CMS Non-Emergency Ambulance Transport Open Door Forum 7/26

CMS Issues Data Elements and Templates for Non-Emergency Ambulance Transports (NEAT): Open Door Forum for Thursday, July 26, 2018 Just Announced As part of its Patients Over Paperwork Project, the Centers for Medicare & Medicaid Services (CMS) Provider Compliance Group (PCG) has been hosting quarterly listening sessions and reviewing the Request for Information submissions. The American…

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OIG Report on Overpayments For Non-Emergency Transports

OIG Report – Overpayments For Non-Emergency Ambulance Transports To Non-Covered Destinations The Office of the Inspector General released its report “Medicare Improperly Paid Providers for Non Emergency Ambulance Transports to Destinations Not Covered by Medicare”. In sum, the OIG reviewed claims that Medicare paid for 2014 – 2016 non-emergency ambulance transports. The review focused on…

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Physician Fee Schedule Proposed Rule 2018

On Thursday, July 12, the Centers for Medicare & Medicaid Services (CMS) released the “Revisions to Payment Policies under the Physician Fee Schedule and Other Revisions to Part B for CY 2019; Medicare Shared Savings Program Requirements; Quality Payment Program; and Medicaid Promoting Interoperability Program” Proposed Rule (Proposed Rule). As you know, the American Ambulance…

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AAA Releases Updated 2018 Medicare Rate Calculator

CMS Posts Updated 2018 Public Use File; OIG Guidance on Waiver of Small Cost-Sharing Balances Updated AAA 2018 Medicare Rate Calculator Now Available! The Centers for Medicare and Medicaid Services (CMS) has posted an updated version of the 2018 Medicare Ambulance Fee Schedule Public Use Files (PUF). These files contain the Medicare allowed base rate…

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VA Issues Rule Expanding Coverage of Ambulance Services

Veterans Administration Issues Interim Final Rule Expanding
Coverage of Ambulance Services under Millennium Bill

On January 9, 2018, the Department of Veterans Affairs issued an interim final rule that would amend its policy for payment of Millennium Bill claims. The Millennium Bill authorizes the Veterans Administration (VA) to pay for emergency care provided to veterans in non-VA facilities — including emergency ambulance transportation — provided the veteran has no other health insurance that would cover the costs of such emergency care. These changes were necessitated, in part, by a recent decision of the U.S. Court of Appeals for Veterans’ Appeals (Staab v. McDonald, 28 Vet. App. 50, 2016).

The two major changes being made by the interim final rule are: (1) the expansion of payment eligibility to include veterans who received partial payment or reimbursement from a health plan for their non-VA emergency care and (2) the expansion of payment eligibility for emergency transportation associated with a veteran’s receipt of emergency treatment in a non-VA facility.

These changes went into effect on January 9, 2018.

Relevant Background

38 U.S.C. §1725 authorizes the VA to reimburse veterans for the costs of emergency treatment for non-service connected conditions furnished in a non-VA facility, provided certain criteria were met. One requirement was that the veteran be personally liable for the costs of that emergency treatment. As originally enacted in 1999, the statute indicated that the veteran would be personally liable if the veteran: (1) has no entitlement to care or services under a health-plan contract and/or (2) the veteran had no contractual or legal recourse against a third party that would, in part or in whole, extinguish such liability. The VA historically interpreted its payment obligations under the Millennium Bill to be limited to situations where the veteran had no entitlement to coverage under their health insurance or any other contractual or legal recourse against a third party.

The Expansion of Veteran Eligibility for Reimbursement Act of 2010 amended the requirements related to non-health insurance payments to remove the phrase “in part”. As a result, the VA revised its regulations to permit it to make a payment under the Millennium Bill in situations where automobile or other forms of non-health insurance made a partial payment, and where the veteran remained liable for the balance of the health care provider’s bill. However, there was no corresponding change made to the provisions related to health insurance contracts. As a result, the VA continued to view partial payment by a health plan as a bar to payment by the VA.

In Staab, the Court of Appeals adopted a more lenient interpretation of the statute, i.e., a more restrictive view of the VA’s statutory bar on reimbursement. Specifically, the Court held that the reimbursement bar would only apply when the payment from the health plan fully extinguished the veteran’s liability. The practical effect was to place health insurance plans on equal footing with other forms of insurance. The Court remanded the case back to the lower court for further proceedings.

