How Does Medicare Fee Schedule Apply To "International" Ambulance Services

Medicare Ambulance Relief Pecker introduced in Senate

Written by AAA Staff on June 11, 2021. Posted in Advocacy Priorities, Government Affairs, Legislative, Medicare.

Yesterday, Senators Catherine Cortez Masto (D-NV) and Susan Collins (R-ME) introduced the Protecting Access to Ground Ambulance Medical Services Act of 2021 (S. 2037). Senators Cortez Masto and Collins were joined past Senators Debbie Stabenow (D-MI), Bill Cassidy (R-LA), Patrick Leahy (D-VT) and Bernie Sanders (D-VT) every bit primary cosponsors and leads on the legislation.

S. 2037 is identical to H.R. 2454 by Representatives Terri Sewell (D-AL), Devin Nunes (R-CA), Peter Welch (D-VT) and Markwayne Mullin (R-OK) and would extend the temporary Medicare ground ambulance increases of ii% urban, iii% rural and the super rural bonus payment for five years. The increases are currently scheduled to elapse on Dec 31, 2022. The five-year extension would allow for the increases to remain in place during the two-year filibuster on ambulance data collection due to the COVID-nineteen public wellness emergency, an analysis of the data by MedPAC and subsequent action by the Congress to reform the Medicare ambulance fee schedule.

The legislation would also help ensure that rural zip codes in large urban counties remain rural following geographical changes nether the fee schedule as a upshot of the 2020 census data. The electric current definition using rural urban commuting areas (RUCA) in Goldsmith Modification areas would be modified for zilch codes with 1,000 people or less per foursquare mile would also be rural. Ground ambulance service providers and suppliers could also petition the Centers for Medicare and Medicaid Services (CMS) to make the argument that a specific goose egg code should be rural. Information technology is vital that this provision be implemented before CMS makes changes from the 2020 census data which volition likely occur in 2023.

The AAA has been leading the attempt on the legislation with the support of the International Association of Burn down Chiefs, International Association of Fire Fighters, National Association of EMTs, National Rural Wellness Association and the National Volunteer Fire Quango.

The AAA will be launching a Telephone call to Action shortly requesting AAA members to ask their Senators to cosponsor S. 2037, and reach out to their Representatives to cosponsor H.R. 2454 if they have not already done and so.

We greatly capeesh the leadership of Senators Cortez Masto, Collins, Stabenow, Cassidy, Leahy, and Sanders on this vitally important legislation.

Give thanks you @SenCortezMasto, @SenatorCollins, @SenBillCassidy, @SenStabenow, @SenatorLeahy, and @SenSanders for collaborating to support America'south #Ems providers in the pandemic and beyond! #SupportEMS #AlwaysOpen #MobileHealthcare #NotJustaRide film.twitter.com/q7Divtby8z

— AmericanAmbulanceAsc (@amerambassoc) June 10, 2021

CMS Bolsters Payments for Calm COVID-19 Vaccines

Written by AAA Staff on June 10, 2021. Posted in Finance, Medicare, Operations, Patient Care, Reimbursement.

From CMS on June 9, 2021

Biden Administration Continues Efforts to Increase Vaccinations past Bolstering Payments for At-Habitation COVID-nineteen Vaccinations for Medicare Beneficiaries

As office of President Biden'south commitment to increasing access to vaccinations, CMS appear an additional payment amount for administering in-home COVID-xix vaccinations to Medicare beneficiaries who accept difficulty leaving their homes or are otherwise hard-to-attain. This proclamation farther demonstrates continued efforts of the Biden-Harris Administration to encounter people where they are and get in equally like shooting fish in a barrel as possible for all Americans to get vaccinated. In that location are approximately 1.vi 1000000 adults 65 or older who may take problem accessing COVID-19 vaccinations because they have difficulty leaving domicile.

