Tag: 2017

2018 National and State-Specific Medicare Data

The American Ambulance Association is pleased to announce the publication of its 2018 Medicare Payment Data Report. This report is based on the “Early Edition” of the 2018 Part B National Summary Data File (previously known as the Bess Report). The report consists of an overview of total Medicare spending nationwide, and then a separate breakdown of Medicare spending in each of the 50 states, the District of Columbia, and the various other U.S. Territories.

For each jurisdiction, the report contains two charts: the first reflects data for all ambulance services, with the second limited to dialysis transports. Each chart is further broken down by HCPCS code. The charts provide information on the total number of allows services and the total Medicare payments for CYs 2017 and 2018. Percentage changes will allow members to view payment trends over the past year.

2018 National & State-Specific Medicare Data

Questions? Contact Brian Werfel at bwerfel@aol.com.


CMS SNF Edits Go Into Effect – April 1, 2019

CMS Set to Implement New Common Working File Edits to Identify Ambulance Services Provided in Connection with Outpatient Hospital Services that should be bundled to the SNF under Consolidated Billing

On November 2, 2018, the Centers for Medicare and Medicaid Services (CMS) issued Transmittal 2176 (Change Request 10955), which would establish a new series of Common Working File (CWF) edits intended to identify ambulance transports furnished in connection with outpatient hospital services that are properly bundled to the skilled nursing facility under the SNF Consolidated Billing regime. These new edits are set to go into effect on April 1, 2019. 

Why these edits are necessary?

In 2017, the HHS Office of the Inspector General conducted an investigation of ground ambulance claims that were furnished to Medicare beneficiaries during the first 100 days of a skilled nursing home (SNF) stay. Under the SNF Consolidated Billing regime, SNFs are paid a per diem, case-mix-adjusted amount that is intended to cover all costs incurred on behalf of their residents.  Federal regulations further provide that, with limited exceptions, the SNF’s per diem payment includes medically necessary ambulance transportation provided during the beneficiary’s Part A stay. The OIG’s report was issued in February 2019.

The OIG conducted a review of all SNF beneficiary days from July 1, 2014 through June 30, 2016 to determine whether the beneficiary day contained a ground ambulance claim line. The OIG excluded beneficiary days where the only ambulance claim line related to: (1) certain emergency or intensive outpatient hospital services or (2) dialysis services, as such ambulance transportation would be excluded from SNF Consolidated Billing. The OIG determined that there were 58,006 qualifying beneficiary days during this period, corresponding to $25.3 million in Medicare payments to ambulance suppliers.

The OIG then selected a random sample of 100 beneficiary days for review. The OIG determined that 78 of these 100 beneficiary days contained an overpayment for the associated ambulance claims, as the services the beneficiary received did not suspend or end their SNF resident status, nor was the transport for dialysis. The OIG determined that ambulance providers were overpaid a total of $41,456 for these ambulance transports. The OIG further determined that beneficiaries (or their secondary insurances) incurred an additional $10,723 in incorrect coinsurance and deductibles.

Based on the results of its review, the OIG estimates that Medicare made a total of $19.9 million in Part B overpayments to ambulance suppliers for transports that should have been bundled to the SNFs under SNF Consolidated Billing regime. The OIG estimated that beneficiaries (and their secondary insurances) incurred an additional $5.2 million in coinsurance and deductibles related to these incorrect payments.

The OIG concluded that the existing edits were inadequate to identify ambulance claims for services associated with hospital outpatient services that did not suspend or end the beneficiary’s SNF resident status, and which were not related to dialysis. The OIG recommended that CMS implement additional edits to identify such ambulance claims.

Overview of new claims processing edits

In response to the OIG’s report, CMS issued Transmittal 2176, which implements a new series of claims processing edits to identify ambulance claims associated with outpatient hospital services that should be bundled to the SNF. As noted above, these edits will go into effect on April 1, 2019.

These new claims processing edits are somewhat complicated. In order to properly understand how these claims edits will work, it is helpful to understand that CMS already has claims processing edits in place to identify hospital outpatient claims that should be bundled to the SNF. These CWF 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. For convenience, the list of HCPCS and CPT codes excluded from SNF Consolidated Billing is hereinafter referred to as the “Exempted Codes.”

The new edits for ambulance claims will compare Part B ambulance claims to the associated outpatient hospital claim to see whether or not that hospital claim is excluded from SNF Consolidated Billing.

Specifics related to new claims processing edits

Under these new edits, the CWF will reject an incoming ambulance claim whenever the beneficiary is determined to be in an SNF Part A stay if either:

  1. There is no associated outpatient hospital claims for the same date of service on file; or
  2. There is an associated outpatient hospital claim for the same date of service on file (paid or denied), but where that outpatient hospital claim does not contain at least one Exempted Code.

When an incoming ambulance claim is rejected by the CWF, it will be sent to the applicable Medicare Administrative Contractor and rejected (Part A Ambulance Providers) or denied (Part B Ambulance Suppliers) using the applicable Claim Adjustment Reason Code/Remittance Advice Remark Code for SNF Consolidated Billing.  In other words, the ambulance claim will be denied with an indication that youshould bill the SNF.

The Transmittal contains further instructions that the CWF be updated to identify previously rejected ambulance claims upon receipt of an associated hospital claim for the same date of service that contains an Exempted Code. Once identified, the Shared System Maintainer (SSM) is supposed to adjust the previously rejected or denied ambulance claim. At this point, the nature of that “adjustment” is unclear, i.e., it is unknown whether the SSM will automatically reprocess the ambulance claim for payment. The AAA is seeking additional clarification from CMS on this important point.

Potential concerns for ambulance providers and suppliers

Based on the current experience of hospital providers, the AAA is cautiously optimistic that the new edits can be implemented in a way that proper identifies ambulance transports associated with hospital outpatient claims that should be bundled to the SNF vs. those that correctly remain separately payable by Medicare Part B.

However, the AAA has some concerns with the manner in which CMS intends to apply these edits.  Ambulance providers and suppliers are typically in a position to submit their claims earlier than the corresponding hospital, many of which submit claims on a biweekly or monthly cycle.  This creates a potential timing issue. This timing issue arises because the edits will reject any ambulance claim that is submitted without an associated hospital claim on file.  In other words, even if the hospital outpatient service is properly excluded from SNF Consolidated Billing, the ambulance claim will still be rejected if it beats the hospital claim into the system. The hope is that CMS will subsequently reprocess the ambulance claim once the hospital claim hits the system. However, at this point in time, it is unclear whether these claims will be automatically reprocessed, or whether ambulance providers and suppliers will be forced to appeal these claims for payment.

One option available to ambulance providers and suppliers would be to hold these claims for a period of time, in order to allow the hospitals to submit their claims. By waiting for the hospital to submit its claim, you can ensure that your claims will not be denied solely due to the timing issue. This should eliminate the disruption associated with separately payable claims being rejected and then subsequently reprocessed and/or appealed. It would also give you a degree of certainty when billing the SNF for claims that are denied for SNF Consolidated Billing. However, holding claims carries an obvious downside, i.e., it will disrupt your normal cash flow.

To summarize, the implementation of these new edits will force ambulance providers and suppliers to rethink their current claims submission processes for SNF residents. Ambulance providers and suppliers will need to make a decision on whether to hold claims to minimize the potential for problems, or to continue their existing submission practices and deal with any issues as they arise.

AAA webinar on new SNF Consolidated Billing edits

March 27, 2019 | 2:00 PM Eastern
Speakers: Brian Werfel, Esq.
$99 for Members | $198 for Non-Members

Join AAA Medicare Consultant Brian Werfel, Esq., to go over the new SNF Consolidated Billing edits that go into effect April 1, 2019. These edits are being implemented by CMS in response to 2017 investigation by the HHS Office of the Inspector General that determined that CMS lacked the appropriate claims processing edits to properly identify ambulance transports provided in connection with hospital outpatient services that are not expressly excluded from SNF PPS. The implementation of these new edits will force ambulance providers and suppliers to rethink their current claims submission processes for SNF residents. Ambulance providers and suppliers will need to make a decision on what to do with these claims moving forward. Sign up today to make sure your service is ready!

Register for the Webinar

2017 National and State-Specific Medicare Data

The American Ambulance Association is pleased to announce the publication of its 2017 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 report contains an overview of total Medicare spending nationwide in CY 2017, and then a separate breakdown of Medicare spending in each of the 50 states, the District of Columbia, and the various other U.S. Territories.

For each jurisdiction, the report contains two charts: the first reflects data for all ambulance services, while the second is limited solely to dialysis transports. Each chart lists total spending by procedure code (i.e., base rates and mileage). For comparison purposes, information is also provided on Medicare spending in CY 2016.

