Friday, June 29, 2018

Ambulance Industry Legislation Update

In this space…

Over a few month we reported in this space about legislation in several States that had the potential to impact the ambulance industry in a big way.

Since those posts, there have been some positive developments on a few fronts.

Ambulance Industry Legislation UpdatePennsylvania Legislation Passes

The new State budget passed with little fanfare in the Commonwealth of Pennsylvania. Dubbed House Bill 2121, the bill passed easily in a State where budget bills often cause heated discussion and prolonged passage delays.

The new budget incorporates the provisions of the aforementioned House Bill 699 ushering in a 50% increase in Medicaid reimbursement for the first time since 2004. The increase will take effect January 1, 2019.

Basic Life Support transports will now be paid at a base rate of $180 per transport, up from the previous $120. Payment for transporting at the Advanced Life Support level will increase from $200 per transport to $300.

New York Legislation Push Advances

While legislation allowing fire-based EMS to bill and collect reimbursement in the State of New York has yet to pass, the word circulating at Fire 2018, the annual New York State Association of Fire Chiefs (NYSAFC) conference, is that there has been headway made in talks to advance the legislation in the Empire State.

As we reported previously, New York statute prohibits fire-based EMS from billing. The NYSAFC and others are strongly pushing for this moratorium to be lifted, allowing fire departments with an EMS component to bill for their services. Citing a growing number of fire departments mothballing EMS, with negative effect on smaller, remote communities noticeable; the legislation is being championed as a “rescue effort” for EMS in those community fire departments.

Word from the floor at convention headquarters in Verona, New York, is that discussion between the NYSAFC and State lawmakers is advancing with compromise verbiage being discussed on some of the finer points of the final language in the bills (Assembly and Senate.)

CMS Holds Data Collection System Listening Session

This week, the Centers for Medicare and Medicaid Services (CMS) hosted an audioconference listening session as the first step in response to Congress passing the Bipartisan Budget Act (BBA) of 2018.

You’ll recall that Section 50203 of the BBA of 2018, brought an extension of the Medicare ambulance add-on payments through 2022. However, with that extension comes the Congressional mandate for CMS to begin the process of developing a method for collecting cost data from the industry.

The statute calls for Ground Ambulance Providers and Suppliers to submit information detailing their costs. CMS must collect cost, revenue, utilization and other information determined appropriate by the Secretary of Health and Human Services (HHS) and submit the report to Congress. The Act mandates CMS to specify the data collection system that will be used and who must report by no later than December 31, 2019.

The listening session was meant to gather on-the-record testimony from industry stakeholders regarding their thoughts on what data is to be collected and the method for collecting it. While CMS is not bound to follow these recommendations, it was well-received by those participating that CMS opened the door for input from the industry up front and prior to making a final decision on the cost data collection process.

Synopsis of Comments

Numerous comments were entertained during the listening session call. Some of the most notable included these suggestions.
  • Nearly all those who commented applauded the announced CMS decision to not use the existing hospital cost reporting mechanism. Those commenting agreed that the hospital data collection process would not serve the ambulance industry adequately for this mandate.
  • One commenter asked CMS to insure to have a mechanism in place to filter out the non-cost of volunteer labor. The commenter asked for a data collection floor of a minimum of two full-time employees to be the benchmark so to not negatively skew cost data collection results by including all- or mostly-volunteer staffed EMS agencies with zero labor costs.
  • It was requested that CMS gather cost data that includes the costs for EMS to treat patients who do not require transport.
  • One caller asked CMS to consider, in their final analysis, how the Medicare Fee Schedule not only impacts the American ambulance industry directly through Medicare program reimbursements, but also to take into account how many commercial payer sources base their ambulance reimbursements fee schedules on the National Medicare Ambulance Fee Schedule.
  • There was a request for CMS to devise a means to factor in local government-based EMS department costs which the commenter explained are subsidized by tax dollars, potentially affecting the cost picture for those entities. The concern by this caller was that local tax dollar supported EMS providers would potentially lower the final cost report due to those locally-collected subsidies.

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