While many Medicare beneficiaries can receive a COVID-19 vaccine at a retail chemist's, their physician's office, or a mass vaccination site, some beneficiaries take great difficulty leaving their homes or face a taxing endeavour getting effectually their communities easily to access vaccination in these settings. To better serve this grouping, Medicare is incentivizing providers and will pay an additional $35 per dose for COVID-19 vaccine administration in a beneficiary's home, increasing the total payment amount for at-dwelling vaccination from approximately $40 to approximately $75 per vaccine dose. For a two-dose vaccine, this results in a total payment of approximately $150 for the administration of both doses, or approximately $lxx more than the current rate.

"CMS is committed to meeting the unique needs of Medicare consumers and their communities – particularly those who are abode jump or who have trouble getting to a vaccination site. That'south why nosotros're acting today to expand the availability of the COVID-19 vaccine to people with Medicare at home," said CMS Ambassador Chiquita Brooks-Lasure. "We're committed to taking action wherever barriers exist and bringing the fight against the COVID-19 pandemic to the door of older adults and other individuals covered by Medicare who nevertheless need protection."

Delivering COVID-19 vaccination to access-challenged and hard-to-achieve individuals poses some unique challenges, such as ensuring appropriate vaccine storage temperatures, handling, and administration. The CDC has outlined guidance to assistance vaccinators in overcoming these challenges. This proclamation now helps to address the financial burden associated with accommodating these complications.

The additional payment amount also accounts for the clinical fourth dimension needed to monitor a casher after the vaccine is administered, as well equally the upfront costs associated with administering the vaccine safely and appropriately in a beneficiary's home. The payment rate for administering each dose of a COVID-xix vaccine, also every bit the additional in-home payment amount, will be geographically adapted based on where the service is furnished.

How to Find a COVID-19 Vaccine:

As this action demonstrates, a person'due south power to leave their dwelling house should not exist an obstacle to getting the COVID-19 vaccine. Every bit states and the federal government proceed to suspension down barriers – like where vaccines can be administered – resources for connecting communities to vaccination options remain fundamental. Unvaccinated individuals and those looking to help friends and family tin can:

Visit vaccines.gov (English) or vacunas.gov (Spanish) to search for vaccines nearby
Text GETVAX (438829) for English or VACUNA (822862) for Castilian for near-instant access to details on three vaccine sites in the local area
Call the National COVID-19 Vaccination Assist Hotline at 1-800-232-0233 (TTY: 1-888-720-7489) for assistance in English language and Spanish

Coverage of COVID-19 Vaccines:

The federal government is providing the COVID-19 vaccine free of charge or with no toll-sharing for all people living in the Usa. Every bit a condition of receiving free COVID-19 vaccines from the federal government, vaccine providers cannot charge patients any corporeality for administering the vaccine.

Considering no patient tin can be billed for COVID-19 vaccinations, CMS and its partners have provided a multifariousness of information online for providers vaccinating all Americans regardless of their insurance status:

Original Medicare and Medicare Advantage: Beneficiaries with Medicare pay nothing for COVID-19 vaccines or their assistants, and at that place is no applicable copayment, coinsurance or deductible.
Medicaid and the Children's Wellness Insurance Program (CHIP):State Medicaid and CHIP agencies must cover COVID-19 vaccine administration with no cost sharing for nearly all beneficiaries during the COVID-19 Public Health Emergency (PHE) and for over a year after it ends. For the very limited number of Medicaid beneficiaries who are not eligible for this coverage (and exercise not receive information technology through other coverage they might take), providers may submit claims for reimbursement for administering the COVID-xix vaccine to underinsured individuals through the COVID-19 Coverage Assistance Fund, administered by the Health Resource and Services Administration (HRSA), as discussed beneath. Nether the American Rescue Plan Act of 2021 (ARP), signed by President Biden on March 11, 2021, the federal matching percentage for land Medicaid and Bit expenditures on COVID-19 vaccine administration is currently 100% (as of April 1, 2021), and volition remain 100% for more than a yr after the COVID-19 PHE ends. The ARP as well expands coverage of COVID-nineteen vaccine administration under Medicaid and CHIP to boosted eligibility groups. CMS recently updated the Medicaid vaccine toolkit to reverberate the enactment of the ARP at https://www.medicaid.gov/land-resources-center/downloads/covid-19-vaccine-toolkit.pdf.
Individual Plans: The vaccine is free for people enrolled in private health plans and issuers COVID-nineteen vaccine and its administration is covered without cost sharing for most enrollees, and such coverage must be provided both in-network and out-of-network during the PHE. Current regulations provide that out-of-network rates must be reasonable as compared to prevailing market place rates, and the rules reference using the Medicare payment rates equally a potential guideline for insurance companies. In light of CMS's increased Medicare payment rates, CMS will expect health insurance issuers and group health plans to go along to ensure their rates are reasonable when compared to prevailing marketplace rates. Under the conditions of participation in the CDC COVID-xix Vaccination Program, providers cannot accuse plan enrollees any administration fee or cost sharing, regardless of whether the COVID-nineteen vaccine is administered in-network or out-of-network.