2017 National & State-Specific Medicare Data

Questions? Contact Brian Werfel at bwerfel@aol.com.


Congress Passes Ambulance Medicare Add-Ons


It is my pleasure to share with you that—just minutes ago—Congress passed the 5 year extension of the Medicare ambulance add-ons. The extension was part of the two-year budget deal reached by congressional leaders and passed by the Senate early this morning and then shortly thereafter by the House. The ambulance provisions in the final deal differ from the provisions passed earlier this week by the House in one key area – the collection of ambulance cost data. This means that we are truly in the endzone of the add-on payment extension process.

While we ask your continued patience as we jump through one last procedural hoop, I am confident that the add-ons will be back in effect as soon as the President signs the legislation. In today’s deeply divided political climate, I am proud of what we have accomplished through collaboration as an association and industry.

Here are the specifics of the final package:

  • 5 year extension of the ambulance Medicare add-ons through December 31, 2022, retroactive to January 1, 2018.
  • AAA’s preferred method of Cost data collection that provides flexibility to the Secretary of HHS in developing the system. Consultation with the industry is required so that it strikes the appropriate balance between obtaining meaningful data while not overly burdening or onerously penalizing the ambulance services.
  • The penalty for failing to report required data would be a reduction in payment up to 10% for the year following the year in which the data should have been submitted. AAA objected to the house proposed penalty of up to a year of Medicare payments clawback or withholding of payments. A clause is included to wave the penalty in cases of hardship.
  • A “pay-for” for the 5-year extension of the add-ons with a 13% cut to non-emergent dialysis transports – the AAA had objected to the offset and pushed for a cut targeted to just those entities which abuse the dialysis transport benefit. We were successful in reducing the initial cut from 22% to 13%. The AAA is actively working on other pay-for options that would replace the 13% cut with something targeting dialysis fraud and abuse.

Next Steps

All that remains to bring the add-ons into effect retroactively to January 1, 2018 are a few administrative formalities and the signature of the President, who has indicated his support of the agreement. Given the government shutdown, we are cautiously optimistic that this will proceed quickly. However, bumps are always a possibility—we will keep you informed! (Follow AAA on Twitter at @amerambassoc or Facebook for instant updates.)

Thank You

This week’s tremendous progress would not have been possible without months of effort by AAA volunteer leaders, advocacy experts, and staff, as well as support from our key champions in Congress.

I’d like to personally thank the AAA Government Affairs Committee, including Chair Jamie Pafford-Gresham and Vice Chair Shawn Baird, as well as the entire AAA Board for their hundreds of hours of hard work on this issue. We are all truly grateful for your dedication to moving mountains to find sustainable funding for EMS.

Last but certainly not least, thank you to the dozens of state ambulance associations and thousands of individual members who wrote letters to their Members of Congress in support of the add-ons. We truly couldn’t have made it this far without your support.

Again, thank you, and please stay tuned for final updates!

Mark Postma
American Ambulance Association
“Representing EMS in America”

House Passes Ambulance Medicare Add-Ons

Moments ago, the U.S. House of Representatives passed legislation which includes a five-year extension of the Medicare ambulance add-ons. The House voted 245 to 182 to pass a Continuing Resolution (CR) to fund the federal government beyond the current expiration date of February 8. The CR included a package of Medicare provider extenders including an extension of the temporary Medicare ambulance add-ons.

The ambulance provisions in the CR include the following:

  • A five-year extension of the temporary Medicare ambulance increases of 2% urban and 3% rural to base and mileage rates and 22.6% to the base rate in super rural areas. The extension would be retroactive to January 1, 2018 and expire on December 31, 2022.
  • The requirement for ambulance service suppliers to submit cost reports. The language is based on H.R. 3729 as reported by the House Ways and Means Committee but with new language providing the CMS Administrator with the discretion to apply a payment suspension or overpayment as the penalty for suppliers that do not submit timely, accurate and complete data after the initial two years.
  • To offset the cost of the add-ons extension, a further reduction of 13% in Medicare reimbursement for BLS non-emergency transports to and from dialysis centers. The initial reduction was 22% but the AAA was able to help lower the estimated cost of the add-ons and thus lower the percentage of the offsetting cut.

The CR now goes to the Senate for its consideration. The Senate is likely to act tomorrow, February 7.

We will keep you posted of new developments. Thank you for your continued support of the American Ambulance Association.

Mark Postma
American Ambulance Association
“Representing EMS in America”

2017 EEO Survey

The EEOC announced that it has launched the EEO Survey to report 2017 Workforce Data. Ambulance services who Federal contractors or private employers with 100 or more employees are required to report the Workforce Data by March 31, 2018. To clarify, billing the federal insurance programs does not qualify as being a Federal contractor for the purposes of reporting EEO-1 Data. If you or your agency needs assistance in determining if your organization is required to report EEO Workforce Data, please contact the AAA.

Build Your Future with a Career in EMS

The U.S. Bureau of Labor Statistics expects career opportunities for EMTs and Paramedics to grow another 15 percent by 2026, far outpacing most other professions… With EMS agencies hungry for skilled providers, there has never been a better time to chart your career path in mobile healthcare.

This week, an editorial from AAA President Mark Postma was featured in a special Media Planet section on healthcare careers. Read the full article►

AAA Holiday Office Closure

American Ambulance Association headquarters will be closed Saturday, December 23 to Monday, January 1. For urgent inquiries, please contact info@ambulance.org. All other messages will be responded to upon our return to the office. Thank you for your support, and happy holidays!

Electronic Injury Deadline Now 12/31

This is an important reminder to all agencies who are required to electronically report their injury data to OSHA.  OSHA announced today that they are giving employers until midnight on December 31, 2017 to submit their injury data for 2016.  If you need assistance with submitting your injury data, please be sure to call or email the AAA.  We can assist you in making sure you meet the deadline.  As of January 1, 2018, employers will not be able to submit their 2016 injury data.

Medicare Extender Update

As president of your association, keeping you informed of our advocacy efforts is one of my top priorities. In keeping with this approach, I would like to share with you an update on the American Ambulance Association’s latest efforts on Capitol Hill. The temporary Medicare ambulance increases are currently scheduled to expire on December 31, 2017. And once again, Congress is waiting until the last minute to extend them. Thankfully, a long-term solution is on the horizon.

The House and Senate are in the process of negotiating the details of a Medicare provider extender package including our ambulance provisions. The House and Senate positions both include a five-year extension of the 2% urban, 3% rural, and super rural increases. Where their positions differ reflects the respective preferences of the Senate Finance and House Ways and Means Committees on how best to collect cost data from ambulance services suppliers and providers.

The Senate position is based on a Senate Finance Committee Discussion Draft from October 26 which includes the five-year extension of the increases as well as a data collection system based on the one from the Medicare Ambulance Access, Fraud Prevention and Reform Act (S. 967). The provision would direct CMS to collect data from a statistically significant number of ambulance service suppliers and providers. This would occur each year for the first three years, then a minimum of every three years thereafter. The penalty for not reporting data if selected would be a 10% cut in Medicare reimbursement for the following year. The language gives CMS flexibility in designing the system, and would place minimal burden on small ambulance service suppliers. The outcome would be usable data to further substantiate the need for rate increases and reform of the Medicare ambulance fee schedule.

The House position is based on H.R. 3729, which also includes the five-year extension of the increases. However, it adds mandatory annual cost reporting for ambulance service suppliers and providers as well. The AAA worked with the bill sponsors and Committee staff to modify the cost reporting language to reflect the unique nature of our industry. However, since ambulance service suppliers and providers aren’t paid based on cost reports, and cost reporting requirements are very stringent, there are several compatibility issues when attempting to apply this model to our industry. The primary problem is the penalty for not reporting timely data, as well as a new standard requiring the data to be accurate and complete. As a result, after the first two years of reporting, the penalty of an overpayment for not reporting timely, accurate, and complete data could be an entire year of Medicare payments. The AAA therefore prefers the Senate language due to its flexibility for our industry as well as its less severe penalty.

The good news is that the House and Senate are in agreement on a five-year extension of the increases. As part of the increase package, our industry will also have a data collection system to demonstrate that we are reimbursed below cost, and to make data-driven decisions on reforming the Medicare ambulance fee schedule. However, it is critical that we get the data collection provision right so that it provides useful information and is not overly burdensome for our members.

Thanks to our champions on Capitol Hill, member advocates, and our lobbying team, the super rural bonus payment has been in effect since 2003, and the urban and rural increases since 2008. Subsequently, we have successfully advocated for Congress to extend the increases eight times, including the current 33-month extension. However, with Congress pressed to address a number of priorities by the end of this year, a Medicare extenders package may not occur until early January.

