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Congressional Letter on Updating Medicare Zip Codes

Written by Tristan North on . Posted in Advocacy Priorities, Government Affairs, Medicare.

On September 18, Congresswoman Carol Miller (R-WV) was joined by 13 members of Congress in a letter to CMS requesting that the agency update the zip code designations under the Medicare ambulance fee schedule based on the 2020 census.

According to an analysis by AAA data firm of Health Management Associates, the update would result in a net of 1,490 zip codes being redesigned as super rural instead of rural and 782 zip codes being rural instead of urban. Ground ambulance service organizations that serve these rural and super rural areas would thus benefit from the additional reimbursement for rural and super rural areas.

CMS is overdue in automatically updating the zip codes based on the 2020 census data.
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Impact of Potential Federal Government Shutdown on Medicare Payments

Written by Brian Werfel on . Posted in Government Affairs, Medicare, Member Advisories, Reimbursement.

Impact of Potential Federal Government Shutdown on Medicare Payments, Including  the Temporary Aad-ons for Ground Ambulance Services

 

The federal government is funded through annual appropriations enacted by Congress.  Funding for the federal government’s current fiscal year is currently set to expire today, September 30, 2025.  If Congress fails to pass a spending package for the full year – – or a temporary funding package for a shorter period (known as a “continuing resolution”) – – many federal agencies will have to curtail their activities.  On September 18, 2025, the House of Representatives passed a continuing resolution that would have funded the federal government through November 21, 2025; however, that bill failed to pass the Senate.  As a result, barring a last-minute deal, a federal government shutdown will commence on October 1, 2025.

A government shutdown is not expected to impact Medicare payments to health care providers, i.e., Medicare Administrative Contractors will continue to process and pay Medicare claims.  However, past government shutdowns have impacted other Medicare operations, including provider enrollment and pre- and post-payment audit activities.  Providers that are currently in the process of enrolling and/or revalidating their Medicare enrollment may experience delays in the processing of these applications.

As a reminder, existing law requires that Medicare Administrative Contractors hold claims for a minimum of fourteen (14) days.  This “payment floor” would provide a bit of breathing room in the event of a relatively short federal shutdown.  If, however, a shutdown continues for longer than 2 weeks, it is likely that Medicare contractors would be forced to pay ambulance claims with dates of service on or after October 1, 2025 at the statutorily required amount (i.e., an amount that does not take into account the current add-ons).  If the spending deal to reopen the government includes the retroactive extension of those add-ons, the MACs would need to subsequently adjust any payments made at that lower amount.  There is precedent for such retroactive adjustments.  Of course, the current hope is that a deal can be reached early enough to avoid the need for any retroactive adjustments.

Thus, while Medicare payments for ambulance services will continue without interruption, the payment amounts will be impacted.  This is because the temporary add-ons for ground ambulance services (i.e., the 2% urban, 3% rural, and super-rural bonuses) are currently set to expire on September 30, 2025.  The hope is that any deal to avert a shutdown and/or to reopen the government after any potential shutdown will include an extension of these critical add-ons.

The American Ambulance Association is monitoring the situation closely, and will continue to keep our members updated as new information become available.

Update on House Budget Reconciliation Process

Written by Meghan Winesett on . Posted in Government Affairs, Legislative, Medicaid, Medicare.

Earlier this week, the House Committees on Ways & Means and Energy & Commerce reported out favorably their respective language on tax and Medicaid changes as part of Budget Reconciliation. Tomorrow, the House Committee on the Budget is scheduled to mark up the Budget Reconciliation package comprised of the combined pieces of language from the House Energy & Commerce and Ways & Means Committees. The package is scheduled to be considered on the House floor next week.

We will continue to keep our membership informed following the Budget Committee markup tomorrow and the House floor consideration schedule for next week.

House Reintroduces Vital Medicare Extender and EMS Workforce Bills

Written by Tristan North on . Posted in Government Affairs, Legislative, Medicare, Reimbursement, Workforce Shortage.

