AAA Government Affairs E-Update

June 24, 2009

1. CALL TO ACTION: Meet with Your Members of Congress during July 4 Recess

2. SCT and ALS - California

1. CALL TO ACTION: Meet with Your Members of Congress during July 4 Recess

The time is now for you to meet with your members of Congress regarding permanent Medicare ambulance relief!

All the temporary Medicare ambulance relief provisions expire at the end of this year.   This includes the 2% urban and 3% rural increases, the "super rural" bonus payment of an additional 22.6% to the base rate and the remaining partial relief from the regional fee schedule.   It is therefore critical that Congress implement permanent Medicare ambulance relief before this happens.   The AAA is now asking its member representatives to meet with their Members of Congress in their home state during the 4^th of July congressional recess from July 3 to July 12.

Congress will soon begin formal consideration of proposals for health care reform with votes on the Senate and House floors scheduled for July.   Health care reform legislation represents the best opportunity this year for passage of permanent Medicare ambulance relief.   A two-year extension of the 2% urban and 3% rural increases is currently in the initial draft of the House bill on health care reform but inclusion of the provision in the final package is far from certain.   It is vital that you meet soon with your Members of Congress and ask that they cosponsor the Medicare Ambulance Access Preservation Act (S. 1066, H.R. 2443) and support inclusion of Medicare ambulance relief in the final version of health care reform legislation.

Scheduling Meetings Back Home with Your Members of Congress

To schedule meetings during the 4^th of July congressional recess with your Members of Congress for back in the district or state, contact either their local district office or the scheduler in their Capitol Hill office.   Use the 111^th Congress Directory provided to you by the AAA to look up the phone numbers.   You can also use the Capwiz site at http://capwiz.com/the-aaa/home/ and enter your zip code to access the information.   Please let Tristan North know of your meetings.   His e-mail is tnorth@the-aaa.org.

Continue to Write Letters to Your Members of Congress

If you have not already done so and even if you plan to meet with your Members of Congress, please write to them today in support of cosponsoring the Medicare Ambulance Access Preservation Act.   The AAA online letter writing tool will take only minutes for you to send letters to your Members of Congress.   All you will need to do is enter your zip code and the tool will determine your Members of Congress and provide you with a draft letter.   It will then e-mail or fax your letter for you.

To access the AAA online letter writing system, go to: http://capwiz.com/the-aaa/home/

About the Medicare Ambulance Access Preservation Act

The Medicare Ambulance Access Preservation Act (MAAPA) was introduced in the Senate by Senators Charles Schumer (D-NY), Pat Roberts (R-KS), Kent Conrad (D-ND) and Jeff Sessions (R-AL) and in the House by Congressmen Richard Neal (D-MA) and Fred Upton (R-MI).   MAAPA would provide a permanent 6% Medicare increase for transports originating in an urban or rural area and permanently extend the bonus base payment of 22.6% for transports originating in super rural areas.   If Congress does not act on Medicare ambulance relief by the end of this year, ambulance service providers will lose a minimum of 2% in urban areas, 3% in rural areas and 17% in super rural areas.   So please write today!

To access the AAA online letter writing system, go to: http://capwiz.com/the-aaa/home/

Current Cosponsors of the MAAPA

Since our last report, Senator Byron Dorgan (D-ND) has been officially added as a cosponsor of the Medicare Ambulance Access Preservation Act (S. 1066, H.R. 2443).   If the Member of Congress to whom you are writing is already a cosponsor of the Medicare Ambulance Access Preservation Act, please include a statement in your letter thanking him or her for cosponsoring the bill.   Below is a list, current as of today, by state of Members of Congress who have officially been added as cosponsors or who have given AAA staff a commitment to cosponsor.

AL: Sen. Jeff Sessions

AR: Sen. Blanche Lincoln

CA: Rep. Devin Nunes

KS: Sen. Pat Roberts

LA: Sen. Mary Landrieu

MA: Sen. John Kerry, Rep. Richard Neal

MN: Sen. Amy Klobuchar

MI: Sen. Debbie Stabenow, Rep. Fred Upton

MT: Sen. Jon Tester

NV: Rep. Shelley Berkley

NY: Sen. Charles Schumer, Rep. Paul Tonko

ND: Sen. Kent Conrad, Sen. Byron Dorgan

OH: Rep. Patrick Tiberi

VT: Sen. Patrick Leahy, Sen. Bernie Sanders, Rep. Peter Welch

To access the AAA online letter writing system, go to: http://capwiz.com/the-aaa/home/

Please Make Arrangements Today to Meet with Your Members of Congress!

2. SCT and ALS - California

By David M. Werfel, Esq.

On May 28, 2009, the AAA published a Member Advisory to advise its California members of a solution to the problem with billing ALS, ALS-2 and SCT claims.   The article indicated that the AAA had been notified on May 22 by CMS that the MAC, Palmetto, would be publishing a revised article on their website, explaining the problem and the solution.

However, when published, there was still this statement, when referring to billing SCT: "For example, a nurse on a BLS ambulance will not qualify the ambulance as ALS".   On May 23, the AAA wrote to CMS advising them that this line needed to be removed.   On June 17, CMS wrote back indicating that a new revised article would be published by Palmetto (for Jurisdiction 1, i.e. CA/NV).   The quote in this new letter, correctly omits the line noted above.

On June 19, 2009, Palmetto published an article on their website which not only resolves this issue, but advises ambulance suppliers of the correct procedure if they receive PR-B7 denials (provider not certified/eligible to be paid for this service on this date of service).

The article can be accessed at: http://www.palmettogba.com/palmetto/providers.nsf/DocsCat/Jurisdiction%201%20Part%20B~Articles~Ambulance~8525746A00550AA3852575DD00553683

If you receive PR-B7 denials for ALS or SCT claims, it means that you are not certified in Palmetto's system to provide these services.   You will need to provide the appropriate documentation to Palmetto (but to their Provider Enrollment Department in Augusta, GA).   Once your enrollment file is updated, claims denied with PR-B7 can be resubmitted for payment.

Hopefully, this issue is now resolved.