered on the call and the caller was asked to submit their questions to CMS, or was told to ask their Medicare Administrative Contractor or was told to appeal the denied claim referenced in their question. A few were answered, as follows:

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Senate Delays Vote on SGR Repeal Package

Written by Michael Hall on . Posted in Government Affairs, Legislative, Medicare, Member Advisories, Reimbursement.

Early this morning after completing action on a FY 2016 Senate Budget Resolution, Senate Majority Leader Mitch McConnell (R-KY) announced that the Senate would not act on legislation (H.R. 2) to permanently repeal the sustainable growth rate (SGR) formula for physicians until after the Easter recess. H.R. 2 includes the 33-month extension of the temporary Medicare ambulance increases. Senate Majority Leader McConnell had sought consideration today of H.R. 2 under unanimous consent which requires the support of all 100 Senators. There were objections to the expedited vote and thus the Senate is now expected to consider the bill when it returns on April 14.

The temporary Medicare ambulance increases expire on March 31. However, contractors have a standard requirement to hold all Medicare claims for 14 days before making payment. The Centers of Medicare and Medicaid Services (CMS) has issued a notice to contractors formally directing them to utilize this hold. So if the Senate does complete action on H.R. 2 on April 14 there will be no need for reprocessing any claims for the retroactive increases. Should action on H.R. 2 be delayed further, Congress could do a short-term extension or simply allow the provisions to expire for a short period of time. Senate Majority Leader Mitch McConnell and Senate Minority Leader Harry Reid (D-NV) have both stated they would like quick consideration of H.R. 2 when the Senate returns.

We will continue to keep you posted of new developments.

House Votes in Favor of Permanent Doc Fix, Bill Moves to the Senate

Written by Michael Hall on . Posted in Government Affairs, Legislative, Medicare, Member Advisories, Regulatory, Reimbursement.

Earlier today, the U.S. House of Representatives voted in favor of H.R. 2, doing away with Medicare’s sustainable growth-rate formula and passing a permanent doc fix. The 392-37 vote was overwhelmingly bipartisan. As we reported on March 24, thanks to our champions on Capitol Hill, a 33-month extension of the temporary Medicare ambulance increases was included in the bill. If enacted, the bill would extend the deadline for expiration of Medicare ambulance relief from March 31 until December 31, 2017.

The Senate still needs to pass the bill and is working on a short time-line before they adjourn for recess. Senate Republicans and Democrats have expressed concerns about different aspects of the bill so it is unclear whether the chamber will consider H.R. 2 before it recesses. It is also uncertain if Congress would pass a short-term extension to give the Senate more time or if CMS would be required to formalize its 14-day claim hold policy should H.R. 2 not be enacted before March 31.

In addition to Medicare ambulance relief, the package also includes language from the Protecting Integrity of Medicare Act (H.R. 1021) expanding the current prior authorization pilot programs on repetitive BLS non-emergency ambulance transports in South Carolina, Pennsylvania and New Jersey. Starting in January 2016, the bill would expand the programs to Delaware, DC, Maryland, North Carolina, West Virginia and Virginia. The program would then expand nationwide starting in January 2017.

The AAA will continue to push for the Medicare Ambulance Access, Fraud Prevention and Reform Act (S. 377, H.R. 745). S. 377 and H.R. 745 would make the current temporary ambulance increases permanent and place our industry in a strong position moving forward for data-driven reforms to the ambulance fee schedule. S. 377 and H.R. 745 would also address fraud and abuse with repetitive BLS non-emergency dialysis transports. While a similar program to the current pilot programs. The prior authorization within S. 377 and H.R. 745 would apply only to dialysis transports and would institute additional safeguards to ensure timely prior authorization for medically necessary transports.

I want to thank all AAA members, staff and consultants who continue to work tirelessly on extending essential Medicare ambulance relief. We will keep you posted of new developments.

House SGR Repeal Package Contains Ambulance Relief Extension

Written by Michael Hall on . Posted in Government Affairs, Legislative, Medicare, Member Advisories, Regulatory, Reimbursement.