The VA subsequently appealed the Court of Appeals decision. However, on June 14, 2017, Veterans Affairs Secretary David Shulkin announced that the Department would drop its appeal.  Reversing course, Secretary Shulkin indicated that the VA had drafted regulations to implement the expanded Millennium Bill coverage. Those regulations form the basis of this interim final rule.

Provisions of Interim Final Rule

Partial Payment from Health Insurance Plan

The VA revised its regulations at 38 C.F.R. §17.1002(f) to indicate that the VA will make payment under the Millennium Bill to the extent the veteran otherwise qualifies for coverage to the extent that the veteran “does not have coverage under a health-plan contract that would fully extinguish the medical liability for the emergency treatment.” The VA retained the reimbursement bar for situations where the veteran would have been covered under a health plan had the veteran or the provider failed to comply with the requirements of that health plan, e.g., by failing to submit a timely claim. This change will apply to: (1) all claims pending with the VA as of April 8, 2016 or (2) submitted after that date.

Expansion of Payment Authority for Emergency Transportation

The VA historically viewed emergency ambulance transportation to the non-VA facility as part of the overall emergency treatment of the veteran. As a result, the VA believed that a health plan’s payment for the hospital care, in whole or in part, triggered its reimbursement bar. One common situation that impacts ambulance suppliers involves veterans that have Medicare Part A benefits (which cover the costs of their hospital care), but where the veteran has elected to forego paying for Medicare Part B.  In these situations, Medicare would pay for the hospital care. The VA took the position that this triggered the reimbursement bar, and therefore prevented it from making payment for the emergency ambulance transportation.

Because the interim final rule expands Millennium Bill coverage to include situations where a health plan makes a partial payment, the VA found it necessary to amend its regulations governing the payment of ambulance claims. Specifically, the VA amended its regulations at 38 C.F.R. 17.1003 to provide that ambulance providers will now be eligible for payment provided the following conditions are met:

  1. Payment for emergency care provided at the non-VA facility is authorized or would have been authorized had:
  2. The veteran’s personal liability for the emergency treatment was not fully extinguished by payment by the health plan or other third-party; or
  3. Death not occurred before emergency treatment (at the hospital) could be provided);
  4. The veteran is financially liable to the ambulance provider;
  5. The veteran does not have coverage under a health insurance plan that would fully extinguish the medical liability for the emergency transport (and further provided that the veteran or the provider has timely filed a claim with the health plan);
  6. If the emergency transportation is the result of an accident or work-related injury, the veteran must have reasonably exhausted his remedies against a third-party payor (e.g., auto insurance policy or workers’ compensation policy); and
  7. The veteran remains liable for all copayments and deductibles.
Effect of Coinsurance and Deductibles

The A.A.A. has confirmed that the VA does not consider the coinsurance or deductible obligations imposed by a veteran’s health plan for the purposes of determining whether the veteran’s liability has been fully extinguished by the health plan’s payment.

Therefore, in situations where the veteran has health care coverage, payment by the VA is likely to be limited to situations where the ambulance provider is permitted under state and local laws to bill patients for the difference between their billed charges and the amounts allowed by the health insurer, i.e., those areas that currently permit balance billing. This would also mean that the VA would be unlikely to have any payment responsibility in situations where Medicare has made payment on the ambulance claim (although it leaves open the possibility that the VA may be responsible for non-covered Medicare services such as excess mileage).

Amount of Payment

 When the VA pays under this expanded Millennium Bill authority, its payment will be based on the following methodology:

  1. When the veteran has no coverage under a health plan or other third-party payor, the VA will pay the lesser of: (a) the amount for which the veteran is personally liable or (b) 70% of the applicable Medicare allowable;
  2. When partial payment is made by a health plan or other third party payer, the VA will pay the difference between: (a) the amount the VA would have paid under the preceding bullet point (typically 70% of the Medicare allowable) or (b) the amount paid (or payable) by the health plan or other third-party payor; provided that amount is greater than zero;
  3. If the calculation in the preceding bullet point would not result in the VA making a payment (i.e., because the resulting amount would be less than zero), the VA will pay the lesser of: (a) the veteran’s personal liability after the third-party payment (excluding deductibles and copayments) and (b) 70% of the applicable Medicare allowable;
  4. In the absence of a corresponding allowable, the VA will be the lesser of: (a) the amount for which the veteran is personally liable or (b) the amount calculated by the VA Fee Schedule in 38 C.F.R. 17.56(a)(2)(i)(B).

