Congressional Committee Moves Revised Ambulance Relief Bill

On 9/11…

In a bit of displaced irony, on the very day we remember one of the greatest mass casualty incidents to ever strike the United States, September 11, the House Ways and Means Committee voted out an amendment to alter legislation that brought hope to many of us.

Congressional Committee Moves Revised Ambulance Relief BillLast week we blogged concerning efforts lead by the American Ambulance Association (AAA) to urge the House and the Senate to move on Medicare Ambulance Relief Bills H.R. 3436 and S. 967.

Action was taken, however that action was not as positive as the industry had hoped for.

H.R. 3729

In essence, Ways and Means presented an amendment in the form of a substitute to the Comprehensive Operations, Sustainability, and Transport Act of 2017. The bills formally labeled H.R. 3729 was championed by Congressmen Nunes (R-CA) and Sewell (D-AL).

The bill now pends action on the floor of the House of Representatives at an undetermined time or, if ever.

Bonus Payments Extended

Should H.R. 3729 become law, the legislation would extend the all-important Medicare add-on payments of 2% urban, 3% rural and 22.6% super rural bonus plus retain the 50% rural mileage add-on.

As a revision to H.R. 3236 of the American Medicare Budget and Operations Act, the proposed law takes a negative step forward by adding a proposed 22% cut to reimbursement for BLS non-emergency transports to and from dialysis centers. It also adds a penalty to spur ambulances to submit a newly mandated cost report.

Cost Report

Loyal readers of this blog space will recall that some time ago we blogged in a series regarding the cost reporting provisions that were tagged in the then-companion bill in the Senate, S. 967. It is the desire of Congress to push the Medicare Payment Advisory Commission (MedPAC) for data detailing the American ambulance industry’s costs.

The legislation would require the Centers for Medicare and Medicaid Services (CMS) to work with industry stakeholders to develop a working cost report model that is functional and not burdensome.

However, as many of you know, once the Federal Government’s bureaucracy latches onto a new project, we fear as many other industry watchdogs fear, that this “not burdensome” report will become just that- burdensome!

The timeframe to review and potentially add a cost reporting tool to the mix will be mandated by no later than December 31, 2019 should the bill become law. Additionally, by 2021 the new cost reports will then potentially be subject to auditing for accuracy- raising another concern for the industry as a whole.

The Teeth in the Bill

There are “teeth” proposed for this bill.

The bill proposes to amend Section 1834 of the Social Security Act regarding overpayments to include new CMS authority.

CMS would have the ability to suspend payments to suppliers of ground ambulance services if they do not submit timely cost reports. Plus, if the Secretary of CMS finds that an ambulance supplier has not submitted complete, accurate and timely data in the form of the cost report then the Secretary will have the authority to recoup overpayments for the period covered by the incomplete or missing cost report.

Most ambulance industry analysts worry about this provision because it provides a broad brush for CMS to take action against ambulance suppliers while potentially adding cost to suppliers in order to prepare and submit the required report.

Dialysis Targeted

And, as if all of that wasn’t enough, Congress is proposing to add a sharp cutting knife to select payments with H.R. 3729.

Already, reimbursements for BLS non-emergency transports to and from dialysis have been sliced by 10%.

This proposed legislation seeks to add an additional 22% cut to those payments for a total hit of 32% cut in reimbursement across the board for trips for dialysis.

It’s long been known that the Feds have dialysis transports smack dab in the middle of their crosshairs, but this cut takes a giant leap and will definitely alter even further the business models of many ambulances that still have a heavy footprint in that line of business.

(Key information for this blog was provided via the American Ambulance Association’s Advocacy Update from Friday, September 15, 2017. We thank the AAA for their tireless efforts on behalf of the ambulance industry in America.)

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