AAA Government Affairs E-Update

July 21, 2010

1. AAA Member Representatives Named to NEMSAC

2. Medicare Inflation Update for 2011

3. AAA Finalizing Comment Letter on Fractional Mileage

4. New Feature Added to AAA Medicare Rate Calculator

5. Cosponsors of Permanent Medicare Ambulance Relief Bills

6. Cosponsors of Nongovernmental EMS Federal Death Benefits Bills

1. AAA Member Representatives Named to NEMSAC

On July 17, Transportation Secretary Ray LaHood announced the selection of appointees to the National Emergency Medical Services Advisory Council (NEMSAC).  AAA Immediate Past President Jim McPartlon with Mohawk Ambulance Service in Schenectady, NY was appointed as a new member of the Council.  In addition, AAA Board Member Aarron Reinert with Lakes Region EMS in North Branch, MN, and Gary Wingrove with Mayo Clinic Medical Transport in Buffalo, MN, were reappointed.  NEMSAC advises Federal agencies on emergency medical services issues.

Here is a complete list of the appointments:

• Dia Gainor. Gainor is Idaho's state emergency medical services director and past president of the National Association of State EMS Officials.
• Jeffrey P. Salomone, MD. Dr. Salomone, a trauma surgeon, is associate professor of surgery at the Emory University School of Medicine and deputy chief of surgery at Grady Memorial Hospital in Atlanta.
• Linda K. Squirrel. Squirrel is the EMS special projects coordinator for the Cherokee Nation.
• Kenneth R. Knipper. Knipper has been a prominent and outspoken advocate for volunteer EMS providers, both in Kentucky and nationally, for more than 25 years.
• Gary G. Ludwig. Ludwig is the deputy fire chief for the city of Memphis, TN. He is currently chair of the EMS Section of the International Association of Fire Chiefs.
• James McPartlon. McPartlon is the general manager of the Mohawk Ambulance Service in Schenectady, NY. He is as past president of the American Ambulance Association.
• Gary L. Wingrove. Wingrove specializes in government relations and strategic affairs for Mayo Medical Transportation.
• Kyle R. Gorman.  Gorman is the executive officer of the Clackamas County Fire District One in Oregon.
• Marc Goldstone. Goldstone, who served 14 years as a paramedic, is currently the vice president and associate general counsel for the Community Health Systems of Tennessee.
• Daniel Patterson, PhD. Dr. Patterson is an assistant professor at the University of Pittsburgh School of Medicine's Department of Emergency Medicine.
• Troy M. Hagen. Hagen is director of the Ada County, Idaho, Paramedics and oversees all aspects of the countywide ambulance taxing district which covers 1,055 miles and 400,000 residents who live in both urban and rural areas.
• Arthur Cooper, MD. Dr. Cooper is a professor of surgery and director of trauma and pediatric surgical services at Columbia University's Medical Center in affiliation with the Harlem Hospital Center.
• Thomas Judge. Judge is executive director of LifeFlight of Maine and the immediate past president of the Association of Air Medical Services, which represents 300 air medical services.
• Aarron Reinert. Reinert is executive director of the Lakes Region EMS in Minnesota. He served as the data manager for Minnesota's EMS system from 2001 to 2004, focusing on the use of data to improve EMS services.
• Robert Oenning. Oenning is the Enhanced 9-1-1 program administrator for the State of Washington.
• Leaugeay Barnes. Barnes is the program director for emergency medical services at Oklahoma City Community College.
• Matthew Tatum. Tatum has served as the EMS coordinator and emergency manager for Henry County, Virginia, since 2002.
• Sherri-Lynne Almeida, MSN. Almeida serves as the chief nursing officer for CareFusion and as EMS administrator, as well as the infection control officer for the Houston Fire Department.
• Kenneth Miller, M.D., Ph.D.  Dr. Miller, an emergency physician, serves as the medical director of the Orange County Fire Authority in California, as well as the assistant medical director of the Orange County Healthcare Agency/EMS.
• Ritu Sahni, M.D. Dr. Sahni, an emergency physician, is on the faculty of Oregon Health and Science University (OHSU).
• Joseph Wright, M.D. Dr. Wright is a pediatric emergency physician who has practiced for 17 years at the Children's National Medical Center in Washington, D.C.
• Baxter Larmon, M.D., PhD. Dr. Larmon is professor of emergency medicine at the David Geffen School of Medicine at the University of California at Los Angeles (UCLA) and the founding director of the UCLA Center for Prehospital Care.
• Scott Somers, Ph.D. As member of the Mesa City Council in Arizona, Dr. Somers has extensive experience setting public policy for emergency medical services and public health.

2. Medicare Inflation Update for 2011

By Brian S. Werfel, Esq.

On July 16, 2010, the Bureau of Labor Statistics (BLS) released the June 2010 consumer price index numbers.  The annual updates to the Medicare Ambulance Fee Schedule are based on the increase in the consumer price index for all urban consumers (CPI-U, U.S. City Average) for the 12-month period ended June 30, 2010.  The change for the past 12-month period was 1.05%.  Note: BLS has made revisions to CPI data in the past.  Therefore, this number is subject to change.

In the past, this would have resulted in a 1.05% increase to your Medicare rates for 2011.  However, Section 3401(j) of the Patient Protection and Affordable Care Act of 2010 changes the way the annual update will be calculated, starting in 2011.  Effective January 1, 2011, the annual update to the Ambulance Fee Schedule will be equal to: (1) the increase in the CPI-U for the 12 month period ended June 30, 2010 minus (2) the 10-year moving average of changes in the annual economy-wide private nonfarm business multi-factor productivity index (MFP).  For the last measured period, the MFP was approximately 1.3%.

Therefore, at this time, it appears that the 2011 update to the Medicare Ambulance Fee Schedule will be approximately negative 0.25% (– 0.25%).  Note: this number may change based on CMS' projection of the final MFP for the applicable period.  CMS will announce the final 2011 update by transmittal and on its website.  This number also does not take into account the expiration of the recent extension of the 2% urban, 3% rural and "super rural" bonus payments, all of which are currently scheduled to expire on December 31, 2010.

3. AAA Finalizing Comment Letter on Fractional Mileage

The AAA is currently finalizing its comment letter to the recently issued proposed rule on changes to Medicare ambulance fee schedule.  The focus of the letter will be on the proposed change by CMS to reimburse mileage at the tenth of a mile instead of the current policy of rounding up to the next whole mile.  Once the AAA comment letter is finalized, we will issue a sample letter that AAA members can then use to submit their own comment letter to CMS.

4. New Feature Added to AAA Medicare Rate Calculator

The AAA has added a new feature to its 2010 Rate Calculator and Forecasting Tool (June 2010 version) to allow AAA members to see the comparison of reimbursement rates with and without the extensions of Medicare ambulance relief.  This new feature shows what ambulance services will lose if the 2% urban, 3% rural and super rural bonus payment increases are not extended beyond their current expiration date of December 31, 2010.  The 2% urban and 3% rural increases apply to both the base rate and mileage and the super rural bonus payment of 22.6% applies to the base rate.  The Tool can be found on the "Reimbursement Issues" page in the Members Only section of the AAA website.

5. 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, Representatives Charlie Melancon (D-LA) and Patrick Murphy (D-PA) have been added as cosponsors of 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, Rep. Charlie Melancon

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, Rep. Patrick Murphy

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

6. 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

MI: Sen. Debbie Stabenow

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