Securing a five-year extension will require the action of our entire membership. I urge you to please write your members of Congress today in support of the Medicare ambulance increases!

Contact your members of Congress now>

EMS Employer Year-End Wrap-Up and Preview

2017 was a bit of a wild ride in the employment realm.  The Trump Administration worked to change the trajectory set during the eight years of the Obama Administration.  This past year, we saw the undoing or attempts to undo many of the Obama Administration initiatives, including the Fair Labor Standards Act (FLSA) updates, changes to the Persuader Rule, interpretations of Title VII as it relates to transgender protections.  Not to mention the repeated attempts to chip away at the Affordable Care Act (ACA). In addition, there were several new requirements for employers that went into effect in 2017 and a few upcoming in 2018.  Here is a quick review to ensure that your service is up-to-date and compliant.

The Fair Labor Standards Act Changes

These changes, which would have more than doubled the minimum salary levels for those “White Collar” exemptions, were set to go into effect back in 2016.  A Federal Court in Texas enjoined and put on hold these changes until the question of whether the Department of Labor (DOL) had the authority to unilaterally change the Regulations.  In July, 2016, the DOL published an Request For Information (RFI) with responses due in late September, requesting input from stakeholders about what changes to the FLSA might be appropriate.  We are still awaiting the final action.

The Persuader Rule

In 2016, the DOL Office of Labor-Management Standards (OLMS) released its revised interpretation of the rule that seeks to level the playing field between unions and employers.  The new interpretation of the Persuader Rule, which would have taken effect on April 25, 2016, would have required that employers who hire consultants or labor attorneys to counsel them during union organizing campaigns to report if they will undertake “persuader” activities and the cost of those services.  This rule was an attempt to increase transparency for unions with regard to these services. The U.S. District Court for the Northern District of Texas blocked the persuader rule late last year stating it was overly broad, arbitrary and capricious. The DOL published a notice of public rule making in June, 2017 of its intent to rescind the new rule.

Dismantling of the ACA

In a surprising announcement this past October, the Trump Administration, the DOL, the Department of Health and Human Services (HHS) released an interim rule that rolled back the Obama Administration position regarding the requirement of employer sponsored health plans to pay for “preventative services” which included birth control and abortion procedures under religious or moral objections. This would permit employers who object on these grounds to limit or not offer these coverages under their employer sponsored health plan.  There are several lawsuits pending regarding this move, more to come in 2018.

In another October announcement, the Trump Administration stated that the President had signed an Executive Order that directed the Secretary of Labor to consider expanding access to Association Health Plans (AHP) would give employers the right to form groups in multiple states for the purposes of negotiating health care benefits.  This change would require a amenedment to the current interpretation of Employee Retirement Security Act (ERISA). In addition, the Executive Order directed the Departments of the Treasury, Labor, and Health and Human Services to consider changing several ACA restrictions, including low-cost short term limited duration insurance (STDLI) and Health Reimbursement Accounts (HRAs).  The impact of this Executive Order may be an impact to the ACA insurance markets because it may attract the younger and healthier away from current plan groups causing those coverage costs to increase substantially.

Title VII Transgender Protections

In October, Attorney General Jeff Sessions published memo to Federal prosecutors stating that Title VII’s discrimination protections did not include protections on the basis of gender identity or for transgender individuals.  In the memo, Sessions states that this was a conclusion of law, not of policy and that it would be inappropriate for the DOJ to expand the law beyond what Congress provided.  Sessions said that the law provides protections for men and women but not specifically on the basis of gender identity. This goes against current interpretation and is not shared by the Equal Employment Opportunity Commission (EEOC) who enforces Title VII.  Employers need to ensure that they provide a workplace that is inclusive and respectful to all employees.

EEO-1 Pay Reporting

In February 2016, the EEOC published notice that would add pay information to the EEO-1 reporting form in an effort to further identify disparities in pay between different protected groups.  This new reporting requirement was set to go into effect on September 30, 2017. The deadline was pushed back until March 31, 2018.  Under the new pay reporting requirements, employers with 100 or more employees would report W-2 wage information and total hours worked for all employees by race, ethnicity and sex within the 12 proposed pay bands.  In August, the Office of Management and Budget (OMB) announced plans to stay the effective date of the pay-data collection provisions in order to review the appropriateness of the revisions under the Paperwork Reduction Act (PRA).  In the meantime, employers should still observe the March 1, 2018 deadline and prepare the information on the new EEO-1 Form while we await a decision on if this requirement will go into effect.

OSHA Electronic Injury Reporting

OSHA announced in July that it will be launching the new electronic Injury Tracking Application (ITA) on August 1, 2017.  The new rules are an effort to “nudge” employers to improve safety in the workplace by publishing employee injury data, as reported by employers.  OSHA pushed back the electronic reporting deadline until December 15, 2017.  Many ambulance services already report this information electronically to the Bureau of Labor Statistics (BLS), who collects data on behalf of the Department of Labor but the employer specific information is not released publicly.  Under these new rules, employer injury data will be published.

The electronic reporting requirements are based on the size of employer.  For the purposes of determining employer size, employers must count each individual employed at any time during the calendar year as one employee.  This includes full-time, part-time, seasonal, and temporary workers.  All employers with 250 or more employees in industries covered by the recordkeeping regulation must electronically submit to OSHA injury and illness information from OSHA Forms 300, 300A, and 301.  Employers with 20-249 employees must electronically submit information from OSHA Form 300A only.

If you have not already submitted your data, you need to do so immediately.

New Form I9

Starting this past January 22, 2017, employers were required to begin using the new Form I9.  The old Form I9 expired on August 31, 2017.  The new form can be found on the US Citizenship and Immigration Services (USCIS) website.  To be certain that you are utilizing the correct form, ensure the expiration date of August 31, 2019 is in the top right hand corner of the form. Last year, several ambulance services were audited by the USCIS and fined for technical form violations.  The easiest way to ensure that you are using the correct form and filling it out correctly is to utilize the comprehensive online training resources available on the USCIS website.

Summary of State Law Changes

Ban the Box

Currently 29 states and over 150 local municipalities have enacted criminal background inquiry limitations in an effort to give individuals with criminal histories a fair chance to become employed.  Several of the states that had already enacted these laws have passed additional provisions in 2017 and 2018 that expand the application to smaller employers.

Most of the laws regarding the “ban the box” movement require the removal of criminal history inquiries on the job application.  Others require that no criminal history inquiries can be made until after a conditional job offer is made to the candidate.  If you have not done so already, please remove any criminal history questions from your pre-offer process.  For those ambulance providers that are in states that specifically permit EMS agencies from inquiring prior to a job offer, I strongly recommend that any criminal history inquiries occur after a conditional job offer is made.  State laws permissions do not prevent an employer from being liable for disparate impact discrimination.

Paid Sick Time

Multiple states (AZ, CA, CT, MA, OR, VT, DC) and municipalities already have or have enacted paid sick time laws or ordinances prior to this year.  Joining them in 2017 are Federal Contractors and the states of Arizona, Vermont, and Washington.  Each of these laws share similar provisions.  Employees earn an hour of paid sick leave after having worked a certain number of hours.  Most provide for a 90 day period of employment before an employee can utilize the accrued sick time. For the purposes of calculating working hours, the hours are counted across weeks.  Most of the laws provide for some carry-over of unused time from year to year.

Several other states have enacted or will be expanding existing paid sick time provisions which will take effect in 2018. (CA, RI, WA, VT).  The state of Oregon passed an amendment to the paid sick time law that was enacted in 2016 that permits employers to limit the accrual of sick time to 40 hours per year. In addition, the amendment permit employers to not count certain individuals in the employee count for the purposes of the application of this law.

Parental Leave

California has enacted the New Parent Leave Act which takes effect on January 1, 2018.  The Act requires employers with 20 to 49 workers to offer 12 weeks of job-protected leave to mothers and fathers for the purposes of bonding with newborn or newly adopted children, or foster care placement. The employer also must maintain the employees’ health insurance and reinstate them at the end of their leave period. The law includes a strong anti-retaliation provision for employees who take leave under this law.

Paid Family Medical Leave

Currently three states (CA, NJ, RI) provide for some form of paid Family & Medical Leave.  Starting on January 1, 2018 private employers in New York must provide their employees who regularly work at least 20 hours a week the eligibility to collect paid-family-leave benefits after 26 weeks of employment, and employees who work fewer than 20 hours a week will be eligible after 175 work days. The leave can be used to after the birth, adoption, or placement of a foster child for up to one year.  Additionally, the leave can be used to care for the serious illness of a family member or a qualifying reason an employees’ spouse, domestic partner, child, or parent being on active military duty.

