Rep. Sewell Introduces Legislation to Protect Access to Ground Ambulance Medical Services for Rural and Underserved Communities
Washington, D.C. – This Congress, U.S. Rep. Terri Sewell (AL-07), along with Reps. Devin Nunes (CA-22), Peter Welch (VT-AL), and Markwayne Mullin (OK-02), introduced H.R. 2454, the Protecting Access to Ground Ambulance Medical Services Act of 2021. The bill would ensure that ambulance service providers, including rural providers and those in underserved communities, are able to continue delivering quality critical first responder and health care services.
“When tragedy strikes and medical emergencies happen, we should feel confident that our first responders have the resources they need to deliver life-saving care,” said Rep. Sewell. “Unfortunately, inadequate Medicare reimbursement rates are putting a strain on ambulance service providers in the most vulnerable communities across the country and making it harder for them to care for our neighbors.”
“The problem is particularly severe for rural communities and has been worsened by the demands of the COVID-19 pandemic,” continued Sewell. “That is why I am proud to introduce the Protecting Access to Ground Ambulance Medical Services Act of 2021. This bill would permanently adjust Medicare reimbursement practices so that vital ambulance services remain vibrant and available to all Americans.”
“This bipartisan bill includes key reforms to ensure that rural Americans are not harmed by the delay in updating the Medicare ground ambulance fee schedule due to the COVID-19 pandemic,” said Rep. Nunes, Lead Republican Co-Sponsor. “Extending these temporary Medicare ground ambulance add-on payments for another five years and expanding coverage for those who live in zip codes with fewer than 1,000 people per square mile will keep ambulance costs affordable for Americans when they need ground ambulance transportation.”
“Rural ambulance services save lives and provide needed care in underserved areas every day,” said Rep. Peter Welch, Lead Democratic Co-Sponsor. “This bipartisan bill will ensure that patients in rural areas have access to critical ambulance services and that the providers of these services receive fair, consistent reimbursement for their important work. It’s time for Congress to pass this bill and give ambulance services the certainty they need to continue serving all Americans.”
“Ambulance services are critically important to rural Americans who may live close to an hour away from the nearest emergency room,” said Rep. Mullin, Lead Republican Co-Sponsor. “Providing this care literally means the difference between life and death for many people. As we continue to battle the closures of critical access hospitals across Oklahoma, ambulance services are more important now than ever before. We must ensure that rural Americans receive the care they need. I’m proud to join my colleagues in support of this bill which would enhance and increase resources for first responders in Oklahoma.”
Currently, ambulance service providers across the country are reimbursed by Medicare at rates below the cost of providing services, as determined by the Government Accountability Office (GAO). Consequently, providers rely on “add-on” payments to continue providing services. Add-on payments vary depending on whether a provider is located in an urban, rural, or “super rural” ZIP Code.
Congress has extended current add-on payment rates through December 31, 2022, and planned to review Medicare cost data in considering whether they should be made permanent. However, due to the upcoming ZIP Code reclassification which will occur following the 2020 Census, providers are faced with uncertainty regarding the future of these payments. Additionally, the COVID-19 pandemic forced the Centers for Medicare and Medicaid Services (CMS) to delay the first two rounds of data collection, compounding this uncertainty.
Background on the Protecting Access to Ground Ambulance Medical Services Act of 2021
H.R. 2454, the Protecting Access to Ground Ambulance Medical Services Act of 2021, would end the band-aid approach and make permanent adjustments to the reimbursement methodology for services in urban, rural, and “super rural” areas by building the temporary add-ons into the base rate fee. Specifically, it would extend the current temporary Medicare ground ambulance increases of 2% urban, 3% rural, and the super rural bonus payments for five years and would ensure that rural zip codes continue to be classified as rural following the ZIP Code reclassification.
These payments are vital to the financial viability of the ambulance community and have been extended numerous times on a bipartisan basis, most recently for 5 years. This five-year extension would allow a new data cost collection system time to be put into place and collect meaningful data following the delays caused by the COVID-19 pandemic.
“NRHA applauds Representative Terri Sewell for her leadership in working to preserve ground ambulance services in rural America. Throughout the pandemic ambulance services have provided critical first responder services in our most rural communities. Passing H.R. 2454, the Protecting Access to Ground Ambulance Medical Services Act of 2021, is critical to ensuring that these important services remain in their communities long after the public health emergency,” said Alan Morgan, Chief Executive Officer of the National Rural Health Association.
