EMS needs your support to survive! Learn from American Emergency Vehicles founder Mark Van Arnam what you can do to advocate for sustainable funding for ambulance services, then visit the AAA Advocacy page to reach out to your elected officials.
(AAA is deeply grateful to REV Group, Inc. for developing this video.)
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.
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:
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.
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.
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.
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.
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.
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.
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
This afternoon Senate Republican leaders released the revised version of the Better Care Reconciliation Act (BCRA). Legislative language and section-by-section summaries are now available.. The material was provided by our team at Akin Gump. The AAA will continue to keep members up to date in regards to the Obamacare repeal and replacement efforts.
Better Care Reconciliation Act (BCRA) Revised Text
BCRA Section by Section Summary
Please contact info@ambulance.org if you have any questions.
The American Ambulance Association (AAA) hosted the Government Affairs and Member Forum on June 29 to provide an update on legislation on the expiring temporary Medicare ambulance add-on payments, the immediate and long-term goals of AAA on Medicare reform, and how members can get involved with ambulance service-related issues. Mark Postma, president of AAA, and a panel of experts covered varied topics, including where Senate Bill S.967 stands and what changes might occur within the industry, and then fielded questions from members to offer a better understanding of regulatory issues and what’s happening in Washington.
“We put a forum together at this critical time because we currently have a Senate bill to make the add-on permanent, and we’ve been working on a House bill for a long-term extension of the add-ons to be dropped soon,” said Postma. “We have been working diligently to get the appropriate bills introduced, to keep the Medicare extenders and other items that we’ll discuss in this forum.”
Capitol Hill Landscape
The Senate “Medicare Ambulance Access, Fraud Prevention and Reform Act” (S.967) has bipartisan support and is currently being championed Sen. Debbie Stabenow (D-MI), Pat Roberts (R-KS), Chuck Schumer (D-NY), Susan Collins (R-ME) and Patrick Leahy (D-VT). The bill would make permanent the temporary Medicare add-ons, treat ambulance service suppliers more like providers, cut down on dialysis transport fraud and abuse, and implement our preferred cost-data collection system that is beneficial, not burdensome, to ambulance services.
The AAA is currently working on the language for a bill to introduce the House of Representatives. While the bill has yet to be introduced, the AAA is collaborating with our House supporters and Committee staff to put together a bill that, at the very least, extends the Medicare add-ons for five years. The bill will also include cost-data reporting on which the AAA is negotiating the final details.
“This year really is critical for us,” said Tristan North, senior vice president of government affairs for AAA. “We need to make sure the Medicare add-on payments don’t expire on December 31.”
Going Forward
The panel discussed immediate, intermediate, and long-term goals to improve the ambulance fee schedule in the foreseeable future. The pending legislation covers many of the immediate goals, but AAA consultant Kathy Lester offered information that could impact the industry in the future.
Lester talked about better defining nonemergency services, the “Uber-ization” of medical transport, and what community paramedicine means to ambulance service providers.
The panel agreed that members and the community need to show their support for legislation, causes, and issues that will shape the future of ambulance services. It was suggested that members advocate to their representatives and leaders—offering to take them on ambulance “ride-alongs,” writing letters, or showing up at government functions—and explain to them how important these pieces of legislation and resources are to the EMS profession.
“We’re working hard and hoping for change in the future,” AAA’s Chair of Government Affairs, Jamie Pafford-Gresham, said. “We need you professionals and the relationships you have with your elected officials… your voices matter to Congress and they matter to us.”
From Akin Gump:
The Congressional Budget Office (CBO) this afternoon released its cost estimate of the Senate’s health care bill, the Better Care Reconciliation Act (BCRA), projecting that the legislation would increase the number of uninsured by 22 million in 2026 relative to the number under current law. This is slightly fewer than the number of uninsured estimated for the House-passed American Health Care Act (AHCA). CBO also estimates that the BCRA would reduce federal deficits by $321 billion over 10 years, $202 billion more than estimated net savings for the House bill.
According to the Senate Budget Committee, below is a brief summary of the changes that were made to the previous draft:
Ambulance providers are invited to tune in to this afternoon’s livestream of the House Ways and Means Hearing on the current status of the Medicare program, changes needed to Medicare’s payment systems, and Medicare programs that are set to expire before the end of the year. To access the livestream, please visit https://waysandmeans.house.gov/live at 2pm ET today, May 18.
