AAA Government Affairs E-Update

December 16, 2009

1. Write your Members of Congress on Medicare Ambulance Relief

2. CMS Issues Final Rule on Medicare Appeals Process

3. CMS Conducts Fifth Annual Medicare Contractor Provider Satisfaction Survey

4. DHS Announces Grant Guidance for Fiscal Year 2010 Grant Programs

5. Medicare Advantage Plans Issue Provider Fraud, Waste and Abuse Training

1. Write your Members of Congress on Medicare Ambulance Relief

Please continue to contact your members of Congress in support of temporary Medicare ambulance relief within health care reform legislation as well as requesting that they support permant Medicare ambulance relief by cosponsoring the Medicare Ambulance Access Preservation Act (S. 1066, H.R. 2443).   Please act today!

To access the AAA online letter writing system, go to: http://capwiz.com/the-aaa/issues/alert/?alertid=13387251

On the evening of Saturday, November 21, the United States Senate voted 60 to 39 to proceed to consideration of health care reform legislation, the Patient Protection and Affordable Care Act.   The Senate is currently considering the bill with a final vote on passage scheduled for late December shortly before Christmas.   The U.S. House of Representatives passed their health care reform legislation, the Affordable Health Care for America Act (H.R. 3962), on November 7.

The Patient Protection and Affordable Care Act includes a nine-month extension of the 2% urban and 3% rural increases as well as the super rural bonus payment but the effective date is April 1, 2010.   The AAA is advocating that the effect date be January 1, 2010, so that there is no lapse in relief.   The Affordable Health Care for America Act includes a two-year extension of the 2% urban and 3% rural increases but no extension of the super rural bonus payment.   The AAA is pushing for a final package to include a two-year extension of the urban and rural increases and the super rural bonus payment and would like to see the larger provisions of the bill to be palatable for providers.

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 extend Medicare ambulance relief before this happens.   The AAA is asking all ambulance service professionals to write their Senators and ask that they support including Medicare ambulance relief extensions in health care reform legislation and, if they have not done so already, that they cosponsor the Medicare Ambulance Access Preservation Act (S. 1066, H.R. 2443) which would implement permanent relief.

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.  

To access the AAA online letter writing system, go to: http://capwiz.com/the-aaa/issues/alert/?alertid=13387251

Current Cosponsors of the MAAPA

Below is a list, current as of today, by state of members of Congress who have officially been added as cosponsors or made a commitment to the bill sponsors.   Since our last report, Senator Kristen Gillibrand (D-NY) has cosponsored S. 1066.

AL : Sen. Jeff Sessions

AR: Sen. Blanche Lincoln, Sen. Mark Pryor

CA: Rep. Devin Nunes

CT: Rep. Rosa DeLauro: Rep. Chris Murphy

GA: Sen. Saxby Chambliss, Sen. Johnny Isakson

IA: Sen. Tom Harkin

KS: Sen. Pat Roberts

LA: Sen. Mary Landrieu

ME: Sen. Susan Collins, Rep. Michael Michaud

MA: Sen. John Kerry, Rep. Richard Neal, Rep. James McGovern

MI: Sen. Debbie Stabenow, Rep. Fred Upton, Rep. Dale Kildee, Rep. Bart Stupak

MN: Sen. Amy Klobuchar

MS: Sen. Thad Cochran

MO: Sen. Kit Bond

MT: Sen. Jon Tester

NV: Rep. Shelley Berkley

NJ: Sen. Frank Lautenberg, Rep. Steven Rothman, Rep. Albio Sires

NY: Sen. Charles Schumer, Sen. Kristen Gillibrand, Rep. Paul Tonko

ND: Sen. Kent Conrad, Sen. Byron Dorgan

OH: Rep. Patrick Tiberi

PA: Rep. Jim Gerlach, Rep. Tim Murphy

SC: Sen. Lindsey Graham

SD: Rep. Stephanie Sandlin Herseth

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

WA: Rep. Doc Hastings

WV: Rep. Nick Rahall

WI: Rep. Steve Kagen

To access the AAA online letter writing system, go to: http://capwiz.com/the-aaa/issues/alert/?alertid=13387251

Please write your members of Congress today!

2. CMS Issues Final Rule on Medicare Appeals Process

By Brian S. Werfel, Esq.

On December 9, 2009, CMS issued a Final Rule affecting the appeals process for Medicare claims.   This Final Rule follows an earlier Interim Final Rule with Comment Period, issued in March 2005, which implemented changes to the Medicare appeals process mandated by Medicare, Medicaid, and SCHIP Benefits Improvement and Protection Act of 2000 ("BIPA") and the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 ("MMA").

The March 2005 Interim Final Rule implemented a major overhaul of the appeals process, in order to create a uniform process for all Part A and Part B claims.   Other changes made by the Interim Final Rule were:

• the creation of the Qualified Independent Contractor to act as the second stage for all Medicare appeals;
• revised timeframes for submitting each level of appeal;
• the establishment of time limits in which a Medicare contractor must decide an initial redetermination; and,
• the transfer of the ALJ function (i.e., the 3^rd level of appeal) from the Social Security Administration to the Department of Health and Human Services.

