The American Ambulance Association is proud to announce the winners of the 2023 AAA Legislative Awards. Each Member of Congress is being recognized for their strong advocacy for emergency medical services and their ongoing dedication to ambulance services across the United States.
2023 AAA Legislators of the Year
Senator Bill Cassidy, M.D (LA)
Senator Jon Tester (MT)
Earlier today, Senators Catherine Cortez Masto (D-NV), Susan Collins (R-ME), Debbie Stabenow (D-MI) and Bill Cassidy, MD (R-LA) introduced the Preserving Access to Ground Ambulance Medical Services Act of 2023. The legislation would extend the temporary Medicare ambulance add-on payments for an additional three years.
“We thank Senators Cortez Masto, Collins, Stabenow, and Cassidy for introducing the Preserving Access to Ground Ambulance Medical Services Act and for their strong support for ground ambulance services and the communities and patients we serve,” said AAA President Randy Strozyk. “The disparity between Medicare reimbursement and the costs of providing services has grown significantly through reductions in reimbursement and skyrocketing expenses for labor, ambulances, and equipment. This bill would help reduce that gap and maintain access to vital ground ambulance services for communities around the country.”
The Senate version of the bill would go even further by increasing the add-on payment levels for urban from 2% to 3.4% urban, for rural from 3% to 4.3% rural and for super rural from 22.6% 26.2%. The last extension of the add-on payments was scheduled to end on December 31, 2022, but our champions on Capitol Hill were able to secure a two-year extension through December 31, 2024. The additional three-year extension is critical to keep the add-on payments in place through ambulance data collection and provide time to Congress to then use the data to reform the Medicare ambulance fee schedule.
Representatives Brad Wenstrup (R-OH), Terri Sewell (D-AL), Buddy Carter (R-GA) and Paul Tonko (D-NY) introduced the House version (H.R. 1666) of the bill on March 17. The House bill would be a three-year extension of the add-on payments at their present levels.
This progress is the result of tireless advocacy on the part of AAA volunteer leaders, staff, and consultants made possible by the sustained support of our members. It is critical that AAA members reach out to both their Senators and Representatives to cosponsor the respective versions of the Preserving Access to Ground Ambulance Services Act of 2023. It is vital that we generate a groundswell of support in the Congress for extending the add-on payments and will need that support to then also advocate for the higher add-on percentages when Congress negotiates on Medicare payment extensions.
Yesterday, Senators Catherine Cortez Masto (D-NV) and Susan Collins (R-ME) introduced the Protecting Access to Ground Ambulance Medical Services Act of 2021 (S. 2037). Senators Cortez Masto and Collins were joined by Senators Debbie Stabenow (D-MI), Bill Cassidy (R-LA), Patrick Leahy (D-VT) and Bernie Sanders (D-VT) as primary cosponsors and leads on the legislation.
S. 2037 is identical to H.R. 2454 by Representatives Terri Sewell (D-AL), Devin Nunes (R-CA), Peter Welch (D-VT) and Markwayne Mullin (R-OK) and 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 due to the COVID-19 public health emergency, an analysis of the data by MedPAC and subsequent action by the Congress to reform the Medicare ambulance fee schedule.
The legislation would also help ensure that rural zip codes in large urban counties remain rural following geographical changes under the fee schedule as a result of the 2020 census data. The current definition using rural urban commuting areas (RUCA) in Goldsmith Modification areas would be modified for zip codes with 1,000 people or less per square mile would also be 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 be 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 International Association of Fire Chiefs, International Association of Fire Fighters, National Association of EMTs, National Rural Health Association and the National Volunteer Fire Council.
The AAA will be launching a Call to Action shortly requesting AAA members to ask their Senators to cosponsor S. 2037, and reach out to their Representatives to cosponsor H.R. 2454 if they have not already done so.
We greatly appreciate the leadership of Senators Cortez Masto, Collins, Stabenow, Cassidy, Leahy, and Sanders on this vitally important legislation.
The American Ambulance Association has been working hard to accomplish the legislative goals of the membership in the 116th Congress. The AAA would like to take this opportunity to provide an update on what we have accomplished thus far in the 116th Congress.