The Act will be phased in over the next few years.  Providing 8 weeks of leave in 2018 paid at 50% os the state’s average weekly was (SAWW).  In 2019, the leave time extends to 10 weeks at 55% of SAWW, 2020 maintains 10 weeks of leave paid at 60% of SAWW, to full implementation in 2021 when an employee can take up to 12 weeks of leave paid at 67% SAWW.

The State of Washington has passed a paid FMLA law that will start collecting premiums from employers in 2019 for enactment in 2020.  Washington DC also enacted paid FMLA that will begin in 2020 as well.


Starting in 2018, the State of California will require that employers with 50 or more employees include additional training information fo its employees on gender identity, gender expression and sexual orientation. The training must include practical examples of harassment. The new law also requires employers to post a poster, developed by the California Department of Fair Employment and Housing, on transgender rights.  In addition, the currently mandated two hour supervisor training must also include this new information and provide for annual updates to training programs.

That’s a Wrap

For many employers 2017 proved to be an unusual and challenging year. Aside from the changes details above, it is uncertain what lies on the horizon for EMS employers in 2018. As always, the American Ambulance Association will keep you posted on the important employment and human resources developments that may impact you.

2017 AAA Board of Directors Election Results

The winners of the 2017 AAA Board of Directors election are listed below. Please join us in thanking all candidates for their service to the American Ambulance Association.

Region I

Director (2019)

Jim McPartlon
Mohawk Ambulance Service



Alternate Director

Mike Addario
Vice President Operations – New York
American Medical Response


Region II

Director (2019)

Josef Penner
Executive Director


Alternate Director

Larry Wiersch
Chief Executive Officer
Cetronia Ambulance Corps, Inc.


Region III

Director (2019)

Wayne Jurecki
Vice President & Chief Operating Officer
Bell Ambulance, Inc.



Alternate Director

Tom Tornstrom
Executive Director
Gundersen Tri-State Ambulance


Region IV

Director (2019)

Alternate Directortetrault-david

David Tetrault
Administrator/ CEO
St. Francois County Ambulance District


Alternate Director

Doug Hooten
Chief Executive Officer
MedStar Mobile Healthcare


Region V

Director (2019)

Chris Archuleta
Superior Ambulance Service, Inc.



Alternate Directorpaul-pedersen

Paul Pedersen
Chris ArchuletaManaging Partner
Arizona Ambulance Transport


Ethics Committee

Ethics Committee (2019)

Deb Bode
Billing Manager
Lifeline Ambulance LLC.

Jamie Chebra

Ken Morris
Executive Vice President
Life EMS Ambulance

James “Jim” Winham
Chief Operating Officer
Emergency Medical Services Authority (EMSA)

American Ambulance Association Announces 2017 AMBY Award Winners

The American Ambulance Association is proud to announce the recipients of the 2017 AMBY Awards. The AMBYs highlight excellence in EMS and the ingenuity and entrepreneurial spirit that epitomize AAA members. The mission of the awards is to showcase creativity and innovation in the ambulance industry by fostering a culture of collaboration, cooperation and a passion for excellence in patient care. This year’s awards will be presented at the Annual Conference & Trade Show Awards Reception on Tuesday, November 14, 2017. Please join us in congratulating our 2017 winners!

Community Impact Program

NorthStar EMS, Inc.
St. Charles County Ambulance District

Employee Programs

MEDIC EMS Agency (North Carolina)

Quality Improvement Programs

MEDIC EMS Agency (North Carolina)

Public Relations Campaign

Medic Ambulance Service, Inc. (California)
Sunstar Paramedics

Other Programs

Porter EMS

Learn more about the AMBYs.

2017 AAA Award Winners Announced

The American Ambulance Association is proud to announce this year’s award winners. Awards will be presented at the AAA Annual Conference & Trade Show Membership Meeting on Tuesday, November 14, 2017. Please join us in congratulating this year’s winners!

J. Walter Schaeffer Award

Mark Meijer, Life EMS Ambulance
The J. Walter Schaeffer Award is given annually to an individual whose work in EMS has contributed positively to the advancement of the industry as a whole. Mark Meijer has achieved this through his many years of commitment and service to the ambulance industry.

Robert L. Forbuss Lifetime Achievement Award

Fred Della Valle, AMR Connecticut
The Robert L. Forbuss Lifetime Achievement Award is named in honor of the first Executive Director of the American Ambulance Association. It recognizes a volunteer leader who has made a significant long-term impact on the association. Fred Della Valle has achieved this through his decades of service, commitment, and dedication to the AAA and its members.

President’s Award

Dr. John Russell, Cape County Private Ambulance
Paul Main, American Ambulance of Visalia
These awards are bestowed by the President to volunteer leaders who have shown commitment to the advancement of the AAA above and beyond the call of duty. This year, the two outstanding volunteers represent tireless work on behalf of the AAA. Dr. Russell is recognized for his ongoing support of AAA’s programs and leadership on clinical and ambulance service standards. Paul Main has achieved this honor for his dedication and service to AAA’s Government Affairs efforts.

Distinguished Service Award

Jamie Pafford-Gresham, Pafford EMS
Shawn Baird, Woodburn Ambulance Service
The American Ambulance Association is proud to award Jamie Pafford-Gresham and Shawn Baird with the 2017 Distinguished Service Awards. Jamie Pafford-Gresham and Shawn Baird have achieved this distinction through their dedication, passion, and commitment in support of AAA’s Legislative Priorities.

2017 Affiliate of the Year

The American Ambulance Association (AAA) is proud to award REV with the 2017 Affiliate of the Year Award. REV has achieved this honor through their support of AAA’s programs and services including our 2017 Legislative Priorities.

EMS Partnership of the Year

James D. Green
National Institute of Occupational Safety and Health
Centers for Disease Control and Prevention
The EMS Partnership of the Year Award is given to an organization or individual whose collaboration with the AAA enhances educational programs, legislative priorities, and/or member benefits. James D. Green and NIOSH have achieved this honor through their commitment to ambulance vehicle and personnel safety standards.

EMS Innovation Award

Savvik Foundation
Savvik Foundation is honored with a special EMS Innovation Award for its commitment to supporting the future of emergency medical services through their grant program.

2017 Board of Director Candidates

Election Timeline | Board Candidates | Ethics Committee Candidates

The 2017 AAA Election is going paperless and this year’s election will be held entirely online. Primary contacts of Active Single State and Multi-State Members are permitted by AAA’s bylaws to vote in board elections.

Election Timeline

  • 10/11 | Voting Opens
    Ballots will be delivered to AAA Active Member primary contacts via email from announcement@associationvoting.com. If you have questions about your organization’s voter, please email Aidan Camas at acamas@ambulance.org
  • 11/2 | Voting Closes 11:59pm (Eastern)
  • 11/14 | Election results announced at the 2017 AAA Annual Conference & Tradeshow.

Slate of Candidates

Thank you and best of luck to this year’s slate of talented and seasoned board candidates.

Region I (4)

Region I Director—4 Candidates

Region 1


Mike Addario

Vice President Operations – New York
American Medical Response

Candidate Statement

Thank you for considering me as a director for Region 1. While a relative new-comer to the AAA, I have extensive experience in the EMS industry as a provider, leader and advocate. I firmly believe that we all share the same goal – to serve our communities and customers with excellence in care. However, we strive to do so in a rapidly changing environment that presents growing challenges to our industry. Since the release of “Accidental Death and Disability: The Neglected Disease of Modern Society” more than 50 years ago, so much has changed in EMS and in healthcare in general. As we look to the future, our long-term sustainability as an industry will be predicated upon our ability to adapt to this changing environment.The American Ambulance Association, through the participation of its members, is vitally important to our industry as we face these changes. It is my desire to be an advocate for the members in Region 1 as we prepare for the future and work toward the continued evolution of our industry.

History of Career in EMS

I started my career in 1983 after I took my first EMT class at Golden Cross Ambulance Service in Claremont, NH. I began working for Golden Cross as an EMT that year and continued working after I became a paramedic in 1987. I also volunteered for the University of New Hampshire-Durham Ambulance Corps from 1984 to 1986 while attending the University of New Hampshire. In 1988 I began work as a paramedic for Eastern Paramedics in Syracuse, NY. I became a supervisor in 1992 and continued to work in that capacity after Eastern was acquired by Rural/Metro in 1994. I became an operations manager in 1996 and General Manager in 1999. In 2014 I was promoted to Vice President of Operations for New York and remain in that capacity today with AMR. I also have experience as flight paramedic for the Onondaga County Sheriff’s Department/University Hospital air-medical program and as paramedic preceptor and board member for the Upstate Medical University’s paramedic program. I currently serve as a member of the United New York Ambulance Network, and served for more than a dozen years on the Central New York Regional Emergency Medical Services Council and Onondaga County Ambulance Board. Within the community, I served as chair of the American Heart Association’s Central New York Chapter in 2006 and in 2013 and as Chair of Leadership Greater Syracuse (LGS) from 2013 to 2015. LGS was founded in 1990 as a partnership between the City of Syracuse, Onondaga County, Onondaga Community College and Centerstate CEO with a mission to inspire current and future leaders to make a difference in the community.

