Congress Passes SIREN Act

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

On December 12, 2018, Congress passed the 2018 Farm Bill (S. 3042) by a 386-47 vote in the House and 87 – 13 vote in the Senate. Included in the final Bill was language similar to the SIREN Act (S. 2830, H.R. 5429) to reauthorize the Rural EMS Grant program.

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 – which haven’t been funded for over a decade. These grants would now provide funds up to $200,000 for training, equipment, and personnel retention in rural areas. The grants also require a 10% contribution by the grant recipient.

The Health Resources and Services Administration (HRSA) will issue a guidance with the details on how these grants will be administered. Since the program has been unfunded for so long, it is unclear at this time, how it will be rolled out. HRSA will most likely follow past protocol providing details through guidance including how to submit and deadlines. The AAA will be sure to share additional details as soon as they become available.

While the AAA had advocated that language be revised to ensure small rural for-profit providers would still be able to apply for grants, we are happy to see this program reauthorized. The AAA was concerned not to push too hard for any changes because the House-passed version of the Farm Bill did not include the SIREN Act provision and didn’t want to give lawmakers any reason not to include the provision in the final Farm Bill.

Special thanks to the IAFC and NAEMT, and other partner organizations for all of their work in getting this legislation passed. The AAA would also like to thank members Congress who advocated for the passage of the SIREN Act including Senators Durbin, Roberts and Stabenow.

Federal District Court Judge Strikes Down the ACA

Written by Brian Werfel on . Posted in Legislative, Member Advisories, News, Reimbursement.

On December 14, 2018, a federal district court judge for the Northern District of Texas issued a ruling striking down the Affordable Care Act (ACA) on the grounds that the Individual Mandate was unconstitutional, and that the rest of the law cannot withstand constitutional scrutiny without the Individual Mandate.

District Court Judge Reed O’Connor’s decision relates to a lawsuit filed earlier this year by 20 states and two individuals. The plaintiffs argued that the Tax Cuts and Jobs Act of 2017 — which amended the Individual Mandate to eliminate the penalty on individuals that failed to purchase qualifying insurance effect January 1, 2019 — rendered the Individual Mandate unconstitutional. The plaintiffs further argued that the Individual Mandate was inseverable from the rest of the ACA, and, therefore, that the entire ACA should be struck down.

The defendants in this case were the United States of America, the U.S. Department of Health and Human Services (HHS), Alex Azar, in his capacity as the Secretary of HHS, and David J. Kautter, in his capacity as the Acting Commissioner of the Internal Revenue Service (IRS). 16 states and the District of Columbia intervened as additional defendants.

In order to properly understand the district court’s ruling, it is necessary to revisit the Supreme Court’s 2012 decision on the constitutionality of the ACA, National Federal of Independent Business v. Sebelius (NFIB). In that case, 26 states, along with several individuals and a business organization challenged the ACA’s Individual Mandate and Medicaid expansion provisions as exceeding Congress’ enumerated powers. In a complicated decision, the majority of Justices ruled that the Individual Mandate was unconstitutional under Congress’ authority to regulate interstate commerce, but that the provision could be salvaged under Congress’ authority to lay and collect taxes. In reaching this conclusion, the majority of Justices focused on the “shared responsibility payment” aspect of the Individual Mandate, which imposed a tax on those individuals that failed to purchase or otherwise obtain qualifying health insurance. The majority of Justices concluded that the shared responsibility payment was a “tax.” It was therefore constitutional under the Congress’ general taxing authority.

In sum, the Supreme Court ruled that Congress lacked the power to compel individuals to buy qualifying health insurance, but that it could constitutionally impose a tax on those that failed to purchase or otherwise obtain qualifying health insurance.

In the current case, the court was asked to reconsider the Individual Mandate in light of the TCJA, which “zeroed” out of the shared responsibility payment, effective January 1, 2019. The plaintiffs argued that the Individual Mandate could no longer be justified as a valid exercise of Congress’ taxing authority. The federal government and its agents did not necessarily contest the plaintiffs’ argument with respect to the Individual Mandate. By contrast, the intervening states and the District of Columbia argued that the Individual Mandate could continue to be construed as a tax because it continues to satisfy the factors set forth by the Supreme Court in NFIB.

Judge O’Connor sided with the plaintiffs, holding that, because the Individual Mandate would no longer trigger a tax beginning in 2019, the Supreme Court’s ruling on this point in NFIB was no longer applicable. He therefore concluded that the Individual Mandate could no longer be upheld under Congress’ taxing authority. Judge O’Connor then fell back on the Supreme Court’s previous holding that the Individual Mandate, as a stand-alone command, remained unconstitutional under the Interstate Commerce Clause. Judge O’Connor then ruled that the Individual Mandate could not be severed from the rest of the ACA. On this point, the judge cited the express provisions of the ACA, as well as the Supreme Court’s decisions in NFIB and King v. Burwell.

What this decision means

On its face, the decision strikes down the Affordable Care Act in its entirety. However, the ruling is likely to be appealed to the Fifth Circuit Court of Appeals. Most legal experts expect that, regardless of the decision at the Circuit Court, the case is likely to make its way up to the Supreme Court.

Pending the resolution of these appeals, the Administration has adopted a “business as usual” approach. The White House has already indicated that it will not attempt to enforce the ruling during the appeals process. CMS Administrator Seema Verma recently tweeted that the decision will have “no impact to current coverage or coverage in a 2019 plan.”

The American Ambulance Association will continue to monitor this case as it makes its way through the appeals process, and we will notify our members of any new developments.

Senate Introduces NEATSA Act Companion Bill (S. 3619)

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

Earlier this year, 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.

