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AAA Member Advisory - Congress Extends Medicare Ambulance Relief

Congress Extends Medicare Ambulance Relief

January 2, 2013
TO:           AAA Membership
FROM:     Jimmy Johnson, AAA President
RE:           Congress Extends Medicare Ambulance Relief

I am happy to report that thanks to the AAA and many of you, Congress has extended the temporary Medicare ambulance relief for another year as part of the package to avert the fiscal cliff.  This includes the 2% urban, 3% rural and super rural increases.  In addition, Congress delayed the 2% cut to Medicare providers as part of sequestration.  Congress did, however, also target nonemergency basic life support transports of ESRD patients with a 10% cut in response to concerns cited by MedPAC, the GAO and OIG.  The President has stated he will sign the bill as soon as it reaches his desk.  A detailed summary of the ambulance provisions contained in the package, the American Taxpayer Relief Act (H.R. 8), is listed below.

The AAA had advocated relentlessly for the ambulance extensions and to prevent the cut under sequestration.  We are extremely pleased to deliver another success to our members and thank all of you who reached out to your members of Congress on this issue.  This was a team effort.  We would also like to thank our champions in Congress including Senators Charles Schumer (D-NY), Pat Roberts (R-KS), Kent Conrad (D-ND) and Congressmen Charles Boustany, MD (R-LA) and Richard Neal (D-MA) who spearheaded efforts on ambulance relief legislation and the extensions.  We would like to also thank Senator Max Baucus (D-MT), Chairman of the Senate Finance Committee, and all the other members of Congress who were also extremely supportive and helped ensure the relief was extended.

While we had success again with the extensions of relief, it is taking more and more resources of the AAA to get the job done.  The AAA is a small organization in comparison to the other health care associations in DC and we rely heavily on the financial and advocacy support of our members. This year will use even more resources.

Key members of Congress and their staff have made clear that this is likely the last extension of relief for health care providers.  Their hope is to permanently fix the physician fix schedule which will be the last legislative vehicle for Medicare provider relief.  While it may mean an end to extensions of Medicare ambulance relief, it presents the AAA and its members with an opportunity to put forward a recommendation for permanent relief.  The AAA has a plan and timeline for putting forth recommendations on relief to Congress later this year.  This undertaking will require enormous financial resources on the part of the AAA if we are to be successful.  It is therefore critical that you renew your AAA membership today!

The ambulance related provisions are as follows:

Ground Ambulance Add-On Payments

  1. Extends the 2% urban base rate and mileage increase until December 31, 2013;
  2. Extends the 3% rural base rate and mileage increase until December 31, 2013; and,
  3. Extends the 22.6% super rural base rate increase until December 31, 2013.

Air Ambulance Add-On Payments

  1. Extends the expanded rural designation for air ambulance services until June 30 2013.

Studies of Ambulance Costs

Ambulance Cost Study 1

  1. Directs the HHS Secretary to conduct a study which analyzes data on existing cost reports for hospital-based ambulance providers.
    1. HHS Secretary to submit report to Congress by October 1, 2013 on findings and any recommendations for legislative or administrative action.

Ambulance Cost Study 2

  1. Directs the HHS Secretary to conduct a study of the feasibility of periodically obtaining cost data from all ambulance service providers and supplier s to examine the appropriateness of the ground ambulance add-on payments.
    1. HHS Secretary to submit report to Congress by July 1, 2014 on findings and recommendations for legislative or administrative action;
    2. HHS Secretary shall consult the industry on design and collection efforts;
    3. Explore the use collecting cost data using cost surveys and cost reports;
    4. Explore the feasibility of developing a standard cost reporting tool; and,
    5. Examine the ability for providers to furnish data by provider type, especially rural and super rural.

The AAA has been working with The Moran Company on a survey method to collect cost data from ambulance service suppliers and providers.  This method would be far less burdensome than cost reporting for AAA members.  Congress included language provided by the AAA which would direct CMS to also consider a survey method of data collection instead of just requiring cost reporting.

Medicare Payment Adjustment for Transport of ESRD Patients

  1. Reduces Medicare reimbursement by 10% for the nonemergency basic life support transport of an end-stage renal dialysis (ESRD) patient.

The Medicare Payment Advisory Commission (MedPAC) had recommended a 5.7% cut in Medicare reimbursement for all nonemergency basic life support transports.  The recommendation was in large part to target the growth in BLS nonemergency transports especially in ESRD transports.  Also, MedPAC, the HHS Office of Inspector General (OIG) and the Government Accountability Office (GAO) have all noted recently the fraud and abuse problem with the ambulance transport of ESRD patients.  Congress therefore targeted a cut in payments for ESRD transports instead of all nonemergency basic life support transports.

Sequestration: 2% Reduction for Medicare Providers

  1. The reduction of 2% in reimbursement rates for all health care providers, including ambulance service providers, was scheduled to take effect on January 1, 2013.  The reduction has been delayed until March 1, 2013.

Again, thank you to all of you who helped with this success and please renew your AAA membership today!

Guaranteed cash flow during transition.