House Energy & Commerce Subcommittee Takes Action on Balance Billing

On July 11, 2019, the House Energy and Commerce Committee Health Subcommittee held a markup in which they advanced 10 health care bills, including legislation on surprise/balance billing. This legislation, H.R. 3630, the No Surprises Act attempts to address out-of-network surprise medical bills. The AAA Government Affairs team has been in regular communication with the Energy and Commerce Committee and member offices leading up to the markup to ensure that the ground ambulance industry and AAA members were not negatively impacted by the legislation or any introduced amendments. Thanks to the attentive efforts of AAA members, staff, and consultants, there was no mention of ground ambulance during the markup of H.R. 3630, the No Surprises Act. While ground ambulance was not mentioned, Rep. Lujan (D-NM) highlighted the air ambulance transparency language that is included in the No Surprises Act and called for it to be strengthened further before this legislation is considered by the full Energy and Commerce Committee. Over the course of the markup, Subcommittee Chairwoman Eshoo (D-CA) thanked Rep. Lujan for bringing attention to the “extraordinary costs” associated with air ambulance. Rep. Ruiz (D-CA) then expressed his ongoing concerns regarding the balance billing provisions of the No Surprises...

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Update on AAA Legislative Priorities

The American Ambulance Association has been working hard to accomplish the legislative goals of the membership in the 116th Congress. The AAA would like to take this opportunity to provide an update on what we have accomplished thus far in the 116th Congress. Balance/Surprise Billing Balance/surprise billing is a hot button issue that recently came into the spotlight at the start of the 116th Congress. With the President’s announcement calling for Congress to pass legislation that would end surprise billing for patients, there has been an increase in Congressional action on the issue including introduced legislation, discussion drafts and hearings in all committees of jurisdiction. The AAA has been working tirelessly with the Congressional committees of jurisdiction to educate Members and staff on the unique characteristics of EMS systems and that it would be inappropriate to apply the same restrictions on balanced billing to ground ambulance services. The AAA has formed a working group comprised of AAA member volunteers that have worked on policy and messaging on balance billing. The working group has submitted comments to the Energy and Commerce Committee and Senate HELP committees advocating that the ambulance industry is unique from other stakeholders, and as such, should be looked (more…)

Nevada Passes Law that Restricts Employer Drug Test Use in Hiring

A new Nevada law that bans employers from refusing to hire job candidates who fail a drug test due to the presence of marijuana has specifically carved out Fire, EMS, or employers whose employees must operate a motor vehicle.  The new law, which was signed by Governor Sisolak on June 5th makes it unlawful for most employers to fail to hire a job candidate on the basis of failing a drug screen due to the presence of marijuana.  Nevada is the first state to pass a law of this nature.  The new law takes effect in 2020. Many employers are struggling to address their employee’s drug use and its impact on the workplace as thirty-three (33) states and the District of Columbia have passed laws that legalize marijuana in some form.  This is particularly difficult with EMS and public safety employers.  Generally, most EMS and public safety employers prohibit employee use of marijuana and other drugs because they are federal contractors and are subject to the Drug Free Workplace Act.  Other employers prohibit employee drug use because EMS personnel perform “safety sensitive” positions as defined under the Department of Transportation Regulations.  However, those employers who are not subject to the...

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CMMI Releases Preview of ET3 RFA

On May 22, 2019, the Center for Medicare and Medicaid Innovation (CMMI) released a preview of the Request for Applications (RFAs). This documentation will be used by ambulance providers and suppliers to apply for inclusion as “Participants” in the Emergency Triage, Treat, and Transport (ET3) pilot program. Webinar: Learn More About the RFA June 13, 2019 | 2:00 PM Eastern Speakers: Brian Werfel, Kathy Lester, Rebecca Williamson, Asbel Montes $99 for Members | $198 for Non-Members Relevant Background On February 14, 2019, CMMI announced the creation of a new 5-year pilot program designed to give participating EMS agencies greater flexibility to address the needs of Medicare beneficiaries following a 911 call. The ET3 model would create a new payment model under which participating EMS agencies will be eligible for Medicare reimbursement for: (1) transportation to alternative treatment destinations and (2) treatment at the scene. At the time, CMMI indicated that it anticipated starting the ET3 model in early 2020. To that end, CMMI anticipated soliciting Requests for Participation in the Summer of 2019. Participation in this pilot program is voluntary. Regardless of whether an ambulance provider or supplier participates in the pilot program, payment for ambulance transportation currently covered under...