Senators Bill Cassidy (R-LA) and Doug Jones (D-AL) just introduced S. 3619 which 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 to and from dialysis centers. S. 3619 will serve as a companion Bill to the House version, the NEATSA Act (H.R.6269) by Congressman LaHood (R-IL) and Congresswoman Sewell (D-AL) which was introduced in June 2018.

The additional cut went into effect on October 1 and impacted AAA members and the AAA are working to get this legislation passed. The AAA will be sure to keep members updated as this legislation moves through Congress.

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 | (202) 802-9025

Ruth Hazdovac – AAA Senior Manager of Federal Government Affairs
rhazdovac@ambulance.org | (202) 802-9027

Aidan Camas – Manager of State & Federal Government Affairs
acamas@ambulance.org | (202) 802-9026

Thank you for your continued membership and support.

Rural Health Day Advocacy Update

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

Happy National Rural Health Day! Thank you to all of the ambulance service providers who work hard providing life-saving treatment in rural areas every day.

In part of our ongoing advocacy efforts, the AAA sent a letter today to the Rural Caucuses in the United States Senate and House of Representatives. Addressed to leadership of the caucuses, Sen. Pat Roberts (R-KS), Sen. Heidi Heitkamp (D-ND), Rep. Adrian Smith (R-NE), and Rep. Tim Walz (D-MN), this in-depth letter highlights the critical work that our members do every day around the country and raises important issues affecting the industry. Issues covered in the letter include:

Stabilizing the Ambulance Fee Schedule
  • Make the add-ons permanent and build them into the base rate
  • Use new data from the ambulance cost collection program to ensure reimbursement is adequate going forward
  • New data should be used to assess the problems with the current ZIP-code methodology for determining rural and super-rural services
Ambulance Fee Schedule Reform
  • Proposed alternative models for rural ambulance services
  • Encouraging Congress to look at alternative destination options for ambulance service providers
Recognizing Ambulance Services as Providers of Health Care
  • Moving non-fire-based ambulance services from suppliers to providers under Medicare

The letter also highlights some of the burdensome regulations facing ambulance service providers that the AAA has recommended Congress address through its Red Tape initiative. These include:

Removing Unnecessary Regulatory Burdens:
  • Reduce the burdens created by the Physician Certificate Statement
  • Simplify the 855B Ambulance Enrollment Form
  • Address burdensome requirements of the patient signature on claims and the strict application of the revocation of billing authority

This letter from the AAA to Congressional leaders is just one part of the AAA’s ongoing effort to educate Congress on the crucial role ambulance service providers play in America’s healthcare system. The AAA wants Congress to know that in many rural areas of the country, ambulances are the medical safety net, yet face extreme challenges to staying in business thanks to below cost reimbursement and burdensome regulations. The AAA will continue to pursue this list of priorities with our members next year and going forward.

Read the Full Letter

Again, Happy Rural Health Day to our members – thanks for all that you do!

If you have any questions about our letter or rural advocacy, please contact us:

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 | (202) 802-9025

Ruth Hazdovac – AAA Senior Manager of Federal Government Affairs
rhazdovac@ambulance.org | (202) 802-9027

Aidan Camas – Manager of State & Federal Government Affairs
acamas@ambulance.org | (202) 802-9026

Thank you for your continued membership and support.

Mid-term Election Analysis

Written by AAA Staff on . Posted in Government Affairs, Legislative, Member Advisories, Member-Only, News, Uncategorized.

As a result of Tuesdays’ elections, Democrats will control the U.S. House of Representatives next Congress and Republicans will have a larger majority in the United States Senate. Presently, Democrats have gained a net of 30 seats in the House with Republicans netting two seats in the Senate. Democrats needed to capture 23 seats from Republicans to gain the majority. There are still several races in the House and Senate to be called which will likely add to those totals.

Akin Gump, the lobbying firm for the AAA, has put together a synopsis of the election results as of this morning and a slide deck on historical trends and the outcome of races called so far.

Key supporters of the industry who will not be returning next Congress include Representatives Peter Roskam (R-IL), Mike Coffman (R-CO) and Erik Paulsen (R-MN). All three members have been supportive of ambulance initiatives with Roskam in his position as Chair of the House Ways and Means Health Subcommittee and Paulsen as a member of the Subcommittee. Coffman sponsored legislation to apply the prudent layperson definition to emergency ambulance services provided to veterans. In late breaking news, the Senate race in Montana was called in favor for Senator Jon Tester (D-MT) who has been very supportive on several EMS policies.

As to the changes in Committee leadership with Democrats taking control of the House, Congressman Richard Neal (D-MA) will become Chair of the Ways and Means Committee and Kevin Brady (R-TX) will become Ranking Member. Congressman Mike Thompson (D-CA) will likely become Chair of the Health Subcommittee with the top candidate for Ranking Member being Devin Nunes (R-CA). On the Energy and Commerce Committee, Congressman Frank Pallone (D-NJ) will become Chair and Greg Walden (R-OR) will become Ranking Member.

In the Senate, Senator Charles Grassley (R-IA) will likely become Chair of the Senate Finance Committee In lieu of Senator Hatch who is retiring. Senator Ron Wyden (D-OR) will continue in his role as Ranking Member of the Committee.

The AAA has good relationships with all the likely Chairs and Ranking Members of the key Committees of jurisdiction as well as with House and Senate leaders of both political parties. Several of them have championed causes for the industry and we will continue to be well-positioned next year to push our initiatives. We will be reaching out to you in the coming weeks to help build upon our list of champions and supporters in the new Congress.

Statement on Ambulance Cost Data Collection

Written by AAA Staff on . Posted in Advocacy Priorities, Cost Data Collection, Cost Survey, Government Affairs, Legislative, Member Advisories, Regulatory.