Top 3 Issues in Emergency Healthcare

1. Reimbursement (Declining reimbursement and antiquated reimbursement models).
2. Outdated regulatory environment at the federal and many state levels.
3. EMS provider recruitment and retention.

Top 3 Priorities for AAA

1. Recognition and promotion of the ambulance industry’s current and future role in the healthcare spectrum, especially as it relates to the role of our EMS professionals. We need to transition away from the paradigm of transportation and focus on our evolving role as a key member of the healthcare community.
2. Payment reform to ensure a long-term, financially sustainable reimbursement model for our industry that is reflective of our changing environment. In concert with payment reform, we should focus on equal access to federal funding opportunities for workforce development. In 2012, total federal funding obligated to healthcare workforce development exceeded $14 billion.
3. Regulatory reform that positions our industry to be able to more readily adapt to our changing role within healthcare so we can continue to bring high quality care to our patients and the communities we serve well into the 21st century. We also need to continue advocating for regulatory reform that leads to a more streamlined focus on fraud, abuse and waste while easing regulatory burdens placed upon ambulance services.

Reginald Allen

CHS Mobile Integrated Health Care

Candidate Statement

I have enjoyed participating on AAA committees. I currently serve on the Professional Standards Committee, Payment Reform Committee, and represent the AAA on the EMS 3.0 Committee. I have been involved in EMS for the past 35 years, serving in many capacities. I am interested in sharing my experience with fellow members of AAA and serve to support the efforts of the AAA.

History of Career in EMS

I began my EMS service as an Explorer at the Gates Volunteer Ambulance in 1978. In 1980 (when I was 18 years old) I became a medic on the ambulance. At that time advanced first aid was all that was needed to be a medic. I also joined the Volunteer Fire Department in 1980. I attained EMT certification in 1983. I rose through the ranks at Gates Ambulance and served for 5 years as the Chief of Operations. I also rose through the ranks at the Volunteer Fire Department and attained the rank of Battalion Chief. I was working full time in the Safety industry during this time. I also worked part time at Monroe Ambulance, a commercial ambulance service providing 911 emergency service to the City of Rochester, NY. I taught Paramedic classes between 1997 and 2002 at the local Community College and started up a paramedic program at Jefferson Community College in Watertown, NY. I was hired as the Chief of Ontario County Advanced Life Support in 2004 and served in that position until 2007. I was hired as the Chief of Henrietta Ambulance in 2007 and continue my employment. In 2017, Henrietta Ambulance merged with Chili Ambulance and Scottsville Ambulance and our corporation name was changed to CHS Mobile Integrated Health Care and I was named CEO.

Top 3 Issues in Emergency Healthcare

1. Continue to ensure excellence in the ambulance services industry and provide research and educational programs that will have a positive impact on the services to help address the recruitment and retention issues that we in EMS are currently faceing.
2. Recognition of Paramedics and EMTs as a profession and paying a livable wage and agencies as providers.
3. Community Paramedicine or similar programs to help reduce overall health care costs and have patients treated at the most appropriate location, be it home, urgent care, physicians office, ED, etc.

Top 3 Priorities for AAA

1. Engagement of the EMS Community. We need a common voice to our communities and legislators to effect change to move our profession forward.
2. Lobby for stabilized and appropriate funding for EMS agencies
3. Recognition as EMS as essential emergency service and recognition as a provider for payors.


John Iazzetta

Vice President & Chief Operating Officer
Alert Ambulance Service, Inc.

Candidate Statement

The AAA serves a vital role by advocating and lobbying for essential reforms, educating members and providing even the smallest companies access to industry experts and services. These important things are only accomplished with a guidance, hard work and dedication of a strong Board of Directors. I feel that as the Region I Director I can help the AAA further its mission.

History of Career in EMS

I began as a 17 year old cadet EMT on my local volunteer first aid squad. I got my first paying job as an EMT with a small, private, family owned ambulance service while attending college. In 1997, after getting a job as a Dispatcher at Monoc (New Jersey’s largest EMS provider), I began Paramedic school. After working as a staff Paramedic for quite a few years, I eventually made my way into management. I was Monoc’s ALS Operations Coordinator when I left to become the Director of Operations at Alert Ambulance Service; a large, family owned private company transporting over 100,000 patients a year. A few years later I was promoted into my current position of VP & COO.

Top 3 Issues in Emergency Healthcare

1. Ambulance Payment Reform.
2. Recruitment & Retention of EMTs & Paramedics.
3. Educating the Public as to who we are and what we really do.

Top 3 Priorities for AAA

1. Advocating and Lobbying for Ambulance Payment Reform.
2. Facilitating Provider Education through Webinars, Workshops and Conferences.
3. Providing access to services such a HR and Legal advice to even the smallest companies so as to further our industry as a whole.

Jim McPartlon

Mohawk Ambulance Service

Candidate Statement

Many challenges continue to occur with Medicare Relief Extensions and Payment Reform which I would like to continue working on. I would like the opportunity to continue to share my experience and vision on the AAA Board of Directors. I would be honored to have the opportunity to continue to serve the AAA members and not only advance our solid foundation, but use the knowledge that I have obtained over 40 years in the ambulance industry to provide unparalleled service to those who depend on us. As a current the AAA Board Director, and former Treasurer, and Past President, I have personally worked with Senator Schumer, his office, and other Congressional Offices to secure Medicare Relief for all of us. I would like the opportunity to continue working on our behalf in an effort to promote additional Medicare Relief, encourage permanent payment reform and, most importantly, be your voice on the significant issues that challenge this vital industry. Your vote for me to represent you on the Board of Directors of the American Ambulance Association will allow me the chance to once again, work on your behalf. If ever you need to reach out to me, please call me at (518) 346-5060. I ask for your vote and support for Region 1 Director.

.History of Career in EMS

I began working on the ambulance in high school, continued through college and became active with the AAA as a member upon graduating college. I have remained actively involved in EMS and it has remained my life’s work.

Top 3 Issues in Emergency Healthcare

1. Reimbursement
2. Employee Recruitment & Retention
3. Management Bench Strength

Top 3 Priorities for AAA

1. Reimbursement for its members
2. Membership Development
3. Educational Sessions.

Region II (2)

Region II Director—2 Candidates

Region 2


Josef Penner

Executive Director

Candidate Statement

The AAA’s advocacy on national reimbursement is critical to success of EMS delivery. Reform of the healthcare systems and payment systems like Medicare must progress with a strategic framework that represents the needs of all members and their communities. We must develop effective programs that help members identify and engage employees into becoming the leaders of tomorrow. The Association cannot be all things for all folks; rather it should aim to convene and connect members to ideas, technical information and competency development to advantage their success in the local marketplace.

History of Career in EMS

Joe Penner is the Executive Director for Medic, the paramedic service for the Charlotte, North Carolina area. He is a Fellow and Board Certified in Healthcare Management by the American College of Healthcare Executives, Board member for the Commission on Accreditation of Ambulance Services, Chairman of the Charlotte Mecklenburg Housing Coalition and Charlotte Rotary Board Member. Mr. Penner is an active member of the American Ambulance Association and North Carolina EMS Administrators Association. He holds an MBA from Marquette University, completed training as an Improvement Advisor with the Institute for Healthcare Improvement and graduated from the UCLA/Daniel Freeman Hospital School of Paramedics.

Top 3 Issues in Emergency Healthcare

1. Improving reimbursement.
2. Reducing costs and simultaneously improving access and quality.
3. Leveraging access points (like EMS) to connect people to the care they need.

Top 3 Priorities for AAA

1. Defending and improving Medicare reimbursement.
2. Educating members to navigate opportunities brought by healthcare reform.
3. Provide / facilitate useful educational opportunities for our members.

Larry Wiersch

Chief Executive Officer
Cetronia Ambulance Corps., Inc.

