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2016 Ambulance Ride-Alongs

The AAA 2016 Congressional Ride-Along Toolkit is now available.

Congress adjourned on July 15 for their August congressional recess with members of Congress returning home to their districts and states.  This is the perfect opportunity for you to educate your members of Congress about those issues, in particular Medicare ambulance relief and reform, which are important to your operation.  The most effective way to deliver these key messages is to host your member of Congress or their staff on a tour of your operation and an ambulance ride-along.  If you cannot host a tour and ride-along, we strongly encourage you to arrange local meetings with your members of Congress during August. The AAA has made the process of arranging a ride-long or scheduling a meeting easy for you with our 2016 Congressional Ride-Along Toolkit.

While the current temporary Medicare ambulance relief increases don’t expire unit December 31, 2017, meet with your members of Congress now to gain their support for making the relief permanent.  Also, there is a potential opportunity this year to make progress on provisions to change our status from “suppliers” to “providers” of health care services and to direct CMS to collect ambulance cost data.  Enactment of these two provisions is necessary to set the stage for future reform of the Medicare fee schedule and reimbursement for services other than a transport.  During the tours or meetings, please therefore request your members of Congress to cosponsor the Medicare Ambulance Access, Fraud Prevention and Relief Act (S. 377, H.R. 745) and support moving the provider status and cost data provisions of the bill this year.

Everything you need to arrange the ride-along or schedule a meeting is included on the AAA Website.

Email the AAA at info@ambulance.org if you need any assistance.

AAA Submits Testimony on Access to Emergency Medications

On July 12, the House Energy and Commerce Subcommittee on Health held a hearing on “Strengthening our National Trauma System.”  As part of the hearing, the Subcommittee heard from witnesses about the Preserving Patient Access to Emergency Medications Act (H.R. 4365).  The AAA strongly supports H.R. 4365 which would ensure that EMS personnel can continue to administer controlled substances to patients. The AAA submitted written testimony for the hearing record which can be accessed here and read below.

The American Ambulance Association (AAA) thanks the Chairman, Ranking Member, and Members of the Subcommittee on Health for holding a hearing to consider proposals to improve and strengthen the national trauma system. The AAA represents hundreds of ambulance services across the United States that participate in emergency and nonemergency health care and medical transportation. The Association serves as a voice and clearinghouse for ambulance services, and views prehospital care not only as a public service, but also as an essential part of the total public health care system. To that end, we urge Congress to pass the Protecting Patient Access to Emergency Medications Act of 2016 (H.R. 4365) by Congressman Hudson (R-NC). This legislation is necessary to ensure that patients in need of emergency medical care have access to life-saving medications.

A longstanding practice has allowed Emergency Medical Services (EMS) practitioners to administer and deliver controlled substances under the oversight of physicians through directional guidelines known as standing orders. The use of standing orders allows EMS personnel who are the often the entry point into the health care system to administer potentially life-saving drugs as quickly as possible to patients in emergency situations. However, the Drug Enforcement Administration has determined that the Controlled Substances Act as currently written prohibits EMS personnel from administering such medications to patients through standing orders. This endangers lives by limiting access to emergency medications that seriously ill or injured patients may need.

Congressman Hudson’s legislation would remedy this situation by clarifying that EMS agencies are allowed to use standing orders from their medical director to administer controlled substances to patients. Codifying this current practice will ensure that EMS practitioners and patients do not see any disruption in the provision of emergency care. H.R. 4365 would also permit EMS agencies to register directly with the DEA; require each EMS agency to have one or more medical directors; allow a single registration for an EMS agency, not a separate registration for each location; and update requirements for EMS agencies’ receipt, storage, and tracking of controlled substances.

The unique nature of mobile emergency medical services sets us apart from other health care services governed by the Controlled Substances Act. H.R. 4365 is needed to ensure that regulatory oversight to prevent abuse of controlled substances does not threaten the provision of time-sensitive emergency medical care to those with critical injuries and illnesses. The AAA respectfully requests that the Committee move expeditiously to support this vital legislation so that our nation’s EMS practitioners can care effectively for patients in need.

