Congress Restores Medicare Ambulance Add-On Payments

On Feb. 9 passed the Bipartisan Budget Act of 2018 (H.R. 1892) which funds the federal government through March 22 and raises government spending limits. H.R. 1982 also contains several provisions which address challenges facing the fire and emergency service.

Emergency Medical Services

H.R. 1892 contains some of the most significant EMS reimbursement reforms that Congress has enacted in several years. This legislation restores the Medicare Ambulance Add-On Payments which provides up to 22.6% additional payment for patient transports but had expired on December 31. This restoration of these additional payments is retroactive to January 1 and is authorized to continue for the next five years.

Furthermore, H.R. 1892 creates an important data collection system whereby the U.S. Department of Health and Human Services (HHS) will collect information on the costs of providing EMS care throughout the United States. The IAFC believes this data will be crucial in revising the Medicare Ambulance Fee Schedule and potentially securing payment for practices such as treating a patient without transporting them to a hospital. The IAFC worked closely with Representatives Devin Nunes (R-CA) and Terri Sewell (D-AL) to develop these policies and thanks them for their strong work.

Additionally, H.R. 1892 provides a two-year delay of a planned cut to the Disproportionate Share Hospital (DSH) program. DSH is an important funding source for state-level supplemental ambulance reimbursement programs like the Ground Emergency Medical Transportation (GEMT) program. The delay of these cuts maintains full funding for DSH and thereby protects the GEMT and other similar supplemental reimbursement programs.  

Disaster Mitigation and Response

H.R. 1892 also provides important disaster preparedness reforms which the IAFC has supported for several years. Funds the Fire Management Assistance Grants (FMAG) provide assistance during wildland fires, but do not help communities as they face post-fire emergencies such as landslides, flooding, and significant erosion. H.R. 1892 contained a provision to allow localities to receive post-fire mitigation assistance if they have received an FMAG in either 2017 or 2018.

Additionally, H.R. 1892 provides important incentives for states to support pre-disaster mitigation efforts by allowing the federal government to increase its cost share after a disaster from 75% to 85% based upon a state’s resiliency. States can undertake a variety of actions to gain additional federal funding and improve their resiliency such as adopting a mitigation plan and building codes, investing in insurance and emergency management programs, and participating in community rating systems.

Honoring Fallen First Responders

Lastly, H.R. 1892 also contains a provision to empower governors with the authority to order the lowering of the flag in their respective state upon the line of duty death of a first responder in their state. Previously, the U.S. Flag Code only permitted governors to order the lowering of flags upon the combat death of a soldier from their state. The IAFC has worked closely with Rep. John Larson to support this policy and thanks Congress for including this measure in H.R. 1892.

Evan Davis is the IAFC's government relations manager and liaison to the EMS Section.

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