Balance/surprise billing is a hot button issue that recently came into the spotlight at the start of the 116th Congress. With the President’s announcement calling for Congress to pass legislation that would end surprise billing for patients, there has been an increase in Congressional action on the issue including introduced legislation, discussion drafts and hearings in all committees of jurisdiction. The AAA has been working tirelessly with the Congressional committees of jurisdiction to educate Members and staff on the unique characteristics of EMS systems and that it would be inappropriate to apply the same restrictions on balanced billing to ground ambulance services.
The AAA has formed a working group comprised of AAA member volunteers that have worked on policy and messaging on balance billing. The working group has submitted comments to the Energy and Commerce Committee and Senate HELP committees advocating that the ambulance industry is unique from other stakeholders, and as such, should be looked at differently. Ambulance service providers and suppliers are required by law to treat and transport all patients, regardless of their ability to pay and are heavily regulated at the local level. The AAA has been working to communicate these factors that place the ambulance industry in a different situation than many other stakeholders.
Public Safety Officers Death Benefit (PSOB)
The Public Safety Officers Death Benefit (PSOB), a one-time benefit paid to families of first responders killed in the line of duty, is an issue that the AAA has passionately advocated for over many years. In the 116th Congress, the AAA has secured introduction of legislation in the House of Representatives, H.R. 2887, the Emergency Medical Service Providers Protection Act. H.R. 2887 would extend the PSOB to first responders employed by private for-profit EMS agencies. The AAA was able to secure several commitments from Members of Congress to cosponsor the legislation during Stars of Life meetings in Washington, DC. In addition to taking action to move H.R. 2887 through the legislative process, the AAA will be engaging in an outreach campaign in the next few weeks.
Dialysis Off-Set Restructuring
The AAA has worked toward reintroduction of legislation to restructure the offset that was passed into law in the Bipartisan Budget Act of 2018 (H.R. 1892) in the 115th Congress. This offset included a total cut of 23% to the Medicare reimbursement for basic life support (BLS) non-emergency transports performed by all ambulance service suppliers and providers to and from dialysis centers. This cut served as an offset to the 5-year extension of Medicare add on payments that our industry worked hard to get extended.
The AAA has secured introduction of legislation in both the House and Senate. H.R. 3021 was introduced by Representatives LaHood (R-IL) and Sewell (D-AL) and S. 228 by Senators Cassidy (R-LA) and Jones (D-AL). If passed, this legislation would change the cut that is currently in place so that it applies specifically to companies conducting over 50% ESRD non-emergency transports. Those ambulance services with over 50% ESRD transports would get a cut of 29.5%, while those doing less would receive a 15.5% cut. The AAA will continue to work toward movement and passage of this legislation that would better distribute the reduction to those providers which do almost exclusively non-emergency dialysis transports and thus have a lower cost of providing services.
Medicare Priorities Bill
The AAA has crafted legislation that is specifically aimed at addressing major Medicare ambulance industry issues. The issues that will be included in future legislation include making Medicare ambulance add-ons permanent, implementing a prior-authorization program across the nation, allowing for transportation to alternative destinations, reducing regulatory burdens, and providing relief through maintaining many zip codes as rural following the next census. The AAA is working to get this Medicare priorities legislation introduced in the coming months so that we can get to work on solving these Medicare issues that impact our industry as a whole.
Another priority that that the AAA has been diligently working toward getting introduced is Veterans Affairs (VA) legislation. The Veterans Reimbursement for Emergency Ambulance Services Act (VREASA) introduced by Congressman Tipton (R-CO) would provide veterans with reimbursement for emergency ambulance services when a Prudent Layperson would have a reasonable expectation that a delay in seeking immediate medical attention will jeopardize the life or health of the veteran. This legislation was introduced as a result of the VA consistently requiring all medical records be provided, including the records of treatment after the emergency service has taken place. Should those records show that it was not a life threatening emergency or a false alarm, the claim for reimbursement is being denied. The VA legislation would mandate that the VA apply the “prudent layperson” definition of emergency to determine coverage of ambulance claims.
The AAA is also working toward addressing two other issues with the VA to enforce more prompt payment by the VA and treating the VA as the first payor, similar to Medicare, as it is determined whether there is a different primary payor. The AAA has been working with Senators Collins and Tester on language help solve this ongoing and serious reimbursement issue.