Medicare Ambulance Extender Bill Introduced in House

Yesterday, March 18, Representatives Claudia Tenney (R-NY), Terry Sewell (D-AL), Cliff Bentz (R-OR), Paul Tonko (D-NY), Mike Carey (R-OH), Danny Davis (D-IL), Carol Miller (R-WV) and Marie Gluesenkamp Perez (D-WA) reintroduced the Protecting Access to Ground Ambulance Medical Services Act (H.R. 2232). This legislation would extend the temporary Medicare ambulance add-on payments at their current levels of 2% urban, 3% rural and 22.6% super rural until January 1, 2028.
The AAA and our partners at the International Association of Fire Chiefs (IAFC), International Association of Fire Fighters (IAFF), National Association of Emergency Medical Technicians (NAEMT) and National Rural Health Association (NRHA) have spearheaded efforts to extend and increase the levels of the Medicare ambulance add-on payments. We expect to see a Senate bill with the higher levels of 3.4% urban, 4.3% rural and 26.7% super rural introduced in the near future.

EMS Workforce Shortage Bill Introduced in House

Additionally, yesterday Representatives Marie Gluesenkamp Perez (D-WA), Brad Finstad (R-MN), Randy Feenstra (R-IA), Suzanne Bonamici (D-OR), Michael Lawler (R-NY), Josh Harder (D-CA) reintroduced the Preserve Access to Rapid Ambulance Emergency Medical Treatment Act (PARA-EMT Act). H.R. 2220 would provide funding for grants to help recruit and train paramedics and EMTs, reduce barriers that prevent veteran medics transitioning to civilian paramedics and EMTs, and request the Secretary of Labor to conduct a study on the EMS workforce shortage and report their findings.
The legislation is supported by the AAA, NAEMT and NRHA. A copy of the press release on the introduction of H.R. 2220 can be found here.

Congress Extends Ambulance Add-On Payments Through September 30

Written by Tristan North on . Posted in Advocacy Priorities, Government Affairs, Legislative, Medicare.

Yesterday evening, March 14, the United States Senate by a vote of 54 to 46 passed the Full-Year Continuining Appropriations and Extensions Act, 2025 (H.R. 1968) to fund the federal government through the end of the 2025 fiscal year ending September 30. An extension of the current levels of the temporary Medicare ambulance add-on payments was included in H.R. 1968 with an expiration date of also September 30. President Trump is expected to sign H.R. 1968 into law shortly.

The AAA, our champions and supporters on Capitol Hill, and EMS partner organizations fought hard to ensure the ambulance extension was included in the lean bill of just 99 pages. We greatly appreciate the outreach by the AAA membership and state EMS associations to their members of Congress in support of the extension of the ambulance add-on payments. The AAA will continue to advocate for a long-term extension of the add-on payments at the higher levels of 3.4% urban, 4.3% rural and 26.7% super rural.

Revised versions of the Protecting Access to Ground Ambulance Medical Services Act with a long-term extension of the add-on payments, and at the higher levels in the Senate bill, will be reintroduced in the near future. Once introduced, we will be launching a new Call To Action asking you to contact your members of Congress to cosponsor the legislation

AAA Releases 2025 Medicare Rate Calculator

Written by Brian Werfel on . Posted in Medicare, Member-Only, Regulatory, Reimbursement.

On December 23, 2024, CMS posted a revised version of the CY 2025 Ambulance Fee Schedule Public Use Files on its website.  These files contain the Medicare allowed amounts for the various levels of ambulance service and mileage.  The file is organized by state, and by payment locality within each state.  The 2025 Ambulance Fee Schedule Public Use File can be viewed by clicking here.

Unfortunately, CMS has elected in recent years to release its Public Use Files without state and payment locality headings.  As a result, in order to look up the rates in your service area, you would need to know the CMS contract number assigned to your state.  This is not something the typical ambulance service would necessarily have on hand.  For this reason, the AAA has created a reformatted version of the CMS Medicare Ambulance Fee Schedule, which includes the state and payment locality headings.  Members can access this reformatted fee schedule below.