Candidate Statement

I am proud of my service to EMS and our AAA Board as a Region II Alternate Director. During this time of uncertainty and constant change, I will continue to work hard for our association members to ensure that whatever we do for our industry serves our patients and our dedicated professionals with the very best. We need leadership that understands the need to change, challenges the “status quo” on issues that affect our members. Our members, our patients and our communities deserve national leadership that incorporates meaningful processes that supports healthy debate that achieves outcomes with the best possible results.
I believe that my past involvement with the AAA as a Board member for more than ten years and also on multiple committees including government affairs, professional standards, federal reimbursement and numerous other special work groups gives me insight into methods that work. While we must not dwell in the past, we must learn from it while moving forward into the future. I promise, that I will do my very best to represent our region, our association, our employees and most importantly our life saving mission. I will always promote quality EMS that represents all provider types, support good governance and embrace healthy change that saves more lives and allows us to deliver on our promise of service to our community.

History of Career in EMS

I my career in EMS in 1976 as one of the first crews on newly formed Upper Saucon Ambulance in Center Valley, PA where I volunteered as an advanced first aid certified provider. I progressed to one of the regions first emergency medical technician graduates in 1977 and became a paramedic in 1982 where I served as one of the first paramedics on newly formed South Mountain Area Medic Five in Center Valley Pennsylvania where I also volunteered until moving to a full time EMS career in the mid 1980’s. I have worked for the City of Allentown Paramedics, Upper Bucks Paramedics, and began my career with Cetronia Ambulance Corps in 1982 as a volunteer and later accepting a full time Paramedic Supervisors position in 1989; Director of Operations in 1992 and Chief Executive in 1998, a position that I hold today. I am a 1995 Graduate Cum Laude of Allentown College of Saint Francis DeSales, with a Bachelor in Safety Management and a Certificate in Business Management. I also am a graduate of The University of Maryland Baltimore County Campus with a Master of Science in Emergency Health Services with a GPA of 4.0.

Top 3 Issues in Emergency Healthcare

1. Reimbursement.
2. Strategic Development of alternative revenue streams and sustainability plans.
3. Succession and staff development planning.

Top 3 Priorities for AAA

1. Reimbursement.
2. Government Affairs.
3. Professional Standards.

Region III (2)

Region III Director—2 Candidates

Region 3


Wayne Jurecki

Vice President & Chief Operating Officer
Bell Ambulance, Inc.

Candidate Statement

My name is Wayne Jurecki and I am honored to have been elected, and to serve, as Director – Region III of the American Ambulance Association since 2015. I have been involved with the Association since the early 1990’s. Previously I had been a co-chair of the Medicare Regulatory Committee, member of the Strategic Planning Workgroup, and speaker at both the Reimbursement and Annual conferences of the Association.

I am the Vice President and Chief Operating Officer of Bell Ambulance, Inc. of Milwaukee, Wisconsin. I have been with Bell for 33 years and started by doing data entry in the Billing Office. During my time at Bell I have worked in the Billing, Accounting, Human Resources, and Information Technology Departments. In 2003 I became Vice President and in 2011 became the Chief Operating Officers. I was instrumental in the drafting and negotiation of several service contracts, including Bell’s involvement in the City of Milwaukee’s 911 system. I have been involved in Bell’s growth from three locations within the City of Milwaukee to nine locations in Southeastern Wisconsin.

I am seeking re-election to the position of Director – Region III of the American Ambulance Association. I feel I can continue to be beneficial to the Association as we attempt to secure long-term reimbursement and regulatory reforms for the ambulance industry.

History of Career in EMS

I am currently a Director – Region III of the American Ambulance Association, and Director on the Catalyst Insurance, Ltd. Board. I have been involved in EMS with Bell Ambulance since 1985. I have worked in the Billing, Accounting, Dispatching, and IT departments over the intervening years. Significant involvement in Bell’s contract negotiations with the City of Milwaukee and Hospital Systems. Ongoing influence on local Ordinance revisions affecting the ambulance industry in the City and County of Milwaukee. Instrumental with the Professional Ambulance Association of Wisconsin’s contract negotiations with the State Division of Health regarding non-emergency transportation services to Medicaid recipients. I have been involved with the AAA for over 20 years.

Top 3 Issues in Emergency Healthcare

1. Sustainability under increasing regularity and fiscal pressures
2. Uncertainty of non-emergency transportation coverage
3. Uncompensated and under-compensated care

Top 3 Priorities for AAA

1. Obtain long-term reimbursement relief
2. Obtain/ensure a consistent industry message
3. Maintain/expand the AAA’s influential position on regulatory issues

Tom Tornstrom

Executive Director
Gundersen Tri-State Ambulance

Candidate Statement

I am excited to seek candidacy to represent Region III on the AAA board of directors. My career in EMS began in 1990 as a volunteer EMT for a small town in the Midwest. It didn’t take long as an EMT to change my career goal from law enforcement to EMS and it was the right move for me. I love EMS and will continue to do my part to ensure its healthy future.

Having held numerous positions from EMT, paramedic, technology supervisor, manager, and on to my current role for the past eight years as an executive director has given me a strong understanding of our profession and industry. I’m experienced with rural and urban operational, financial, clinical, and political challenges inherent and unique to our profession. I have a very strong interest in business management processes and the use of technology in working toward better patient outcomes and improved efficiencies.

As an executive board member of the Professional Ambulance Association of Wisconsin (PAAW), I demonstrate my advocacy for our members by being integrally involved in new and exciting legislation which benefit all ambulance service providers in the state. I know first-hand the current struggles our profession faces and realize that we must work hard on many levels to prepare for and shape our future.

As a Region III board representative I will strive to represent our profession and region with professionalism, competence, and optimism. I appreciate your consideration of my candidacy.

History of Career in EMS

1990: EMT – volunteer in Caledonia, MN
1994: Paramedic – full time with Tri-State Ambulance, La Crosse, WI
2006: Supervisor – operations and technology
2008: Operations supervisor
2009: Executive Director (three related companies)

Top 3 Issues in Emergency Healthcare

1. Proving our worth by adequately improving and proving patient outcomes.
2. Reimbursement levels and their cause/effect.
3. Recruitment and retention.

Top 3 Priorities for AAA

1. Reimbursement improvement/sustainability.
2. Promotion of the profession as a career.
3. Greater integration with healthcare.

Region IV (3)

Region IV Director—3 Candidates

Region 4


Daniel Gillespie

Dan-imageRegional President
Allegiance Mobile Health of Texas

Candidate Statement

As an active member of the AAA, I am proud to have previously served on the board as alternate director for region 4, and currently serve on the Non-Emergency Task Force. I believe strongly in the work that the AAA does on behalf of EMS in America. I will continue to personally support the collective efforts of our industry in both monetary, and time commitments. As we progress thru a new legislative cycle it is imperative that our message is heard loud and clear by our leaders in D.C. We must also stay focused on operational issues plaguing our industry such as paramedic shortages and limited access to educational systems in our rural areas that produce new medics and EMT’s. If chosen, I will continue to work diligently along side the AAA leadership to protect the fabric of our industry and to further the advancement of the EMS profession.

History of Career in EMS

EMT – Wayne Township Fire Department Indianapolis, IN
Director of Public Relations – Care Ambulance Service. Indianapolis, IN
EMS/Critical Care Transport Program Manager – St. Vincent Hospital. Indianapolis, IN.
Indiana Division General Manager – Rural/Metro Ambulance
Executive Director – Gateway Ambulance. St. Louis, MO.
Vice President of Operations – Allegiance Ambulance. Corpus Christi, TX.
Regional President – Allegiance Mobile Health. South/Central Texas

Top 3 Issues in Emergency Healthcare

1. Funding and Reimbursement.
2. Heavily regulated by multiple agencies with conflicting rules.
3. Staffing shortages and difficulty in recruiting due to pay limitations from the above mentioned issues.

Top 3 Priorities for AAA

1. We MUST become recognized as a provider with CMS to further our profession. We will continue to be limited in both scope and in reimbursement options as long as we are a supplier.
2. We must work to get reimbursed by CMS at a level that meets or exceeds our cost to operate.
3. We need to work closely with the current presidential administration to begin eliminating the efficiency crushing regulations and reform our payment structure.

Douglas Hooten

Chief Executive Officer
MedStar Mobile Healthcare

Candidate Statement

America’s healthcare system is dramatically changing. Healthcare finance reform has created a dramatically new environment for all types of providers, including ambulance providers. The leadership of the American Ambulance Association needs to prepare its members to navigate this new environment. MedStar Mobile Healthcare has successfully capitalized on this new environment and if re-elected, I will continue to assist the members of the Association thrive in this new environment.

Working with local and national officials, too often I hear their frustrations about the complexity of the financial models of industry. We must help our membership and industry enhance our financial acumen and economic agility to test new payment models. At MedStar, we have done exactly that – testing several new payment models, with more to be tested in the near future. We also hear from our external partners that the ambulance industry as very fragmented messages within the DC beltway and with large national payers. One of my goals will be to help bring external message clarity to the profession.