October 22, 2018

Contact: Amanda Riordan
Phone: 703-615-4492
Email: ariordan@ambulance.org

For Immediate Release

Statement on Cost Data Collection for Ambulance Services

WASHINGTON, DC—On October 17, the International Association of Fire Chiefs (IAFC), International Association of Fire Fighters (IAFF), and The Metropolitan Fire Chiefs Association released a joint statement discouraging fire-based providers from endorsing AAA’s proposed ambulance cost collection methodology. While we regret to learn that they do not believe that our method is appropriate for the segment of providers they represent, we respectfully disagree and invite open dialogue as our previous requests to discuss cost collection with the IAFF and IAFC were declined.

The American Ambulance Association membership is composed of ambulance providers of all types and sizes, ranging from non-profit, for-profit, volunteer, hospital-based, county-based, public utility models, and more. We represent 911 ambulance providers in major metropolitan areas, small 911 providers in rural America, and those who provide vital hospital-to-hospital interfacility mobile healthcare throughout the country. AAA encourages all ambulance providers to visit www.ambulancereports.org to learn about the extensive research, time, and thought devoted to ensure that our comprehensive recommendations accurately capture data for the full spectrum of providers.

“Regardless of an ambulance organization’s service model, we collectively serve our communities with round-the-clock mobile healthcare. The collection and analysis of accurate cost data for ambulance providers of all types is essential to the future of our industry. If adopted by CMS, AAA’s cost collection recommendations will demonstrate the value of the care that we provide to our patients, as well as open the door for the establishment of forward-thinking payment models that sustain operations and grow innovation. The American Ambulance Association welcomes discussion with fire and other stakeholders. Our door is always open,” said AAA President Aarron Reinert on Monday.

Medicare cost reporting is an exhaustive and extremely technical system that has been in place in other healthcare specialties for many years. While not all ambulance services are Medicare “providers of service,” it has long been clear to AAA that ambulance services would eventually be required to provide cost data to support Medicare reimbursement, especially for purposes of making the add-ons permanent and expanding the benefit to include innovative payment models, including mobile integrated health. As such, our ambulance cost collection leadership began in 2012 with the commission of an extensive independent research study to design a cost model that would be accurate, complete, and minimally burdensome to ambulance providers of all sizes, types, and models. The findings of this study were released in 2014 and form the foundation of AAA’s cost data collection system design.

Following extensive advocacy efforts led by the American Ambulance Association, the Bipartisan Budget Act of 2018 was passed into law in February of this year. This bill included language that extended the ambulance Medicare add-ons for five years. It also required that ambulance services begin collecting and reporting cost data to the Centers for Medicare & Medicaid Services (CMS) in 2020. CMS has the ability to determine certain aspects of how the data is collected as well as the data elements so AAA is working closely with this agency to advocate for the implementation of our survey-based model. It is also clear that given the Congressional instruction to use the cost collection data to assess Medicare rates, the data collection will be aligned with the costs Medicare has the statutory authority to reimburse, but not necessarily all costs suppliers may incur to support the non-healthcare aspects of their services.

It is essential that ambulance providers speak with one voice on this critically important issue.  Inconsistencies in reporting and failure to standardize costs allowable under the Medicare statute will result in data being eliminated and will threaten the sustainability of the program. As such, throughout this lengthy and intensive process, AAA leadership remains open to feedback and focused on the development of and advocacy for a cost collection system that encompasses all mobile healthcare provider types. Learn more at www.ambulancereports.org.

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About the American Ambulance Association (AAA)

The AAA was formed in 1979 in response to the need for improvements in emergency medical services and mobile healthcare. The American Ambulance Association represents hundreds of ambulance services across the United States who provide emergency and interfacility mobile healthcare. The Association serves as a voice and clearinghouse for ambulance services.

Opioid Bill Heads to President Trump’s Desk

Written by on . Posted in Drugs & Pharma, Legislative, News.

The AAA is pleased to report that language we supported on grant funding for opioid protection training for first responders has passed both the House of Representatives and the Senate and is now headed to the President’s desk.

On Wednesday, the Senate passed the Opioid Crisis Response Act with a bipartisan vote of 98-1 in the last necessary needed action before being signed into law by the President. The impact of this legislation on the ambulance industry includes providing resources and training so that first responders and other key community sectors, including emergency medical services agencies, can appropriately protect themselves from exposure to drugs such as fentanyl, carfentanil and other dangerous licit and illicit drugs. $36,000,000 will be given annually for each fiscal year from 2019 through 2023. The bill also gives $10,000,000 in supplemental competitive grants to areas that have a record of high seizure of fentanyl to be used toward training of law enforcement and other first responders on how best to handle fentanyl as well as to purchase protective equipment, including overdose reversal drugs.

Lastly, the legislation allows the Department of Labor to award grants to states that have been heavily impacted by the opioid crisis in order to assist local workforce boards and local partnerships in closing the gaps in the workforce for mental health care and substance use disorder. Based on an analysis by counsel, we believe all ambulance service agencies would be eligible to apply for the described grants. It is encouraging to see both parties and chambers come together to pass legislation that takes steps to better our country as a whole and finally help address this growing public health emergency. The President is expected to sign the legislation into law.

Senator Debbie Stabenow Named Legislator of the Year

Written by AAA Staff on . Posted in Awards, Government Affairs, Legislative, Legislative Awards, News, Stars of Life, Uncategorized.

For Immediate Release

Senator Debbie Stabenow To Receive Highest Legislative Honor From American Ambulance Association

To Be Recognized As AAA Legislator of the Year

Contact
Amanda Riordan
703-610-9018
ariordan@ambulance.org
www.ambulance.org

Washington, DC – The American Ambulance Association (AAA) will honor Senator Debbie Stabenow of Michigan with its Legislator of the Year Award in appreciation of her advocacy for emergency medical services.

