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EMS Cost Collection workshop coming to Nashville – April 21, 2024

  • Agencies selected in Year 3 or 4 lists, collecting 2023 data to submit to CMS in 2024
  • Directors, Officers, Billing Managers, or anyone responsible for their agency’s cost data collection process
  • Anyone who wants to prepare for future ground ambulance cost data collection requirements
  • Cost Collection Basics
  • Deep Dive, Amber Walk-Through
  • Lessons Learned
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Senate passes amendment to stop new VA reimbursement rule

WASHINGTON, D.C. – Today, the U.S. Senate passed the FY2024 Military Construction, Veterans Affairs, and Related Agencies Act, which included an amendment introduced by U.S. Senators Jerry Moran (R-Kan.), Jon Tester (D-Mont.) and John Boozman (R-Ark.) – members of the Senate Veterans’ Affairs Committee – to protect rural veterans’ access to life-saving emergency medical transportation services.

The amendment would prohibit VA from implementing a rule to reduce reimbursement rates for special mode transportation providers, including ground and air ambulances, in FY2024. Under the current timeline, VA’s rule will go into effect in February 2024, which would lead to longer wait times for veterans during emergencies and disrupt the ambulance industry in Kansas and across the country.

“This amendment makes certain that veterans across the nation will continue to receive lifesaving care and transportation without disruption over the next year,” said Sen. Moran. “By stopping this rule from being implemented in February, we will allow more time for VA to do its due diligence in creating reasonable and commonsense parameters for resetting reimbursement rates for these life-saving services.”

“Emergency air and ground transportation services are a lifeline for Montanans when a medical emergency happens,” said Sen. Tester. “Our provision means these services can stay afloat so Montana veterans can continue receiving these lifesaving emergency services when they need it. VA still has to work to do to fix this reimbursement issue, and that’s why I’m continuing to push for our bipartisan VA Emergency Transportation Act.”

“Arkansas veterans rely on lifesaving transportation services when experiencing health care emergencies,” said Sen. Boozman. “Passage of this provision is critical to ensuring these heroes continue to have access to these crucial resources no matter where they live, and the operators are appropriately compensated for the care they deliver.”

The full text of the amendment here.

The amendment was also co-sponsored by Mike Crapo (R-Idaho), Steve Daines (R-Mont.) and Dan Sullivan (R-Alaska). It is also supported by Global Medical Response, Air Methods, the American Ambulance Association, the International Association of Fire Chiefs and the National Association of Emergency Medical Technicians.

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Update – Ground Ambulance Assessment SFY24 Q1

The SFY24 Q1 invoices have been mailed by TennCare (payments are due 11-29-2023). We are waiting on the payment reports to be completed (possibly by the end of this week). We will mail the payment reports as soon as we receive them from TennCare.

New Invoice Calculation Process
Previous invoices were based on the most recent calendar year total of transports. That number was divided by 4 and then multiplied by $20.53 to get your quarterly invoice.

This fiscal year’s invoices are based on transports during the period 2 quarters behind. That number is multiplied by $20.00 to get your quarterly invoice. The current invoice is based on transports during SFY23 Q4 (May-June 2023).

The next quarterly invoice (expected late January-early February) will be based on transports during SFY24 Q1 (July-September 2023).

Ground Assessment Program Reminders

  • Qualifying transports that apply towards your quarterly invoices are based on an emergency response that resulted in a transport. These transports are derived from the Office of EMS TNEMSIS system. Per TN Code Annotated § 71-5-1506.
  • Policy Measures to Ensure Enforcement and Compliance — Penalties — Quarterly Transport Count Data The bureau has the authority to create policy measures that ensure the enforcement and compliance of this part. The bureau shall require an ambulance provider that fails to pay an assessment due under this part to pay the bureau, in addition to the assessment, a penalty of fifty dollars ($50.00) per calendar day for each day the assessment remains unpaid in full after the date due. The bureau may waive penalties for a delinquent provider if the provider has entered into a payment plan approved by the bureau. If the provider fails to comply with the terms of the payment plan, then the bureau may reinstate the waived penalties. Other enforcement measures determined by the bureau include, but are not limited to, recoupments, withholding of future payments, and loss of Medicaid ID.
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PWW reports – No Surprises Act does NOT apply to ground ambulance

New Federal clarification that NSA doesn’t apply to ground ambulance aligns with longstanding PWW guidance
An upcoming Federal Register notice provides further clarification of the fact that ground ambulance services are not included in the Federal No Surprises Act, which prohibits balance billing for air ambulance services.  The Feds’ latest statement on the subject says:

         “The Departments have received questions about how the surprise billing protections under the No Surprises Act apply to ground ambulance services. In particular, the Departments understand that some plans and issuers have construed a statement in the preamble to the July 2021 interim final rules addressing when a participant, beneficiary, or enrollee is in a condition to receive notice and provide consent to waive surprise billing protections for post-stabilization services188 to mean that the No Surprises Act surprise billing protections apply to post stabilization inter-facility ground ambulance transports. The Departments do not interpret the No Surprises Act’s surprise billing provisions to apply to emergency or non-emergency ground ambulance services.