The Final Rule does not make any substantive changes to the Medicare appeals process.   Rather, it contains clarifications to a number of existing provisions.   The Final Rule also responds to comments submitted in response to the March 2005 Final Rule.   Among the clarifications contained in the Final Rule are the following:

• the regulations are referring to "calendar days" when describing various timelines for submitting appeals and rendering decisions;
• the regulations permit certain contractors to reopen initial determinations, even where such contractor was not the one to issue the initial determination;
• ALJs are required to conduct a "de novo" review; and,
• ALJs may not issue subpoenas to CMS or its contractors to compel an appearance, testimony or the production of evidence.

The provisions of the Final Rule will become effective January 8, 2010.

The Final Rule can be viewed in its entirely in the Federal Register at: http://edocket.access.gpo.gov/2009/pdf/E9-28707.pdf

3. CMS Conducts Fifth Annual Medicare Contractor Provider Satisfaction Survey

Forwarded from CMS

The Centers for Medicare & Medicaid Services (CMS) is listening and wants to hear from you about the services provided by your Medicare Fee-for-Service (FFS) contractor that processes and pays your Medicare claims.   CMS is preparing to conduct the fifth annual Medicare Contractor Provider Satisfaction Survey (MCPSS).   This survey offers Medicare FFS providers and suppliers an opportunity to give CMS feedback on their interactions with Medicare FFS contractors related to seven key business functions: Provider Inquiries, Provider Outreach & Education, Claims Processing, Appeals, Provider Enrollment, Medical Review, and Provider Audit & Reimbursement.

The survey will be sent to a random sample of approximately 30,000 Medicare FFS providers and suppliers. Those who are selected to participate in the 2010 MCPSS will be notified starting in January. If you are selected to participate, please take a few minutes to complete this important survey. Providers and suppliers can complete the survey on the Internet via a secure website or by mail, fax, or telephone. To learn more about the MCPSS, please visit  http://www.cms.hhs.gov/MCPSS/ on the CMS website.

4. DHS Announces Grant Guidance for Fiscal Year 2010 Grant Programs

Homeland Security Secretary Janet Napolitano recently announced the release of fiscal year 2010 grant application kits for the 13 grant programs under the Department of Homeland Security.   There are two primary programs, the Urban Area Security Initiative (UASI) and Homeland Security Grant Program (HSGP), for which governmental and nongovernmental ambulance service providers are eligible.   The HSGP grants must be applied through a state government with a deadline for their submission of April 19, 2010.   The UASI grants are eligible for providers in 60 areas determined as being high threat and high density.

As a result of efforts of the AAA, states must include emergency medical service providers in their state homeland security plans.   Below is the language outlining the requirements of states for EMS as well as additional information about applying for grants.

For more information specific to your state including who to contact about grants, the grants eligible within your state and the allocated funding, please go to the DHS website at: http://www.dhs.gov/xgovt/grants/index.shtm .

Homeland Security Grant Program

Department of Homeland Security Website on HSGP

http://www.fema.gov/government/grant/hsgp/index.shtm

FY 2010 HSGP Guidance and Application Kit – April 19, 2010 due date

http://www.fema.gov/pdf/government/grant/2010/fy10_hsgp_kit.pdf

Inclusion of Emergency Medical Services ( EMS) Providers

DHS requires State and local governments to include emergency medical services ( EMS) providers in their State and Urban Area homeland security plans. Grantees should include a minimum number of quantitative and qualitative measures necessary to demonstrate achievement with regard to improving EMS system integration with public health systems. These measures should be drawn from the Emergency Triage and Pre-Hospital Treatment target capability. Such measures may include establishment of a recognized EMS medical direction program, establishment of a National EMS Information System (NEMSIS) compliant electronic documentation system, and other appropriate preparedness measures.

States, territories, localities, and tribes are reminded of the importance for inclusion of various response disciplines that have important roles and responsibilities in prevention, deterrence, protection, and response activities, including the State EMS Office.

Inclusion should take place with respect to planning, organization, equipment, training, and exercise efforts to include the unique needs of infants and children up to 18 years of age and individuals with disabilities. Response disciplines include, but are not limited to: governmental and nongovernmental emergency medical, firefighting, and law enforcement services; public health; hospitals; emergency management; hazardous materials; public safety communications; public works; and governmental leadership and administration personnel. Special consideration should be made to those entities who maintain responsibility for the development and administration of fusion centers.

DHS/FEMA's Grants Reporting Tool (GRT) will continue to be utilized for grantees to report and for DHS to track, on a biannual basis, homeland security funding provided to response disciplines. If no State or local funding is provided to EMS, the State should be prepared to demonstrate that related target capabilities have been met or identify more significant priorities.

5. Medicare Advantage Plans Issue Provider Fraud, Waste and Abuse Training

42 CFR 422.503(b)(4)(vi) requires a Medicare Advantage plan to demonstrate to CMS that they have a valid compliance program in place.   As part of that program, a Medicare Advantage plan is required to "educate" the healthcare providers in their network about fraud, abuse and other compliance issues.   Most Medicare Advantage plans interpreted this requirement to be limited simply to putting out notices and other education materials.

However, in a December 2007 Final Rule, CMS clarified that Medicare Advantage plans would be required to be more proactive in their educational efforts.   Specifically, CMS indicated that: "[CMS] would expect that a Part D sponsor and a Medicare Advantage organization would have training logs and copies of attestations from the first tier, downstream or related entities to comply with this requirement."

This provision became effective January 1, 2009.   Thus, this is the first year of the new requirement and providers may see Medicare Advantage plans issue training programs for health care providers.   The program can be as simple as reviewing a presentation and affirming that the presentation has been reviewed by the appropriate individuals.