Senator Stabenow is invited to receive this honor at the AAA’s Annual Stars of Life Recognition Ceremony on June 11 in Washington, D.C.

The Stars of Life program celebrates the contributions of ambulance professionals who have gone above and beyond the call of duty in service to their communities or the EMS profession. The Stars of Life program pays tribute to the dedication of these heroes while shining light on the critical role EMS plays in our healthcare infrastructure. This year, 100 EMS professionals will be honored as 2018 Stars of Life. In addition to Senator Stabenow’s recognition as 2018 Legislator of the Year, 34 United States Senators and Representatives will receive Legislative Recognition Awards for their support of ambulance services.

Senator Stabenow was selected for the Legislator of the Year Award in thanks for leading the effort in the United States Senate that secured a five-year extension of the Medicare ambulance temporary add-on increases of 2% urban and 3% urban and the super rural bonus payment. Senator Stabenow also ensured that other key provisions for the industry were included in the passage of the Bipartisan Budget Act of 2018. Senator Stabenow continues to go above and beyond to ensure that EMS in Michigan and across the country, receive sustainable reimbursement.

AAA President Mark Postma notes, “Senator Stabenow has been a trusted advocate for health care and emergency medical services, both in Michigan and across our country. The AAA is proud to present her with the distinction of Legislator of the Year Award.”

Elected to the U.S. Senate in 2000, Senator Stabenow is the Ranking Member of the Senate Finance Subcommittee on Health Care, Chair of the Democratic Policy and Communications Center, and Co-Chair of the Senate Great Lakes Task Force, and bipartisan Senate Manufacturing Caucus.

In recognition of her ongoing service to the ambulance services of the United States, AAA is proud to call Senator Stabenow our Legislator of the Year.

# # #

About the American Ambulance Association

Founded in 1979, the AAA represents hundreds of ambulance services across the United States that participate in emergency and nonemergency 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.

AAA Stars of Life

The Stars of Life program celebrates the contributions of ambulance professionals who have gone above and beyond the call of duty in service to their communities or the EMS profession. Stars of Life honors the dedication of these heroes while shining light on the critical role EMS plays in our healthcare infrastructure. This year, 100 EMS professionals will be honored as the 2018 Stars of Life. Meet the stars at www.stars.ambulance.org.

AAA Mission Statement

The mission of the American Ambulance Association is to promote health care policies that ensure excellence in the ambulance services industry and provide research, education, and communications programs to enable its members to effectively address the needs of the communities they serve.

Congress Passes Ambulance Medicare Add-Ons

Written by Mark Postma on . Posted in Legislative, Medicare, Reimbursement.

 

It is my pleasure to share with you that—just minutes ago—Congress passed the 5 year extension of the Medicare ambulance add-ons. The extension was part of the two-year budget deal reached by congressional leaders and passed by the Senate early this morning and then shortly thereafter by the House. The ambulance provisions in the final deal differ from the provisions passed earlier this week by the House in one key area – the collection of ambulance cost data. This means that we are truly in the endzone of the add-on payment extension process.

While we ask your continued patience as we jump through one last procedural hoop, I am confident that the add-ons will be back in effect as soon as the President signs the legislation. In today’s deeply divided political climate, I am proud of what we have accomplished through collaboration as an association and industry.

Here are the specifics of the final package:

  • 5 year extension of the ambulance Medicare add-ons through December 31, 2022, retroactive to January 1, 2018.
  • AAA’s preferred method of Cost data collection that provides flexibility to the Secretary of HHS in developing the system. Consultation with the industry is required so that it strikes the appropriate balance between obtaining meaningful data while not overly burdening or onerously penalizing the ambulance services.
  • The penalty for failing to report required data would be a reduction in payment up to 10% for the year following the year in which the data should have been submitted. AAA objected to the house proposed penalty of up to a year of Medicare payments clawback or withholding of payments. A clause is included to wave the penalty in cases of hardship.
  • A “pay-for” for the 5-year extension of the add-ons with a 13% cut to non-emergent dialysis transports – the AAA had objected to the offset and pushed for a cut targeted to just those entities which abuse the dialysis transport benefit. We were successful in reducing the initial cut from 22% to 13%. The AAA is actively working on other pay-for options that would replace the 13% cut with something targeting dialysis fraud and abuse.

Next Steps

All that remains to bring the add-ons into effect retroactively to January 1, 2018 are a few administrative formalities and the signature of the President, who has indicated his support of the agreement. Given the government shutdown, we are cautiously optimistic that this will proceed quickly. However, bumps are always a possibility—we will keep you informed! (Follow AAA on Twitter at @amerambassoc or Facebook for instant updates.)

Thank You

This week’s tremendous progress would not have been possible without months of effort by AAA volunteer leaders, advocacy experts, and staff, as well as support from our key champions in Congress.

I’d like to personally thank the AAA Government Affairs Committee, including Chair Jamie Pafford-Gresham and Vice Chair Shawn Baird, as well as the entire AAA Board for their hundreds of hours of hard work on this issue. We are all truly grateful for your dedication to moving mountains to find sustainable funding for EMS.

Last but certainly not least, thank you to the dozens of state ambulance associations and thousands of individual members who wrote letters to their Members of Congress in support of the add-ons. We truly couldn’t have made it this far without your support.

Again, thank you, and please stay tuned for final updates!

Mark Postma
President
American Ambulance Association
“Representing EMS in America”

House Passes Ambulance Medicare Add-Ons

Written by Mark Postma on . Posted in Legislative, Medicare, Reimbursement.

