PA Ambulances Celebrate Second Legislative Victory for 2018

June… in this space

In June, we passed along some key legislation initiatives in this space that were pending and, in the case of Pennsylvania, a proposal that had passed and was signed into law.

Now, just a short four months later, Pennsylvania’s EMS system can celebrate yet another major victory with this week’s passage of House Bill No. 1013.

Pa Ambulances Celebrate Second Legislative Victory For 2018 10 19 2018

Victory on top of Victory!

When Governor Wolf signed House Bill 2121 in June, Pennsylvania Medicaid reimbursement for ambulance transport saw a proposed 50% increase set into motion for January 1, 2019. It was the first time that those payment rates were raised in well over 15 years.

Rarely are the Keystone State’s lawmakers so in agreement. However, as more and more EMS systems have expressed the pressure of rising costs coupled with stagnant reimbursement from Medicare and Medicaid nationwide, the Commonwealth’s legislative body began hearing the desperate requests for assistance as relayed by the Ambulance Association of Pennsylvania (AAP) and other lobbying voices across Pennsylvania.

But certainly the Pennsylvania EMS industry did not expect one major victory on top of another major victory. This week the Commonwealth’s EMS community realized that second victory for the future with the passage of House Bill 1013 which, when signed by Governor Tom Wolf, will force insurance payers to reimburse when emergency treatment is provided but without ultimate transportation of the patient in the ambulance.

Payment will be made for the care rendered in these situations as called for by this new law.

The Bill’s Champion

Pennsylvania State Representative Stephen Barrar, a 21 year Republican member of the State House out of the 160th Legislative District (Chester (part) / Delaware (part), first introduced House Bill 1013 in January 2017. Barrar served as the bill’s champion, nudging the legislative initiative first through the Veterans Affairs and Emergency Preparedness Committee, where he serves as the chair, until it finally reached the floors of the State House and Senate this past week.

The Bill amends the longstanding Insurance Act that has been in place since 1921.

Intro Memo

In his introduction memo to the Pennsylvania House, Barrar entitled his memo to fellow members of the House using the subject line “EMS Reimbursement for NON-Transport Services.”

His memo delivered to all House members on January 26, 2017 explains the need for and the intent of the newly introduced legislation he had just introduced for consideration.

“As you may know, under current law EMS agencies can only be reimbursed for a covered claim if they transport the patient to a hospital. Many times an ambulance and/or advanced life support squad will render care at an incident and not provide transport, usually because the patient has refused transport to the hospital.”

Later in the memo he continued in establishing his rationale for fathering the bill.

“Too many times EMS providers must wait to respond to a 911 call only to show up at the incident and provide care and treatment, but not transport for various reasons. In either case, the EMS provider responded to the call and expended time and resources on responding to the call. No other sector of the ‘healthcare’ industry operates in this fashion.”

Conditions

The legislation lays down two conditions for payment to be issued.

  • The ambulance (BLS or ALS) must be dispatched by a PSAP (Public Service Access Point/911 Center.)
  • The EMS provider must have rendered care even though transport was refused.

This limits the provisions of the bill to emergency ambulance incidents and calls for some type of care to be rendered to deserve payment.

Of course, the State can legislate Medicaid and insurance companies operating within the Commonwealth, but cannot force Medicare into enacting reimbursements for treatment minus transport as Federal rules overtake the Pennsylvania initiative.

While the bill calls for payments at the contracted and/or usual and customary rates, there is a bit of ambiguity regarding what the final reimbursement amounts will be when treatment is provided without transport as currently there is typically no existing payment amount for those services across the majority of payers operating within the Commonwealth.

Looking Ahead

Pennsylvania is one of several States to either have legislation pending or are considering initiatives similar to the Pennsylvania bill. Of course, the larger discussion looms as there has been serious consideration at the Federal level to categorize EMS as individual providers rather than group suppliers. Should Congress make such a move, then the door swings wide open enabling Medicare to begin reimbursing for services rendered versus paying for transportation.

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