President signs law providing funds to combat Corona Virus

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

President Donald Trump today signed H.R. H.R. 6074 into law, approving $8.3 billion in supplemental appropriations to fund programs in response to the COVID-19 illness. The bill would bolster vaccine development, research, equipment stockpiles, and state and local health budgets as government officials and health workers fight to contain the outbreak, which has claimed 11 lives in the U.S. and sickened more than 160 people across more than a dozen states.

The AAA advocated to negotiators of the bill that first responders needed to be included in the funding package and that all communities be eligible for the funding. Due in part to our outreach, the emergency funding provides a transfer of no less than $10 million to the National Institute of Environmental Health Sciences for worker-based training aimed at preventing exposure of the virus to emergency first responders, and others at risk of exposure (i.e., hospital employees).

The supplemental also appropriates $1 billion for state and local preparedness, which will allow state and local governments to carry out preparedness and response activities, with each State receiving a minimum of $4 million. Of the $1 billion, $300 million is allocated for global disease detection and emergency response, and FY 2019 Public Health Emergency Preparedness grantees.

Permanent Medicare Ambulance Relief Bill Introduced in House

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

Moments ago, Congresswoman Terri Sewell (D-AL) and Congressman Devin Nunes (R-CA) introduced the Medicare Ambulance Access, Fraud Prevention, and Reform Act of 2019 (H.R. 4938). Congressmen Peter Welch, (D-VT), Markwayne Mullin (R-OK), and Earl Blumenauer (D-OR) are original cosponsors of the legislation. Thank you to the bill sponsors for their continued support!

H.R. 4938 would help stabilize current and future Medicare reimbursement of ambulance services and set the stage for future reform of the Medicare ambulance fee schedule. If passed, this bill would:

  • Make Medicare Add-ons Permanent – Current temporary 2 percent urban, 3 percent rural, and super rural bonus payments would be made permanent.
  • Expand Prior Authorization Pilot Program Nationwide – To address fraud and abuse with the transportation of dialysis patients by ambulance, the bill expands the Centers for Medicare & Medicaid Services (CMS) national prior authorization program for repetitive non-emergency basic life support (BLS) dialysis transports. CMS has not yet exercised its authority to expand this successful pilot program nationwide. While CMS is considering exercising its authority to extend the program nationwide in a recent proposed rule, it has not made a final determination yet.
  • Provide Regulatory Relief – Amend requirements under the 855 form to make change notifications less burdensome.
  • Protect Access to Ambulance Services in Rural and Low Population Density Areas – Protect access to ambulance services in rural and super-rural areas, by establishing a policy to protect low volume areas and a process for CMS to review changes in the rural or super-rural status of an area after the next census occurs.

The AAA has worked diligently to get this legislation introduced and we are excited to share this news with the membership. We would like to thank all the AAA members who have worked closely with their elected representatives to get this legislation introduced. In the coming weeks, the AAA will be asking members to contact their Members of Congress to voice their support of this legislation.

If you have any questions, please contact Tristan North (tnorth@ambulance.org) or Aidan Camas (acamas@ambulance.org).

CMS Releases Proposed Cost Collection Rule

Written by Aidan Camas on . Posted in Cost Data Collection, Government Affairs, Legislative, Member Advisories, News, Regulatory.

Today, CMS has released the proposed rule that would establish the ambulance fee schedule cost collection system as required by statute. The AAA is currently reviewing the rule and will provide a more detailed summary in the coming days.

On Tueusday, July 30 at 12:00pm Eastern, the AAA will be hosting a free webinar during which AAA counsel will provide an overview of the proposals in the rule. Do not miss out on this chance for the most up to date information.

Read the Proposed Rule

Sign Up for the Webinar

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.

2019 AAA Legislative Awards

Written by AAA Staff on . Posted in Awards, Legislative, Legislative Awards, News, Press, Stars of Life.

The American Ambulance Association is proud to announce the winners of the 2019 AAA Legislative Awards, in recognition of their strong advocacy for emergency medical services. Each legislator was chosen for their ongoing dedication to the ambulance services across the United States.

