AAA Government Affairs E-Update

June 17, 2010

1. Positive Change to Temporary Increases for GPCI Localities Lower than 1.0

2. AAA Issues Updated Medicare Rate Calculator

3. Cosponsors of Permanent Medicare Ambulance Relief Bills

4. Cosponsors of Nongovernmental EMS Federal Death Benefits Bills

1. Positive Change to Temporary Increases for GPCI Localities Lower than 1.0

Ambulance service providers which serve localities with a Geographic Price Cost Index (GPCI) of lower than 1.0 will see a larger increase in Medicare reimbursement rates in 2010 than what was first reported.  In late April, the AAA reported that ambulance service providers which serve localities with a GPCI of lower than 1.0 will see a Medicare reimbursement rate increase in 2010 and a larger increase in 2011.  The increases in rates are a result of language in the recently enacted health care reform legislation.  But now as a result of a modification made in the health care reconciliation bill, the larger increase will take effect in 2010 retroactive to January 1 of this year.  For the "frontier" states of Montana, North Dakota, South Dakota, Utah and Wyoming, the GPCI will increase in 2010 and then becomes 1.0 starting in 2011.

Temporary Increases for Localities with less than 1.0 GPCIs

On the Medicare Ambulance Open Door Forum of April 7, CMS officials announced that changes included in health care reform legislation to the GPCI for the physician fee schedule would impact ambulance reimbursement rates.  This is due to the GPCI for the Medicare ambulance fee schedule being based on the practice expense component of the physician GPCI.  Immediately following the forum, AAA representatives contacted CMS officials and confirmed that the provision would not be budget neutral for the ambulance fee schedule.  Therefore any increases in GPCIs for some localities will not result in decreases in reimbursement rates for other areas.

Within health care reform legislation, Congress temporarily altered the wage and rent percentages of the practice expense component to increase reimbursement for physicians which serve areas with GPCIs of less than 1.0.  The actual percentage increase to these GPCIs vary for each locality.  For the "frontier" states of Montana, North Dakota, South Dakota, Utah and Wyoming, the GPCI becomes 1.0 starting in 2011.  Congress also included language to ensure that the alteration would not reduce reimbursement for physicians which serve areas that have a GPCI of 1.0 or higher.

As a result of these changes, for 2010 and 2011, rates under the Medicare ambulance fee schedule for localities with a GPCI of less than 1.0 will see an additional increase in reimbursement rates and localities with a GPCI of 1.0 or higher will not be affected by the provision.  The provision is retroactive to January 1, 2010 and the increases expire on December 31, 2011.  The GPCI floor of 1.0 for "frontier" states does not take effect until 2011, but does not have an expiration date.  CMS is directed to evaluate changes to the physician GPCI which would potentially take effect in 2012.

2. AAA Issues Updated Medicare Rate Calculator

The AAA has updated its 2010 Rate Calculator and Forecasting Tool (June 2010 version) to reflect the newly calculated increases to rates in 2010 for those localities with a Geographic Price Cost Index (GPCI) of lower than 1.0.  For 2012 and later years, the GPCI reverts back to the original 2010 levels prior to the enactment of health care reform legislation.  The AAA is currently updating the document entitled "2010-2011 Medicare Increases for less than 1.0 GPCI Localities" to displays the larger increases for each locality and the resulting percentage increase, if any, in reimbursement rates for 2010 and 2011.

3. 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 (S. 1066, H.R. 2443) would provide a permanent 6% Medicare increase for ambulance transports originating in urban or rural areas and permanently extend the bonus base payment of 22.6% for ambulance transports originating in super rural areas.

The AAA was successful in efforts to extend the temporary 2% urban, 3% rural and super rural bonus increases until the end of 2010.  The relief from MAAPA would take the place of any temporary Medicare ambulance relief beyond 2010 and not in addition to it.  The AAA will continue to pursue efforts for the extension of the temporary Medicare ambulance relief provisions as well as advocate for passage of MAAPA as the permanent solution to below-cost Medicare ambulance reimbursement.  Medicare ambulance relief is the top legislative priority of the AAA.

Current Cosponsors of MAAPA

Below is a list, current as of today, of members of Congress who have officially been added as cosponsors to MAAPA (S. 1066, H.R. 2443).  The names of sponsors and champions of the bills are underlined.

AL: Sen. Jeff Sessions

AR: Sen. Blanche Lincoln, Sen. Mark Pryor, Rep. Marion Berry

CA: Rep. Devin Nunes

CT: Rep. Rosa DeLauro: Rep. Chris Murphy

DC: Del. Eleanor Holmes Norton

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

MP: Del. Gregorio Sablan

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

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

MN: Sen. Amy Klobuchar; Rep. Jim Oberstar

MS: Sen. Thad Cochran

MO: Sen. Kit Bond

MT: Sen. Jon Tester

NE: Rep. Adrian Smith

NV: Rep. Shelley Berkley

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

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

NH: Sen. Jeanne Shaheen

ND: Sen. Kent Conrad, Sen. Byron Dorgan

OH: Rep. Patrick Tiberi

OR: Rep. Peter DeFazio, Rep. David Wu

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

RI: Sen. Sheldon Whitehouse, Rep. James Langevin

SD: Rep. Stephanie Sandlin Herseth

SC: Sen. Lindsey Graham

VA: Rep. Gerry Connolly

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

WA: Rep. Doc Hastings

WV: Rep. Nick Rahall

WI: Rep. Steve Kagen, Rep. Tammy Baldwin

4. Cosponsors of Federal Death Benefit Nongovernmental EMS Bills

The second highest legislative priority of the AAA is to ensure that paramedics and EMTs who are employed by nongovernmental ambulance agencies are covered by federal death benefits in the unfortunate event that he or she dies in the line of duty.   To address this issue, the AAA has been working closely with the offices of Senator Patrick Leahy who introduced the Dale Long Emergency Medical Service Providers Protection Act (S. 1353) and Congressman Keith Ellison who introduced the Nongovernmental Emergency Responder Family Protection Act (H.R. 2485).  S. 1353 is pending on the Senate Calendar and H.R. 2485 has been referred to the House Judiciary Committee.

The Nongovernmental Emergency Responder Family Protection Act (NERFPA) would clarify that the PSOB program covers private non-profit and for-profit public safety officers who provide emergency medical and ground or air ambulance service, fire protection and suppression.  The Dale Long Emergency Medical Service Providers Protection Act would cover non-profit public safety officers.

Below is a list, current as of today, of members of Congress who have officially been added as cosponsors to the Dale Long Act (S. 1353) and H.R. 2485.  The names of sponsors and champions of the bills are underlined.

Dale Long Act (S. 1353) Cosponsors

MN: Sen. Al Franken

NJ: Sen. Bob Menendez

NY: Sen. Chuck Schumer

ND: Sen. Kent Conrad

VT: Sen. Patrick Leahy, Sen. Bernie Sanders

NERFPA (H.R. 2485) Cosponsors

CA: Rep. Zoe Lofgren

DC: Del. Eleanor Holmes Norton

GA: Rep. Sanford Bishop

IN: Rep. Andre Carson

KS: Rep. Dennis Moore

ME: Rep. Michael Michaud

MD: Rep. Elijah Cummings

MA: Rep. Barney Frank

MI: Rep. Mark Schauer

MN: Rep. Keith Ellison, Rep. Collin Peterson, Rep. Tim Walz

NJ: Rep. Steven Rothman

NY: Rep. Yvette Clarke, Rep. Paul Tonko

OR: Rep. David Wu

VT: Rep. Peter Welch