VA Issues Notice on Delay of Special Modes of Transportation Final Rule
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Author: Tristan North
2023 Year-End Government Affairs Update
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Gluesenkamp Perez and Finstad Introduce EMS Workforce Shortage Bill
Yesterday, November 15, Congresswoman Marie Gluesenkamp Perez (D-WA) and Congressman Brad Finstad (R-MN) introduced the Preserve Access to Rapid Ambulance Emergency Medical Treatment (PARA-EMT) Act (H.R. 6433). H.R. 6433 is the first broad, stand-alone piece of legislation specifically designed to focus solely on helping address the EMS workforce shortage.
“We greatly appreciate the leadership of Congresswoman Gluesenkamp Perez and Congressman Finstad on introducing this momentous legislation to assist with the hiring and retention of paramedics and EMTs,” stated AAA President Randy Strozyk. “We look forward to working with them on passage of the bill.”
H.R. 6433 would establish a pilot grant program under the Assistant Secretary for Preparedness and Response (ASPR) at the Department of Health and Human Services (HHS) for the recruitment and training of paramedics and EMTs. The grant program would be authorized from 2024 through 2028 with $50 million a year in funding.
The legislation would also provide states with funding to help facilitate and expedite the transition of medics coming out of military service with the requirements of becoming a civilian paramedic or EMT. The program would be authorized from 2024 through 2028 with $20 million a year in grant funding for states.
Lastly, H.R. 6433 would direct the Secretary of Labor to conduct a study on the EMS workforce shortage and issue a report to Congress. The report would include an analysis on potentially adding paramedics and EMTs to the list of health care occupations which benefit from an easier hiring process of professionals outside the U.S.
The American Ambulance Association, National Rural Health Association and Washington Ambulance Association have endorsed H.R. 6433. In the coming days, the AAA will be launching a Call to Action to encourage and assist our members in contacting their U.S. Representatives in support of cosponsoring H.R. 6433.
Thank you to all of the AAA members and volunteer leaders who worked tirelessly to push for the introduction of this important EMS legislation!
Welch, Sanders, & Balint Introduce Treatment in Place Bill
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Impact of Partial Government Shutdown on Healthcare
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VA Final Rule on Ambulance Services Update
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House Passes Sequestration Cut Delay Bill
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Notice on Ground Ambulance and Patient Billing Advisory Committee
The Centers for Medicare and Medicaid Services (CMS) has filed for publication in the Federal Register the Solicitation of Nominations Notice for the Ground Ambulance and Patient Billing (GAPB) Advisory Committee. The Notice is scheduled to be included in the Federal Register for tomorrow, Tuesday, November 23.
The Congress created the GAPB Advisory Committee as part of The No Surprises Act enacted last year and currently being implemented by the Departments of Health and Human Services, Labor and the Treasury. The American Ambulance Association, International Association of Fire Chiefs, International Association of Fire Fighters, National Association of Emergency Medical Technicians, and the National Volunteer Fire Council successfully advocated that the Congress take into consideration the unique characteristics of ground ambulance services when determining balance billing policy for our services. The Congress excluded ground ambulance services from the provisions of The No Surprises Act and created the GAPB Advisory Committee to address balance billing.
The AAA has identified candidates, including AAA President Baird, who we will be supporting for inclusion on the Advisory Committee who we believe are well-positioned to represent the AAA membership. Once formed, the Advisory Committee has 180 days in which to report its recommendations to the Congress. The directive of the Committee is to review options to “improve the disclosure of charges and fees for ground ambulance services, better inform consumers of insurance options for such services, and protect consumers from balance billing.” We will be keeping the AAA membership continually informed of the actions and deliberations of the GAPB Advisory Committee.
Should you have any questions regarding the GAPB Advisory Committee, please contact AAA Senior Vice President of Government Affairs Tristan North. He can be reached at tnorth@ambulance.org.
CMS Announcement on Treatment in Place Waiver
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Medicare 2% Cut Freeze Extended
Yesterday, Presiden Biden signed into law legislation (H.R. 1868) to extend the current temporary freeze on the 2% Medicare sequestration cut. H.R. 1868 extends the deadline of the freeze from today until December 31. Contractors had been holding Medicare claims to avoid any issues but will again start processing claims. The AAA as well as other national EMS and fire organizations had pushed for the extension of the freeze.
