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Congress Considers Legislation to Extend Ambulance Add-On Payments

In order to meet a statutory deadline, Congress is in the process of considering legislation to extend ambulance add-on payments until January 1, 2018. The Medicare Access and CHIP Reauthorization Act (H.R. 2) passed the House on March 26 by a vote of 392-37. The Senate may consider this legislation when it returns to session on April 13.

Congress first created the Sustainable Growth Rate (SGR) in 1997 to tie Medicare payments to the country’s economic growth rate. Since 2002, the SGR would have resulted in a pay cut for anyone accepting Medicare payments. Congress has consistently passed a bill known as the “Doc Fix” on 17 occasions since 2002 to avert this pay cut.

The doc fix is important for the fire service because it normally includes a reauthorization of the Medicare Ambulance Add-Payments. For the third time since 2002, Congress missed the annual doc fix. On April 1, the ambulance add-on payments expired and the SGR cuts kicked in.

The Medicare Ambulance Add-On Payments were initially created to incentivize ambulance service in underserved areas. These payments provide an additional 2%, 3% and 22.6% for transports of Medicare beneficiaries originating in predetermined zip codes. Much to the chagrin of the planning and budget-minded fire chiefs, Congress reauthorized these payments on an annual basis as part of the doc fix.

While many Congressional sessions have talked about passing a permanent doc fix, none has achieved it. In March, House Democratic and Republican leadership agreed to a bipartisan permanent doc fix, the Medicare Access and CHIP Reauthorization Act of 2015 (H.R. 2). H.R. 2 also contained a reauthorization of the Medicare Ambulance Add-On Payments through 2017.

On March 26, the House passed H.R. 2 by a vote of 392-37. The decisive vote in the House, however, failed to influence the Senate, where the bill was not voted on before the chamber recessed on March 27 with no plans to return until April 13, nearly two weeks after the ambulance add-on payments expired on April 1.

So, where does that leave us now?

The Centers for Medicare and Medicaid Services (CMS) has announced that it will place a two-week hold on processing new claims in order to buy more time for Congress to pass a doc fix. Since claims normally take two weeks to process, CMS does not expect Medicare providers to notice any changes—as long as Congress, particularly the Senate, acts immediately upon their return. CMS successfully used a similar tactic in 2002 and 2010 when Congress failed to pass a doc fix in time.

The IAFC urges Congress to pass a long-term, preferably permanent, reauthorization of the Medicare Ambulanced Add-On Payments. Senator Charles Schumer (D-N.Y.) and Representative Greg Walden (R-Ore.) recently introduced the Medicare Ambulance Access, Fraud Prevention, and Reform Act of 2015 (S. 377/H.R. 745), which would permanently reauthorize the Medicare Ambulance Add-On Payments.

In the short term, we would like to see the Senate pass H.R. 2 to keep the ambulance add-on payments. In the long term, we would prefer to see Congress permanently authorize these necessary payments by passing S. 377/H.R. 745.

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