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”
Post on Facebook why S. 967 is important! Be sure to tag your Senators and encourage others to share your post! Ask others to write letters of support as well! http://bit.ly/AAAbill
More About Our Bill S. 967, the 2017 Medicare Ambulance Access, Fraud Prevention, and Reform Act:
Permanent ambulance relief legislation has been introduced by Senators Stabenow, Roberts, Schumer, Collins, and Leahy (S. 967). This legislation will allow ambulance service providers to maintain high quality ambulance services and budget for the future.
Specifically, the bill:
The House this afternoon voted 217-213 to pass the American Health Care Act (H.R. 1628), as amended. The bill now heads to the Senate where it will be up for intense debate. The AAA will continue to monitor this legislation as it makes its way through the Senate.
The House also voted 429-0 to pass a bill (H.R. 2192) from Rep. Martha McSally (R-AZ) that would eliminate a congressional exemption from health care changes. The exemption was included in AHCA to comply with budget reconciliation rules.
Two key amendments were added to the healthcare bill in order to ensure Republican support, the Upton Amendment and the MacArthur Amendment. These amendments were two of the more substantial changes to the bill since it was originally introduced. The AAA is currently working on drafting a detailed overview of this legislation and will distribute to members once completed.
Dear Fellow Members,
As you know, the Medicare ambulance add-on payments are set to expire on December 31, 2017. I’m proud to share with you that today, due to AAA advocacy efforts, permanent ambulance relief legislation was introduced by Senators Stabenow, Roberts, Schumer, Collins, and Leahy.
This bill, S.967, “Medicare Ambulance Access, Fraud Prevention, and Reform Act” would make permanent the vital urban and rural Medicare add-ons and super-rural bonus payments. Although some changes are likely during the committee markup process, we are cautiously optimistic that it will also carry through proposals to reclassify ambulance organizations as providers of health care (not suppliers of transportation), as well as a cost data collection system that does not place undue burden on ambulance services.
On behalf of the AAA, I’d like to extend my deepest thanks to Senators Stabenow, Roberts, Schumer, Collins, and Leahy for sponsoring the legislation, as well as the AAA Board, Government Affairs Committee, advocacy consultants, and staff who worked so diligently to build support on Capitol Hill.
Over the coming months, AAA will continue to connect with policymakers to build support for sustainable ambulance Medicare reimbursement. However, we need your help to ensure that this critical revenue remains in place. We ask that you please contact your Senators to voice your support for S. 967. AAA makes it easy to connect with your legislators through our online advocacy tool—please use it today to quickly send messages expressing the importance of the legislation to your ambulance service and the communities you serve.
If possible, we ask that you also work with fellow ambulance providers in your area to schedule in-person meetings with your legislators’ offices. If you arrange a meeting in your home state, please contact AAA staff at info@ambulance.org for talking points to support your conversation.
Now, more than ever, we need the active participation of each member organization to ensure our collective future! Thank you in advance for your assistance with advocacy outreach, as well as for your continued membership to the American Ambulance Association.
Mark Postma
President, American Ambulance Association
“Representing EMS in America”
Congress returns to Washington next week, and House Republican Leadership maintains an ambitious agenda to pass the American Health Care Act (AHCA) despite an unclear path navigating its moderate and conservative factions. President Trump, who refuses to let health care reform disappear from the agenda, is especially eager for a victory, and today predicted AHCA would pass within the next few weeks.
During the in-district work period these past two weeks, the White House, House Leadership and Republican committee staff have kept conversations going with the two disagreeing factions within their caucus – the moderate Tuesday Group and the conservative Freedom Caucus. At this stage, there appears to be no agreement within the Republican Caucus, and there are varying reports on how close are discussions. The wild card is whether President Trump and his team can help force a deal. As soon as a deal materializes, the House will move the bill to the floor.
In addition to health care, the discretionary aspects of the Federal government are under a temporary continuing resolution which expires at the end of next week. An effort is underway to pass a measure that will fund the government through the remainder of the 2017 Fiscal Year, which ends September 30. This effort is not without controversy, and includes an attempt by the Trump Administration to appropriate funds to build its border wall. However, Republicans will need at least eight Senate Democrats to vote with them to pass an omnibus spending bill, so compromise will be required. There may be a series of short-term funding patches as Congress considers spending priorities.