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New SNF PPS Edits Highlight the Importance of Facility Agreements

On April 1, 2019, CMS implemented a new series of Common Working File (CWF) edits that are intended to better identify ground ambulance transports that are furnished in connection with an outpatient hospital service that is properly bundled to the skilled nursing facility (SNF) under the SNF Consolidated Billing regime. These edits work by comparing the ambulance claim to the associated outpatient hospital claim.  Hospital claims were already subject to CWF edits designed to identify outpatient hospital services that should be bundled to the SNF.  These hospital edits operate by referencing a list of Healthcare Common Procedure Coding System (HCPCS) or Current Procedural Terminology (CPT) codes that correspond to outpatient hospital services that are expressly excluded from SNF Consolidated Billing.  Hospital claims for outpatient services that are submitted with one of these excluded codes bypass the existing CWF edits, and are then sent to the appropriate Medicare Administrative Contractor for further editing and payment.  Hospital claims submitted without one of these codes are denied for SNF Consolidated Billing. The new ambulance edits will extend these process one step further.  The ambulance claim will be associated with the outpatient hospital claim on the same date.  To the extent that hospital claim...

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Summary of March 28, 2019 Ambulance ODF

The Centers for Medicare and Medicaid Services (CMS) held its latest Open Door Forum on Wednesday, March 28, 2019.  As with past Open Door Forums, CMS started the call with the following announcements: Ambulance Cost Data Collection – CMS reminded the industry that the Bipartisan Budget Act of 2018, enacted on February 9, 2018, requires CMS to create a new cost data collection system by December 31, 2019. Emergency Triage, Treat, and Transport Model – A representative from the Innovation Center within CMS provided an overview of the “Emergency Triage, Treat, and Transport Model” or “ET3.” This is a 5-year pilot program intended to provide ambulance providers with greater flexibility to handle low-acuity 911 calls, by providing Medicare payment for: (a) ambulance transportation to alternative treatment destinations and (b) treatment at the scene. The CMS representative indicated that CMS is in possession of data that suggests that 16% of emergency ambulance transports to a hospital emergency department could have been resolved by transporting the patient to an alternative treatment site, e.g., an urgent care center. CMS estimates that had all of these patients elected to receive care in the lower-acuity setting, it would have saved the Medicare Program approximately $560 (more…)

The Paycheck Fairness Act

Following many states that have enacted laws geared towards preventing or eliminating inequities in pay between men and women, The Paycheck Fairness Act which was introduced on March 27, 2019, will prohibit employers from asking job applicants about their salary histories or using those histories to base pay or compensation rates.  The Act would require that employers to justify any pay disparities as job-related and would also permit employees to file class action lawsuits based on pay discrimination.  Numerous states around the country have passed laws that prohibit pay history inquiries.   It is strongly recommended that employers conduct a wage analysis to identify any pay disparities between individuals from any of the protected classes performing comparable work....

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New Parents Act Introduced to Provide for Paid Family Leave

On March 27, 2019, Senator Marco Rubio (FL) and Mitt Romney (UT) introduced the New Parents Act which would provide paid parental leave for up to three months by permitting new parents to tap into future Social Security Benefits by either delaying or reducing those benefits later in life.  The Bill also permits new parents to continue to work and use the funds to pay for childcare expenses.  There are several bills that are currently under consideration that provide for paid Family Leave by either postponing Social Security Benefits (The Child Rearing & Development Leave Empowerment Act (CRADLE) and The Family & Medical Insurance Leave Act (FAMILY) which provides for some wage replacement that is funded through a tax on payroll.  These Bills follow numerous state laws recently enacted or currently under consideration around the country to provide a form of paid family and medical leave....

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