September 20, 2015

Government Affairs Update

Currently, there are two federal activities to keep an eye on.

First, the Center for Medicare & Medicaid Services (CMS) has proposed a change to its Medicare Part B payment policies for calendar year 2016. None of the proposed changes affects reimbursement for air medical transport; however, proposed changes do affect the ambulance fee schedule for ground transport and provide insight into the future approach of CMS regarding medical transport reimbursement.

As described by Gregory Lynskey, Government Relations Manager of the Association of Air Medical Services (AAMS), used with permission:

On Wednesday [July 8, 2015], for your information, I sent you the link to a CMS CY 2016 proposed rule entitled: “Revisions to Payment Policies under the Physician Fee Schedule and Other Revisions to Part B for CY 2016” shortly after it was posted on CMS’ public inspection website.  After review, there were only three provisions relating to ambulance policy, all relating to ground transports and all formalizing or clarifying current policy.  However, as noted previously, these provisions, as well as the entire rule, is open for public comment.

  1. The rule formalizes in regulation the extension of the ground ambulance payment add-ons through December 31, 2017, as mandated by the Medicare Access and CHIP Reauthorization Act of 2015.  These add-ons include the 2% add-on for urban transports, 3% add-on for rural transports, and the so-called “Super Rural” bonus.
  2. The rule also re-proposes the continued adoption of OMB revised geographic delineations, as first proposed in February 2013 and subsequently corrected.  The use of these revised delineations will bring the geographic designations in line with those used by the Inpatient Hospital PPS and other Medicare payment systems.
  3. The rule proposes a clarification to the staffing requirements for BLS ground transports.  For a BLS transport to be covered by Medicare, it will require two crewmembers, one of which must be licensed at a minimum as an EMT-Basic.  Furthermore, it is clarified that all crewmembers must meet the requirements set forth in Medicare regulations AND any requirements dictated by the state or locality in which the service is performed.  According to CMS, these technical changes better state their current policy.  CMS is also proposing to eliminate the last sentence in their definition of “Basic Level Service” that offers an example they feel offers confusion and does not accurately represent current policy.  None of these clarifications affects Critical Care Ground or Air transports.

Second, H.R. 2366 is the Field EMS Modernization and Innovation Act, known colloquially as the Field EMS bill that has been through numerous iterations over the years. While there are no specific air medical transport provisions, this version includes provisions for demonstration projects to study reimbursement for readiness and medical care (not only transport), mobile integrated healthcare, community paramedicine, and alternate destination transports (other than to an emergency department). There are provisions for the Secretary of Health and Human Services to develop a quality incentive program. The bill creates a field EMS medical oversight advisory committee comprised of physicians which may lead to opportunities for air medical physician involvement. Also, the bill clarifies that HIPAA allows for exchange of information between hospitals and EMS agencies which might facilitate air medical services receiving follow-up information from hospitals after transfer of care. Finally, the bill supports research in medical transport which air medical physicians will likely take advantage.

Since it behooves us to stay apprised of any federal legislative or regulatory activities that impact our practice as air medical physicians, I encourage all of us to join the ACEP 911 Legislative Network, to know each of our service’s government relations individual(s), and to consider joining the AAMS Government Relations Committee and monitoring the activities of the National Association of EMS Physicians (NAEMSP®) Advocates for EMS.

David Stuhlmiller, MD, FACEP, CMTE

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