One of the more interesting issues Congress and the Trump Administration face is what to do with Affordable Care Act (ACA) subsidies that were meant to help reduce cost sharing (deductibles, co-payments) for especially poor, non-Medicaid eligible individuals buying insurance on the exchange. House Republicans had successfully sued the Obama Administration in district court arguing that Congress must appropriate the money before the ACA’s Cost Sharing Reduction (CSR) subsidies could be paid. With an injunction from the district court in place, Congress must decide whether to appropriate the money in the upcoming spending bill. Some Democrats have stated they will not vote to pass any budget without funds for the CSR program included. If Republicans can pass a budget without funding the CSR subsidies, they aren’t out of the woods yet on the CSR program. Specifically, the President still has to decide whether to appeal the district court decision on May 22. If President Trump chooses to accept the district court decision and there is no appropriation, the President could unilaterally shut down the CSR subsidy program. The President has threatened to use this court decision to bring Democrats to the negotiating table, in the event that the program is not appropriated and AHCA is not passed.
The AAA will continue to keep members up to date on these issues.
For Immediate Release
Contact
Amanda Riordan
703-610-9018
ariordan@ambulance.org
www.ambulance.org
Washington, D.C. – The American Ambulance Association (AAA) has named Senator Susan Collins of Maine as the AAA Legislator of the Year, in recognition of her strong advocacy for emergency medical services. Senator Collins is invited to receive this honor at the AAA’s annual Stars of Life recognition ceremony on June 13 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. Stars of Life pays tribute to the dedication of these heroes while shining light on the critical role EMS plays in our healthcare infrastructure. This year, 101 EMS professionals will be honored as 2017 Stars of Life. In addition to Senator Collins’s recognition as as Legislator of the Year, twenty-four United States Senators and Representatives will receive Legislative Recognition Awards for their support of ambulance services.
AAA President Mark Postma notes, “Senator Collins has been a tireless advocate for emergency medical services, both in Maine and across our country. The AAA is honored to present her with the distinction of AAA Legislator of the Year.”
Senator Collins is a primary sponsor of the Medicare Ambulance Access, Fraud Prevention and Reform Act which would make permanent the current temporary Medicare ambulance relief. This bill ensures that ambulance service providers across the nation have the resources necessary to provide often life-saving emergency- as well as vital non-emergency medical transportation.
As Chair of the Senate Committee on Homeland Security and Governmental Affairs from 2003 to 2007, Senator Collins ensured both governmental and nongovernmental medical service providers were included in the definition of an emergency responder in the Homeland Security Act. This enabled ambulance service providers as first responders access to critical funding and resources.
First elected to the senate in 1996, Senator Collins has earned a national reputation for working across party lines to seek consensus on our nation’s most important issues. Senator Collins has carried out her longstanding commitment to healthcare issues through her work on the Special Committee on Aging as well as the Committee on Health, Education, Labor and Pensions.
In recognition of her ongoing service to the ambulance services of the United States, AAA is proud to call Senator Collins our Legislator of the Year.
# # #
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.
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.
The House Rules Committee met last week to consider a new amendment to the American Health Care Act (AHCA) to establish a federal risk-sharing fund and appropriate $15 billion for a high-risk pool program from 2018 to 2026.
The amendment, which aims to reduce premiums for those with pre-existing conditions, is sponsored by Reps. Gary Palmer (R-AL) and Dave Schweikert (R-AZ), both members of the House Freedom Caucus.
Washington Post: “GOP House leaders say health bill tweak shows progress, but larger divisions remain“
The program is reportedly modeled after a successful initiative in the State of Maine. The federal government would run the program initially, but each state will have the ability to take over the high-risk pool after three years.
The amendment represents one area of limited agreement in the broader AHCA debate. Conservative House Members are likely to support it to the extent it shifts authority and funding to the states to help keep premiums down, and moderates are likely to support it because it would add a layer of protection for individuals with pre-existing conditions. It is unclear whether the level of funding appropriated will be sufficient to meet the need, however.
The development is not evidence of a breakthrough, however, and negotiations are far from over. Rather, it is a strategic move by House Republican leaders to signal progress in the Affordable Care Act (ACA) repeal-and-replace debate before lawmakers head home for a two-week congressional recess at the end of this week. It also is unclear whether the amendment will have any impact on the broader areas of disagreement between the House and Senate regarding the timing, substance and process for ACA repeal.
