AAA Government Affairs E-Update

June 30, 2010

1. CMS Issues Proposed Rule on Fractional Mileage, Adjustments, Updates

2. CMS Launches Information Site for Billing and Coding Professionals

3. REMINDER: AAA Posts New 2010 GPCI Increases for Localities Lower than 1.0

4. Cosponsors of Permanent Medicare Ambulance Relief Bills

5. Cosponsors of Nongovernmental EMS Federal Death Benefits Bills

1. CMS Issues Proposed Rule on Fractional Mileage, Adjustments, Updates

On June 25, 2010, the Centers for Medicare and Medicaid Services (CMS) issued a Proposed Rule (1,250 pages) on Medicare reimbursement policy.  While much of it pertains to physician payment, there are several provisions that apply to ambulance services.  The AAA is developing a comment letter to the proposed rule and will issue a sample letter for AAA members to submit on the rule as well.  The comments will focus primarily on the fractional mileage change.  Also, the AAA audio conference scheduled for July 6 will now address the issues raised in the proposed rule and the implications for ambulance service providers.  Listed below are the provisions of the proposed rule impacting ambulance services.

Temporary Adjustments

·         The 2% adjustment for ground ambulance services with urban points of pick up is extended retroactive for one year from January 1, 2010 to December 31, 2010.

·         The 3% adjustment for ground ambulance services with rural points of pick up is extended retroactive for one year from January 1, 2010 to December 31, 2010.

·         The 22.6% adjustment for ground ambulance services with "super-rural" points of pick up is extended retroactive for one year from January 1, 2010 to December 31, 2010.

·         For air ambulance services, any area designated as rural as of December 31, 2006 will continue to be treated as rural retroactive for one year from January 1, 2010 to December 31, 2010.

Annual Updates

In recent years, the annual update has been the Ambulance Inflation Factor, calculated as the change in the CPI-Urban for the 12 month period ending on June 30.  Effective January 1, 2011, the update will be the Ambulance Inflation Factor less what is called the MFP (Multi-Factor Productivity) adjustment.  The MFP is the 10-year moving average of the changes in the annual economy-wide private non farm business index.  The inclusion of the MFP was the result of language included in the recent health care reform bill.

If the 12-month change in the CPI-Urban is negative, the Ambulance Inflation Factor for the following calendar year will be zero.  However, it is possible for the annual update for that year to be negative, based on the MFP.

Fractional Mileage

CMS is proposing that mileage no longer be rounded up to the next whole number.  Instead, they are proposing that mileage be rounded up to the nearest tenth of a mile.  The only exception would be for mileage in excess of 100 miles.  In those cases, mileage would continue to be rounded up to the next whole number (the reason for this is the number of characters that CMS contractors can support when using the 1500 paper claim).  A few examples are provided below:

Loaded Mileage         Mileage to Bill

         0.6                             0.6

         3.2                             3.2

     100.2                          101

Enrollment Form

CMS is proposing that the enrollment form be amended to also require that ambulance suppliers and providers notify CMS of any revocation or suspension of certifications (not just licenses) of the company.  Such notification will be required within 30 days of the revocation or suspension.  The language will also be amended to state that this includes any changes with respect to the FAA and CLIA.

2. CMS Launches Information Site for Billing and Coding Professionals

Forwarded from CMS

It is important to the Centers for Medicare & Medicaid Services (CMS) that the billing and coding professionals who work with Fee-For-Service (FFS) Providers have the timely and accurate information they need to properly bill the Medicare Program. That is why we developed the Medicare Learning Network® Suite of Products and Resources for Billing and Coding Professionals – to help billers, coders and other reimbursement specialists submit claims correctly the first time.

Like all MLN products, the Suite has nationally consistent, up-to-date Medicare information prepared by subject-specific experts —and it is available at no cost!  The Suite addresses – The Business of Medicare, Medicare Benefits and Services, Special Medicare Initiatives, and General Medicare Program Information and Resources, and offers an uncomplicated way to understand more about the Medicare Program.

To access this exciting new product, go to http://www.cms.gov/MLNEdWebGuide/ and click on " Medicare Learning Network Suite of Products and Resources for Billing and Coding Professionals" on the left side of the page.

3. REMINDER: AAA Posts New 2010 GPCI Increases for Localities Lower than 1.0

As we reported previously, 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.  The AAA had revised its 2010 Medicare Rate Calculator and Forecasting Tool to account for the change and posted it on the AAA website.  We have now revised the spreadsheet showing the new percentage increases for 2010 which will be the same for 2011.  The spreadsheet is entitled "Revised 2010-2011 Medicare <1.0 GPCI Increases – NEW" and can be found in the members only section of the AAA website on the reimbursement page.

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 will 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.

4. 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).   Since our last report, Representative Brett Guthrie (R-KY) has cosponsored 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

IL: Rep. Aaron Schock

IA: Sen. Tom Harkin

KS: Sen. Pat Roberts

KY: Brett Guthrie

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

5. 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.   Since our last report, Senator Jeff Merkley (D-OR) has been added as a cosponsor of The Dale Long Act.  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

OR: Sen. Jeff Merkley

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