“The Alabama Rural Health Association lends its full support behind the ‘Protecting Access to Ground Ambulance Medical Services Act of 2021’ (H.R. 2454). As rural EMS transportation is one of the greatest challenges for quality access to care in rural Alabama, support is greatly needed to reinforce the existing emergency transportation system. With additional funding and flexibility created in the system, states like Alabama will have the ability to provide improved emergency transportation in critically rural and underserved areas and allow patients to receive the care that they need in a timely manner. We are thankful for Rep. Sewell’s introduction of this language, and we encourage support for H.R. 2454,” said Ryan Kelly, Administrator of the Alabama Rural Health Association.
The legislation is also supported by the following organizations:
- American Ambulance Association (AAA)
- International Association of Fire Chiefs (IAFC)
- International Association of Fire Fighters (IAFF)
- National Association of Emergency Medical Technicians (NAEMT)
- National Volunteer Fire Council (NVFC)
H.R. 2454 can be found here.
Thank you to Reps @RepTerriSewell, @RepDevinNunes, @PeterWelch, and @RepMullin for their tireless advocacy in support of #EMS access for ALL Americans. #HR2454 #ruralhealth #SupportEMS #AlwaysOpen #NotJustaRide #MobileHealthcare https://t.co/L7uHcxyOXg @NRHA_Advocacy pic.twitter.com/qD6p4Hymjo
— AmericanAmbulanceAsc (@amerambassoc) May 7, 2021
Thank you to Representatives Rep. Terri Sewell, Congressman Devin Nunes, Peter Welch, and Congressman Markwayne Mullin…May 6, 2021Press Release
Yesterday, Congresswoman Terri Sewell (D-AL) introduced the Protecting Access to Ground Ambulance Medical Services Act of 2021 (H.R. 2454). Congresswoman Sewell was joined by Congressmen Devin Nunes (R-CA), Peter Welch (D-VT) and Markwayne Mullin (R-OK) as primary cosponsors and leads on the legislation.
H.R. 2454 would extend the temporary Medicare ground ambulance increases of 2% urban, 3% rural and the super rural bonus payment for five years. The increases are currently scheduled to expire on December 31, 2022. The five-year extension would allow for the increases to remain in place during the two-year delay on ambulance data collection period due to the COVID-19 public health emergency. It would also permit the cost collection program to move forward so that the statutorily mandated MedPAC analysis could be completed before the Congress would have to act to either further extend the add-ons or make them permanent through reforming the Medicare ambulance fee schedule.
The legislation would help address potential problems that rural zip codes in large urban counties could face as a result of the 2020 census data. As we saw after the 2010 Census, the new Census data collection methodology resulted in geographical changes under the fee schedule that shifted rural ZIP codes to urban, despite there being no significant change in their population. The current definition using rural urban commuting areas (RUCA) in Goldsmith Modification areas would be modified to ensure ZIP codes with 1,000 people or less per square mile would remain rural. Ground ambulance service providers and suppliers could also petition the Centers for Medicare and Medicaid Services (CMS) to make the argument that a specific ZIP code should remain rural. It is vital that this provision be implemented before CMS makes changes from the 2020 Census data which will likely occur in 2023.
The AAA has been leading the effort on the legislation with the support of the Congressional Fire Services Institute, International Association of Fire Chiefs, International Association of Fire Fighters, National Association of EMTs and the National Volunteer Fire Council.
The AAA is working with champions of the effort in the Senate on introduction of a companion bill. We expect the bill to be introducing in the coming weeks.
The legislation is one of the policy issues being raised as part of EMS on the Hill Day and the AAA will be launching a Call To Action shortly requesting AAA members to ask their members of Congress to cosponsor the bill.
We greatly appreciate the leadership of Representatives Sewell, Nunes, Welch and Mullin on this vital issue.
Moments ago, Congresswoman Terri Sewell (D-AL) and Congressman Devin Nunes (R-CA) introduced the Medicare Ambulance Access, Fraud Prevention, and Reform Act of 2019 (H.R. 4938). Congressmen Peter Welch, (D-VT), Markwayne Mullin (R-OK), and Earl Blumenauer (D-OR) are original cosponsors of the legislation. Thank you to the bill sponsors for their continued support!