Senate Passes Sequestration Suspension Extension Bill
Last week, the Senate by a vote of 90 to 2 passed legislation (H.R. 1868) to further extend the suspension of the 2% Medicare sequestration cut. H.R. 1868 would extend the suspension from March 31 to December 31. The Senate amended the bill so it goes back to the House which will likely consider the legislation the week of April 12 when it returns from the Easter holiday break. The House is expected to easily pass the bill. CMS will hold claims until the House passes the bill to avoid any retroactivity issues.
The House had previously passed a version of H.R. 1868 which would not only extend the sequestration suspension until December 31 but also prevent a potential 4% sequestration cut later this year. The additional cut is the result of a provision in the Budget Control Act which was triggered with passage of the American Rescue Plan. Senate Republicans objected to addressing the additional cut as part of the legislation and a compromise was reached to just extend the 2% cut suspension for the time being.
The AAA as well as the IAFC, IAFF, NVFC, CFSI and NAEMT had written to congressional leaders in support of passage of the House-passed version of H.R. 1868.
Senate Passes Ambulance Treatment in Place Language
On Saturday, the U.S. Senate passed language for Medicare coverage of emergency treatment in place of lower acuity patients by ground ambulance services providers and suppliers during the COVID-19 public health emergency (PHE). The language is from S. 149 by Senators Cortez Masto (D-NV) and Cassidy (R-LA) and passed as part of the $1.9 Trillion American Rescue Plan (H.R. 1319). The House is scheduled to vote and expected to pass the package tomorrow.
The American Ambulance Association along with the International Association of Fire Chiefs, International Association of Firefighters, National Association of EMTs and National Volunteer Fire Council pushed for passage of the bill language.
S. 149 would authorize the Centers for Medicare and Medicaid Services (CMS) to waive the transport requirement under Medicare for treatment in place for 9-1-1 or equivalent ambulance responses in which community EMS protocols dictate that the patient not be transported to a facility. The waiver would apply during the public health emergency.
Similar to other waivers provided by Congress for Medicare coverage during the pandemic, CMS would not be required to implement the policy. However, CMS has done so in all other situations and has also made the coverage retroactive to the beginning of the PHE. Upon passage of the language, the AAA will strongly advocate for CMS to implement the waiver and make it retroactive.
The AAA will be offering educational services to our members on the requirements of the proposed new policy and how to bill for covered services.
AAA Task Force to Address Balance Billing Challenges
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Paycheck Protection Program Funding Update
The Department of Treasury has announced that the $350 billion appropriated under the CARES Act for the Paycheck Protection Program has been exhausted. However, Congressional leaders are currently negotiating an economic stimulus package to act as a bridge between the CARES Act and the next comprehensive package stimulus package. A core provision of the bridge package is an allocation of an additional $250 billion for the Paycheck Protection Program. If your operation is in the process or plans to apply for a loan under the Paycheck Protection Program, you should move forward with your efforts. The AAA is advocating that the bridge package or next comprehensive package include more funding for ambulance services.
Member Advisory: CMMI Releases Initial List of ET3 Participants
The Centers for Medicare and Medicaid Services (CMMI) has released its initial list of applicants selected to participate in the ET3 pilot program. CMMI notes that the list is not final as it still needs to execute participation agreements with the applicants. CMMI will issue a final list once it completes the process.
Applicants from 36 states and the District of Columbia were selected to participate in the program. Approximately 200 applicants were approved with instances in which the same ambulance service organization submitted applications for multiple counties as well as more than one organization submitting an application for the same county. CMMI has sent notifications to each of the applicants letting them know to expect a follow up email with the partnership agreement, program guidance and additional details.
The ET3 program is a five-year voluntary pilot program designed to test the potential benefit to the Medicare program and patients of ambulance service providers and suppliers furnishing treatment in place as well as transport to alternative destinations. For more information about the ET3 program, please go the ET3 website.
House Committees Consider Balance Billing Proposals
This past Tuesday and Wednesday, respectively, the House Ways & Means and Education & Labor Committees marked up their proposals on balance or “surprise” billing. As we reported on Monday of this week, the Ways & Means Committee proposal, the Consumer Protections Against Surprise Medical Bills Act (H.R. 5826), did not include a provision on ground ambulance services. The House Education & Labor proposal, The Ban Surprise Billing Act (H.R. 5800), however, included a provision to create a federal advisory committee to recommend restrictions on the ability of ground ambulance service providers and suppliers to balance bill.