The Biden-Harris Administration is providing free access to COVID-xix vaccines for every adult living in the United States. For individuals who are underinsured, providers may submit claims for reimbursement for administering the COVID-19 vaccine through the COVID-nineteen Coverage Assist Fund administered by HRSA afterwards the merits to the private'southward health programme for payment has been denied or only partially paid. Data is available at https://www.hrsa.gov/covid19-coverage-help.

For individuals who are uninsured, providers may submit claims for reimbursement for administering the COVID-19 vaccine to individuals without insurance through the Provider Relief Fund, administered by HRSA. Information on the COVID-19 Claims Reimbursement to Health Care Providers and Facilities for Testing, Treatment, and Vaccine Administration for the Uninsured Program is available at https://www.hrsa.gov/CovidUninsuredClaim.

More information on Medicare payment for COVID-19 vaccine administration – including a listing of billing codes, payment allowances and effective dates – is available at https://world wide web.cms.gov/medicare/covid-19/medicare-covid-xix-vaccine-shot-payment.

More information regarding the CDC COVID-19 Vaccination Program Provider Requirements and how the COVID-19 vaccine is provided through that program at no toll to recipients is bachelor at https://www.cdc.gov/vaccines/covid-xix/vaccination-provider-support.html.

Medicare Ambulance Relief Bill Introduced in Business firm

Written past AAA Staff on April 13, 2021. Posted in Advocacy Priorities, Government Affairs, Legislative, Medicare, News.

Yesterday, Congresswoman Terri Sewell (D-AL) introduced the Protecting Admission to Ground Ambulance Medical Services Act of 2021 (H.R. 2454). Congresswoman Sewell was joined past Congressmen Devin Nunes (R-CA), Peter Welch (D-VT) and Markwayne Mullin (R-OK) equally primary cosponsors and leads on the legislation.

H.R. 2454 would extend the temporary Medicare ground ambulance increases of 2% urban, three% rural and the super rural bonus payment for five years. The increases are currently scheduled to expire on December 31, 2022. The five-yr extension would permit for the increases to remain in identify during the ii-year filibuster on ambulance data collection period due to the COVID-xix public wellness emergency. It would also allow the cost collection programme to movement forrad so that the statutorily mandated MedPAC analysis could be completed before the Congress would have to act to either further extend the add-ons or make them permanent through reforming the Medicare ambulance fee schedule.

The legislation would help accost potential problems that rural zip codes in large urban counties could face as a event of the 2020 demography data. As we saw afterward the 2010 Census, the new Census data collection methodology resulted in geographical changes nether the fee schedule that shifted rural ZIP codes to urban, despite there being no pregnant modify in their population. The electric current definition using rural urban commuting areas (RUCA) in Goldsmith Modification areas would be modified to ensure ZIP codes with ane,000 people or less per square mile would remain rural. Footing ambulance service providers and suppliers could also petition the Centers for Medicare and Medicaid Services (CMS) to make the argument that a specific Goose egg code should remain rural. It is vital that this provision be implemented before CMS makes changes from the 2020 Census data which will likely occur in 2023.

The AAA has been leading the effort on the legislation with the back up of the Congressional Fire Services Institute, International Association of Fire Chiefs, International Association of Fire Fighters, National Clan of EMTs and the National Volunteer Fire Council.

The AAA is working with champions of the endeavour in the Senate on introduction of a companion bill. We expect the bill to be introducing in the coming weeks.