Our customer’s expectations are changing – most notably, the desire to carefully shift from volume-to-value based economic models. Our industry leadership is currently ill prepared to make this shift, primarily because we have not taught them how. Having worked diligently with numerous external partners on demonstrating, and getting paid based on the value we bring, as your Region IV representative, one of my goals will be to help facilitate educational opportunities based on value-based payment models to the AAA members.

History of Career in EMS

My EMS career began at the age of 18 working for my mother in her small ambulance service in south Texas as an EMT. Those humble beginnings led to a passion for the ambulance industry. In my early career, I worked as a Paramedic and Supervisor for the Montgomery County Hospital District in Central Texas. From there, my career took me through numerous senior management roles at Rural/Metro in Texas, Ohio, Georgia, South Carolina and Florida. I then served as the Executive Director for the Kansas City, MO Public Utility Model (MAST) before accepting the position Senior Vice-President for Domestic Operations at AMR. I came home to MedStar in 2011 as their Chief Executive Officer.

Top 3 Issues in Emergency Healthcare

1. Transitioning from fee for service to outcome-based payment models.
2. The changing expectations of current customers and entrance of new customers for our services into the market.
3. Demonstrating “value” of our service delivery model, or changing the model to demonstrate value.

Top 3 Priorities for AAA

1. Making the temporary Medicare Add-Ons permanent.
2. Changing our payment focus away from simply Fee For Service payment to types of value-based payment model that pays us for the care we provide rather than the transport we supply.
3. Collaborating on unified key messages with other associations about the value the ambulance industry brings to our patients, our community and our payers.

David Tetrault

Administrator/ CEO
St. Francois County Ambulance District

Candidate Statement

As I run for the AAA Board of Directors Region 4 seat, I’m asking for your vote to continue our work bringing EMS forward. Let me be your voice on Capitol Hill as we continue to fight for both small, rural services as well as larger and urban providers. I will follow through, surface and address concerns within the region, and serve the needs of ambulance services across our nation to the very best of my ability.

I’ve served in EMS for more than 27 years, and have demonstrated my committed to EMS advocacy through attendance at hundreds of meetings and volunteering thousands of hours as a director and chair at both the state and national level.

As past president of the Missouri Emergency Medical Services Association and other positions I have been responsible for assisting and participating in planning, preparation, and execution of our annual meetings and workshops. I have also been instrumental in internal audits and the recommendation and implementation of financial procedures for MEMSA. I was a principal player in starting EMS day at the State Capital more than 10 years ago and am still actively involved in legislative activities and initiatives.

I am presently Chair of the AAA’s Membership Committee, in addition to Alternate Director for Region 4. I am also a proud past AAA Region 4 Director.

Given the opportunity, I will use all of my experience, skills, and abilities to drive results for YOUR ambulance service.

History of Career in EMS

Critical Care Paramedic University of Baltimore Maryland Provider
Experienced Provider, Instructor American Heart Association Instructor
ACLS Instructor, Regional Faculty American Heart Association
BCLS Instructor, Regional Faculty American Heart Association
PALS Instructor, Regional Faculty American Heart Association
ITLS Instructor, Affiliate Faculty-MO International Trauma Life Support
EPC Instructor National Association of EMT
AMLS, Instructor National association of EMT
PEPP ALS Course Coordinator American Academy of Pediatrics
Pediatric ITLS Instructor International Trauma Life Support
Advanced Stroke Life Support University of Miami Miller School Provider
Ambulance Strike TEAM/Task Force Leader

Top 3 Issues in Emergency Healthcare

1. Healthcare Reform, Medicare and Medicaid issues with understanding EMS
2. Making sure that EMS, stays in front and continues to be recognized in this country as part of the 3 first responders and held in the same light, strength and representation as Police and Fire.
3. Standardization across the country and less fragmentation among EMS providers

Top 3 Priorities for AAA

1. Education, training, focused work on reimbursement for Ambulance services throughout the country
2. Communications to its members and growing strength in numbers and voices across the country
3. Moving EMS forward and continuing to make our voices heard loud and clear, and that we are here to stay. Keeping up with all the healthcare changes and reforming EMS for the future.

Region V (2)

Region V Director—2 Candidates

Region 5


Chris Archuleta

Superior Ambulance Service, Inc.

Candidate Statement

Last year I was voted to represent you in Region V as an Alternate to the Board of Directors. This has been a great experience working with the AAA Board of Directors. As a Director I’ve seen how much the Board of Directors are involved with issues that affect our industry, and how important it is to have active and members on the Board that are well versed with our industry.

In the past year we discussed changes and upcoming changes within our industry that affect us daily; changes in Federal regulations such as reimbursement, increased audits, and CMS expecting more and more from us as providers. Although we as an industry all feel the effects of the demands being placed upon us, I see that many of us as medium and small providers will have a difficult time trying to stay compliant while trying to stay fiscally viable. Many of us as small and medium providers live and operate within the communities we serve, and because we’re vested to our communities, we’re so entrenched and obligated to our communities that we don’t always have the time to voice our concerns to those handing down regulations that will affect our business. Therefore it’s important that we have someone representing us, someone who knows how these regulations will affect us. My concern is your concern, as many of the ambulance services in this country are small and medium sized services, and just like you, I have everyday concerns as I too am a medium sized provider, that when new regulations are handed down upon us, I wonder and worry how it will effect my business.

As your Director I want to involve myself as much as possible in voicing the concerns of our industry and how some regulation changes can affect the ambulance industry, and how the effects can impact the smaller and medium services. As I indicated above, I was elected last year as an alternate which gave me the experience to continue forward as a Director. This year I’m seeking your vote so that I can continue in representing you as a Director for Region V. Thank you for your consideration.

History of Career in EMS

I was an EMT and a paramedic between 1977 and 1986 while in the fire department, and prior to my becoming a fire investigator in the department. My role in EMS was limited until my deciding to go back into EMS in 1994 when I purchased the ambulance company I currently operate. The company I own started as a small privately owned service in NM to one of the larger private and territorial services in NM.

Top 3 Issues in Emergency Healthcare

1. The repeal and/or changes regarding the ACA
2. Medicare / Medicaid reimbursement
3. The lack of private sector paramedics available for employment

Top 3 Priorities for AAA

1. CMS regulatory issues and Medicare reimbursement
2. Legislative representation in Congress regarding the repeal or modification of the ACA
3. AAA increases in membership recruitment

Paul Pedersen

paul-pedersenManaging Partner
Arizona Ambulance Transport

Candidate Statement

I have served on the board for almost a year. I know first hand the good work the association does. I have had occasion to advocate with legislators for Medicare reform. The AAA’s work in advocating for members helps to create an environment in which we members can provide the professional services our patients deserve. The AAA offers an excellent array of services to members.

History of Career in EMS

Area General Manager for Southern Arizona, Rural/Metro Corp.
Co-founder, co-owner, Arizona Ambulance Transport.

Paul Pedersen is a graduate of the University of Arizona and holds a masters degree from St. Mary’s College of California. Pedersen is a 20 year veteran of the Pima County Sheriff’s Department in Tucson, retiring as a lieutenant. He retired as a lieutenant colonel from the U.S. Army Reserve. Pedersen has worked in the private sector managing the installation of public safety radio communications systems. He was the director of Clackamas County Oregon Communications Department and was general manager of Southern Arizona for the Rural/Metro Corporation. He has held board positions with the Red Cross in Tucson, Minneapolis and Portland, Oregon. He has also served as an instructor for numerous law enforcement training courses as well as the Federal Emergency Management Agency.

Top 3 Issues in Emergency Healthcare

1. Reimbursement/funding
2. Changing healthcare systems/delivery
3. Recruitment & retention

Top 3 Priorities for AAA

1. Reimbursement/funding
2. Be a viable and recognized player in healthcare (and the changes therein)
3. Market member benefits

Ethics Committee Candidates

Thank you to the following candidates for the AAA Ethics Committee. Voters may select up to four.

  • Deb Bode – Lifeline Ambulance LLC.
  • Jamie Chebra – JFK EMS
  • Ken Morris – Life EMS Ambulance
  • Michael Pieroni – MedEx Ambulance Service
  • Jim Winham – Emergency Medical Services Authority (EMSA)

Questions? Please contact acamas@ambulance.org for assistance.

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”

Hurricane Harvey: JEMS-AAA Adopt-An-EMS-Family Program

JEMSEMS professionals selflessly serve their communities each day. But even the most capable healthcare providers sometimes need a little help themselves, especially in the face of a natural disaster. AAA has partnered with JEMS to assist EMS families severely impacted by Hurricane Harvey in Texas and Louisiana via the “Adopt-an-EMS-Family” program.