The Ways & Means Committee reported out H.R 5826 favorably by voice vote. While the Education & Labor Committee also reported out H.R. 5800 favorably, the vote was 30 to 13 as a block of its Committee members preferred the approach of the Ways & Means proposal on how to address balance billing for other providers. It is now up to House leadership to determine next steps on how the chamber will approach a final package on balance billing.
While H.R. 5800 as reported out by the Education & Labor Committee still includes the provision on ground ambulance services, Chairman Scott (D-VA) and Ranking Member Foxx (R-NC) prior to mark up had removed the most problematic language in the bill. As introduced, H.R. 5800 would have given the Department of Health and Human Services the authority to issue regulations to restrict balance billing based on the findings of the advisory committee. This would have eliminated federal lawmakers from being able to evaluate the recommendations prior to the changes being implemented. The language was removed in the chairman’s mark of the bill, and thus the Congress would now have an opportunity to debate and craft legislation on the recommendations.
The AAA along with the International Association of Fire Chiefs (IAFC), International Association of Firefighters (IAFF) and National Association of EMTs (NAEMT) had advocated against the ground ambulance provision. We thank Chairman Scott, Ranking Member Foxx and members of the Committee for listening to our concerns and removing the regulation authority language.
Only one of the four pieces of legislation on balance billing reported out by congressional committees includes a provision on ground ambulance services. We will continue to advocate to preserve the ability of local governments to determine the rates and standards for their EMS systems and against the inclusion of a ground ambulance provision in a final package on balance billing.
We will keep you apprised of new developments on the issue.
Balance Billing Update
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CMS Releases List of Ambulance Organizations Selected for Data Collection
CMS Releases List of Ambulance Organizations Selected for Data Collection
The Centers for Medicare & Medicaid Services (CMS) has released the list of ambulance service providers and suppliers selected to provide data in the first year of data collection. CMS has published the data by National Provider Identifier (NPI) number and the AAA has also sorted the data by state in alphabetical order.
On Friday, CMS had made public the final rule on the Establishment of an Ambulance Data Collection System. The AAA will be issuing a Member Advisory tomorrow on the details of the final rule and changes from the proposed rule.
To access the list by NPI number click here and to access the list by state click here.
Government Affairs Update
Government Affairs Update: What We’re Working On
The AAA continues to press policy initiatives with Congress and the Administration that are important to our members. While not as high-profile as our successful efforts earlier this year on the five-year extension of the Medicare ambulance add-ons, the AAA is working hard on ambulance legislation and regulations that impact the EMS industry and ambulance services across the country. Here is a snapshot of those current efforts. Over the next month, we will be providing weekly in-depth updates highlighting these issues.
Ambulance Cost Data Collection System
The AAA was successful in getting our preferred language of an ambulance cost data collection system using a survey and random sample methodology included with the extension of the add-ons in the Bipartisan Budget Act of 2018. However, that was just the first key step in the process. We now need to ensure that CMS gets the details right as the agency develops the structural specifics and data elements for the system. It is critical that the system is designed in a way that ambulance service suppliers and providers will submit the most accurate data possible.
The data will ultimately provide the information necessary for Congress, the Centers for Medicare and Medicaid Services (CMS) as well as the AAA and other stakeholders to reform the Medicare ambulance fee schedule. Reform will include potential reimbursement for services such as community paramedicine, treat and refer, and other items that don’t involve transporting the patient. However, in order to determine the reimbursement levels, we first need the data on what it could cost for these additional services. The AAA therefore has been working closely with officials at CMS on the development of the data collection system.
Medicare Community Bill
The five-year extension of the add-ons and authorization of data cost collection system were the first steps needed in the long-term goal of reforming the Medicare ambulance fee schedule. The AAA is now developing the next piece of legislation as step two of the process. The “Community Bill” would make the Medicare ambulance add-ons permanent, treat ambulance service suppliers like providers in three specific instances, direct the Centers for Medicare and Medicaid Services (CMMI) to do additional pilot programs on innovative services being done by ambulance agencies, reduce regulatory burdens, and implement a more accurate definition of what Goldsmith Modification zip codes should remain as rural. The AAA is currently developing the draft bill and reaching out to congressional offices regarding the introduction of the bill which will likely occur early next Congress.