Payment from the VA is generally considered to be payment-in-full, and extinguishes the veteran’s remaining liability to the provider for unpaid amounts. Note: the veteran would remain liable for unpaid co-payments and deductibles. If the provider does not wish to accept the VA’s payment, it has 30 days from its receipt of such payment to reject and refund the payment.


Have any Medicare questions? Contact Brian at bwerfel@aol.com

CMS Extends Moratorium on Non-Emergency Ground Services

CMS Extends Temporary Moratorium on Non-Emergency Ground Ambulance Services in New Jersey and Pennsylvania On January 30, 2018, the Centers for Medicare & Medicaid Services (CMS) issued a notice in the Federal Register extending the temporary moratoria on the enrollment of new Medicare Part B non-emergency ground ambulance providers and suppliers in the states of…

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Add-Ons Update & Impact of Partial Government Shutdown

Call To Action:  Ambulance Add-Ons Update &
Impact of Partial Government Shutdown

Congress is heading toward a possible partial shutdown of the federal government without taking action on our expired Medicare add-on payments. While the AAA and other industry stakeholders have pressed hard for Congress to immediately pass a five-year extension of the ambulance add-ons, our message is not being heard loud enough amongst all the other noise. We need you to contact your members of Congress today in support of extending the 2% urban, 3% rural and 22.6% super rural increases!

Write to Your Member of Congress

Last night, the House of Representatives mostly along party lines passed a Continuing Resolution to fund the federal government through February 16. The fate of the bill in the Senate is uncertain. If Congress does not pass by midnight tonight a measure extending funding for the federal government, there will be a partial government shutdown.

The AAA had pushed for Congress to attach a Medicare provider extender package including a five-year extension of the ambulance add-ons to the Continuing Resolution.  Since the extender package was not included in the Resolution, we are pressing Congress to consider a separate extenders only package including the five-year ambulance extension or attach the package to another moving legislative vehicle.  We are also pushing Congress to at the very least pass a short-term extension retroactive to January 1 until a Medicare extender package can move.

It is critical that we get the Medicare ambulance add-ons reinstated as soon as possible.
So please write your members of Congress today!

In the meantime, here are answers to questions about whether you should continue to hold claims and what a partial government shutdown would mean for Medicare and Medicaid payments.

Should my organization still hold Medicare claims?

CMS has not formally stated whether it is holding claims beyond the requirement for contractors to not pay claims until two weeks after receiving them.  AAA members may want to consider holding claims until the issue is resolved, assuming their financial position permits.  Holding claims would potentially allow members to avoid the need to have claims subsequently adjusted at a later date.

Will CMS pay claims during a partial government shutdown?

Yes. CMS has issued the following:  CMS would continue key Federal Exchange activities, such as open enrollment eligibility verification, using Federal Exchange user fee carryover. In the short term, the Medicare Program will continue largely without disruption during a lapse in appropriations. Additionally, other non-discretionary activities including Health Care Fraud and Abuse Control, and Center for Medicare & Medicaid Innovation activities would continue. States will have sufficient funding for Medicaid through the second quarter, due to the continuation of authority under the CR for appropriated entitlements, and CMS will maintain the staff necessary to make payments to eligible states from remaining Children’s Health Insurance Program (CHIP) carryover balances.

Should I Hold My Medicare Claims?

The Great Medicare Debate: Should I Hold My Medicare Claims? By: Brian S. Werfel, Esq. and Rebecca Williamson, Chair, AAA Medicare Regulatory Committee Ambulance suppliers face an important decision at the start of every calendar year on whether to hold their Medicare claims for the first few weeks of the calendar year. This decision historically revolved around…

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Alert: Medicare Increases Will Expire For Now: What You Need to Know

While the Congress succeeded in passing the Republican tax bill and keeping the federal government open with a short-term continuing resolution that included a temporary extension for the State Children’s Health Insurance Program (CHIP), it did not act upon the several Medicare extenders that expire on December 31, 2017. This extenders package includes the ambulance add-ons for urban, rural, and super-rural areas, as well as a moratorium on therapy caps, extenders for hospitals, and several other extenders important to other Medicare providers.

Despite the fact that the Congress left town, there is still strong bipartisan support for reinstating these extenders – including the ambulance extenders – early in January 2018. The most likely time frame will be for the extenders to be added to the next government funding legislation, which must be passed by January 19.