In our next update, we will be reporting on the progress the AAA has made this year on regulatory issues.
Questions? Contact Us
If you have questions about the discussion draft or balance billing initiatives being undertaken by the AAA, please do not hesitate to contact a member of the AAA Government Affairs Team.
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.
Senate Committee Releases Draft Package with 5-year Ambulance Extender
The Senate Finance Committee has released a discussion draft of its Medicare provider extender package. A five-year extension of the temporary Medicare ambulance add-ons and a modified version of the cost data collection provision from the Medicare Ambulance Access, Fraud Prevention and Reform Act (S. 967) are included in the package. The ambulance provisions being part of the package marks significant progress in the Senate toward a long-term extension of the add-ons and a model cost data collection system.
A five-year extension of the 2% urban and 3% increases and the super rural bonus payment would provide approximately $1 billion in desperately needed Medicare relief for our industry. Having the increases in place for five years would give ambulance service suppliers and providers greater funding stability and help with long-term budgeting. There are now proposals in both the House and Senate with Committee backing which reflect a five-year extension of the add-ons.
The five-year extension reflects the efforts of our champions in the Senate on S. 967. The cost data collection system is also from S. 967 with modifications. Instead of a random sampling of ambulance service providers and suppliers a minimum of every three years, the sampling would occur each year for three years than a minimum of every three years. Also, in place of a 5% penalty in Medicare reimbursement for not submitting cost data if selected to report data, the penalty would be 10%. There is a hardship clause within the draft for CMS to work with ambulance service suppliers to ensure they are not penalized. The provision is also streamlined from the version introduced in S. 967.
We greatly appreciate the efforts of Senators Debbie Stabenow (D-MI), Pat Roberts (R-KS), Chuck Schumer (D-NY), Susan Collins (R-ME) and Patrick Leahy (D-VT) as champions of S. 967 and Senator Bill Cassidy (R-LA) on getting the ambulance provisions into the draft. We also thank Senators Orrin Hatch (R-UT) and Ron Wyden (D-OR) as Chairman and Ranking Member respectively of the Senate Finance Committee for their support.
While the discussion draft includes the five-year extension of Medicare ambulance add-ons and cost data collection provisions, there is still a long way to go. If your Senators are not already cosponsors of S. 967, please reach out to them today and ask they cosponsor the bill. Write to your Senators using the AAA online letter writing tool below, or go to:https://ambulance.org/advocacy/
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”
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.
Washington, D.C. – The American Ambulance Association (AAA) has named Senator Susan Collins of Maine as the AAA Legislator of the Year, in recognition of her strong advocacy for emergency medical services. Senator Collins is invited to receive this honor at the AAA’s annual Stars of Life recognition ceremony on June 13 in Washington, D.C.
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 pays tribute to 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 2017 Stars of Life. In addition to Senator Collins’s recognition as as Legislator of the Year, twenty-four United States Senators and Representatives will receive Legislative Recognition Awards for their support of ambulance services.
AAA President Mark Postma notes, “Senator Collins has been a tireless advocate for emergency medical services, both in Maine and across our country. The AAA is honored to present her with the distinction of AAA Legislator of the Year.”
Senator Collins is a primary sponsor of the Medicare Ambulance Access, Fraud Prevention and Reform Act which would make permanent the current temporary Medicare ambulance relief. This bill ensures that ambulance service providers across the nation have the resources necessary to provide often life-saving emergency- as well as vital non-emergency medical transportation.
As Chair of the Senate Committee on Homeland Security and Governmental Affairs from 2003 to 2007, Senator Collins ensured both governmental and nongovernmental medical service providers were included in the definition of an emergency responder in the Homeland Security Act. This enabled ambulance service providers as first responders access to critical funding and resources.
First elected to the senate in 1996, Senator Collins has earned a national reputation for working across party lines to seek consensus on our nation’s most important issues. Senator Collins has carried out her longstanding commitment to healthcare issues through her work on the Special Committee on Aging as well as the Committee on Health, Education, Labor and Pensions.
In recognition of her ongoing service to the ambulance services of the United States, AAA is proud to call Senator Collins our Legislator of the Year.
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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 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.