2019 AAA Legislator of the Year

Representative Terri Sewell (D-AL)

2019 AAA Legislative Recognition Award Recipients

Senators

  • Senator Bill Cassidy, M.D.
  • Senator Susan M. Collins
  • Senator Chuck Grassley
  • Senator Doug Jones
  • Senator Patrick J. Leahy
  • Senator Pat Roberts
  • Senator Charles E. Schumer
  • Senator Debbie Stabenow
  • Senator Jon Tester
  • Senator John Thune
  • Senator Ron Wyden

Representatives

  • Representative Earl Blumenauer
  • Representative Rosa DeLauro
  • Representative Debbie Dingell
  • Representative Richard Hudson
  • Representative Darin LaHood
  • Representative Markwayne Mullin
  • Representative Richard E. Neal
  • Representative Devin Nunes
  • Representative Steve Scalise
  • Representative Scott Tipton
  • Representative Fred Upton
  • Representative Greg Walden
  • Representative Peter Welch
  • Representative Lee Zeldin

House Introduces PSOB Bill (H.R. 2887)

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

The American Ambulance Association (AAA) is pleased to announce that Congressman Lee Zeldin (R-NY-01) and Congressman Thomas Suozzi (D-NY-03) have introduced H.R. 2887, the “Emergency Medical Services Providers Protection Act.” This piece of legislation would extend the Public Safety Officers’ Benefit (PSOB) to cover first responders who work for private providers. The PSOB Program provides death and education benefits to survivors of fallen law enforcement officers, firefighters, and other first responders, and disability benefits to officers catastrophically injured in the line of duty.

The AAA has advocated tirelessly for years that all first responders killed in the line of duty, should be eligible for this benefit regardless of who their employer is. Many of the nation’s first responders work for more than one EMS Agency. Local communities throughout the country decide which organization is best fit to provide high quality mobile healthcare to their community. For large parts of the country, privately run ambulance services have been providing high quality health care, and responding to the same natural disasters, incidents, etc. as their peers for decades.

It is common for Paramedics and EMTs to also work/volunteer as firefighters and vice versa. Currently, if a line of duty death occurs, whether first responders receive this benefit depends on which uniform they were wearing that day. A firefighter picking up an extra shift with a local ambulance service could end up being ineligible for this benefit if that company happens to be privately run. The AAA believes this legislation acknowledges the vital role that all first responders play in keeping our communities safe and healthy. If passed, this change would apply to injuries sustained on or after March 1, 2007.

The AAA thanks Congressman Zeldin and Suozzi for taking the lead on this critical issue. AAA members are encouraged to contact their representatives about co-sponsoring H.R. 2887. Full text of the Bill is not yet available online but can be read here. Please contact the AAA’s Government Affairs team if you have any questions.

Questions? Contact Us

If you have questions about the discussion draft or balance billing 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.

Member Update on Balance Billing

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

This morning Ruth Hazdovac and Aidan Camas of AAA staff and Kathy Lester, Esq, Healthcare Consultant to the AAA attended a briefing held by the House Energy & Commerce Committee on the issue of surprise/balance billing. At the briefing, staff for Chairman Frank Pallone (D-NJ) and Ranking Member Greg Walden (R-OR) announced that they would be releasing a bipartisan discussion draft, the No Surprises Act, which would “protect consumers from surprise medical bills and increase transparency in our health care system.”

As of now, ground and air ambulances are NOT included in the discussion draft. However, the committee is asking for comments on ground and air ambulance and recommendations on how to provide relief to the consumer in this area. The AAA has a Balance Billing Work Group that is hard at work developing a policy recommendation that will work for our members.

The House Ways and Means Health Subcommittee Chairman Lloyd Doggett also announced today that the Health Subcommittee will hold a hearing next week entitled “Hearing on Protecting Patients from Surprise Medical Bills.” AAA Staff will be at the briefing and provide a timely update to membership on any developments.

The AAA team will be submitting comments and policy recommendations based off the work of the Balance Billing Work Group to both the Energy & Commerce and Ways & Means Committee to ensure that the views of our members are well represented. We will also be reaching out to AAA members in the states of key policymakers on the Committees to submit comments, as well. The AAA will also provide members with key talking points in the event they are contact by their Members of Congress or their staff.

Questions? Contact Us

If you have questions about the discussion draft or balance billing 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.

President’s Perspective April 2019

Written by Aarron Reinert on . Posted in AAA HQ, Annual Conference & Tradeshow, Leadership Academy, Legislative, Midwest EMS Expo, Uncategorized, Webinars.