First, do not panic. As you may have already heard, CMS is telling providers and suppliers that the add-ons will expire at the end of the month. Technically that is true. The Agency is simply stating the obvious; but no one should imply from such statements that the Congress will not fix them or not make them retroactive. Historically, CMS has followed this pattern of indicating the add-ons have expired until legislation extending the add-ons has passed both chambers of Congress and the President has signed the bill into law.  CMS will make similar statements relative to the other Medicare extenders as well.

Second, prepare. To the extent you are able to do so, you may hold your claims. Medicare requires providers to files claims no later than 12 months after the date when the services were provided. (See Medicare: File a Claim; see also section 6404 of the Affordable Care Act). While this may not work for all claims, holding claims will reduce the number that would have to be reprocessed once the add-ons become law. If CMS believes at some point the legislation will pass, it may also break with its own precedent and indicate that has asked the contractors to hold claims for a short period of time as well. It did this in 2014 when it discovered errors in a final fee schedule rule. Once the claims are processed, so long as the add-ons have been extended by law, the add-on dollars will appear in the reimbursement amounts sent to providers and suppliers.

Third, retroactivity can be expensive, but CMS can mitigate the costs. CMS did this most recently in May of 2017. Then, CMS announced that it would implement the retroactive extension of a transitional payment for durable medical equipment suppliers by having the contractors automatically reprocess claims from the period when the transitional payment was made retroactive. This approach reduced the burden on providers and suppliers by eliminating the need to resubmit claims.

Despite the fact that there are ways to mitigate the problem, the American Ambulance Association (AAA) remains deeply concerned that the Congress did not extend the add-ons before they left for the holidays. We understand that for ambulance services across the country receiving timely payments from Medicare can be the difference between being able to make payroll or not. Having the dollars from the add-ons is also crucial to ensuring adequate cash flow. Therefore, while we advise you to think through your options and take the steps that best meet your needs and the needs of your employees, patients, partners, and businesses, we also ask that you reach out to the Congress and let them know how important it is to get the add-ons extended as early in January as possible. Make your voice heard by going to the AAA’s grassroots page. There you can send an email or reach out through social media to your Members of Congress.  We need everyone, including your employees, patients, and others who support high quality ambulance services, to reach out today.

Write to Your Members of Congress

The AAA will continue our direct efforts on Capitol Hill to make sure these add-ons are extended and overly burdensome new requirements are not placed on ambulance services. With your help, we can get the add-ons extended. For more information please visit https://ambulance.org/advocacy/.

AAA Releases 2018 Medicare Rate Calculator

AAA 2018 Medicare Rate Calculator Now Available!

The American Ambulance Association is pleased to announce the release of its 2018 Medicare Rate Calculator tool. The AAA believes this is a valuable tool that can assist members in budgeting for the coming year. This calculator has been updated to account for recent changes in Medicare policies, including the 2018 Ambulance Inflation Factor (1.1%) and continuation of the current temporary add-ons.

To access the Rate Calculator, please CLICK HERE.

To access the Fee Schedule, please CLICK HERE.

(Please note: the 2018 Fee Schedule does not include the temporary Medicare add-ons that are set to expire on 12/31/2017. The AAA is working hard to get these add-ons extended. Please write your members of Congress today to show your support!)

Download the 2018 Rate Calculator

2018 Fee Schedule

CMS Posts Ambulance 2018 Public Use File – Contact Congress

On December 7, the Centers for Medicare and Medicaid Services (CMS) posted the public use files for reimbursement rates under the Medicare ambulance fee schedule for 2018. In posting the rates, CMS did not include the temporary Medicare ambulance increases of 2% to the urban base and mileage rates, 3% to the rural base and mileage rates and the 22.6% to the super rural base rate. CMS also stated the increases will expire on December 31, 2017.

 

The statement by CMS and the rates in the public use file do not reflect the efforts of the AAA and our champions on Capitol Hill to help ensure the temporary Medicare ambulance increases do not expire at the end of this year. The AAA is fighting for Congress to extend the increases for five years. The House and Senate are currently negotiating a Medicare provider extender package and both the House and Senate positions include the 5-year ambulance increase extension. As usual, Congress is waiting to the last minute to address Medicare provider extenders and other expiring policies.

 

However, we should not take the renewal of an extension of the Medicare ambulance increases as a given. Please write your members of Congress today to ask them to support the five-year extension! 