H.R. 4938 would help stabilize current and future Medicare reimbursement of ambulance services and set the stage for future reform of the Medicare ambulance fee schedule. If passed, this bill would:
- Make Medicare Add-ons Permanent – Current temporary 2 percent urban, 3 percent rural, and super rural bonus payments would be made permanent.
- Expand Prior Authorization Pilot Program Nationwide – To address fraud and abuse with the transportation of dialysis patients by ambulance, the bill expands the Centers for Medicare & Medicaid Services (CMS) national prior authorization program for repetitive non-emergency basic life support (BLS) dialysis transports. CMS has not yet exercised its authority to expand this successful pilot program nationwide. While CMS is considering exercising its authority to extend the program nationwide in a recent proposed rule, it has not made a final determination yet.
- Provide Regulatory Relief – Amend requirements under the 855 form to make change notifications less burdensome.
- Protect Access to Ambulance Services in Rural and Low Population Density Areas – Protect access to ambulance services in rural and super-rural areas, by establishing a policy to protect low volume areas and a process for CMS to review changes in the rural or super-rural status of an area after the next census occurs.
The AAA has worked diligently to get this legislation introduced and we are excited to share this news with the membership. We would like to thank all the AAA members who have worked closely with their elected representatives to get this legislation introduced. In the coming weeks, the AAA will be asking members to contact their Members of Congress to voice their support of this legislation.
The American Ambulance Association is proud to announce the winners of the 2019 AAA Legislative Awards, in recognition of their strong advocacy for emergency medical services. Each legislator was chosen for their ongoing dedication to the ambulance services across the United States.
2019 AAA Legislator of the Year
2019 AAA Legislative Recognition Award Recipients
- Senator Bill Cassidy, M.D.
- Senator Susan M. Collins
- Senator Chuck Grassley
- Senator Doug Jones
- Senator Patrick J. Leahy
- Senator Pat Roberts
- Senator Charles E. Schumer
- Senator Debbie Stabenow
- Senator Jon Tester
- Senator John Thune
- Senator Ron Wyden
- Representative Earl Blumenauer
- Representative Rosa DeLauro
- Representative Debbie Dingell
- Representative Richard Hudson
- Representative Darin LaHood
- Representative Markwayne Mullin
- Representative Richard E. Neal
- Representative Devin Nunes
- Representative Steve Scalise
- Representative Scott Tipton
- Representative Fred Upton
- Representative Greg Walden
- Representative Peter Welch
- Representative Lee Zeldin
As a result of Tuesdays’ elections, Democrats will control the U.S. House of Representatives next Congress and Republicans will have a larger majority in the United States Senate. Presently, Democrats have gained a net of 30 seats in the House with Republicans netting two seats in the Senate. Democrats needed to capture 23 seats from Republicans to gain the majority. There are still several races in the House and Senate to be called which will likely add to those totals.
Key supporters of the industry who will not be returning next Congress include Representatives Peter Roskam (R-IL), Mike Coffman (R-CO) and Erik Paulsen (R-MN). All three members have been supportive of ambulance initiatives with Roskam in his position as Chair of the House Ways and Means Health Subcommittee and Paulsen as a member of the Subcommittee. Coffman sponsored legislation to apply the prudent layperson definition to emergency ambulance services provided to veterans. In late breaking news, the Senate race in Montana was called in favor for Senator Jon Tester (D-MT) who has been very supportive on several EMS policies.
As to the changes in Committee leadership with Democrats taking control of the House, Congressman Richard Neal (D-MA) will become Chair of the Ways and Means Committee and Kevin Brady (R-TX) will become Ranking Member. Congressman Mike Thompson (D-CA) will likely become Chair of the Health Subcommittee with the top candidate for Ranking Member being Devin Nunes (R-CA). On the Energy and Commerce Committee, Congressman Frank Pallone (D-NJ) will become Chair and Greg Walden (R-OR) will become Ranking Member.
In the Senate, Senator Charles Grassley (R-IA) will likely become Chair of the Senate Finance Committee In lieu of Senator Hatch who is retiring. Senator Ron Wyden (D-OR) will continue in his role as Ranking Member of the Committee.
The AAA has good relationships with all the likely Chairs and Ranking Members of the key Committees of jurisdiction as well as with House and Senate leaders of both political parties. Several of them have championed causes for the industry and we will continue to be well-positioned next year to push our initiatives. We will be reaching out to you in the coming weeks to help build upon our list of champions and supporters in the new Congress.