The American Ambulance Association is also pleased to announce the release of its 2025 Medicare Rate Calculator tool.  The AAA believes this is a valuable tool that can assist members in budgeting for the current year.  This calculator has been updated to account for recent changes in Medicare policies, including the 2025 Ambulance Inflation Factor and the extension of the temporary adjustments for ground ambulance services (i.e., 2% urban, 3% rural, and super rural bonus) through March 31, 2025.  This extension was the result of Section 3203 of the American Relief Act, 2025.  Barring further legislation, these temporary adjustments will expire on March 31, 2025.

Note on Medicare Sequestration: Both the Ambulance Fee Schedule Public Use Files and the AAA Medicare Rate Calculator display the current Medicare allowables.  Neither takes into account the impact of so-called “budget sequestration” on Medicare payments.  By law, the sequester requires Medicare contractors (and Medicare Advantage insurers) to reduce the amounts they pay under the Medicare Ambulance Fee Schedule by 2% (i.e., 2% off the 80% of the Medicare allowable typically paid by the Medicare contractor).

2025-Medicare-Rate-Calculator

2025.AmbulanceFeeSchedule.StateLocalHeadings.

A Message from AAA President Jamie Pafford-Gresham

Written by Jamie Pafford-Gresham on . Posted in AAA HQ, Annual Conference & Tradeshow, Medicare, Stars of Life.

Happy New Year from Our New Association President

 

Dear Fellow Members,

I am saddened to begin the New Year with such grim and shocking news from Louisiana and New York. I am sickened and heartbroken—as I know you are—by the terror attack that struck New Orleans this weekend as well as the mass shooting in the Bronx. Our hearts ache for the victims and all those whose lives have been shattered by these senseless acts of violence. We also offer our deepest gratitude to our fellow first responders who selflessly rushed toward danger to provide skilled care and comfort in the midst of these tragedies. May their example galvanize us as we work in concert in support of EMS.

Despite these tragedies, as we ring in 2025, I am excited to begin my two-year term as the president of the AAA. I am deeply honored and humbled by the outpouring of support I have received as we begin this 24-month journey together.

I say TOGETHER because this is about US and OUR profession, and I don’t plan to do this alone. I need your participation as we move forward to ensure the best outcomes for all of us in emergency medical services.

Decades ago, when I began working in the business office (which was the kitchen) of what was then my parents’ small Arkansas ambulance service, I never imagined that one day our family of Pafford companies would care for communities in four states, nor that I would have the opportunity to serve my EMS colleagues on the American Ambulance Association board.

I’d like to thank the outgoing AAA President, my friend, Randy Strozyk, for his hard work and leadership. Randy’s dedication over the past two years has enhanced unity and camaraderie among our leaders, members, and fellow EMS stakeholder organizations. I applaud his efforts and those of the larger board, committee chairs, and vice chairs. I am privileged to continue working with this extraordinary group of mobile healthcare professionals.

Too often, EMS—especially private EMS—feels like an unappreciated and misunderstood underdog. 2025 presents an opportunity to change that narrative. One of my cardinal rules at Pafford EMS is, “no whining allowed,” and another is if you complain about a challenge, be prepared to bring forth a proposed solution at the same time. We each know the incredible value we bring to our communities and patients. Together, our voices will be heard in Washington as we share data and stories highlighting the impact of the 24/7 on-demand mobile healthcare we provide.

I hope to approach my AAA presidency with the same sense of urgency with which we treat our patients. As a profession, we can work side-by-side to quickly and effectively secure the extension of the Medicare add-ons beyond the current March 31 expiration date, then collaborate on advancing additional key priorities including sustainable reimbursement, innovative payment models, and solutions to EMS’s challenging workforce shortage.

To accomplish these shared goals, we ask that AAA members treat our advocacy efforts with the same care, grit, and tenacity we demonstrate in our communities every day. On behalf of the board, I ask that you please respond quickly to requests from our government affairs team to write letters or to set meetings with members of Congress. AAA’s grasstops relationships are sterling and have helped the association punch above its weight for decades. However, I believe all politics are local and you are the secret sauce in our success!  Grassroots efforts rule the day in transitional times like these when every interest group is competing for dollars and attention. Nothing is guaranteed—we quite literally cannot advance ambulance advocacy without the active cooperation of every AAA member organization.