 

Write to Your Representatives

CMS Extends Prior Authorization for 2018

CMS Announces Extension of Prior Authorization for Repetitive Non-Emergency Ground Ambulance Transports

On December 4, 2017, CMS posted a notice on its website indicating that it would be extending the prior authorization demonstration project for another year. The extension is limited to those areas where prior authorization was in effect for calendar year 2017. The affected states are Delaware, Maryland, New Jersey, North Carolina, Pennsylvania, South Carolina, Virginia, and West Virginia, as well as the District of Columbia. The extension will run through December 1, 2018.

Read the Full CMS Notice

In its notice, CMS indicated that claims with dates of service between December 2 and December 4, 2017 would not be subject to prior authorization or prepayment review, but that ambulance providers could elect to submit a request for prior authorization for these transports. All repetitive non-emergency transports on or after December 5, 2017 would require prior authorization.

Act Now: Support 5 Year Medicare Add-on Extension

Take Action for Permanent Medicare Ambulance Relief

Ask your Senators and Representatives to Support Medicare Ambulance Relief!

The temporary Medicare ambulance increases of 2% urban, 3% rural and 22.6% to the base rate in super rural areas are scheduled to expire on December 31 of this year. That is just one month away! Please write your members of Congress today in support of a 5-year extension of the increases.

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.

Over the past 15 years, the AAA has lead efforts on Capitol Hill to establish the increases and ensure they do not expire.  Thanks to the work of our champions and supporters on Capitol Hill, there are provisions in both the House and Senate for a five-year extension of the Medicare ambulance increases.  However, passage of these provisions is in no way certain.  Your members of Congress need to hear that the 5-year extension is important to you!

In addition, the Congress is considering ways to collect Medicare cost data from ambulance service suppliers and providers.  The Senate version, which the AAA prefers, would require a statistically significant sampling of ambulance service suppliers and providers and would provide CMS with significant flexibility on how the system would be designed.  The House version would require all ambulance service suppliers and providers to submit an annual “cost report” which would be subject to a strict financial penalty for not providing timely as well as full data.  We continue to push for changes to the House version and there has been some confusion in the industry about these two provisions.  The bottom-line is that any collection of cost data needs to be tailored to meet the unique needs of ambulance services.

Members of Congress need to hear from you today!  Tell your Senators to support a five-year extension of the Medicare ambulance increases and to cosponsor S. 967.  Tell your Representatives to support a five-year extension of the Medicare ambulance increases and request revisions to cost reporting requirements.

 

POTUS Signs DEA Standing Orders Bill into Law

On Friday, President Trump signed H.R. 304, the Protecting Patient Access to Emergency Medications Act of 2017, into law. H.R. 304 also known as the DEA Standing Orders Bill is an issue that the AAA has been working on closely for over a year. This new law will “improve the Drug Enforcement Administration (DEA) registration process for emergency medical services (EMS) agencies, and clarify that EMS professionals are permitted to administer controlled substances pursuant to standing or verbal orders when certain conditions are met.”

On the passage of H.R. 304, AAA President Mark Postma stated: “the enactment of H.R. 304 ensures that paramedics, EMTs and other emergency medical professionals may continue to administer vital and often life-saving medications to patients. The AAA applauds Congressmen Hudson and Butterfield and Senators Cassidy and Bennet for their successful efforts on this critical issue.”

Special thanks to Rep. Hudson (R-NC-08) for authoring the Bill, and to Rep. Butterfield (D-NC-01), Sen. Bill Cassidy (R-LA) and Sen. Michael Bennet (D-CO) for sponsoring this legislation. Additional thanks to Chairman Greg Walden (R-OR-2) for his continued support. H.R. 304 will help to ensure that ambulance service providers are able to continue providing life saving services throughout the country. The AAA would like to thank NAEMSP for spearheading this effort as well as NAEMT, ACEP, ENA, IAFF, and the IAFC for their hard work and dedication to this issue.

View the full Energy & Commerce press release. Rep. Hudson’s statement on the Bill.