Aarron Reinert
President,  AAA

Dear Fellow AAA Members,

Spring is in full bloom in Washington, D.C., and the American Ambulance Association is hard at work in our nation’s capital advocating for mobile healthcare providers. I am pleased to share with you several updates from your association.

Advocacy Progress

The AAA continues to forge ahead advocating for the legislative and regulatory priorities of our membership. Earlier this month, more than forty AAA volunteer leaders and members came to Washington, D.C., meeting with more than 100 congressional offices to advocate for Medicare policies and improved claims processing by the Department of Veterans Affairs for emergency ambulance services. (View photos on Facebook.)

The AAA has also taken an active role in responding to potentially harmful “surprise billing” legislation. The AAA has been urging Members of Congress to recognize the unique and essential nature of emergency ambulance services and ambulance interfacility mobile healthcare transports. Ambulance service suppliers and providers are already heavily regulated at the local level and struggle with receiving adequate reimbursement. The Congress should protect patient access to ground ambulance services and continue to allow us to balance bill.

The AAA is working closely with CMS and the RAND corporation on the development of the ambulance cost data collection system in order to ensure that the end survey and methodology is feasible for our industry. The AAA has established itself and our membership as an important stakeholder throughout the cost data collection development process, and we look forward to remaining involved this year.

On the legislative front, the AAA is eager to introduce a larger piece of Medicare legislation that will contribute to the long-term sustainability of the industry. This legislation will address issues such as inadequate reimbursement, the need for innovative payment models, the lack of equitable polices, rural zip code classifications, and more. Buy Diamox 250 mg https://www.rpspharmacy.com/product/diamox/

Legislation to restructure the offset included in the Bipartisan Budget Act of 2018 to pay for the 5-year extension of Medicare add-on payments has been reintroduced in the Senate (S. 228) and should be re-introduced in the House soon. The AAA is also working on updating the Veterans Reimbursement for Emergency Ambulance Services Act (VREASA) to adequately address issues regarding reimbursement from the VA.

With many important legislative priorities, we will continue to lean on our members for their support and encourage you all to continue to build relationships with your Members of Congress.

Ambulance Cost Education (ACE)

Time is running out to prepare for the new federal cost data collection requirements for ambulance services which go into effect January 1, 2020. To help ambulance services ready themselves, our expert faculty has developed comprehensive Ambulance Cost Education (ACE) webinars, regional workshops, and online resources. With AAA ACE, your service will have all the tools needed to comply with federally mandated cost collection. An ACE subscription is the turn-key solution to prepare for ambulance cost collection. Learn more about our affordable packages today.

Stars of Life

Every year, the American Ambulance Association’s Stars of Life program showcases the value of mobile healthcare to legislators and the general public. I look forward to seeing many of you this June in Washington D.C., for the 2019 celebration. Follow the 2019 AAA Stars of Life on Facebook and Twitter in the coming months! Levitra generic http://www.gastonpharmacy.com/levitra.php

Annual Conference & Trade Show

Preparations are in full swing for the 2019 AAA Annual Conference & Trade Show in exciting Nashville, Tennessee. AAA Annual is the can’t-miss educational experience for ambulance leaders interested in bringing excellence in reimbursement, operations, and human resources to their services! I hope that you will join me and hundreds of our colleagues for networking, learning, and fun November 4-6. Early bird registration is open now!

Thank You, Members!

It continues to be my pleasure to serve so many talented, dedicated health care professionals. Thank you for your service to your communities, and I wish you continued success in 2019!

Aarron Reinert
President
American Ambulance Association

Senate Introduces S. 228

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

Last year, Congress included in the Bipartisan Budget Act of 2018 an offset to cover the cost of the 5 year extension of the add-ons. The offset cuts reimbursement for BLS nonemergency transports to and from dialysis centers by an additional 13%. This is on top of the preexisting 10% reduction.

The AAA is pleased to announce that Senators Bill Cassidy (R-LA) and Doug Jones (D-AL) have recently introduced S. 228 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. 228 is the reintroduction of S. 3619 from last Congress which served 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. AAA staff and volunteer leaders are working to get a House version of this legislation reintroduced shortly.

The additional cut went into effect on October 1, 2018 and negatively impacted AAA members. The AAA is working to help pass this legislation and we will keep members updated as this legislation moves through Congress.

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>

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