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CMS Provides COVID Support Payments to EMS Agencies

If your fire department provides ambulance transportation for EMS patients, you’ve likely seen a financial impact from COVID-19 responses. While agencies in the COVID-19 hotspots are seeing considerable increases in transports, many other agencies are seeing decreased call volumes (and corresponding reductions in reimbursements) due to fewer patients wanting to go to a hospital. At the same time, agencies are confronted with increased response costs relating to personal protective equipment (PPE) and decontamination requirements. These costs, coupled with increased staffing costs, can make it very difficult for a fire chief to manage their budget.  

When Congress passed the CARES Act (P.L. 116-136) recently, it included $100 billion in financial support for the U.S. Department of Health and Human Services to provide to Medicare suppliers and providers. On April 10, the Centers for Medicare and Medicaid Service (CMS) began distributing the first $30 billion of these funds. The purpose of these funds, designated as the CARES Act Provider Relief Fund, is to assist Medicare-participating entities in covering a variety of unreimbursed costs that they are incurring in the course of caring for COVID-19 patients.

If your agency bills Medicare on a fee-for-service (FFS) basis, you’ll likely see a direct deposit from either CMS or UnitedHealth Group for an amount that is equal to 6.19% of the total Medicare FFS payments that you received in 2019. You may have even already received this payment from CMS. These payments are not loans and are not meant to be repaid. If your agency is eligible to receive these funds, you will need to agree to some terms and conditions. One of these conditions essentially is that your agency will not balance bill COVID patients. While this will be a small loss of reimbursements, the new payments from CMS should more than cover this amount of lost reimbursements. Unfortunately, CMS only is providing these payments for Medicare-enrolled ambulance suppliers and providers.  Additionally, fire departments who provide first response Advanced Life Support (ALS) services in conjunction with an ambulance provider as part of a pass-through agreement will not receive direct reimbursement from CMS.
However, since the private ambulance provider billed CMS at the ALS level on behalf of the fire department and received increased reimbursement due to the pass-through agreement, the fire department could request their portion of the funds be passed along to them by the ambulance company.   
CMS is currently developing its plans for distributing the remaining $70 billion that the CARES Act provides. According to a recent press release from CMS, these funds likely will be used similarly and prioritized for Medicare-participating entities that treat a larger volume of rural patients and Medicaid beneficiaries. Additionally, CMS hopes to use these funds to provide additional support to entities that traditionally receive a smaller share of Medicare FFS reimbursements. Fire departments and EMS agencies certainly fit all three of those categories, so the IAFC hopes that additional funds will be available to help fire departments and EMS agencies in their responses to COVID-19.
Agencies that have not yet received these funds are encouraged to contact their Medicare Administrative Contractor (MAC). While your agency’s MAC may not be distributing these funds, they may have more information on when/how to access these funds.

Lastly, it is essential to note that CMS distributed these funds based on Tax ID Numbers (TIN). Disbursement based on the TIN rather than national provider identification (NPI) number may have caused a fire department’s funds to be sent to a city’s general fund account and combined with supplemental payments for any other municipal agency which billed Medicare on a fee-for-service basis in 2019. In this case, fire chiefs should calculate how much their payment should be and then contact whoever maintains their city’s respective general fund. While the payment may be for an amount more significant than your agency’s estimate (if you share a TIN with other agencies), CMS’ supplemental payment most likely will have originated from Optum Bank and have a payment description of “HHSPAYMENT, US HHS Stimulus or CARES Act Relief Payment.”
CMS also created a CARES Act Provider Relief Fund hotline, which can answer questions regarding payment status and eligibility. The hotline can be reached by phone at 866-569-3522.
Congress is expected to pass legislation later this week, which may provide an additional $75 billion for the HHS Public Health and Social Services Emergency Fund. These funds are expected to be used to support Medicare suppliers and providers in further caring for COVID-19 patients. 

The IAFC will be monitoring the status of these funds and encouraging CMS to use them to support fire and EMS agencies to their fullest extent.

For more COVID-19 resources and information visit iafc.org/covid19.

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