The legislation is 1 of the policy problems beingness raised as part of EMS on the Hill Day and the AAA volition be launching a Call To Activity shortly requesting AAA members to ask their members of Congress to cosponsor the bill.

We profoundly capeesh the leadership of Representatives Sewell, Nunes, Welch and Mullin on this vital issue.

CMS | four/xiii Webinar | HRSA COVID-nineteen Uninsured Program

Written by AAA Staff on Apr 12, 2021. Posted in Legislative, Medicare, Regulatory, Webinars.

From CMS on April 12, 2021

Upcoming Webinar for Providers on the HRSA COVID-xix Uninsured Programme: Interested in learning more about the HRSA COVID-19 Uninsured Program? Participating providers are reimbursed at Medicare rates for testing, treating and administering COVID-19 vaccines to uninsured individuals.

Providers who have conducted COVID-19 testing to uninsured individuals, provided treatment for uninsured individuals with a COVID_19 diagnosis on or after Feb iv, 2020, or administered COVID-19 vaccines to uninsured individuals can begin the procedure to file claims for reimbursement. Providers tin familiarize themselves with this process at https://www.hrsa.gov/coviduninsuredclaim, and learn more and file claims at https://coviduninsuredclaim.linkhealth.com/. Providers tin can besides view Frequently Asked Questions about the program.

Join us on Tuesday April 13, 2021 at 2PM ET for an informational webinar.

Annals Now

Experience gratis to share this with others who may be interested!

Joint Letter on Sequestration Delay

Written by AAA Staff on March eighteen, 2021. Posted in Advancement Priorities, Government Diplomacy, Legislative, Medicare, Reimbursement.

On March 15, the AAA, IAFC, IAFF, NFVC, NAEMT, and the Congressional Burn Services Institute sent a letter to congressional leaders in back up of legislation (H.R. 1868) to extend the current moratorium on the 2% Medicare sequestration cut. The moratorium is currently scheduled to expire on March 31 and H.R. 1868 would extend the moratorium until December 31. Below is a copy of the letter.

This calendar week, the House passed House Resolution 233 with the rules for debate and consideration of H.R. 1868. Congressmen Schneider (D-IL) and McKinley (R-WV) introduced H.R. 315 and Senators Sheehan (D-NH) and Collins (R-ME) introduced South. 748 which would extend the moratorium through the finish of the public health emergency.

March 16, 2021

The Honorable Nancy Pelosi Speaker
U.S. Firm of Representatives
Washington, DC 20515

The Honorable Kevin McCarthy Minority Leader
U.S. House of Representatives
Washington, DC 20515

The Honorable Charles Schumer Bulk Leader
Usa Senate
Washington, DC 20510

The Honorable Mitch McConnell Minority Leader
United States Senate
Washington, DC 20510

Dear Speaker Pelosi, Bulk Leader Schumer, Minority Leader McConnell and Minority Leader McCarthy:

Thank you for your connected support of front-line medical workers throughout the COVID-xix pandemic. Our paramedics, emergency medical technicians (EMTs) and firefighters, likewise as the organizations that they serve, take on substantial gamble every day to care for, send and examination potential COVID-19 patients. We write today to express our deep concern with the impending two% Medicare sequestration cutting scheduled to have effect on Apr 1, 2021.

The American Ambulance Association (AAA), International Clan of Fire Chiefs (IAFC), International Clan of Fire Fighters (IAFF), National Clan of Emergency Medical Technicians (NAEMT), National Volunteer Burn Quango (NVFC) along with the Congressional Fire Services Found (CFSI) correspond the providers of vital emergency and not-emergency ground ambulance services and the paramedics, EMTs and firefighters who deliver the direct medical care and ship for every community beyond the United states of america. We have all experienced the strain on our services, and demand financial help and support every bit we remain the frontline responders to our nation's coronavirus patients. The sequestered cuts, if implemented, would further strain the provision of these critical services.