Congressman Devin Nunes Receives
2017 AAA Legislative Recognition Award
For Immediate Release
Washington, DC – The American Ambulance Association (AAA) will honor Congressman Devin Nunes of California with a Legislative Recognition Award in appreciation of his advocacy for emergency medical services.
Congressman Nunes will be presented this award in June in Washington, DC by AAA’s California Stars of Life—EMS personnel selected for their excellence and dedication. This year’s Stars from the Golden State are Amanda Wilkinson of American Ambulance of Visalia; Lyle Armstrong of Del Norte Ambulance; and Ivan Gonzalez, Chana Alexander, Peter Hastings and Deborah Rath of American Medical Response.
Congressman Nunes was selected for the Legislative Recognition Award for championing the Medicare Ambulance Access, Fraud Prevention and Reform Act, which would make permanent the current temporary Medicare ambulance add-on increases and the super rural bonus payment. The legislation, HR 745 from the 114th Congress, would also treat ambulance services more like providers of health care, and would require CMS to collect cost data utilizing a survey methodology that would result in usable information for future reform of the Medicare ambulance fee schedule. Congressman Nunes was also chosen for championing efforts to ensure that rural areas are correctly identified as such under the CMS fee schedule.
AAA President Mark Postma notes, “Congressman Nunes has been a trusted advocate for health care and emergency medical services, both in California and across our country. We thank him for his dedication and commitment.”
Congressman Nunes has represented California’s 22nd congressional district since 2003. He is Chairman of the House Permanent Select Committee on Intelligence and a member of the Ways and Means Committee, having previously served as Chairman of the Ways and Means Subcommittee on Trade.
In appreciation of his ongoing service to the ambulance services of the United States, AAA is proud to honor Congressman Nunes with a Legislative Recognition Award.
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About the American Ambulance Association
Founded in 1979, the AAA represents hundreds of ambulance services across the United States that participate in emergency and nonemergency care and medical transportation. The Association serves as a voice and clearinghouse for ambulance services, and views prehospital care not only as a public service, but also as an essential part of the total public health care system.
AAA Stars of Life
The Stars of Life program celebrates the contributions of ambulance professionals who have gone above and beyond the call of duty in service to their communities or the EMS profession. Stars of Life honors the dedication of these heroes while shining light on the critical role EMS plays in our healthcare infrastructure. This year, 101 EMS professionals will be honored as the 2017 Stars of Life. Meet the stars at www.stars.ambulance.org.
AAA Mission Statement
The mission of the American Ambulance Association is to promote health care policies that ensure excellence in the ambulance services industry and provide research, education, and communications programs to enable its members to effectively address the needs of the communities they serve.
The American Ambulance Association is proud to announce the winners of the 2017 AAA Legislative Awards, in recognition of their strong advocacy for emergency medical services. Each legislator was chosen for their ongoing service to the ambulance services of the United States.
2017 AAA Legislator of the Year
2017 AAA Legislative Recognition Award Recipients
- Sen. Richard Burr (R-NC) – Press Release
- Sen. Bill Cassidy (R-LA) – Press Release
- Sen. Orrin Hatch (R-UT) – Press Release
- Sen. Patrick Leahy (D-VT) – Press Release
- Sen. Pat Roberts (R-KS) – Press Release
- Sen. Charles Schumer (D-NY) – Press Release
- Sen. Debbie Stabenow (D-MI) – Press Release
- Sen. Jon Tester (D-MT)
- Sen. Ron Wyden (D-OR) – Press Release
- Rep. Kevin Brady (R-TX) – Press Release
- Rep. Mike Coffman (R-CO) – Press Release
- Rep. Gregg Harper (R-MS)
- Rep. Richard Hudson (R-NC) – Press Release
- Rep. Kenny Marchant (R-TX)
- Rep. Markwayne Mullin (R-OK)
- Rep. Richard Neal (D-MA)
- Rep. Devin Nunes (R-CA) – Press Release
- Rep. Erik Paulsen (R-MN)
- Rep. Peter Roskam (R-IL) – Press Release
- Rep. Mike Thompson (D-CA)
- Rep. Pat Tiberi (R-OH) – Press Release
- Rep. Fred Upton (R-MI)
- Rep. Greg Walden (R-OR)
- Rep. Peter Welch (D-VT)