AAA Government Affairs E-Update

February 11, 2010

undefined undefined undefined undefined 1. Medicare Ambulance Relief Extensions Included in Draft Jobs Bill

2. Additional Cosponsors of Permanent Medicare Ambulance Relief Bills

3. Summary of Ambulance Open Door Forum

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undefined undefined undefined undefinedFebruary 23-24 Lobby Days Washington DC

March 19 Stars of Life Registration Deadline

March 23 Regional Reimbursement Workshop Orlando, FL

April 20 Regional Reimbursement Workshop Las Vegas, NV

May 2-5 Stars of Life Washington, DC

1. Medicare Ambulance Relief Extensions Included in Draft Jobs Bill

The Senate Finance Committee has developed a draft jobs bill, the Hiring Incentives to Restore Employment (HIRE) Act, which is intended to stimulate job creation.   The bill also includes one-year, retroactive to January 1, 2010, extensions of the 2% urban, 3% rural and super rural bonus Medicare ambulance increases.   Senate Majority Leader Harry Reid had hoped for the Senate to consider the bill this week but efforts have been slowed by the recent snow storms which have crippled the DC area.

On the House side, the Rural Health Care Coalition is circulating a letter amongst its members on the need for extensions of rural Medicare provider relief.   Included in the letter is a request for extensions of rural ambulance relief.   The letter will be sent to the House Leadership and key committee chairs and ranking members.   The House is expected to consider jobs creation legislation later in February.

House and Senate negotiators on health care reform continue to meet to discuss a possible process forward.   However, any effort on health care reform will not happen in the immediate future.   The AAA therefore has been pushing for inclusion of extensions of Medicare ambulance relief in other legislative vehicles such as the jobs bill.   Our primary goal is to ensure that the time without the relief is minimized and relief is retroactive to January 1, 2010.

2. Additional Cosponsors of Permanent Medicare Ambulance Relief Bills

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.   The AAA is currently pushing for extensions of current Medicare ambulance relief as well as encouraging Members of Congress to cosponsor MAAPA.

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 to MAAPA.   Since our last report, Senators Kirsten Gillibrand (D-NY) and Sheldon Whitehouse (D-RI) have cosponsored S. 1066 and Congressmen Tim Holden (D-PA), James Langevin (D-RI) and Peter DeFazio (D-OR) have cosponsored H.R. 2443.

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. Kirsten Gillibrand, Rep. Paul Tonko

ND: Sen. Kent Conrad, Sen. Byron Dorgan

OH: Rep. Patrick Tiberi

OR: Rep. Peter DeFazio

PA: Rep. Jim Gerlach, Rep. Tim Murphy, Rep. Tim Holden

RI: Sen. Sheldon Whitehouse, Rep. James Langevin

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

3. Summary of Ambulance Open Door Forum

By David M. Werfel, Esq.

On February 3, 2010, CMS held its latest Open Door Forum for ambulance.   CMS started with the following announcements:

ABN- Wheelchair Vans  - No Advance Beneficiary Notice of Non-Coverage form is needed for wheelchair van transports as wheelchair vans are not covered by Medicare.

2010 Ambulance Rates  - CMS has posted the 2010 Medicare ambulance rates on their web-site at: http://www.cms.hhs.gov/AmbulanceFeeSchedule/02_afspuf.asp#TopOfPage.

Reimbursement Adjustments – The temporary adjustments for ambulance reimbursement (e.g. 2% - urban; 3% - rural, etc.) expired, by law, at the end of 2009. CMS cannot reinstate any, without legislative action.

Following these announcements, there was a Q&A period.   Most of the 11 callers asked questions or raised Carrier problems that need to be resolved through their local CMS Regional Office.   The questions answered by CMS on the call were as follows:

• Medicare patients should not be billed up-front for their co-insurance.
• The PCS can be obtained, if the ambulance company wants, even when not needed, e.g. emergencies and transports from a residence to the hospital for a patient not under the direct care of a physician.
• SCT was reviewed with CMS making a point of reminding those listening that, for SCT to be covered, the services of the paramedic with additional training must be needed, not just that they were present.   Also, those services need to be documented.
• An extra attendant and supplies are not separately covered by Medicare. These are included in the payment for the base.
• A scheduled transport for a physician's appointment, where the physician is located in a hospital should be billed with a "P" modifier and not "H".
• An off-site clinic opened by a hospital would only be considered a hospital if it met the definition for provider-based.   Usually, these are not to be billed with the "H" modifier and the "P" modifier should be used.   CMS could not answer the specific question as more facts were needed as to the specific entity.
• A roundtrip transport from a rehabilitation hospital to the ED and back on the same calendar day is considered to be an "interrupted stay", and should be billed to the rehabilitation hospital.   Facilities which refuse to pay should be reported to the CMS Regional Office.

There were 258 participants on the call.   The next Ambulance Open Door Forum will be on April 7, 2010.