Earlier today, House Republican and Democratic leadership released the complete package (H.R. 2) for a permanent fix to the physician fee schedule. I am happy to report that the AAA through our champions on Capitol Hill was successful in getting a 33-month extension of the temporary Medicare ambulance increases included in the bill. If enacted, the bill would extend the deadline for expiration of Medicare ambulance relief from March 31 until December 31, 2017.

The House is scheduled to consider H.R. 2 on either Thursday or Friday prior to adjourning for the two-week Easter recess. The bill is currently expected to pass the House with bipartisan support. Senate Republicans and Democrats have expressed concerns about different aspects of the bill so it is unclear whether the chamber will consider H.R. 2 before it recesses. It is also unclear if Congress would pass a short-term extension to give the Senate more time or if CMS would be required to formalize its 14-day claim hold policy should H.R. 2 not be enacted before March 31.

The package also includes language from the Protecting Integrity of Medicare Act (H.R. 1021) expanding the current prior authorization pilot programs on repetitive BLS non-emergency ambulance transports in South Carolina, Pennsylvania and New Jersey. Starting in January 2016, the bill would expand the programs to Delaware, DC, Maryland, North Carolina, West Virginia and Virginia. The program would then expand nationwide starting in January 2017.

The AAA continues to push for the Medicare Ambulance Access, Fraud Prevention and Reform Act (S. 377, H.R. 745). S. 377 and H.R. 745 would make the current temporary Medicare ambulance increases permanent and place our industry in a strong position moving forward for data-driven reforms to the ambulance fee schedule. S. 377 and H.R. 745 would also address fraud and abuse with repetitive BLS non-emergency dialysis transports. While a similar program to the current pilot programs, the prior authorization within S. 377 and H.R. 745 would apply only to dialysis transports and would institute additional safeguards to ensure timely prior authorization for medically necessary transports.

We will keep you posted of new developments.

Permanent Medicare Ambulance Relief

Written by AAA Staff on . Posted in Government Affairs, Legislative, Medicare, Member Advisories, Regulatory, Reimbursement.

Please reach out to your members of Congress and ask that they cosponsor the Medicare Ambulance Access, Fraud Prevention and Reform Act (H.R. 745, S. 377) and support an extension of the temporary Medicare ambulance add-on payments.  H.R. 745 and S. 377 would make the current temporary Medicare increases of 2% urban, 3% rural and the super rural bonus payment permanent. Please also ask your members of Congress to support an extension of the increases, which expire on March 31.

In the next few weeks, Congress is expected to consider an extension of the temporary fix to the physician fee schedule. This package would also be the legislative vehicle for an extension of the Medicare ambulance add-on payments. An extension of these increases will ensure the continuation of short-term relief while we push to make the increases permanent. So please write today!

Thank you in advance for writing to your members of Congress.

Advocate for Permanent Medicare Ambulance Relief

Written by Michael Hall on . Posted in Government Affairs, Legislative, Medicare, Regulatory, Reimbursement.

The U.S. House of Representatives is currently developing a package on a permanent fix to the physician fee schedule. House Speaker John Boehner recently announced the effort for a permanent fix instead of another extension and the framework of a package is coming together quickly. It is therefore critical that you contact your members of Congress today in support of permanent ambulance relief.

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Permanent Medicare Ambulance Relief Bills Introduced in Congress

Written by Michael Hall on . Posted in Government Affairs, Legislative, Medicare, Member Advisories, Reimbursement.

I am extremely happy to report our Senate and House champions on Medicare ambulance relief introduced on Wednesday the Medicare Ambulance Access, Fraud Prevention, and Reform Act of 2015 (S. 377, H.R. 745). Senators Charles Schumer (D-NY), Pat Roberts (R-KS), Patrick Leahy (D-VT) and Susan Collins (R-ME) introduced the Senate bill (S. 377) and Congressmen Greg Walden (R-OR), Peter Welch (D-VT), Devin Nunes (R-CA) and Richard Neal (D-MA) introduced the House bill (H.R. 745).

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