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
Take Action for Extending Medicare Ambulance Relief
Ask your Representatives to Support H.R. 3236 – The Ambulance Medicare Budget and Operations Act of 2017
The current 33-month extension of the Medicare add-on payments is set to expire at the end of December 2017. Losing these add-on payments would be a devastating blow to ambulance services across the country. It is crucial that the payments be extended as we push for a long-term solution. H.R. 3236 introduced by Reps. Nunes, Upton, and Welch would extend the current temporary Medicare add-ons for five years. More details about the Bill can be found below. Let your Representative know that you support H.R. 3236 — Here are three quick and easy ways to get involved!
Writing to your members of Congress only takes 2 clicks, follow these simple steps:
1. Enter contact information below (required by Congressional offices) and click “Submit”
2. On the next page you’ll see the letter to your Representative (Message 1) and the letter(s) to your Senators (Message 2) – click “Submit Messages”
Feel free to personalize your letter(s) before submitting them.
Active on Social Media? Tweet at your Representative asking for their support of H.R. 3236!
Authorize Your Account
Enter Contact Information
Tweet! (Tweet will be auto-generated with your Senators tagged)
Know your Senators’ Twitter accounts already? Tweet:
“#ambulance svs in your district need you, @[your Representative]! Please co-sponsor HR 3236 to help us continue to provide quality #EMS!”
Post on Facebook why H.R. 3236 is important! Be sure to tag your Representative and encourage others to share your post! Ask others to write letters of support as well! http://bit.ly/AAAbill
More About Our Bill H.R. 3236, the Ambulance Medicare Budget and Operations Act of 2017: Legislation to extend the Medicare ambulance add-on payments for five years has been introduced by Representatives Nunes, Upton, and Welch (H.R. 3236).
Specifically, the bill:
Provides Medicare Ambulance Relief, by extending for five years the current temporary 2 percent urban, 3 percent rural, and super rural bonus payments.
Requires the Medicare Payment Advisory Commission (MedPAC) to submit a report to Congress detailing the burden of cost reports on the ambulance industry and accuracy of the data received through ambulance cost reports and making recommendations on whether the system should be modified no later than July 1, 2019.
Requires CMS to work with stakeholders in the development of an ambulance cost report.
Take Action for Permanent Medicare Ambulance Relief
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”
Tweet! (Tweet will be auto-generated with your Senators tagged)
Know your Senators’ Twitter accounts already? Tweet:
“#ambulance svs in your state need you, @[your Senators]! Please co-sponsor S. 967 to help us continue to provide quality #EMS!”
Post on Facebook why S. 967 is important! Be sure to tag your Senators and encourage others to share your post! Ask others to write letters of support as well! http://bit.ly/AAAbill
More About Our Bill S. 967, the 2017 Medicare Ambulance Access, Fraud Prevention, and Reform Act: Permanent ambulance relief legislation has been introduced by Senators Stabenow, Roberts, Schumer, Collins, and Leahy (S. 967). This legislation will allow ambulance service providers to maintain high quality ambulance services and budget for the future. Specifically, the bill:
Provides Medicare Ambulance Relief, by permanently incorporating the current temporary 2 percent urban, 3 percent rural, and super rural bonus payments into the Medicare ambulance fee schedule rates.
Requires the Centers for Medicare and Medicaid Services (CMS) to submit a report to Congress detailing the features of a reformed payment system for ambulance services under the Medicare program no later than July 1, 2019.
Modifies the process for the transport of dialysis patients by requiring the Department of Health and Human Services to establish a process for the prior authorization of coverage for such patients.
Treat ambulance services designated as “suppliers” as “providers” for certain purposes under Medicare.
Specifies CMS to work with stakeholders in the development of a data collection system for ambulance entities that defines the various types of ambulance entities as well as the relevant cost and data elements required for submission.
The top legislative priority this year for the American Ambulance Association is to extend, or hopefully make permanent, the temporary Medicare ambulance add-on payments. The temporary increases of 2% urban, 3% rural and the super rural bonus expire at the end of this year. The 2% urban and 3% rural increases have been in place since 2008 and the super rural bonus payment since 2004. While the AAA and our members have been successful in getting the payments extended numerous times, 2017 is not a typical year and we need everyone to be prepared to help push to make the increases permanent or extended for the longest possible duration.
The other top priorities for the AAA are for the Centers for Medicare and Medicaid Services (CMS) to recognize ambulance services more like providers of medical services instead of merely suppliers of transportation. In addition, it is critical that Congress direct CMS to collect cost data from ambulance service providers using a method, which will result in usable and meaningful data from everyone, but also not be overly burdensome on extremely low volume providers. Finally, Congress needs to target fraud and abuse with the transport of dialysis patients through a prior authorization program instead an arbitrary payment cut that impacts all providers.
The AAA is pushing its agenda again through a version of the Medicare Ambulance Access, Fraud Prevention and Reform Act which we hope to have introduced in the next few weeks. We are working with our champions on Capitol Hill on a different approach to being treated more like providers to mitigate issues raised about the provision last Congress. Instead of being listed in the Social Security Act as having provider status, we are looking to a hybrid model similar to dialysis facilities. This will clarify that we are not seeking to be treated like providers to achieve Medicare coverage because we are already reimbursed under the Medicare program. It will however still set the foundation for future legislative and regulatory changes to the Medicare fee schedule such as reimbursement for transporting to an alternate destination or treat and referral.
We are also making potential modifications to the House bill on our proposed data collection system. These changes would help with possible Committee consideration of the provision but still hopefully achieve or goal of obtaining useable data that is not overly burdensome to 73% of our industry which is composed of providers that do less than 1,000 Medicare transports a year of less. It is vital that we have meaningful data to make data-driven decisions as to changes to the Medicare ambulance fee schedule.
Ambulance Advocacy Webinar
We will let you know as soon as the revised legislation is introduced for the new Congress. In the meantime, we encourage you to register for the upcoming AAA webinar on the Ambulance Advocacy Action Plan with AAA Senior Vice President of Government Affairs Tristan North and AAA Government Affairs Coordinator Aidan Camas. Tristan and Aidan will provide you the latest information on our advocacy efforts and let you know how you can help. To register for the webinar which is free to AAA members, please go to: https://ambulance.org/product/ambulance-advocacy-action-plan/.
Also read Tristan and Kathy Lester’s recent Member Advisory on ACA Repeal & Reform:
CMS held its latest Ambulance Open Door Forum on April 22. It started with the following two announcements:
– H.R. 2 was signed into law extending the temporary ambulance adjustments through December 31, 2017. The adjustments are 2% (urban pick-ups), 3% (rural) and 22.6% (super rural).
– For free standing facilities, use the “P” modifier if the facility is not part of the hospital and use “H” if it is hospital-based.
Following these announcements, there was a Question and Answer period. Most of the questions were not answered on the call and the caller was asked to submit their questions to CMS, or was told to ask their Medicare Administrative Contractor or was told to appeal the denied claim referenced in their question. A few were answered, as follows:
