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Five-Year Medicare Ambulance Relief Extension Included in Senate Proposal

December 11, 2013
AAA Member Advisory
TO: AAA Membership
FROM:      Jimmy Johnson, AAA President
RE: Five-Year Medicare Ambulance Relief Extension Included in Senate Proposal

Yesterday morning, the U.S. Senate Finance Committee released a proposal to repeal the sustainable growth rate (SGR) formula for Medicare payments to physicians. I am extremely pleased to report that the proposal included a provision to extend for five years the 2% urban, 3% rural and super rural increases to payments under the Medicare ambulance fee schedule. The Senate Finance Committee is scheduled to consider the proposal tomorrow.

The proposal would also reinforce language from the American Taxpayer Relief Act directing the Centers for Medicare and Medicaid Services (CMS) to develop a method for collecting ambulance cost data. CMS would be required to report to Congress by July 1, 2015 on the method selected to collect data and the sample of providers and suppliers identified to provide the data. The data collection would then occur every three years with a penalty for those who are selected to be part of the sample and fail to submit data. CMS would also be required to obtain industry input on the process.

The provision requiring CMS to collect ambulance cost data and sample the industry every three years is in direct relation to the current project of the AAA to collect data. The Moran Company, contracted by the AAA, reached out to the entire ambulance industry earlier this year to identify the characteristics of the different types of ambulance operations and their ability to provide cost data. The Moran Company is now surveying those ambulance operations which responded to the first request in order to collect actual cost and other key data. This effort is the model for the proposed effort for CMS to collect data and we will provide CMS with the structure and tools of our final collection process.

The House Ways and Means Committee also released yesterday its proposal to repeal the SGR formula for Medicare payments to physicians. The Ways and Means Committee, unlike the Senate Finance Committee, did not include any other Medicare provider provisions. The House plans to address other Medicare provider provisions when the SGR repeal package comes to the House floor. The Ways and Means Committee is scheduled to consider its proposal tomorrow as well.

Since the current temporary fix to the SGR expires at the end of this year, as do the temporary Medicare ambulance increases, congressional leaders reached an agreement last night on a package to extend the SGR fix for three months. The package also includes a three-month extension of the ambulance increases. To help offset the cost of the overall package, negotiators extended the 2% cut under Sequestration to Medicare providers for another year through 2023. There would be a 2.9% cut for the first six months of the year followed by a 1.11% cut for the remaining six months.

The agreement on a short-term physician fix is being attached to the two-year budget agreement reached today between Senate Budget Committee Chair Patty Murray (D-WA) and House Budget Committee Chair Paul Ryan (R-WI). The two-year budget agreement would fund the federal government and avoid another partial federal government shutdown. The agreement unfortunately would keep the 2% Medicare provider cut in place. The House is scheduled to vote on the two agreements by Friday evening and the Senate sometime before it adjourns next week.

The ambulance provisions in the proposal by the Senate Finance Committee are a great victory for our champions in the Senate and the AAA. If enacted, it would set into motion a data-driven approach to potential reforms to the Medicare ambulance fees schedule while in the meantime keeping the current temporary Medicare ambulance relief in place. We greatly appreciate the efforts of our primary champions in the Senate including Senators Charles Schumer, Pat Roberts, Patrick Leahy and Mary Landrieu as well as Senate Finance Committee Chair Max Baucus and Ranking Member Orrin Hatch. I want to thank our volunteer leaders, advocacy team on the AAA staff and with Patton Boggs and all of our members who reached out to their Senators on this issue.

While this is a great victory, we are still far from our final objective of getting long-term ambulance relief enacted. There are still many obstacles to overcome and I will call on the entire AAA membership early next year to help push for long-term Medicare ambulance relief to become law. Please answer that call. We cannot do it without you.

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