In addition to supporting you through lobbying, AAA proudly offers outstanding member educational opportunities. Learning and networking abound at the 2025 AAA Annual Conference & Trade Show. We can’t wait to see you—and a thousand of our mutual colleagues—in beautiful Lexington, Kentucky June 22–24. Speaker proposals are due January 31, and the full agenda will be announced in February. However, please don’t hesitate to register for the conference and book your hotel room today. From reimbursement to operations to human resources, AAA 2025 will offer informative, engaging executive-level content to help you keep service rolling. Additionally, thanks to the support of our exhibitors and sponsors, this year’s event will have fun extras including a welcome reception the night before the conference, trade show special events, and entertaining optional outings to visit Lexington’s famous racehorses and distilleries. You don’t want to miss it as we will roll out our southern hospitality and have a great time!

We also look forward to honoring the 2025 class of Stars of Life in Washington, DC November 3–5. Nominations will open in late summer for this year’s cohort of exemplary EMS professionals. We hope that your ambulance service will join AAA in celebrating your hometown heroes in our nation’s capital.

If you have not yet renewed your AAA membership for 2025, I encourage you to do so immediately—your dues power our ability to drive the policy that sustains EMS. As a friendly reminder, your membership includes complimentary access to dozens of webinars and e-books—log in to our website any time for on-demand education from Scott Moore, Brian Werfel, and countless volunteer leaders. Members also receive deep discounts on everything from medical supplies to uniforms to ambulances through Savvik Buying Group. Additionally, we are proud to support your team with counselor matching services and on-site critical incident stress management should the need arise. New for this year, the AAA mentorship match program will offer an exciting career development opportunity for staff of all levels. AAA delivers these resources and many others as part of a comprehensive member benefits package that we are confident pays for itself many times over. (If you need help updating your contact details or accessing your benefits, please contact hello@ambulance.org for assistance.)

Those of you I’ve had the pleasure of meeting in person know that state ambulance advocacy is a personal passion of mine. In the course of operating Pafford Medical Services, I have seen firsthand many times how strong state associations drive enhanced revenue for EMS as well as add might to state and federal lobbying efforts. If you are not yet connected to your state ambulance association, I encourage you to reach out today. For our part, AAA will continue to support state-level boards with resources, research, events, and connection opportunities through our State Association Forum network and State Association Leadership Excellence conference.

Last, but not least, I wanted to share with you that the board has initiated a strategic planning process for the association to ensure that AAA is positioned for continued success. Our trusted consultants at Davidoff Mission-Driven Strategy will be gathering candid feedback from members of all types and sizes. Your insights are essential to charting a course for 2025 and beyond. I thank you in advance for your participation in surveys and/or virtual focus groups that will take place in the coming months.

I look forward to collaborating with you to move EMS forward in the coming 24 months. Thank you again for your support and participation, and happy New Year!

Now, let’s get to work!

Jamie

Jamie Pafford-Gresham
2025–2026 President
American Ambulance Association

Congress Extends Medicare Ambulance Add-On Payments

Written by Tristan North on . Posted in Medicare, Member Advisories, News, Reimbursement.

On Saturday, December 21, the American Relief Act of 2025 (H.R. 10545) became law and thereby averted a partial federal government shutdown. Of critical importance to ground ambulance service organizations, H.R. 10545 also extends the temporary Medicare ambulance add-on payments of 2% urban, 3% rural and 22.6% super rural through March 31, 2025. In addition, the new law wipes clean the PAYGO scorecard preventing a potential 4% cut in Medicare reimbursement for ground ambulance and other Medicare services.

The House of Representatives passed by a vote of 366 to 34 the Continuing Resolution (H.R. 10545) to extend funding for the federal government just hours before reaching the previous funding deadline of midnight on December 20th. The Senate then passed H.R. 10545 by a vote of 85 to 11 late that evening. The CR funds the federal government primarily at current funding levels through March 14, 2025.

The negotiations on the American Relief Act were extremely tense with a more robust initial legislative package, which would have extended the Medicare ambulance add-ons for two years, being replaced with a slimmer bill with fewer and shorter health care provisions. The extension of ground ambulance service payments ended up being just one of twenty-five provisions in the final 118-page Continuing Resolution, which was originally over 1,600 pages.