Established in August 2005 in the aftermath of Hurricane Katrina, the program is empowers EMS agencies, their staff, and other participants to provide direct, personal support to EMTs, Paramedics, Dispatchers, and other EMS professionals who were significantly affected by a large-scale disaster.

We invite your ambulance service to join us in adopting the families of EMS providers recovering from the effects of Hurricane Harvey. Sign up below to be assigned a family or group of families to assist in their time of need. Thank you in advance for your support and participation.

2017 AAA Election Calendar

2017 Election Timeline

  • 8/31Nominations Close
  • 9/14 | Approval of Candidates by AAA Board of Directors
  • 10/11 | Voting Opens
    Election will be paperless and held online. Ballots will be delivered to AAA Active Member primary contacts via email.
  • 11/2 | Voting Closes 11:59pm
  • 11/14 | Election results announced at the 2017 AAA Annual Conference & Tradeshow.

Meet the Candidates

The AAA’s 2017 Election will be for the following positions:
  • Region I Director (CT, MA, ME, NH, NJ, NY, RI & VT)
  • Region II Director (AL, DE, DC, FL, GA, MD, MS, NC, PA, SC, VA, WV)
  • Region III Director (IL, IN, KY, MI, OH, TN WI)
  • Region IV Director (AR, IA, KS, LA, MN, MO, OK, ND, NE, SD, TX)
  • Region V Director (AK, AZ, CA, CO, HI, ID, MT, NM, NV, OR, UT, WA, WY)
  • Ethics Committee



Questions? Please contact acamas@ambulance.org for assistance.

2017 AMBY Nominations Now Open!

Nominations for the 2017 AMBY Awards is now open! The AMBYs recognize excellence in the ambulance profession and the ingenuity and entrepreneurial spirit that epitomize AAA members. Honor excellence in EMS by nominating a project within a service or company for consideration.

Read the 2016 case studies to find out why we’re passionate about honoring your commitment to excellence.

Why Bring the AMBYs to Your Organization?

Share Your Knowledge with Your Peers

By entering the AMBYs you show your commitment to excellence in the ambulance industry and your willingness to share your superior accomplishments with your peers. Winners will are awarded during the AAA Awards Reception at our Annual Conference & Trade Show in Las Vegas, In addition, all entries will be shared with the AAA membership on the website, in the association’s mobile event app and as an online publication.

Show Your Value to Your Community

AMBY Award winners are given the American Ambulance Association’s AMBY Award Winner logo to proudly display on their website, social media sites, and other marketing collateral to let key stakeholders know the Association recognizes your contribution to the industry as outstanding. In addition, winners will receive a press release template to send to your local press. All winners will be published in a press release sent out by the association and in a case study and winner’s gallery e-publications.

Gain Valuable Feedback

The AMBY Awards are judged by your colleagues on the AAA Professional Standards Committee. With years of collective experience the panel of committee member judges understand the challenges, opportunities and desired outcomes inherent in the EMS profession. As leaders who value creativity and innovation they can appreciate the complex demands of the industry and will provide thoughtful and useful feedback in the scoring of all entries.

Strengthen the Profession

Award-winning work helps to nurture the EMS industry’s deeply rooted culture of collaboration, cooperation and a passion for excellence in patient care. The AMBY Award Winners’ Gallery will provide an inspiring collection of winning strategies and best practices to be emulated by other AAA members.


How to Enter

AMBY Award entries are open to AAA ambulance service members and our affiliate members. All entries must include a Statement of Entry. Statements of Entry and all supporting documentation are submitted through our online form with requirements listed below. Entry materials will be retained and shared with AAA members as best practices and entrants agree that all materials may be used by the AAA for AMBY marketing purposes.

Entries will be judged by the Professional Standards Committee. Entries and will be judged against their own objectives not against each other, in 4 equally weighted areas: Goals, Planning & Implementation, Project Results and Impact. Any judge having business relations with an entrant must recuse themselves from scoring that entry. Both the high and low scores will be thrown out and remaining scores will be averaged. Work completed within the last 18 months will be eligible for entry. All Entrants will be notified of the results prior to the AAA Annual Conference & Trade Show.

Ambulance Services

Statement of Entry Requirements

Statement of Entry Requirements

  • Organization
  • Service Type
  • Service Size
  • Individuals involved in the project
  • Situational Analysis
  • Project Goals
  • Planning & Implementation
  • Project Results
  • Impact
  • Cost/Budget ( can be submitted as overall % to departmental budget)

Entry Categories

Entry Categories*

  • Public Relations Campaign
  • Community Impact Program- open to any community based program to include: Safety, Environmental, Health or Awareness Campaigns, Corporate Give Back or any other program that was designed for, or impacted your community.
  • Employee Programs -can be any employee program from recruitment and retention to recognition, leadership development, training, EMS Week programs, etc.
  • Quality Improvement Program
  • Clinical Outcome Project
  • Innovation in EMS
  • Other



AAA Members: $100 per entry
Non-Members: $500 per entry


Affiliates (Vendors) 

Statement of Entry Requirements

Statement of Entry Requirements

  • Organization
  • Product or Service Provided
  • Individuals involved in the project
  • Situational Analysis
  • Target Demographic
  • Project Goals
  • Planning & Implementation
    Project Results
  • Impact for customer
    Cost/Budget (affiliate or client budgets will not be shared or published by the AAA)

Entry Categories

Entry Categories*

  • Equipment/Supplies
  • Consulting/Management
  • Financial/Administration
  • Quality/Safety
  • Education/Training
  • Technology/Hardware/Software



Affiliate Members: $500 per entry
Affiliate Non-Members:  $1,000 per entry

Winning Affiliate entries that include work or projects involving a client that is an AAA member will receive duplicate AMBY’s and both the vendor and the client will be acknowledged as winners.

Board of Director Nominations – Now Open!

Call For Nominations Now Open!

Submit a Nomination

Submit Candidate Questionnaire

In accordance with the Bylaws of the American Ambulance Association, it is time to call for members in good standing that wish to serve on the Board of Directors. The AAA is now seeking candidates for the following positions:
  • Region I Director (CT, MA, ME, NH, NJ, NY, RI & VT)
  • Region II Director (AL, DE, DC, FL, GA, MD, MS, NC, PA, SC, VA, WV)
  • Region III Director (IL, IN, KY, MI, OH, TN WI)
  • Region IV Director (AR, IA, KS, LA, MN, MO, OK, ND, NE, SD, TX)
  • Region V Director (AK, AZ, CA, CO, HI, ID, MT, NM, NV, OR, UT, WA, WY

Individuals who wish to be considered for an elected position as Regional Director must:

1. Be the designated representative of an Active member of the AAA, in good standing;

2. Be ready to devote time and effort to matters which concern the Board of Directors and to actively participate in all Board activities;

3. Be prepared to assist other AAA members with concerns and problems which relate to the ambulance industry and the workings of the AAA; and,

4. Understand that these positions provide no compensation for time or reimbursement for expenses. All travel-related expenses, including transportation, lodging and food are the responsibility of the individual and/or the sponsoring organization.

5. Be willing to comply with all governance policies of the association including, Conflict of Interest, Standards of Conduct, and Board Confidentiality, Public Comment and Lobbying Agreement (PDF).

6. Have served on at least one (1) Association committee within the past five (5) years prior to his or her declaration as a candidate for election as a Director.

There are no restrictions against an individual running for more than one position in the same election cycle, though no person shall hold more than one position simultaneously.

All those who wish to stand for election and believe they are qualified are requested to complete a Nomination Form as well as answer the Candidate Questionnaire which describes both their qualifications and reasons for wanting to participate in the leadership of the AAA.

(Please note that the may Nomination Form be completed by any designated contact for an AAA active member for him or herself, or on behalf of another designated contact at a fellow AAA active member service. The Candidate Questionnaire must be completed by the nominee.)

Candidates’ statements and pictures, as well as the position(s) for which they are running for will be listed on the AAA website.

2017 Election Timeline

  • 8/31Nominations Close
  • 9/14 | Approval of Candidates by AAA Board of Directors
  • 10/3 | Voting Opens
    Election will be paperless and held online. Ballots will be delivered to AAA Active Member primary contacts via email.
  • 11/2 | Voting Closes 11:59pm
  • 11/14 | Election results announced at the 2017 AAA Annual Conference & Tradeshow.

Both forms must be submitted to by Thursday, August 31, 2017

Step 1: Nomination Form    Step 2: Candidate Questionnaire

Questions? Please contact acamas@ambulance.org for assistance.