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Permanent Medicare Ambulance Relief Bill Introduced in House

I am extremely happy to report that yesterday, Congressmen Greg Walden (R-OR), Peter Welch (D-VT), Devin Nunes (R-CA) and Richard Neal (D-MA) introduced in the U.S. House of Representatives the Medicare Ambulance Access, Fraud Prevention, and Reform Act of 2014 (H.R. 5460).  The bill would make permanent beginning on April 1, 2015 the current temporary Medicare 2% urban, 3% rural and super rural add-on payments.  We greatly appreciate Congressmen Walden, Welch, Nunes and Neal leading the charge in the House for desperately needed permanent Medicare ambulance relief.

In addition to making the current relief permanent, H.R. 5460 would 1) implement prior authorization for BLS non-emergency ambulance transports to and from dialysis centers, 2) change the status of ambulance service suppliers to providers, and 3) direct the Centers for Medicare and Medicaid Services (CMS) to collect ambulance cost data using a survey methodology.  The plan is to attach the language of H.R. 5460 to a permanent fix to the physician fee schedule should Congress address the issue during a lame duck session after the elections.  We will distribute a final copy of H.R. 5460 when it becomes available.

H.R. 5460 is a comprehensive legislative package to address many of the challenges facing our industry as well as establish the basis for future efforts of the AAA in improving the Medicare ambulance fee schedule.  The provision on prior authorization will be an additional burden on ambulance service providers who do legitimate dialysis transports but is far better than further cuts in reimbursement.  Surveying every three years a statistically significant number of the different types of ambulance service providers will also be a burden for those providers selected to participate.  However, the alternative to the survey approach is mandatory annual cost reporting for every ambulance service provider.  It is critical that Congress, CMS and the AAA have more precise cost information to make future data-driven policy and reimbursement changes to the fee schedule.

This is the most significant legislation on Medicare reimbursement and policy since the Balanced Budget Act of 1997 and the creation of the Medicare ambulance fee schedule.  To get the language of H.R. 5460 enacted, we will need the assistance of every AAA member representative in getting support for the bill from his or her members of Congress.  We will therefore be issuing a Call To Action next week and I ask that you make it a priority to contact your Congressmen.

Due to the significance of this legislation, the AAA will be devoting a session to it at the 2014 AAA Annual Conference and Trade Show in Las Vegas.  The session, “Health Care and Payment Reform”, is scheduled for Monday, November 17, from 1:30 p.m. to 3:00 p.m.  For more information on the AAA Annual Conference, please go to:

In the meantime, if you have any questions regarding H.R. 5460, please contact AAA Vice President of Government Affairs Tristan North at

From:  Jimmy Johnson, AAA President