 (Emphasis added.)  Although this Federal Register guidance is new, it is not new that the NSA has never applied to ground ambulance services.  PWW has issued guidance since the NSA was first passed that it does not apply to ground ambulance services, and that insurers who were saying otherwise were simply wrong.

 In our December 9, 2022 e-mail bulletin, PWW said: “The Federal No Surprises Act currently only prevents balance billing for air ambulance services.” 

 In our March 9, 2023 bulletin, PWW said: “the NSA does not currently apply to ground ambulance services – a fact that some commercial insurers have chosen to ignore.”
We’ve been clear and steadfast about the non-applicability of the NSA to ground ambulance services in all our communications since the law was first enacted – including at our abc360 conferences. Yet, some commercial insurers have improperly led ambulance services to believe otherwise, affecting the bottom line of many EMS organizations, who are already operating on thin margins.  While Congress may choose to amend the NSA to make it applicable to ground ambulance services in the future, it is crystal clear that it does not apply now, and has never applied, to ground ambulance services.
Where you get your information matters.  It is vital to stay up-to-date on the reliable sources of industry insight and analysis from PWW, your association partners, and other reliable sources. Don’t always accept what insurers and others tell you about your rights and obligations.  Stay informed, and stay vigilant!  CLICK HERE for full Federal Register notice.  
Click Here to Ask Your Questions
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2023 Legislative Wrap-up

The Tennessee General Assembly has completed its business for the year and adjourned on Friday, April 21, 2023. This first session of the 113th General Assembly was a successful one for the Tennessee Ambulance Service Association, which successfully advocated for several beneficial policy changes for ambulance services. Details on these successes are below, and please let us know if you have any questions or comments!

Training Supplement
This legislation provides $800 to each full- time licensed EMS provider (such as current full-time fire, volunteer fire, and law enforcement) who are allotted this training stipend to cover individual training. EMRs, EMTs, AEMTs, and Paramedics are required to pay for both individual licensure and ongoing training CEUs to maintain licensure up to 42 CEUs. Fifty percent of the CEUs are required to be in a classroom setting. This legislation will assist in offsetting these costs, encouraging participation in EMS programs amid a nationwide shortage.

We appreciate Representative Gary Hicks (R-Rogersville) and Senator Bo Watson (R-Hixson) for securing this funding. You can send them emails thanking them at and

Annual Assessment
This legislation sunsets each year, and must be renewed by the General Assembly. It funds ambulance services with federal dollars–no state dollars are used. The program helps to address the cost-per-call deficit. The annual assessment is an extremely successful program that has been in existence for several years, designed to address the specific needs of the ambulance service industry to improve access to TennCare patients across Tennessee.

Thank you to Representative Jay Reedy (R-Erin) and Senator Ken Yager (R-Kingston) for carrying this legislation. You can thank them via email at and

Local Option Emergency Services Funding
Legislation passed this year to allow the local government portion of tax revenue received by the Tennessee Sports Gaming Act to be used for emergency services. Previously, this money was only allowed to be spent on local infrastructure projects. The legislation was championed by Senator Rusty Crowe (R-Johnson City), and he can be thanked at     

Reconstitution of EMS Board
Legislation passed this year to reconstitute the EMS board, changing the makeup and modernizing the processes. After support was expressed during last year’s session to restructure the EMS Board, TASA worked diligently with interested parties to ensure that there was proper representation on the board. This bill is important to ensure the continuation of this vital board with a restructure reflecting the input of interested parties.

This legislation was sponsored by Representative Jeremy Faison (R-Cosby) and Senator Shane Reeves (R-Murfreesboro). You can thank them via email at and

EMS Grant Pool
This year’s legislative amendment to the TN budget for fiscal year 2023-2024 allocated $2 million to the Department of Health to create a grant pool for the sole purpose of making grants on a competitive basis to emergency medical services organizations across the state, to be used for equipment. The Department of Health will set up requirements for the application and eligibility for these grants, and will likely make them available in the next 6 to 9 months. 

The legislative champions of the budget are Representative Patsy Hazlewood (R – Signal Mountain) and Senator Jack Johnson (R – Franklin). Senator Bo Watson (R-Hixson) was also an important part of securing this funding. You can thank them at, and

Tennessee Local Development Authority Public Safety Protection Act of 2023
This legislation creates an avenue for the Local Development Authority to issue low interest or no interest loans to local governments for use in funding the purchase of equipment for firefighters, law enforcement officers, emergency medical services personnel, and emergency communications dispatchers. This new funding mechanism will need to be funded by future budgets, but creates the structure for these loans to be issued.This legislation was sponsored by Representative William Lamberth (R-Portland) and Senator Jack Johnson (R-Franklin).  You can thank them via email at and

Thank you to all of you for making your voice heard, and making the 2023 legislative session of the Tennessee General Assembly a successful one!