Restructuring of Dialysis Offset
The AAA is supporting the efforts of our members who would be significantly adversely affected by the upcoming reduction in dialysis transport reimbursement to restructure the cut. Congress included in the Bipartisan Budget Act of 2018 an offset to go along with the extension of the add-ons that will cut reimbursement for BLS nonemergency transports to and from dialysis centers by an additional 13%. This will be on top of the existing 10% reduction. The NEATSA Act (H.R.6269) by Congressman LaHood (R-IL) and Congresswoman Sewell (D-AL) would restructure the offset so that a majority of the additional reduction would be focused on those ambulance service agencies in which 50% or more of their volume are repetitive BLS nonemergency transports. The cut is currently scheduled to be implemented on October 1 and impacted AAA members and the AAA are working to get a Senate companion bill introduced shortly.
Rural EMS Grant Program
As an amendment to the Farm Bill (S. 3042) that passed the Senate, Senator Dick Durbin (D-IL) included language similar to the SIREN Act (S. 2830, H.R. 5429) to reauthorize the Rural EMS Grant program. However, in an effort to ensure the funding would go to the most needy, small, and rural EMS providers, the language of the amendment and SIREN Act would change the eligibility to just governmental and non-profit EMS agencies. Therefore, small rural for-profit ambulance service providers would no longer be eligible to apply for grants.
The AAA is pressing Senator Durbin as well as other members supportive of the reauthorization to revise the language to ensure small rural for-profit providers would still be able to apply for grants. In the next few weeks, the AAA will be asking AAA members to reach out to their members of Congress in support of the final Farm Bill including the reauthorization language and that it continues to also apply to for-profit providers as well.
Easing Regulatory Burdens
Over the last year, the AAA has responded to several requests for information from CMS as well as Congress on how to ease regulatory burdens for Medicare providers and suppliers. In addition to these broader opportunities, representatives of the AAA and our members have been meeting with CMS officials to reduce burdens for our industry. As a specific example, we are pushing for the elimination of the PCS for interfacility transports and to expand the categories of facility personnel eligible to sign the form.
Protecting Non-Emergency Ambulance Services
The AAA continues to educate members of Congress and congressional staff about the importance of non-emergency ambulance services. We are providing congressional offices with a clearer picture as to the vital role of these transports as part of the overall health care system. We are also looking to ensure that changes in federal payor policies strengthen the role and distinction of non-emergency ambulance transports from non-medical transportation services to health care facilities.
Zip Code Changes
The current use of Rural-Urban Commuting Areas (RUCA) as the basis of the Goldsmith Modification for determining rural areas in larger urban counties needs to be reformed. There are numerous examples of zip codes that are designated as urban under the Medicare ambulance fee schedule that are clearly rural. The AAA Rural Task Force is leading the way on both short-term and long-term efforts to more accurately capture rural zip codes in large urban counties. The AAA will include the ultimate reform provision crafted by the Task Force within the Community Bill as well as look at other legislative opportunities to make the changes.
Questions?: Contact Us
If you have questions about the legislation or regulatory initiatives being undertaken by the AAA, please do not hesitate to contact a member of the AAA Government Affairs Team.
Tristan North – Senior Vice President of Government Affairs
tnorth@ambulance.org | (703) 610-0216
Ruth Hazdovac – AAA Senior Manager of Federal Government Affairs
rhazdovac@ambulance.org | (703) 610-5821
Aidan Camas – Manager of State & Federal Government Affairs
acamas@ambulance.org | (703) 610-9039
Thank you for your continued membership and support.
Ambulance Cost Data Collection is Coming
Although the most prominent ambulance provision passed in the Bipartisan Budget Act of 2018 (H.R. 1892) was the five-year extension of the Medicare add-ons, the Act also included important language directing the Centers for Medicare and Medicaid Services (CMS) to collect cost and other financial data from ambulance service suppliers and providers.
This week, an editorial from AAA Senior Vice President of Government Affairs Tristan North was featured in the June issue of JEMS‘s “EMS Insider”. Read the full article►
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