The decision was reportedly made at a meeting the President convened last week with Speaker Paul Ryan (R-WI) and Majority Leader Kevin McCarthy (R-CA). Speaker Ryan indicated that work will continue “in the days and weeks ahead,” suggesting a longer time-frame for any legislative action beyond last week’s vote in the House Rules Committee.
Today, citing “growing pains” of his Republican majority, Speaker Paul Ryan (R-WI), in consultation with President Donald Trump, determined not to proceed with a planned vote on the American Health Care Act (AHCA), which repealed and replaced important elements of the Affordable Care Act (ACA). The Speaker indicated that the House Republican Caucus “came up short” in the number of votes needed for the bill. House Republican Leadership had been moving AHCA through the Chamber at a rapid pace. The bill was officially released on March 6, and had been changed several times to try to appease various conservative and moderate voting blocs within the Republican Caucus. The Congressional Budget Office (CBO) originally estimated the bill would reduce federal deficits by $337 billion, and subsequently downgraded the deficit reduction to $150 billion based on additional substantive policy changes to the bill. The CBO estimates the bill would have increased the country’s number of uninsured by about 24 million people.
In negotiating the provisions of AHCA, the House Republican Leadership had faced a constant seesaw, as efforts to appease one ideological bloc upset the other. Ultimately, throughout the day in advance of the scheduled vote, an increasing number of moderate Republicans, including Appropriations Committee Chairman Rodney Frelinghuysen (R-NJ), announced they would vote against the bill. As the moderates disappeared, not enough members of the conservative Freedom Caucus decided to support the bill.
As disarray in the House Republican Caucus occurred, there appeared to be a similar lack of consensus amongst their Republican colleagues on the Senate side. While Senate Leadership had planned to move the bill directly to the Senate floor as fast as within a week of receipt from the House, there were a number of Senators from a range of political perspectives with serious concerns about the bill. On one side of the Republican spectrum, Senators Rand Paul (KY), Mike Lee (UT) and Ted Cruz (TX) had planned to push the limits of what can be included in a reconciliation bill to make it more conservative. Senator Paul had advocated for repealing the ACA in full and dealing with the replacement later on. On the other side, more moderate or “purple state” Members like Senators Susan Collins (ME), Lisa Murkowski (AK), Rob Portman (OH), Cory Gardner (CO) and Dean Heller (NV) raised concerns about insurance affordability and the expedited rollback of Medicaid expansion in the House version of the bill. Other Senators who will likely play a prominent role in any further health reform developments include physician Senator Bill Cassidy (LA), and Senator Tom Cotton (AR), who advocated all along to slow the process down. Republicans can only lose two Senators and still pass any health reform bill, with the vote of Vice President Mike Pence breaking the tie.
As a next step, House and Senate Republican Leadership plan to take more time to develop consensus in any future approach to health reform. How much time is unclear – but it seems unlikely the bill will be the legislative focus in the short term. Instead, there will likely be a cooling-off period on health reform legislative activity, since the fundamental disagreements within the caucus are not easily fixed. There will continue to be significant messaging against ACA from conservatives, and there is the potential that the idea of “repeal and delay” may gain more traction. Nonetheless, in the short term, the Speaker indicated he would move on to other items on his conference’s agenda – including tax reform. Keep in mind, however, that since health-related tax provisions are a major component of the tax code, it would not be surprising to see some health issues resurface in tax reform.
The Speaker indicated that he expects the ACA marketplace to get worse – specifically citing rising premium costs. In his own remarks on the failure to pass AHCA, the President suggested the Democrats will own any rising premiums, and provided a rare moment of optimism for the day when he indicated that a bipartisan health care reform bill may be achievable in the future when that happens. As the Legislative Branch takes time to develop consensus, more focus will be placed on the Executive Branch.
We expect HHS Secretary Tom Price and White House Budget Director Mick Mulvaney to take an increasingly important role in driving the health agenda. It is unclear at this point whether the Trump Administration will let ACA drift in the wind, take administrative actions to try to improve the marketplace, or even actively work to derail it further. A likely bellwether as to the Administration’s intent is how it approaches the pending litigation over cost-sharing reduction (CSR) subsidies. The House had sued the Obama Administration over the program, which funnels federal dollars to insurers to help keep out-of-pocket costs manageable for lower-income individuals, saying the funding had to be appropriated. But after the inauguration, the House and Trump Administration sought a stay of the case until May 22 to allow time to resolve the issue. If the Administration agrees to fold, the subsidies would be cut off, leading to further market instability. If the House folds, the CSR payments would continue into the indefinite future.