Moments ago, the U.S. House of Representatives passed legislation which includes a five-year extension of the Medicare ambulance add-ons. The House voted 245 to 182 to pass a Continuing Resolution (CR) to fund the federal government beyond the current expiration date of February 8. The CR included a package of Medicare provider extenders including an extension of the temporary Medicare ambulance add-ons.

The ambulance provisions in the CR include the following:

  • A five-year extension of the temporary Medicare ambulance increases of 2% urban and 3% rural to base and mileage rates and 22.6% to the base rate in super rural areas. The extension would be retroactive to January 1, 2018 and expire on December 31, 2022.
  • The requirement for ambulance service suppliers to submit cost reports. The language is based on H.R. 3729 as reported by the House Ways and Means Committee but with new language providing the CMS Administrator with the discretion to apply a payment suspension or overpayment as the penalty for suppliers that do not submit timely, accurate and complete data after the initial two years.
  • To offset the cost of the add-ons extension, a further reduction of 13% in Medicare reimbursement for BLS non-emergency transports to and from dialysis centers. The initial reduction was 22% but the AAA was able to help lower the estimated cost of the add-ons and thus lower the percentage of the offsetting cut.

The CR now goes to the Senate for its consideration. The Senate is likely to act tomorrow, February 7.

We will keep you posted of new developments. Thank you for your continued support of the American Ambulance Association.

Mark Postma
President
American Ambulance Association
“Representing EMS in America”

President’s Perspective: January 2018

Written by Mark Postma on . Posted in Annual Conference & Tradeshow, Legislative, Medicare, Member-Only, Stars of Life.

Dear Fellow AAA Members,

Happy New Year from the American Ambulance Association!

This year promises to bring new challenges and opportunities for ambulance services. As your association, AAA, its experts, and the whole member community will be there to support you every step of the way.

Advocacy Update

If you’ve missed your recent member advocacy emails, you may be wondering “What is going on with the add-ons?!” I’d like to address this first and foremost.

Despite the best efforts of the American Ambulance Association and other industry stakeholders, the temporary Medicare ambulance increases expired December 31. However, please rest assured that the AAA lobbying team, volunteer leadership, and staff are working tirelessly around-the-clock to advocate for this critical EMS revenue.

The good news is that the end may be in sight. However, we must remain engaged, active, and unified as an industry to carry this effort through in the face of the today’s contentious and unpredictable political climate.

Republicans and Democrats in the House and Senate are working toward a long-term extension of the Children’s Health Insurance Program (CHIP).  As part of these negotiations, the House and Senate are working through the details of a Medicare provider extender package. Thanks to the work of our lobbying team and countless Hill visits, phone calls and letters by dedicated AAA members and our supporters on Capitol Hill, both the House and Senate proposals include five-year extensions of the ambulance increases retroactive to January 1, 2018.

We are cautiously optimistic that Congress will include CHIP in the next Continuing Resolution (CR) on or around January 19. Depending on the outcomes of last-minute discussions, the Medicare provider extender package may be attached to the CHIP bill or moved forward separately shortly thereafter.  However, of course, Congress in 2018 is predictably unpredictable: we ask for your patience, and your continued confidence that AAA is doing everything possible on this issue.

To support this effort, AAA joined forces with other healthcare industry groups to send a letter to Congress urging them to pass the larger Medicare provider extender package. The AAA has also made the case to Congress that it must act now on the ambulance extension as ambulance service providers and suppliers are first responders and cannot afford to hold claims for prolonged periods of time. Congress must therefore move immediately to ensure that our nation’s health care safety net is not put at risk. We pointed out that submitting claims with the increases paid retroactively could result in long delays in providers and suppliers getting the additional funds, an unacceptable risk for an EMS network made up primarily of small providers. As a last resort, we have asked that if Congress cannot address a Medicare provider extender package by January 19 that they pass a short-term extension of the ambulance increases to sustain our operations.

The AAA is also working with congressional offices and committees of jurisdiction to implement a workable system for collecting cost data from ambulance service providers and suppliers and on an offset focused on reducing reimbursement just for those entities which abuse the dialysis transport benefit. The reality is that ambulance services will have to report their costs to the federal government. However, AAA will work to ensure that the system implemented is fair and does not place undue burden on ambulance services or subject ambulance services to standards and penalties that are not applied to other Medicare providers.

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>

Our advocacy team will continue to provide frequent updates as we work to keep this issue at the forefront.

Stars of Life

Despite the challenges on the Hill, I look forward to seeing many of you in Washington, DC in June at Stars of Life. Stars recognizes EMS providers from across the nation who have served their communities with great distinction. The Stars, accompanied by their executive-level Hosts, meet with legislators to shine a light on the importance of ambulance services to our healthcare network. Nominate your Stars today, and help AAA celebrate the best in EMS! (Early bird registration rates end March 31.)

Renew Your Support of AAA

Has your organization renewed its AAA membership? Your continued support is critically important as AAA fights for fair ambulance reimbursement. Membership also include benefits such as free use of the Savvik Buying Group, complimentary CISM and EAP-based counseling for your employees, and access to industry experts on Medicare, operations, and HR.

If you have already renewed, please accept our most sincere thanks. If you have not yet submitted payment for this year’s membership, I encourage you to renew online or reach out to staff at info@ambulance.org for assistance.

AAA Annual Conference & Trade Show

The 2017 AAA Annual Conference was an overwhelming success. In addition to powerful industry-centric presentations on leadership, reimbursement, and operations, this year’s AAA Annual Conference & Trade Show featured three inspiring keynotes—Steven M.R. Covey, Mel Robbins, and Dr. Zubin “ZDoggMD” Damania. Additionally, we honored AMBY Award winners and those who responded to the tragic Route 91 shootings. Check out the photo album for AAA 2017 on our Facebook page.