CMS Announces Ambulance Inflation Update for 2018

CMS Announces Ambulance Inflation Update for 2018 On October 27, 2017, CMS issued Transmittal 3893 (Change Request 10323), which announced the Medicare Ambulance Inflation Factor (AIF) for calendar year 2018. The AIF is calculated by measuring the increase in the consumer price index for all urban consumers (CPI-U) for the 12-month period ending with June…

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Senate Committee Draft Package with 5-year Ambulance Extender

Senate Committee Releases Draft Package with 5-year Ambulance Extender

The Senate Finance Committee has released a discussion draft of its Medicare provider extender package. A five-year extension of the temporary Medicare ambulance add-ons and a modified version of the cost data collection provision from the Medicare Ambulance Access, Fraud Prevention and Reform Act (S. 967) are included in the package. The ambulance provisions being part of the package marks significant progress in the Senate toward a long-term extension of the add-ons and a model cost data collection system.
A five-year extension of the 2% urban and 3% increases and the super rural bonus payment would provide approximately $1 billion in desperately needed Medicare relief for our industry. Having the increases in place for five years would give ambulance service suppliers and providers greater funding stability and help with long-term budgeting. There are now proposals in both the House and Senate with Committee backing which reflect a five-year extension of the add-ons.

The five-year extension reflects the efforts of our champions in the Senate on S. 967. The cost data collection system is also from S. 967 with modifications. Instead of a random sampling of ambulance service providers and suppliers a minimum of every three years, the sampling would occur each year for three years than a minimum of every three years. Also, in place of a 5% penalty in Medicare reimbursement for not submitting cost data if selected to report data, the penalty would be 10%. There is a hardship clause within the draft for CMS to work with ambulance service suppliers to ensure they are not penalized. The provision is also streamlined from the version introduced in S. 967.

We greatly appreciate the efforts of Senators Debbie Stabenow (D-MI), Pat Roberts (R-KS), Chuck Schumer (D-NY), Susan Collins (R-ME) and Patrick Leahy (D-VT) as champions of S. 967 and Senator Bill Cassidy (R-LA) on getting the ambulance provisions into the draft. We also thank Senators Orrin Hatch (R-UT) and Ron Wyden (D-OR) as Chairman and Ranking Member respectively of the Senate Finance Committee for their support.

While the discussion draft includes the five-year extension of Medicare ambulance add-ons and cost data collection provisions, there is still a long way to go. If your Senators are not already cosponsors of S. 967, please reach out to them today and ask they cosponsor the bill. Write to your Senators using the AAA online letter writing tool below, or go to:  https://ambulance.org/advocacy/


Ask your Senators to Support S.967 – 2017 Medicare Ambulance Access, Fraud Prevention, and Reform Act

The current 33-month extension of the Medicare add-on payments is set to expire at the end of December 2017. Losing these add-on payments would be a devastating blow to ambulance services across the country. It is crucial that the payments be made permanent as we push for a long-term solution. More details about the Bill can be found below. Let your Senators know that you support S. 967 — Here are three quick and easy ways to get involved!

Writing to your members of Congress only takes 2 clicks, follow these simple steps:

1. Enter contact information below (required by Congressional offices) and click “Submit”
2. On the next page you’ll see the letter(s) to your Senators – click “Submit Messages”

House Committee Passes Medicare Ambulance Relief Bill

House Committee Passes Medicare Ambulance Relief Bill

On Wednesday, the House Ways and Means Committee voted out favorably an amendment in the nature of a substitute to the Comprehensive Operations, Sustainability, ant Transport Act of 2017 (HR 3729) by Congressman Nunes (R-CA) and Sewell (D-AL). H.R. 3729 would extend for five years the Medicare ambulance add-on payments of 2% urban, 3% rural and the super rural bonus. The legislation would also implement cost reporting for ambulance service suppliers.

H.R. 3729 is a revised version of the Ambulance Medicare Budget and Operations Act  (HR 3236)introduced by Congressmen Nunes (R-CA), Upton (R-MI) and Welch (D-VT). While the AAA supports H.R. 3236, there were several changes made in H.R. 3729  that are concerning to the AAA. In particular, the addition of an offset which would implement an additional 13%* cut to BLS nonemergency transports to and from dialysis centers and a change in the penalty for not filing a time, complete and accurate cost report.  The AAA has therefore taken a neutral position on H.R. 3729 as we work with the House Ways and Means Committee and Congressmen Nunes and Sewell on modifications to the bill.

This week, AAA Board Members and Volunteer Leaders were in DC and met with both sponsors of the bill and other key offices to express our concerns over these new provisions. The AAA was able to secure the commitment of House Ways and Means Chairman Kevin Brady (R-TX) and Congressmen Nunes and Sewell to work with us on those two key provisions.

