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Ambulance Add-On Bonus Payments get a 5 Year Extension… At a Price

February 12, 2018
By G. Christopher Kelly

The ambulance add-on payments that give a 2% urban, 3% rural, and 22.6% super-rural bonus to Medicare’s ground ambulance base rates have been extended by Congress and now await the President’s signature to become final. The add-ons, which had expired at the end of 2017, will now be retroactively reinstated beginning January 1, 2018, and extended through the end of 2022. This is first time that such a long extension has been granted, but it comes at a significant price.

For ambulance service suppliers that do repetitive dialysis transports, an additional 13% discount will be applied to the base rate for these calls. This is on top of the 10% already being cut for these trips. The initial draft of the legislation anticipated an additional 22% cut (32% total) being necessary to fund the add-ons, however that figure was negotiated down to 13% (23% total). This additional cut is set to begin in October of 2018.

But that it not the only price we are paying for the 5 year extension of the add-ons. Beginning in January of 2020, all ambulance service suppliers will be required to submit cost reports. These cost reports will give Congress data necessary for them to determine if the add-ons are truly necessary and therefore should be made permanent. While the details of this are not yet set in stone (the new rule has to go through a notice and comment period that will allow us to chime in on the manner and method of the final cost reporting requirements), the “Comprehensive Operations, Sustainability, and Transport Act of 2017” includes reporting of the following:

(1) The aggregate cost of operation and the aggregate volume of services.
(2) The costs and volume of services for various functional accounts and subaccounts.
(3) Rates, by category of patient and class of purchaser.
(4) Capital assets, as defined by the Secretary, including (as appropriate) capital funds, debt service, lease agreements used in lieu of capital funds, and the value of land, facilities, and equipment.
(5) Discharge and bill data.
(6) Whether the supplier is part of an emergency services department, a governmental organization, or another type of entity (as described by the Secretary).
(7) The number of hours in a week during which the supplier is available for furnishing ground ambulance services.
(8) The average number of volunteer hours a week used by the supplier.

The bill also allows for the Secretary to suspend payments for any ambulance service supplier who does not submit “a complete, accurate, and timely report” beginning in January of 2020. After January 2022 the Secretary can also recoup as “overpayments” monies from suppliers who do not submit their cost reports. These teeth are intended to make sure Congress gets accurate data on our income and expenses.

So, the add-ons are back for now. The price will be felt sooner for the services that have dialysis patients, but it will be felt by us all in the end, as we take on the additional burden of cost reporting. We keep telling Congress we need this extra money, now they are asking us to show them our math if we want the add-ons to be made permanent. Get ready, cost reporting is finally coming to EMS.

Christopher Kelly is a lawyer who focuses on regulatory healthcare law as it relates to the EMS and ambulance industry. This article is not intended as legal advice. For more information, he can be reached at EMS Consultants, Ltd., (800) 342-5460 or email to