During the waning days of the 111th Congress, legislators voted to extend the temporary Medicare rate bonuses paid for ambulance transport. In 2011, ambulance providers will receive an additional 2 percent in Medicare payments for urban transport, 3 percent for rural trips and 22.6 percent for travel from especially low-density, or super-rural, areas. These additional fees, which would have expired at the end of 2010, were part of significant legislation held up over budget and tax-reduction debates, mainly in the Senate.
The news could not have been more welcome or timely. During routine end-of-year housekeeping, the Centers for Medicare and Medicaid Services (CMS), which regulates reimbursements for ambulance transports, announced that base ambulance rate reimbursements will see a net decrease in 2011. (Final rates are posted at cms.gov/AmbulanceFee
Schedule/02_afspuf.asp.) CMS also remained resolute in affirming its policy to require, also beginning in 2011, that ambulances bill CMS for transport reimbursement by rounding off mileage to the next highest tenth of one mile rather than the full mile. The agency transmittal about this policy is at cms.gov/transmittals/downloads/R2103CP.pdf.
In better news for ambulance providers, the president signed into law in late December 2010 a bill freeing them from onerous new credit regulations imposed by the U.S. Federal Trade Commission (FTC). The Red Flag Program Clarification Act exempts ambulance service providers from complying with the new FTC rules designed to prevent identity theft. These rules require covered businesses to design and implement policies and procedures to identify practices or activities that suggest possible identity theft; monitor accounts to detect identity theft; and respond appropriately if such theft occurs. The new law overturns the prior FTC decision to include ambulance and other small health-related service providers among the businesses that must comply with the new rules, a decision the industry protested heartily. Ambulance providers argued that the regulations, which under this new law are now largely limited to financial institutions, would be costly and were unnecessary due to the type and limited number of transactions they handle.
Zadroga Act Passes Both Houses—Finally
After twice experiencing defeat, the bill written to help responders who are ill from their work at the World Trade Center recovery site following the 9/11 attacks has finally overcome opponents’ objects and passed both houses of Congress. The bill faced strong Republican opposition in the Senate during procedural votes but passed in the final hours of the 111th Congress, just before members were to leave until January 2011. House members, who passed their own version in September 2010, had to revisit the bill and voted to accept the Senate version, though its provisions were greatly diminished. The resulting bill, in order to gain Senate passage, was cut from $7.4 billion to $4.3 billion in funds to provide health care and related programs for responders for five years.
The James Zadroga 9/11 Health and Compensation law reopens the September 11 Victim Compensation Fund of 2001 and provides supplemental health care benefits to responders and other workers who are ill from inhaling toxic dust and smoke at the World Trade Center, some for nearly a year. Many have developed cancers and severe respiratory and other illnesses. Responders who were at the two other 9/11 attack sites—the Pentagon in Washington, D.C., and the airplane crash site in Shanksville, Pa.—and have become ill are also covered by the bill’s provisions.
The World Trade Center Health Program, created in the bill, will administer medical monitoring and treatment benefits to eligible responders and recovery workers, including clinical examinations and health monitoring. The program administrator must institute education and outreach to inform potential participants of services provided through this program as well as non-program benefits available to them; create a scientific advisory committee; and ensure the collection and analysis of data on illnesses experienced by participants and treatment effectiveness.
Field EMS Bill Goes to Washington
The first bill ever written to address the EMS community’s legislative agenda specifically and comprehensively was introduced in the House of Representatives in the last days of the 2010 lame-duck congressional session. Developed with input from numerous stakeholders, the Field EMS Quality, Innovation and Cost-Effectiveness Improvement Act would support and improve EMS by creating an infrastructure in Washington, D.C., to oversee and fund all-hazards EMS preparedness and response and service delivery.
The legislation would create three grant programs to enable organizations to purchase communications and information systems, enhance quality assurance programs and promote innovation in EMS; enhance EMS preparedness and excellence through data collection and evidence-based care; and improve the field EMS education infrastructure by funding EMS educational institutions and associations to prepare educators, practitioners and medical directors. Additionally, national guidelines for medical oversight and medical direction; innovation in service delivery, access and management of low-acuity patients; and enhanced Field EMS Practice Center research would be promoted.
The most controversial proposal would establish the National Highway Traffic Safety Administration (NHTSA) as the primary federal agency for field EMS, a role the agency has played for decades, though underfunded and with too little authority among the many federal agencies with out-of-hospital EMS responsibilities. This decision not only gives EMS an official home, it leaves the departments of Health and Human Services and Homeland Security to continue as the primary federal agencies for hospital-based EMS and anti-terror and related activities, respectively. NHTSA would establish national training, credentialing and medical oversight guidelines; expand the National EMS Information System (NEMSIS); and standardize field reporting of data, among other responsibilities. NHTSA is directed to continue to develop policy in partnership with the National EMS Advisory Council (NEMSAC), which would become permanent, and the Federal Interagency Committee on Emergency Medical Services (FICEMS).
Expenditures of about $321 million would be made under this legislation, part of it to be paid through a voluntary contribution check-off option on the federal income tax form to establish the Emergency Medical Services Trust Fund to dispense monies. Advocates for EMS (AEMS) President Kurt Krumperman said this funding mechanism allowed the discussion to begin with Congress, given the new spending environment in Washington, and that additional mechanisms that would not compete with established emergency response funding are being developed.
The bill development process was shepherded by AEMS with the support of major EMS stakeholders and guidance from Holland and Knight, a lobbying firm that represents AEMS on the Hill. The strategy behind the last-minute introduction was to give affected government agencies, potential congressional sponsors and others a formal bill to comment on, so recommendations could be incorporated where they could help secure passage when the bill is reintroduced to the new 112th Congress.
Inaction Kills Volunteer Responder Benefit
As of this writing, a bill that helps municipalities recruit and retain volunteer firefighters and EMS providers was allowed to expire at the end of 2010. The Volunteer Responder Incentive Protection Act (VRIPA) prevents the Internal Revenue Service from taxing a limited portion of financial benefits awarded to responders in lieu of a salary.
Though the benefit is small, it is viewed as an important tool. VRIPA would have increased the maximum qualified benefit waived from taxes from $30 to $50 and extended the benefit through 2013. Supporters are expected to reintroduce the bill this year.