New Member Benefit: StateTrack

Introducing the AAA’s newest member benefit, StateTrack, powered by CQ Roll Call. StateTrack will give AAA members the ability to easily track crucial legislation and regulations in one state or all of them as well as the Federal Government.

StateTrack Map

AAA StateTrack

StateTrack will show you a map of the entire United States. Click on the state you are interested in tracking and you will see a list of all regulations and legislation impacting the following areas:

Affordable Care Act
Ambulance
Community Paramedicine
EMT
Medicaid
Medicare
Mobile Integrated Health
Paramedic

Click on the key words above to narrow down your search to only legislation and regulations that contain those terms.

Members will be able to view the full text of each piece of legislation as well as edits that have been made to the text, bill number, status of the bill and the representative who introduced it. StateTrack will make it easier for AAA members to keep track of legislation and regulations on the state level that could have enormous impacts on their ambulance services. States that are white, are either out of session or do not have any pending legislation or regulations that fall under the AAA search criteria.

Please contact Aidan Camas at acamas@ambulance.org if you have any questions.

The Importance of Ambulance Cost Survey Data

By Kathy Lester, JD, MPH | Updated November 9, 2015

Tomorrow is in your hands today. This statement is especially true when we think about the evolution of ambulance services. Today, care once reserved for the hospital setting is now delivered at the scene, resulting in better patient outcomes. Yet, despite these advances, the Medicare payment system lags behind. Current rates are based upon a negotiated rulemaking process that did not take the cost of providing services into accounts. While many in the industry strive to further expand the delivery of high-quality care, the inflexibility of the current payment system makes it difficult to compensate the next generation of ambulance service providers appropriately.

To prepare for tomorrow, ambulances services must act today. The AAA has taken a leadership role by setting the groundwork needed to reform the payment system so that it recognizes the continued evolution of ambulance services. The two game changers are (1) designating ambulance suppliers as “providers” of care; and (2) implementing a federal data collection system.

“Emergency care has made important advances in recent decades: emergency 9-1-1 service now links virtually all ill and injured Americans to immediate medical response; organized trauma systems transport patients to advanced, lifesaving care within minutes; and advances in resuscitation and lifesaving procedures yield outcomes unheard of just two decades ago.”
Institute of Medicine: Emergency Medical Services at a Crossroads (2007)

Provider Status

Being deemed a “provider” rather than a “supplier” is the first step toward recognizing the clinical component of ambulance services and appropriately incorporating ambulance services into the broader health care coordination and reform discussions.

Under current law, the term provider refers to hospitals, skilled nursing facilities (SNFs), outpatient rehabilitation facilities, home health agencies, ambulatory surgical centers, end-stage renal disease facilities, organ procurement organizations, and clinical labs. Durable medical equipment entities and ambulance services are designated as suppliers.

When ambulance services were first added to the Medicare benefit, the primary services provided were transportation. As noted already, transportation is only one component of the services provided. The deliver of health care services today make ambulances more like other Medicare providers than suppliers.

Achieving this designation is the first step toward having the federal government recognizing the value of the health care services provided by ambulances.

Cost Collection

The second game changer involves collecting cost data from all types and sizes of ambulances services in all areas of the country. Current Medicare rates are not based on cost. As the Government Accountability Office has recognized in two separate reports, these rates do not cover the cost of providing services to beneficiaries. While the Congress has extended the ambulance add-ons year after year, the lack of a permanent fix makes it difficult to plan. There is also the risk of the add-ons not being extended at some point. In addition, the rates take into account only at the most general level the health care being provided.

In the American Taxpayer Relief Act (ATRA), the Congress required the Centers for Medicare and Medicaid Services (CMS) to issue a report evaluating the ability to use current hospital cost reports to determine rates and also to assess the feasibility of obtaining cost data on a periodic basis from all types of ambulance services. Knowing of the strong Congressional interest in obtaining additional cost information, the AAA began working with The Moran Company (a consultant organization with expertise in Medicare cost reporting) to develop recommendations as to how cost data could be most efficiently and effectively collected. The AAA shared these recommendations with CMS and the contractor developing the report. The final report, released in October, supports the AAA’s work and states:

Any cost reporting tool must take into account the wide variety of characteristics of ambulance providers and suppliers. Efforts to obtain cost data from providers and suppliers must also standardize cost measures and ensure that smaller, rural, and super-rural providers and suppliers are represented.