The inclusion of an offset in the bill was necessary for its consideration by the Committee and the AAA is pushing for the language from S. 967 on prior authorization or similar approach just targeting dialysis transport fraud and abuse to replace the current cut. The AAA is also pushing for the Senate to consider S. 967which would make the add-ons permanent and require a random sampling of ambulance services to collect data instead of mandatory annual cost reporting by all ambulance services suppliers.

The AAA encourages its members to write their Senators to cosponsor S. 967.

* This figure was previously 22%.  The AAA worked with the House Ways and Means Committee and Congressional Budget Office (CBO) on the cost estimate for a five-year extension of the add-ons. As a result, CBO lowered its estimate to $1 billion over ten years instead of approximately $1.8 billion. The cut to dialysis as the offset was therefore lowered from 22% to 13%.


Ask your Senators to Support S.967 – 2017 Medicare Ambulance Access, Fraud Prevention, and Reform Act

The current 33-month extension of the Medicare add-on payments is set to expire at the end of December 2017. Losing these add-on payments would be a devastating blow to ambulance services across the country. It is crucial that the payments be made permanent as we push for a long-term solution. More details about the Bill can be found below. Let your Senators know that you support S. 967 — Here are three quick and easy ways to get involved!

Writing to your members of Congress only takes 2 clicks, follow these simple steps:

1. Enter contact information below (required by Congressional offices) and click “Submit”
2. On the next page you’ll see the letter(s) to your Senators – click “Submit Messages”

2016 National and State-Specific Medicare Data

The American Ambulance Association is pleased to announce the publication of its 2016 Medicare Payment Data Report. This report is based on the Physician/Supplier Procedure Summary Master File. This report contains information on all Part B and DME claims processed through the Medicare Common Working File and stored in the National Claims History Repository. The…

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CMS Extends Moratorium on Non-Emergency Ground Ambulance

CMS Extends Temporary Moratorium on Non-Emergency Ground Ambulance Services in New Jersey, Pennsylvania, and Texas On July 28, 2017, the Centers for Medicare & Medicaid Services (CMS) issued a notice in the Federal Register extending the temporary moratoria on the enrollment of new Medicare Part B non-emergency ground ambulance providers and suppliers in the states…

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House Introduces H.R. 3236 – Write to Your Reps!

Take Action for Extending Medicare Ambulance Relief

Ask your Representatives to Support H.R. 3236 – The Ambulance Medicare Budget and Operations Act of 2017

The current 33-month extension of the Medicare add-on payments is set to expire at the end of December 2017. Losing these add-on payments would be a devastating blow to ambulance services across the country. It is crucial that the payments be extended as we push for a long-term solution. H.R. 3236 introduced by Reps. Nunes, Upton, and Welch would extend the current temporary Medicare add-ons for five years. More details about the Bill can be found below. Let your Representative know that you support H.R. 3236 — Here are three quick and easy ways to get involved!

Writing to your members of Congress only takes 2 clicks, follow these simple steps:

1. Enter contact information below (required by Congressional offices) and click “Submit”
2. On the next page you’ll see the letter to your Representative (Message 1) and the letter(s) to your Senators  (Message 2) – click “Submit Messages”
Feel free to personalize your letter(s) before submitting them.

Active on Social Media? Tweet at your Representative asking for their support of H.R. 3236!

  • Authorize Your Account
  • Enter Contact Information
  • Tweet! (Tweet will be auto-generated with your Senators tagged)
Know your Senators’ Twitter accounts already? Tweet:
“#ambulance svs in your district need you, @[your Representative]! Please co-sponsor HR 3236  to help us continue to provide quality #EMS!”

Post on Facebook why H.R. 3236  is important! Be sure to tag your Representative and encourage others to share your post! Ask others to write letters of support as well! http://bit.ly/AAAbill

More About Our Bill H.R. 3236, the Ambulance Medicare Budget and Operations Act of 2017:
Legislation to extend the Medicare ambulance add-on payments for five years has been introduced by Representatives Nunes, Upton, and Welch (H.R. 3236).
Specifically, the bill:

  • Provides Medicare Ambulance Relief, by extending for five years the current temporary 2 percent urban, 3 percent rural, and super rural bonus payments.
  • Requires the Medicare Payment Advisory Commission (MedPAC) to submit a report to Congress detailing the burden of cost reports on the ambulance industry and accuracy of the data received through ambulance cost reports and making recommendations on whether the system should be modified no later than July 1, 2019.
  • Requires CMS to work with stakeholders in the development of an ambulance cost report.