From a health care legislative perspective, 2017 will still be far from a quiet year. The President has proposed significant changes in the funding levels of important discretionary health programs. Those budget battles will now move more front and center on the legislative agenda. Furthermore, there continue to be “must pass” pieces of health care legislation, including CHIP reauthorization, FDA User Fee legislation, and certain Medicare extenders legislation.
The top legislative priority this year for the American Ambulance Association is to extend, or hopefully make permanent, the temporary Medicare ambulance add-on payments. The temporary increases of 2% urban, 3% rural and the super rural bonus expire at the end of this year. The 2% urban and 3% rural increases have been in place since 2008 and the super rural bonus payment since 2004. While the AAA and our members have been successful in getting the payments extended numerous times, 2017 is not a typical year and we need everyone to be prepared to help push to make the increases permanent or extended for the longest possible duration.
The other top priorities for the AAA are for the Centers for Medicare and Medicaid Services (CMS) to recognize ambulance services more like providers of medical services instead of merely suppliers of transportation. In addition, it is critical that Congress direct CMS to collect cost data from ambulance service providers using a method, which will result in usable and meaningful data from everyone, but also not be overly burdensome on extremely low volume providers. Finally, Congress needs to target fraud and abuse with the transport of dialysis patients through a prior authorization program instead an arbitrary payment cut that impacts all providers.
The AAA is pushing its agenda again through a version of the Medicare Ambulance Access, Fraud Prevention and Reform Act which we hope to have introduced in the next few weeks. We are working with our champions on Capitol Hill on a different approach to being treated more like providers to mitigate issues raised about the provision last Congress. Instead of being listed in the Social Security Act as having provider status, we are looking to a hybrid model similar to dialysis facilities. This will clarify that we are not seeking to be treated like providers to achieve Medicare coverage because we are already reimbursed under the Medicare program. It will however still set the foundation for future legislative and regulatory changes to the Medicare fee schedule such as reimbursement for transporting to an alternate destination or treat and referral.
We are also making potential modifications to the House bill on our proposed data collection system. These changes would help with possible Committee consideration of the provision but still hopefully achieve or goal of obtaining useable data that is not overly burdensome to 73% of our industry which is composed of providers that do less than 1,000 Medicare transports a year of less. It is vital that we have meaningful data to make data-driven decisions as to changes to the Medicare ambulance fee schedule.
We will let you know as soon as the revised legislation is introduced for the new Congress. In the meantime, we encourage you to register for the upcoming AAA webinar on the Ambulance Advocacy Action Plan with AAA Senior Vice President of Government Affairs Tristan North and AAA Government Affairs Coordinator Aidan Camas. Tristan and Aidan will provide you the latest information on our advocacy efforts and let you know how you can help. To register for the webinar which is free to AAA members, please go to: https://ambulance.org/product/ambulance-advocacy-action-plan/.
Also read Tristan and Kathy Lester’s recent Member Advisory on ACA Repeal & Reform:
ACA Repeal & Reform – What It Means for Ambulance Services (Pt. 1)
ACA Repeal & Reform – What It Means for Ambulance Services (Pt. 2)
On March 9, 2017, Rep. Mike Coffman [R-CO-6] reintroduced the Veterans Reimbursement for Emergency Ambulance Services Act (H.R. 1445).
The VREASA (Veterans Reimbursement for Emergency Ambulance Services Act) would provide veterans with reimbursement for emergency ambulance services when a Prudent Layperson would have a reasonable expectation that a delay in seeking immediate medical attention will jeopardize the life or health of the veteran.
Currently, prior to reimbursement, the Department of Veterans Affairs (VA) requires all medical records be provided, including the records of treatment after the emergency service has taken place. Should those records show that it was not a life threatening emergency or a false alarm, the claim for reimbursement is denied. The veteran is stuck with the bill.
Medicare, Medicaid, and other major payers adhere to the “prudent layperson” standard for the reimbursement of emergency ambulance services. The VA is the only major payer to not follow this standard. It is time we ensure our veterans are not stuck with the bill for their emergency ambulance service.
AAA Member, American Medical Response and their VP Federal Reimbursement & Regulatory Affairs, Deb Gault, have been working with Rep. Coffman’s office to get this bill reintroduced.