The AAA greatly appreciates the advocacy of our champions and supporters on Capitol Hill to ensure that the temporary ambulance payments extension was included in the final CR. We also want to thank our AAA members for reaching out to their members of Congress to request their help with the add-on payments. We will continue to push for a longer extension of the ambulance payments at percentages higher than the current levels upon the expiration of the CR. 

Senator Stabenow Receives Inaugural EMS Legacy Award

Written by Meghan Winesett on . Posted in Cost Data Collection, Legislative, Legislative Awards, Medicare, Press.

FOR IMMEDIATE RELEASE

Contact:
Tristan North
tnorth@ambulance.org
October 10, 2024

 

Senator Debbie Stabenow Receives Inaugural EMS Legacy Award from the American Ambulance Association

 

Washington, D.C. — Senator Debbie Stabenow has been honored with the first-ever annual EMS Legacy Award by the American Ambulance Association (AAA) for her exemplary leadership and unwavering commitment to emergency medical services (EMS) during her distinguished tenure in the United States Senate.

The award recognizes Senator Stabenow’s significant contributions to the EMS community, particularly her role in introducing and championing critical legislation. Notably, she was instrumental in the creation of the Ground Ambulance Cost Data Collection System, which enhances transparency and supports the sustainability of ground ambulance services across the nation. Additionally, Senator Stabenow’s efforts led to the successful extension of Medicare Ambulance Add-On payments for five years, a vital support mechanism that helps ensure reliable emergency medical care for Medicare beneficiaries.

The EMS Legacy Award underscores the critical importance of legislative support for emergency medical services, highlighting Senator Stabenow’s role in elevating these issues on the national stage. Her advocacy ensures that EMS providers have the resources and support needed to deliver high-quality care.

About the American Ambulance Association:
The American Ambulance Association is a nonprofit organization that advocates for the interests of ambulance service providers and the patients they serve. With a mission to advance the profession and improve patient care, the AAA provides resources, education, and support to its members and the EMS community.

CMS Notifies Individuals Potentially Impacted by WPS Data Breach

Written by Brian Werfel on . Posted in Medicare, News.

On September 6, 2024, the Centers for Medicare and Medicaid Services (CMS) announced that CMS and its contractor, Wisconsin Physician Service Insurance Corporation (WPS), have begun the process of notifying nearly a million Medicare beneficiaries that were potentially impacted by a data breach involving WPS.

The data breach involved WPS’ use of the third-party application MOVEit.  MOVEit is a file transfer application developed by Progress Software.  In May 2023, a hacker group called CL0P discovered a security vulnerability that allowed the company to steal sensitive information from secure databases used by numerous governmental agencies and corporations.  This included the protected health information (PHI) of Medicare beneficiaries and non-Medicare beneficiaries stored within WPS’ databases.

The notices inform affected Medicare beneficiaries of the steps they can take to protect themselves.  As part of its remedial efforts, WPS is offering affected Medicare beneficiaries one year of free credit monitoring from Experian.

CMS indicated that it was not aware of any reported incidents of fraud or improper use of a Medicare Beneficiary Identifier (MBI).  However, CMS noted that, if the beneficiary’s MBI was potentially impacted, they would mail a new Medicare card with a new MBI to the patient.  Thus, the data breach has the potential to impact the patient demographic information you currently maintain within your billing systems.  This is especially true for AAA Members that operate in Medicare jurisdictions currently administered by WPS (Iowa, Indiana, Kansas, Michigan, Missouri, and Nebraska).  Specifically, the MBIs on file for existing patients may no longer be accurate.  This also has the potential to impact Medicare eligibility information that you receive from other parties like hospitals, skilled nursing facilities, etc.

AAA Members will have to make a business judgment on how to address these potential concerns.  One possible option would be to implement a process to confirm the MBI of existing patients prior to the submission of new claims.  Another possible option might be to implement internal procedures to flag claims that are denied for an incorrect MBI as potentially related to this issue, and to then verify the patient’s correct MBI prior to resubmitting any denied claims.

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