I hope that you will join me and hundreds of our colleagues for networking, learning, and fun in Las Vegas at next year’s Annual event September 6–8. Early bird registration is open now!

Webcasts & Regional Workshops

AAA is working hard to make it easier than ever to educate your team. Join us in 2018 for a variety of live and on-demand webcasts as well as convenient regional workshops. Upcoming webinar topics include sexual harassment, CMS low volume settlements, and cybersecurity. This year, we are also proud to host one-day workshops in each of AAA’s five regions (calendar soon to be announced).

Thank You, Members!

I would like to give special thanks to the members who dedicate their time and thought to AAA’s board, committees, and task forces. We literally could not do it without you.

It continues to be my pleasure to serve these individuals, as well as the many other talented, dedicated healthcare professionals who make up the AAA membership. We deeply appreciate your continued support, participation, and unity. Thank you!

—POST!
Mark Postma—President
American Ambulance Association
Representing EMS in America

 

Medicare Extender Update

Written by Mark Postma on . Posted in Government Affairs, Legislative, Reimbursement.

As president of your association, keeping you informed of our advocacy efforts is one of my top priorities. In keeping with this approach, I would like to share with you an update on the American Ambulance Association’s latest efforts on Capitol Hill. The temporary Medicare ambulance increases are currently scheduled to expire on December 31, 2017. And once again, Congress is waiting until the last minute to extend them. Thankfully, a long-term solution is on the horizon.

The House and Senate are in the process of negotiating the details of a Medicare provider extender package including our ambulance provisions. The House and Senate positions both include a five-year extension of the 2% urban, 3% rural, and super rural increases. Where their positions differ reflects the respective preferences of the Senate Finance and House Ways and Means Committees on how best to collect cost data from ambulance services suppliers and providers.

The Senate position is based on a Senate Finance Committee Discussion Draft from October 26 which includes the five-year extension of the increases as well as a data collection system based on the one from the Medicare Ambulance Access, Fraud Prevention and Reform Act (S. 967). The provision would direct CMS to collect data from a statistically significant number of ambulance service suppliers and providers. This would occur each year for the first three years, then a minimum of every three years thereafter. The penalty for not reporting data if selected would be a 10% cut in Medicare reimbursement for the following year. The language gives CMS flexibility in designing the system, and would place minimal burden on small ambulance service suppliers. The outcome would be usable data to further substantiate the need for rate increases and reform of the Medicare ambulance fee schedule.

The House position is based on H.R. 3729, which also includes the five-year extension of the increases. However, it adds mandatory annual cost reporting for ambulance service suppliers and providers as well. The AAA worked with the bill sponsors and Committee staff to modify the cost reporting language to reflect the unique nature of our industry. However, since ambulance service suppliers and providers aren’t paid based on cost reports, and cost reporting requirements are very stringent, there are several compatibility issues when attempting to apply this model to our industry. The primary problem is the penalty for not reporting timely data, as well as a new standard requiring the data to be accurate and complete. As a result, after the first two years of reporting, the penalty of an overpayment for not reporting timely, accurate, and complete data could be an entire year of Medicare payments. The AAA therefore prefers the Senate language due to its flexibility for our industry as well as its less severe penalty.

The good news is that the House and Senate are in agreement on a five-year extension of the increases. As part of the increase package, our industry will also have a data collection system to demonstrate that we are reimbursed below cost, and to make data-driven decisions on reforming the Medicare ambulance fee schedule. However, it is critical that we get the data collection provision right so that it provides useful information and is not overly burdensome for our members.

Thanks to our champions on Capitol Hill, member advocates, and our lobbying team, the super rural bonus payment has been in effect since 2003, and the urban and rural increases since 2008. Subsequently, we have successfully advocated for Congress to extend the increases eight times, including the current 33-month extension. However, with Congress pressed to address a number of priorities by the end of this year, a Medicare extenders package may not occur until early January.

Securing a five-year extension will require the action of our entire membership. I urge you to please write your members of Congress today in support of the Medicare ambulance increases!

Contact your members of Congress now>

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”

President’s Perspective: October 2017

Written by AAA Staff on . Posted in Legislative, Medicare, Member-Only, Regulatory.

Dear Fellow AAA Members,

As I reflect on the past few months, I am awed by the dedication of ambulance services across the nation as they responded to emergencies ranging from hurricanes to wildfires to the Las Vegas MCI. As always, EMS aided their communities with humanity, efficiency, and deep-rooted professionalism. The outcomes of each of these incidents would assuredly have been far worse without the selfless service of our fellow healthcare providers.

I was privileged to see this commitment to excellence firsthand as our staff at Sunstar responded to Hurricane Maria here in Florida, assisted by hundreds of EMTs, Paramedics, and strike team leaders who drove hours or days to help. Thanks to each of you for your service in our country’s time of need.

Advocacy Update

The AAA continues working hard to ensure the Medicare add-on payments don’t expire at the end of this year. In the Senate, S. 967 would make the add-on payments permanent. In the House, two versions of a bill (H.R. 3236, H.R. 3729) would extend the payments for five years. Extensions of Medicare provider provisions, including the ambulance add-on payments, will likely be addressed closer to the end of the year.

We have seen progress already in the House on the ambulance add-ons. On September 11, the House Ways and Means Committee marked up H.R. 3729, the Comprehensive Operations, Sustainability, and Transport Act of 2017. Similar to H.R. 3236, which the AAA supports, H.R. 3729 would extend the Medicare add-on payments for five years and require ambulance service suppliers to report cost data. However, H.R. 3729 would subject suppliers to an overpayment penalty which could potentially put all Medicare payments at risk for a supplier who does not submit timely, accurate, and complete data.

