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Driving to Extend Ambulance Payments

Tucked onto every ambulance transport payment that a fire department receives from the Centers for Medicare and Medicaid Services (CMS) is an additional payment based on the zip code where the transport started. These add-on payments, also known as the “Ground Ambulance Extenders” or just “extenders” for short, are an important source of revenue to assist fire departments in more completely recouping the costs of providing ground ambulance transportation services. The authorization for these payments expires next year and legislation was just introduced to extend this authorization until 2028. The IAFC needs your help to get Congress to pass this bill. 

Nearly 20 years ago, Congress first authorized the ground ambulance extender payments for ground ambulance agencies to assist them in more completely recouping the costs of providing service to Medicare beneficiaries. Through these extender payments, CMS provides an addition 2%, 3%, or 22.6% payment for ground ambulance transportation originating in urban, rural, or super-rural areas. Though these are seemingly small percentages in the urban and rural environments, these payments add up for the agencies that receive them. Congress has acted many times to re-authorize these payments since they first were created in the mid-2000’s. The current authorization for the extenders will run out on January 1, 2023 unless Congress acts.

Reps. Terri Sewell (D-AL) and Devin Nunes (R-CA) recently introduced the Protecting Access to Ground Ambulance Medical Services Act of 2021 (H.R. 2454). This bill has two critically important components to assist fire departments in maintain their ground ambulance operations:

Reauthorization of Extenders: Without Congressional action, the additional payments from the extenders are set to expire on January 1, 2023. This legislation will extend the authorization for these payments until January 1, 2028. While the IAFC continues to urge Congress to make these payments permanent, action must be taken to preserve these payments at least in their current form. 

Analysis of Zip Codes: H.R. 2454 also would make some changes to the process that CMS uses to determine whether a zip code is urban, rural, or super-rural. The bill proposes increasing the population threshold needed to move a zip code into a more populated status (and thus lowering the extender payment). H.R. 2454 also would establish an appeals process for when a zip code is reclassified.  

The IAFC is urging Congress to pass H.R. 2454 as soon as possible and not to let the extender payments expire. All IAFC members are encouraged to log onto the IAFC’s Online Advocacy Center and ask their members of Congress to support H.R. 2454.

Evan Davis is a strategic government relations manager for the IAFC

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