Our costs of operating have increased exponentially in response to COVID-xix, as we maintain full readiness to gainsay the pandemic and go on to provide 24-hour vital not-COVID-19- related services. Our costs for personal protective equipment (PPE), overtime pay, and other expenses directly related to COVID-19 remain loftier. At a time when nosotros are facing considerable economic strain due to the COVID-19 pandemic, we respectfully urge Congress accept action earlier April 1, 2021 to extend the 2% Medicare sequestration moratorium. Nosotros would similar to voice our strong back up for bipartisan legislation, H.R. 1868, to prevent the 2% sequester cut.

Our organizations profoundly capeesh both the fiscal support provided through congressionally enacted COVID-xix relief legislation, also as the recognition of the dangers of providing these critical services on a daily footing. However, the impact of the pandemic on our resource and services remains and the implementation of additional Medicare cuts at this time would be harmful to our members.

Nosotros thank you in advance for your consideration and helping ensure that Ems agencies and personnel have the resources they demand to keep to respond to the COVID-xix pandemic and the funding to maintain the short and long-term viability of our operations.

Sincerely,

American Ambulance Clan

Congressional Fire Services Institute

International Association of Fire Chiefs

International Association of Fire Fighters

National Association of Emergency Medical Technicians

National Volunteer Fire Council

CMS Increases Medicare Payment for COVID-19 Vaccinations

Written by Brian Werfel on March 16, 2021. Posted in Drugs & Pharma, Emergency Preparedness, Medicare, Reimbursement.

CMS Increases Medicare Payment for COVID-19 Vaccinations

By Brian S. Werfel, Esq.

On March 15, 2021, the Centers for Medicare and Medicaid Services (CMS) announced that information technology would be increasing the Medicare payment amount for administrations of the COVID-19 vaccines.

The original Medicare reimbursement rate depended, in part, on whether the vaccine being administered required a 2-dose regimen (as is the case for the Pfizer-Biontech and Moderna vaccines), or a single dose (Johnson & Johnson vaccine). For vaccinations that require a 2-dose regime, CMS initially paid: (ane) $sixteen.04 for the administration of the first dose and (2) $28.39 for the assistants of the second dose. For vaccines that crave only a single dose, Medicare paid $28.39 for the assistants of that single dose.

Constructive for vaccinations administered on or after March 15, 2021, CMS has increased these payments to $40 per administration. Thus, the full reimbursement for a vaccine requiring a single dose will be $40, while the total reimbursement for a vaccine requiring a two-dose regimen will be $80.

CMS Ambulance Open Door Forum Oct 22

Written by AAA Staff on Oct sixteen, 2020. Posted in Medicare, Regulatory.

From CMS on October 16

Open Door Participation Instructions:

October 22, 1:00–2:30 on ET

This telephone call volition be Briefing Call Simply.

To participate by telephone:

Dial: 1-888-455-1397 & Reference Conference Passcode: 9375124

Persons participating past phone do non demand to RSVP. TTY Communications Relay Services are available for the Hearing Dumb. For TTY services dial vii-1-1 or 1-800-855-2880. A Relay Communications Assistant will help.

Instant Replay: 1-866-448-2572; Conference Passcode: No Passcode needed

Instant Replay is an audio recording of this phone call that can be accessed by dialing 1-866-448-2572 and entering the Briefing Passcode kickoff 1 hours later on the call has ended. The recording is available until October 24, 11:59PM ET.

The next CMS Ambulance Open Door Forum is scheduled for:

Date: Th Oct 22, 2020

Commencement Time: 1:00pm-ii:30pm PM Eastern Time (ET);

Please dial-in at to the lowest degree 15 minutes before call kickoff fourth dimension.

Conference Leaders: Jill Darling, Susanne Seagrave

**This Agenda is Subject to Change**

1. Opening Remarks

Acting Chair- Susanne Seagrave, Acting Manager, Division of Data Analysis and Marketplace-Based Pricing (Center for Medicare)
Moderator – Jill Darling (Role of Communications)

ii. Announcements & Updates

Repetitive, Scheduled Non-Emergent Ambulance Transport (RSNAT) Prior Authorization Model Update – https://www.cms.gov/newsroom/printing-releases/cms-expand-successful-ambulance-program-integrity-payment-model-nationwide