H.R. 3729 also includes a 22% across-the-board cut to all ambulance providers and suppliers for non-emergency BLS transports to and from dialysis centers. The 22% cut was the figure estimated as necessary to offset the cost of the five-year extension of the add-on payments. Since then, the AAA was able to demonstrate to the Congressional Budget Office (CBO) that our estimate of a five-year extension of the add-ons was the more appropriate approach. As a result, AAA has received a commitment from the Ways and Means Committee to lower the amount of any cut to cover the lower estimate. However, the AAA opposes any across-the-board cut and is working with the Committee and the bill sponsors to focus on addressing fraud and abuse within the dialysis transport benefit.

The AAA is working with key congressional offices as well as industry stakeholders to make changes to H.R. 3729. We remain hopeful that we can come to a consensus on these outstanding issues.

Meanwhile, on the Senate side, S. 967 is up to 12 co-sponsors with the addition of Sen. Cotton (R-AR), Sen. Boozman (R-AR), and Sen. Cassidy (R-LA). AAA encourages members to continue reaching out to their Senators to ask them to co-sponsor S. 967. The AAA will keep you updated on our progress working on extending the add-ons. Thank you for your continued support.

AAA Annual Conference & Trade Show

As we face this challenging political and regulatory climate, it is essential that ambulance leaders stay abreast of new developments and best practices in reimbursement, operations, leadership, and human resources. In addition to myriad industry experts, this year’s AAA Annual Conference & Trade Show program features three inspiring keynotes—Steven M.R. Covey, Mel Robbins, and Dr. Zubin “ZDoggMD” Damania—plus a ceremony honoring AMBY Award winners for their community impact.

I hope that you will join me and hundreds of our colleagues for networking, learning, and fun in Las Vegas November 13–15. Online registration for Annual is open now.

AAA Board Election

It’s that time again! The 2017 AAA Board of Directors election is underway. This year, active members will elect Regional Directors (Regions 1–5) and new members of the Ethics Committee. Voting opened on Wednesday, October 11th, and closes at 11:59pm Eastern on Thursday, November 2nd. Best of luck to all of the candidates! (If you are the primary contact for an active member organization and did not receive your e-ballot, please contact acamas@ambulance.org.)

Renew Your Support of AAA

Has your organization yet renewed its AAA membership? Your continued support is critically important as AAA fights for fair ambulance reimbursement. Membership also include benefits such as free use of the Savvik Buying Group, complimentary CISM and EAP-based counseling for your employees, and access to industry experts on Medicare, operations, and HR.

If you have already renewed, please accept our most sincere thanks. If you have not yet submitted payment for this year’s membership, I encourage you to renew online or reach out to staff at info@ambulance.org for assistance.

Capital Campaign

Lastly, many of you are aware that during my presidency I began a Capital Campaign to raise $1,000,000 to help sustain our organization and to increase our “rainy day” fund. The funds raised by this effort can only be used in the case of a majority vote by the Board of Directors.

Today, we have raised $250,000 of the $1,000,000 goal, for which I am grateful to our member supporters. But this is not enough—we need to be strong when a crises hits our industry and we must deploy more resources for our advocacy programs. If you have already given, I would ask that you consider another commitment to this fund. If you have not already contributed, I respectfully ask you to support your national association as it works to fight for the future of ambulance services. Thank you in advance! Contribute online now.

It continues to be my pleasure to serve so many talented, dedicated healthcare professionals. Thank you again for your service, and I look forward to seeing you at AAA Annual in Las Vegas!

—POST!
Mark Postma—President
American Ambulance Association
Representing EMS in America

Time to handle 911 call demands with Paramedics

Written by Scott McConnell on . Posted in Community, Legislative, Medicaid, Medicare, News, Training.

When discussing this new and growing field of pre-hospital care, there seems to be two unique paths that services are following. The first is the hospital-owned or contracted service, where community providers seek ways to decrease readmission rates for CHF, COPD, Pneumonia, Sepsis, MI and other chronic illnesses.

When a patient discharged with one of these targeted conditions is readmitted within a 30 day window, “hospitals face penalties of up to 3 percent of Medicare payments in 2018” (Gluck, 2017, para. 10). That is a lot of money. Consider, “Lee Health, Southwest Florida’s largest hospital operator, which is expected to lose $3.4 million in payments” (Gluck, 2017, para. 2). This model represents the if, or, and type of service, meaning if we can do it for less and there are providers willing to do this type of medicine, then we can save the expensive penalties from CMC.

The other model of community paramedicine is 911 abuse reduction. For years EMS has conditioned the public to call 911 for any emergency. But today, what we consider an emergency is far from the public’s perception of an emergency. “EMS has experienced a 37% increase in 911 calls since 2008.” (White, 2016, para. 6) Yet have we increased staffing proportionally to meet the demand? Afraid not since “only 50% of EMS services in 2008 were fully staffed, and more than 63% had a volunteer component as part of their staffing level” (“Critical Staffing Shortages,” 2015, para. 2).

The article references increasing wages to help compensate for the decrease in trained providers by attracting more professionals to the field. With the CMC limiting payments and the major insurance companies following suit, doubtful this will be an option in the near future.

To reduce calls and increase levels of service, we can try to reeducate the public to what is a true emergency, but that is a long and slow process. For example, Philadelphia has started the trend and placed several billboards up around neighborhoods that contribute an ordinarily high amount of non-emergent 911 calls. Will this work? Time will tell but I would believe not enough to affect the volume of calls.

