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Permanent Medicare Ambulance Relief Bills Introduced in Congress

February 6, 2015
AAA Member Advisory
TO:          AAA Membership
FROM:      Mike Hall, AAA President
RE:           Permanent Medicare Ambulance Relief Bills Introduced in Congress

I am extremely happy to report our Senate and House champions on Medicare ambulance relief introduced on Wednesday the Medicare Ambulance Access, Fraud Prevention, and Reform Act of 2015 (S. 377, H.R. 745). Senators Charles Schumer (D-NY), Pat Roberts (R-KS), Patrick Leahy (D-VT) and Susan Collins (R-ME) introduced the Senate bill (S. 377) and Congressmen Greg Walden (R-OR), Peter Welch (D-VT), Devin Nunes (R-CA) and Richard Neal (D-MA) introduced the House bill (H.R. 745).

The legislation would make permanent the current temporary Medicare 2% urban, 3% rural and super rural add-on payments. In addition to making the current relief permanent, the bills would 1) implement prior authorization for BLS non-emergency ambulance transports to and from dialysis centers, 2) change the status of ambulance service suppliers to providers, and 3) direct the Centers for Medicare and Medicaid Services (CMS) to collect ambulance cost data using a survey methodology.

The Medicare Ambulance Access, Fraud Prevention, and Reform Act of 2015 is a comprehensive legislative package to address many of the current challenges facing our industry as well as establish the basis for future efforts of the AAA in improving the Medicare ambulance fee schedule. The provision on prior authorization will be an additional burden on ambulance service providers who do legitimate dialysis transports but is far better than further cuts in reimbursement. Periodically surveying a statistically significant number of the different types of ambulance service providers will also be a burden for providers. However, the alternative to the survey approach is mandatory annual cost reporting for every ambulance service provider. It is critical that Congress, CMS and the AAA have more precise cost information to make future data-driven policy and reimbursement changes to the fee schedule. 

This is the most significant legislation on Medicare reimbursement and policy since the Balanced Budget Act of 1997 and the creation of the Medicare ambulance fee schedule. We plan to build further congressional support for the legislation with the intention of attaching the language to a permanent physician fix package when Congress tackles that issue. In the meantime, we will use support for the bill to push for extensions of the Medicare ambulance add-ons which are scheduled to expire at the end of March along with the current temporary physician fix. Congress is likely to do only another short-term extension of the physician fix before it expires on March 31.

To get the language of S. 377 and H.R. 745 enacted, we will need the assistance of every AAA member representative in getting support for the bills from his or her members of Congress. We will therefore be issuing a Call To Action next week and I ask that you make it a priority to contact your Congressmen.

We greatly appreciate Senators Schumer, Roberts, Leahy and Collins and Congressmen Walden, Welch, Nunes and Neal leading the charge for desperately needed permanent Medicare ambulance relief. We also thank the American Hospital Association, International Association of Fire Chiefs, National Rural Health Association and Michigan Association of Ambulance Services for their endorsements of the legislation.

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