- ET3 Overview and Update
- ET3Model@cms.hhs.gov for inquiries
- ET3 Model Listserv for Model updates: https://public.govdelivery.com/accounts/USCMS/subscriber/new?topic_id=USCMS_12521

COVID-xix Public Wellness Emergency (PHE) Waiver and Flexibility Data
- COVID-nineteen Frequently Asked Questions (FAQs) on Medicare Fee For Service (FFS) Billing certificate is available at: https://www.cms.gov/files/document/03092020-covid-nineteen-faqs-508.pdf. Ambulance services FAQs begins on page 41.
CMS is using its statutory authority nether section 1135(b)(five) of the Act to modify the data collection and reporting menses for ground ambulance organizations that were selected to report in twelvemonth 1 of the Medicare Ground Ambulance Data Collection System. This modification has been issued on folio 30 in the following document: https://www.cms.gov/files/document/summary-covid-19-emergency-declaration-waivers.pdf.

3. Open Q&A

**Appointment IS SUBJECT TO CHANGE**

Next Ambulance Open Door Forum: TBA

ODF electronic mail: AMBULANCEODF@cms.hhs.gov

———————————————————————

This Open Door Forum is open to everyone, but if you are a member of the Press, you may listen in just delight refrain from asking questions during the Q & A portion of the call. If you take inquiries, delight contact CMS at Press@cms.hhs.gov. Thank you.

For ODF schedule updates and East-Mailing List registration, visit our website at http://www.cms.gov/OpenDoorForums/.

Were you unable to attend the recent Ambulance ODF call? We encourage yous to visit our CMS Podcasts and Transcript webpage where you can listen and view the most recent Ambulance ODF call. Please allow upward to three weeks to get both the audio and transcript posted to: https://www.cms.gov/Outreach-and-Educational activity/Outreach/OpenDoorForums/PodcastAndTranscripts.html.

CMS provides free auxiliary aids and services including information in accessible formats. Click here for more data. This will point partners to our CMS.gov version of the "Accessibility & Nondiscrimination observe" page. Give thanks you.

Preliminary Calculation of 2020 Ambulance Inflation Update

Written by Brian Werfel on Baronial 31, 2020. Posted in Finance, Authorities Diplomacy, Medicare, Reimbursement.

Section 1834(l)(3)(B) of the Social Security Act mandates that the Medicare Ambulance Fee Schedule be updated each year to reflect inflation. This update is referred to every bit the "Ambulance Inflation Factor" or "AIF".

The AIF is calculated by measuring the increase in the consumer toll alphabetize for all urban consumers (CPI-U) for the 12-calendar month flow ending with June of the previous year. Starting in agenda year 2011, the change in the CPI-U is now reduced by a so-called "productivity adjustment", which is equal to the 10-year moving boilerplate of changes in the economic system-wide private nonfarm concern multi-factor productivity index (MFP). The MFP reduction may event in a negative AIF for any calendar year. The resulting AIF is then added to the conversion cistron used to calculate Medicare payments under the Ambulance Fee Schedule.

For the 12-calendar month period catastrophe in June 2020, the federal Bureau of Labor Statistics (BLS) has calculated that the CPI-U has increased past 0.646%.

Cautionary Notation Regarding CPI-U. Members should exist advised that the BLS' calculations of the CPI-U are preliminary, and may be subject to later adjustment. Therefore, information technology is possible that these numbers may change.

CMS has yet to release its estimate for the MFP for calendar twelvemonth 2021. Since its inception, this number has fluctuated between 0.3% and ane.ii%. For calendar year 2020, the MFP was 0.seven%. Under normal circumstances, it would exist reasonable to await the 2021 MFP to be within a percentage point or ii of the 2020 MFP. Nonetheless, the economic bear on of the COVID-19 pandemic makes predictions on the MFP difficult at this signal.

Accordingly, the AAA is non in a position to confidently project the 2021 Ambulance Inflation Factor at this point in time. However, the relative low increase in the CPI-U strongly suggests that the 2021 Ambulance Inflation Gene will be significantly lower than last year'southward increment of 0.nine%.

The AAA volition notify members one time CMS issues a transmittal setting along the official 2021 Ambulance Inflation Factor.