AAA Government Affairs E-Update

December 23, 2009

1. Health Care Reform and Medicare Ambulance Relief Update

2. AAA Releases 2010 Medicare Rate Calculator and Forecasting Tool

3. CMS Posts 2010 Ambulance Fee Schedule Public Use File Rates

4. REMINDER: DHS Grant Guidance for Fiscal Year 2010 Grant Programs

5. Timing of Next E-Update and Health Care Reform Update

1. Health Care Reform and Medicare Ambulance Relief Update

Early tomorrow morning, the Senate is scheduled to vote on passage of health care reform legislation, the Patient Protection and Affordable Care Act (H.R. 3590).   The legislation contains a one-year extension starting on January 1, 2010, of the 2% urban, 3% rural and super rural bonus payment increases.   Without an extension, all of the Medicare ambulance relief currently in place will expire at the end of this year.

The Senate is expected to pass H.R. 3590 which would be followed by a brief conference between the House and Senate to resolve differences in the two bills.   Unless in the unlikely event that the House just passes the Senate bill.   Once a compromise is reached, the House and Senate would vote on the final bill which would then be sent to the President for his signature.   This is planned to occur before the State of the Union Address by the President in February.

The extensions of Medicare ambulance relief would therefore be retroactive to January 1, 2010.   The process for implementing the new rates would likely be very similar to when the 2% urban and 3% rural increases were passed in the Medicare Improvements for Patients and Providers Act (MIPPA).   The Centers for Medicare and Medicaid Services (CMS) would issue a transmittal to Carriers and Fiscal Intermediaries on the change in reimbursement rates and post a revised Public Use File for 2010 with the new rates.

Please be prepared to contact your Members of Congress regarding extensions of Medicare ambulance relief.   We need to ensure that the final bill resulting from conference committee includes the extension of the super rural ambulance bonus payment, which would only be in the Senate bill, as well as the retroactive effective date of January 1, 2010.   We will provide all the necessary information for you to make the contacts.

2. AAA Releases 2010 Medicare Rate Calculator and Forecasting Tool

The AAA has posted its 2010 Medicare Rate Calculator and Forecasting Tool in the "Members Only" section of the AAA website.   Because this area is password protected to access the Tool, please go to the AAA website at www.the-aaa.org and log into the "Members Only" section and then go to Industry Issues and select Reimbursement Issues or directly by clicking HERE

The 2010 Tool takes into consideration that the 2% urban, 3% rural and super rural bonus payment have expired.   The Tool also reflects the complete phase-in of the national fee schedule rates and the completion of the phase-out of regional fee schedule rates.   We will release a revised version of the Tool upon enactment of extensions of Medicare ambulance relief.

3. CMS Posts 2010 Ambulance Fee Schedule Public Use File

By Brian Werfel, Esq.

The Centers for Medicare and Medicaid Services (CMS) recently posted the public use file (PUF) containing the 2010 rates for the Medicare ambulance fee schedule.   The AAA has reviewed the rates for all jurisdictions and they appear to be correct.   Please keep in mind, these rates are based on the law as it exists today, rather than on the health care reform bills pending in the House and Senate.   Thus, the temporary adjustments of 2% urban (base rate and mileage), 3% rural (base rate and mileage) and 22.6% super rural bonus payment (just base rate) are not included.

The fee schedule for 2010 also reflects the final phase-in of the national fee schedule for those whose regional fee schedule has not yet been phased out.   The rates also include the phase-in of new geographical price cost index (GPCI) figures.   Also, there is no inflation update for 2010.

Here is the link to the CMS web site.   You will have to then scroll to CY 2010.

http://www.cms.hhs.gov/AmbulanceFeeSchedule/02_afspuf.asp#TopOfPage

4. REMINDER: DHS Grant Guidance for Fiscal Year 2010 Grant Programs

Homeland Security Secretary Janet Napolitano 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. Timing of Next E-Update and Health Care Reform Update

The AAA headquarters will close tomorrow, December 24, at 3:00 p.m. (eastern) and will reopen on Monday, January 4, 2010.   During that period, there will be no Government Affairs E-Update or Health Care Reform Update issued.   The next Government Affairs E-Update will be issued on Wednesday, January 6 and the next Health Care Reform Update on Friday, January 8.