What about enlisting Community Paramedics in these situations? I believe this is a viable solution with nurses triaging the low acuity calls in the 911 center. Dispatching Community Paramedics armed with not only the usual equipment, but also the knowledge base to connect these patients with primary care physicians, social workers, and the programs that are available to them. This will help people receive the long-term care they deserve.

Scott F. McConnell is Vice President of EMS Education for OnCourse Learning and one of the Founders of Distance CME. Since its inception in 2010, more than 10,000 learners worldwide have relied on Distance CME to recertify their credentials. Scott is a true believer in sharing not only his perspectives and experiences but also those of other providers in educational settings.

References
* Critical Staffing Shortages (2015)
* Gluck, F. (2017, February 7th, 2017). Lee Health will lose $3.4 million in Medicare payments because of readmission rates. USA Today
* White, D. (2016, February 16th, 2016). Community paramedic? program intended to reduce 911 calls. Manatee Technical College

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.

President’s Perspective: July 2017

Written by Mark Postma on . Posted in Annual Conference & Tradeshow, Legislative.

Dear Fellow AAA Member,

I am proud to share with you that just yesterday legislation was introduced in the House on a long-term extension of Medicare ambulance add-ons. The House bill follows introduction of the Medicare Ambulance Access, Fraud Prevention and Reform Act (S. 967) in the Senate, giving us a bill in both houses of Congress.

The Ambulance Medicare Budget and Operations Act (H.R. 3236) would extend for five years the 2% urban, 3% rural, and super rural bonus increases. The bill would also direct CMS to collect cost data from ambulance service suppliers. The AAA has been working with Congressman Nunes (R-CA) and Upton (R-MI) as well as the House Ways and Means and Energy and Commerce Committees on the bill language. You will soon receive a Call to Action to reach out to your Representatives to cosponsor the new House bill.

  1. 967 would make the add-on payments permanent and direct CMS to collect cost data from ambulance service suppliers using a survey methodology. Since its introduction, four additional Senators have signed on to co-sponsor S. 967, Senators Sanders (VT), Cochran (MS), Tester (MT) and Gillibrand (NY), bringing the total number of cosponsors to nine. While this is good progress, we need our member’s continued assistance in getting more co-sponsors on both of our bills.

While both bills meet the needs of our industry, the language in the two bills is different. That being said, it is not uncommon for the Senate bill and the House bill to have minor differences in their respective language that have to be worked out before getting final approval. When this happens, a special conference committee made up of members from both houses will work together to come to consensus about the different provisions in the bill. It is unlikely that our bills will be passed as stand-alone legislation. Instead, our provisions will likely be included in a larger bill similar to how the extenders were passed last time as a part of the CHIP (Children’s Health Insurance Program) Reauthorization Act. It is crucial that we have as many co-sponsors on both of our bills so that we can again be included on a larger piece of legislation.

The Medicare ambulance add-on payments will expire on December 31, 2017. To ensure continued access these critically-necessary extenders, we need the collective advocacy of ambulance services across the country. We ask that you please add your voice to the AAA’s by writing your Senators in support of Bill S.967. Additionally, you will soon receive a Call to Action to reach out to your Representatives to cosponsor the new House bill.

As always, the AAA Board, Government Affairs Committee, advocacy consultants, and staff are working diligently to build support on Capitol Hill to ensure that this vital revenue remains in place. If you missed our June 29 government affairs update webinar, I invite you to watch it on-demand now.

Annual Conference

The Education Committee recently finalized programming for the 2017 AAA Annual Conference & Trade Show. This year, we welcome three exciting keynotes—Steven M.R. Covey, Mel Robbins, and Dr. Zubin “ZDoggMD” Damania—as well as dozens of industry leaders and experts. I hope that you will join me and hundreds of our colleagues in ambulance leadership in Las Vegas in November! Online registration is open now.

Educational Events

AAA will host its inaugural SimLab workshop in Tulsa, Oklahoma on September 28. We are excited to share with members this immersive learning experience. AAA SimLab content will also be featured at the Mississippians for EMS Conference October 2–4 in Biloxi, Mississippi.

Save the date for AAA’s newest educational partnership, the Midwest EMS Expo May 2–3, 2018 in La Crosse, Wisconsin. Co-hosted with the Minnesota Ambulance Association and the Professional Ambulance Association of Wisconsin, the Midwest EMS Expo will bring together the best in national and regional education.

AAA is also proud to offer learning on-the-go, in the form of engaging webinars on human resources, reimbursement, compliance, and other topics. Don’t miss upcoming sessions on drug use, the OIG Safe Harbor on Cost Sharing, and the management of airborne medical emergencies.

Website

I am happy to share with you that AAA has a new URL, www.ambulance.org. This updated domain should assist us in clearly communicating our identity to the world, as well as in attracting new members not previously familiar with our organization.

Capital Campaign

To date, we have raised more than $255,000 of our $1mm Capital Campaign goal through the generous contributions of our fellow members. Our deepest thanks to all who have given. If you have not done so already, please consider donating today. Funds contributed to this campaign are managed separately from operating accounts, and can only be accessed after a full Board vote.

Stars of Life

It was a privilege to see many of you at Stars of Life in Washington in June. This year’s Stars program recognized 108 EMS providers from across the nation who have served their communities with distinction. The Stars, accompanied by their executive-level Hosts, met with their Senators and US Representatives to shine a light on the importance of ambulance services to our healthcare infrastructure. Nominations for the 2018 class of Stars will open in January. We hope to meet your Stars in D.C. next year.

As always, please don’t hesitate to contact the AAA at 703-610-9018 or info@ambulance.org if we can be of assistance to your service.

Thank you for your service to your communities, and have a great summer.

Mark Postma
President
American Ambulance Association
“Representing EMS in America”
www.ambulance.org

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