Since the 111th Congress convened in January, lawmakers have introduced a number of EMS-related bills. Most of these bills won't pass, but some will, likely tucked into a larger piece of legislation. But a bill is much more likely to become law if members of Congress hear from constituents who strongly support it. Consider also providing input to your Congressional delegation if you oppose a bill or some of its provisions.
Reps. Richard Neal (D-MA)and Fred Upton (R-RI) introduced the"Medicare Ambulance Access Preservation Act"(H.R. 2443) May 15 and Senators Chuck Schumer (D-NY), Pat Roberts (R-KS), Kent Conrad (D-ND) and Jeff Sessions (R-AL) introduced a similar bill(S. 1066)May 18. The legislation would provide a 6% increase in the Medicare base rate and mileage rate for ground ambulance transports originating in an urban or rural area and a 17% increase for those from "super rural" areas.
These bills reflect the findings of the Government Accountability Office that Medicare pays on average 6% less than the cost of an ambulance transport and 17% less than it costs for a ground transport from a super-rural area. Their passage is the American Ambulance Association's (AAA) highest priority. AAA Senior Vice President for Government Affairs Tristan North told members that the AAA is also working with members of Congress "to include a new ambulance rural definition in a larger rural health-care bill scheduled to be introduced in the coming weeks." The new definition "would expand the number of rural areas and result in 7% of [current] urban transports being classified as rural transports and thus eligible for the 1-17 rural mileage bump of 50%."
Reps. Rose DeLauro (D-CT) and Todd Russell Platts (R-PA) introduced the"Medicare Paramedic Intercept Services Coverage Act"(H.R. 1915)April 2. It would allow Medicare to directly reimburse an agency that provides ALS services on a BLS ambulance in a community served only by a BLS provider. Currently, that provision is available only in rural New York, where state law prevents volunteer services from billing.
Senators Tom Carper (D-DE) and Susan Collins (R-ME) introduced the"Volunteer Firefighter and EMS Personnel Job Protection Act"(S. 1025)May 12. It would provide up to 14 days of employment protection per calendar year to volunteer emergency personnel responding to major disasters "in an official capacity." The National Volunteer Fire Council and the International Association of Fire Chiefs (IAFC) support this bill. "Under the bill, employers would not be required to compensate employees for time missed while responding to an event, but would be required to let them keep their jobs when they return," the IAFC said in a briefing on the bill.
Sen. Bernie Sanders (D-VT) introduced the"Volunteer Firefighter and EMS Support Act"(S. 882)April 6. It would authorize federal matching funds to state or local governments or nonprofit organizations that provide such incentives to volunteer firefighters and EMS personnel. "The federal government would pay half the cost of the incentives, which could include retirement benefits, travel and training reimbursement, health insurance assistance, life insurance, tuition and school-loan forgiveness and property tax reductions," Sanders said in a press release. The funds would come through the Department of Homeland Security. The AAA and the NVFC support this bill.
Reps. Peter King (R-NY), Bill Pascrell (D-NJ), Joseph Crowley (D-NY) and Heath Schuler (D-NC) introduced the"Volunteer Emergency Services Recruitment and Retention Act"(H.R. 1792)March 30. It would stipulate how the federal tax code and Internal Revenue Service should treat "length of service award programs" (LOSAP) that provide some pension money for volunteer fire and EMS personnel. H.R. 1792 would have individuals taxed on their LOSAP funds only when they draw on those funds, instead of every year a contribution is made to that LOSAP. It would also increase the limit on how much can be contributed to an individual volunteer's LOSAP account from $3,000 to $5,500 per year. "This legislation is crucial for the volunteer fire and emergency services," said NVFC Chairman Philip Stittleburg. "LOSAPs have no clear place in the current tax structure. This creates problems for states and communities that want to provide LOSAPs for their volunteers but face unnecessary complications in setting up programs."
EMS for Children
Rep. Jim Matheson (D-UT) introduced"The Wakefield Act"(H.R. 479)Jan. 13 to reauthorize the federal EMS for Children Program for five more years. The bill would also authorize Congress to give the program $25 million for the program for FY 2010, $26,250,000 for FY 2011, $27,562,500 for FY 2012, $28,940,625 for FY 2013 and $30,387,656 for FY 2014 (although Congress would still need to vote each year to appropriate those amounts). The House passed the legislation March 31 and passed it to the Senate, where it was read twice and referred to the Committee on Health, Education, Labor, and Pensions.
Rep. Edolphus Towns (D-NY) introduced the"National Trauma Center Stabilizations Act"(H.R. 936)in the House Feb. 10 and Sen. Patty Murray (D-WA) introduced an identical bill(S. 733)in the Senate March 26. It would provide federal grants to trauma centers nationwide, many of which are struggling financially because of the increasing burden of uncompensated care, and prevent further trauma center closures.
EDs, EMTALA & Ambulance Diversions
On Feb. 25, Sen. Debbie Stabenow (D-MI) and Bart Gordon, (D-TN) introduced the"Access to Emergency Medical Services Act"(S. 468/H.R. 1188)in the House and Senate.
The identical bills would create a bipartisan commission to identify and examine factors that affect the delivery of screening and stabilization services in emergency departments (EDs) under the Emergency Medical Treatment and Active Labor Act (EMTALA) and provide additional payments for some physician EMTALA services.
It would also direct the Centers for Medicare & Medicaid Services to convene a multidisciplinary working group to identify barriers contributing to delays in the admission of ED patients and best practices for improving the flow of hospital patients; develop ED boarding and diversion standards and measures and incentives for implementing, monitoring and enforcing those standards; and report to Congress on those matters. Passage of this legislation is a high priority for the American College of Emergency Physicians.
Rep. Anh "Joseph" Cao (R-LA) introduced an untitled bill(H.R. 1819)March 31to amend the "Digital Television Transition and Public Safety Act of 2005"to extend the Interoperable Emergency Communications Grant Program through FY 2012. Under current law, the $1 billion in federal funds appropriated for the grants must be spent by Sept. 30, 2010. "Many projects would have difficulty meeting the 2010 deadline for multiple reasons," said the Association of Public-Safety Communications Officials, which supports the bill. "In some cases, the grant money was not available for several months as legislatures wrangled over state budget issues. In other situations, issues related to procurement requirements, FCC licensing and compliance with environmental protection laws have caused delays."
Pay for border-area work
Rep. Bob Filner (D-CA) introduced the"Save our Border Communities Act" (H.R. 670)Jan. 26. It would authorize DHS to "provide payment to first responders, including police, firefighters, and emergency medical technicians, for costs associated with providing emergency services at the international borders of the United States, but only to the extent that such costs are not otherwise reimbursed through any Federal program and cannot otherwise be recovered."
Rep. Keith Ellison (D-MD) introduced the "Nongovernmental Emergency Responders Family Protection Act" (H.R. 2485) May 19, which would expand the Public Safety Officers Benefit program to include all paramedics and EMTs, instead of restricting benefits to those employed by public-sector departments.
Ryan White Act
On May 21, the Senate Homeland Security and Government Affairs passed a the "Federal Firefighters Fairness Act" (S. 599), which would create a presumption that a job injury occurred if a firefighter with at least five years experience dies or is disabled due to heart disease, lung disease or certain cancers. Notable for EMS, the committee first added an amendment that would reauthorize provisions of the Ryan White Care Act that require first-responder notification of an infectious disease exposure. Congress dropped that provision, which included protocols for such notification, several years ago. (See "Action Needed to Fix Infection Control Law," April 2008 EMS Insider.)