The House VA Committee hearing started at 7:30 p.m., but it was well-attended and lasted until 10 p.m. The witnesses included Senator John McCain (R-AZ), VA Secretary David Shulkin, and representatives of the VA Office of Inspector General and the Government Accountability Office. Senator McCain and Secretary Shulkin were both warmly welcomed by Members of the Committee on a bipartisan basis.
Chairman Roe (R-TN) emphasized the need to act quickly to extend the authorization for the Veterans Choice Program, which expires on August 7. To that end, the House VA Committee is voting today on a bill to eliminate the sunset of the program’s authorization. In addition, the Committee will consider broader legislation later this year to make comprehensive reforms to the Choice Program. He noted that the VA has additional funds available but will not be able to spend them once the authorization expires. A copy of Chairman Roe’s opening statement is available here.
Secretary Shulkin testified in support of extending the Choice Program, and he clarified that the VA was not seeking additional funding – just the authority to spend funds already obligated. He noted that the VA already is being forced to deny Choice Program coverage to veterans whose episodes of care would extend beyond the August 7 expiration date (e.g., pregnancy).
Secretary Shulkin also urged Congress to support the VA’s efforts to bring appointment scheduling in-house for care coordination purposes. However, the VA OIG witness noted challenges in records going out to community-based providers and coming back to the VA. The GAO witness also underscored the need for the VA to have better systems in place in order to effectively coordinate care, which will take time to procure and implement. Rep. Brownley (D-CA) echoed that point, calling the VA’s information technology systems a “Model T in a Tesla world.” Rep. Esty (D-CT) also urged improvements in the VA’s information systems and expressed concern that veterans are being improperly billed.
Other Members, including Rep. Wenstrup (R-OH) and Rep. Poliquin (R-ME), raised concerns about continuing delays in the processing of claims and payments to providers. Secretary Shulkin agreed that providers deserve to be paid for their services, noting his own experience as a physician in the private sector. He acknowledged that the VA is not processing enough claims electronically today, and he advised that he plans to pursue options outside the VA for systems procurement going forward.
Many Members also raised serious concerns about treatment of PTSD and mental health conditions for veterans, including Rep. Wenstrup (R-OH), Rep. O’Rourke (D-TX), Rep. Sablan (D-MP), Rep. Banks (R-IN), Rep. Rutherford (R-FL) and Rep. Takano (D-CA). Rep. O’Rourke emphasized that suicide among veterans is the most serious crisis, and Secretary Shulkin agreed that it is his number one priority. The Secretary announced that the VA will begin providing urgent mental health care that also will include individuals other than those service members who were honorably discharged. He added that the VA needs 1,000 more mental health providers, as well as telemental health services, and is looking to expand community partnerships to address suicide.
Rep. Banks noted interest among Indiana veterans in greater access to alternative treatments for PTSD and traumatic brain injury. Secretary Shulkin underscored that he is “most concerned about areas like PTSD, where we do not have effective treatments.” He also advised that the VA has established an “Office of Compassionate Innovation” (separate from the VA’s Center for Innovation), which will focus on finding new approaches to health and physical wellness and explore alternative treatment options for veterans when traditional methods fall short.
Rep. Wenstrup inquired about the VA’s GME and residency programs, as well as its associations with academic institutions. Secretary Shulkin responded that the VA is “doubling down” on partnerships with academic medical institutions.
Chairman Roe concluded his remarks by emphasizing the need to extend the Choice Program authorization soon and to consolidate the VA’s community-based care programs. He also expressed support for the VA’s decision to stop developing its own information technology internally.
The American Ambulance Association needs your help to build the future of EMS—an innovative industry compensated fairly and recognized appropriately for the critical healthcare it provides. Learn more in the video below, then visit our Payment Reform page to get involved!
Ambulance services across the country are struggling to survive in the face of falling reimbursement, short-sighted regulations, and rising costs. EMS providers of all sizes must share critical cost data, meet with legislators, and speak with one voice as we work to surmount these obstacles and position ambulance services for success today and for many years to come.
Find out how to get involved with AAA’s advocacy efforts in this short video featuring Tristan North, the American Ambulance Association’s Senior Vice President of Government Affairs.
Get the scoop on AAA’s advocacy priorities in this short video featuring Tristan North, the American Ambulance Association’s Senior Vice President of Government Affairs.