The next step in the process is to provide CMS with direction and authority to implement the AAA’s cost survey methodology. In brief, the methodology would:

  • Require all ambulance services to report to CMS demographic information, such as organizational type (governmental agency, public safety, private, all volunteer, etc), average duration of transports, number of emergency and nonemergency transports. CMS would use this data to establish organization categories so that the data collected aligns with the type of organization providing it.
  • Require all ambulance services to report cost data, such as labor costs, administrative costs, local jurisdiction costs, through a survey process. During any survey period, CMS would identify a statistically valid sample of ambulance services in each category to be surveyed. These services would have to provide the data or be subject to a five percent penalty. Those ambulance services that provide data will not be asked to do so again until every service in its organization category has submitted the data.

As part of this process, the AAA has begun developing a common language for reporting these data. This work will ensure that the information is collected in a standardized manner. The AAA will also provide assistance to services that may need extra help in completing the surveys.

This information can then be aggregated and used to evaluate the adequacy of Medicare payments and support additional coverage policies. Most importantly, it will allow policy-makers, the AAA, and other stakeholders to reform the current Medicare ambulance payment system so that it incorporates the health care services currently being provided and those that will be in the future.

Conclusion

In order to be prepared for the reimbursement structures of tomorrow, ambulance services need to be designated a providers and recognized for the health care they provide. They also need to participate in a standardized cost collection program that will provide accurate data in the least burdensome way possible. The AAA is leading the effort to help ambulance services prepare for tomorrow.

Update: House & Senate Approve Veterans Health Care Choice Act

Yesterday, the House of Representatives voted overwhelmingly to approve H.R. 3236, the Surface Transportation and Veterans Health Care Choice Improvement Act. Update 2:16 p.m. on July 30: The Senate approved the legislation today, and it is now headed to the President’s desk for signature.

Among its provisions, the bill would allow the Department of Veterans Affairs (VA) to use $3.3 billion from the Veterans Choice Fund to pay for care provided to veterans by non-VA providers between May 1 and October 1, 2015 under the VA’s community care programs.

H.R. 3236 also would require the VA to develop a plan to consolidate all non-VA programs into a single “Veterans Choice Program” and to submit a report on the plan to Congress by November 1, 2015. Among its provisions, the plan must include the structuring of the billing and reimbursement process; a description of the reimbursement rate to be paid; and an explanation of the processes to be used to ensure that the Secretary will fully comply with the federal Prompt Payment Act.

Further, H.R. 3236 would make a number of changes to the current Veterans Choice Program, including: eliminating the requirement that a veteran be enrolled in the VA health care system by Aug. 1, 2014 in order to participate; allowing the VA to expand the number of non-VA providers that may offer medical services; waiving the program’s wait-time eligibility threshold if clinically necessary for the veteran; and allowing veterans residing within 40 driving miles of a VA medical facility to use non-VA services if the VA facility does not have a full-time physician on staff.

M. Todd Tuten is a Senior Policy Advisor at Akin Gump Strauss Hauer & Feld, LLP.

CMS Issues Proposed Rule for Calendar Year 2016

On July 8, 2015, the Centers for Medicare and Medicaid Services (CMS) published a display copy of a proposed rule titled “Medicare Program; Revisions to Payment Policies under the Physician Fee Schedule and Other Revisions to Part B for CY 2016”.  The proposed rule makes a number of changes to the Medicare Physician Fee Schedule.  It also makes certain changes to the Medicare Ambulance Fee Schedule.  These proposed changes are summarized below.

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AAA’s 2015 Ambulance Ride-Along Toolkit

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.

Ask Your Members of Congress to Cosponsor Permanent Medicare Relief Legislation

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

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

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

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

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

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.

Advocate for Permanent Medicare Ambulance Relief

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

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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