Administration and Leadership

Lobby Congress Now

Congress is currently crafting its 13 appropriations bills for fiscal year 2008, and House leaders hope to get its versions of those bills passed before the July 4th recess. So the time is right for the EMS community to contact its members of Congress and convince them to move on the primary initiatives identified by national EMS organizations.

Medicare reimbursement
While awaiting release of the Government Accountability Office report on the cost of ambulance transport, the American Ambulance Association wants Congress to providessome ˙temporary reliefÓ by approving a two-year, 5% across-the-board rate increase to the base rate for all Medicare transports.„

Senators Charles Schumer, D-N.Y., Trent Lott, R-Miss., and Kent Conrad, D-N.D., and Representatives Mike McNulty, D-N.Y., Chip Pickering, R-Miss., and Tom Allen, D-Maine, introduced the Medicare Ambulance Payment Extension Act (S.1310/H.R.2164) on May 3.

According to the AAA, the temporary rate increase would result in an estimated $341 million to ambulance services to compensate for the money they will lose from the loss of the temporary 2% rural / 1% urban boost Congress provided in 2004, which expired at the end of 2006, and the declining impact of the regional Medicare fee schedule. Ambulance services in 26 states benefit from the regional fee schedule, which expires at the end of 2009. However, only 20% of the Medicare rates in those states are now based on that regional schedule, which pays more than the regular fee schedule.

˙Once the GAO report is released, we will review the findings internally and make recommendations to Congress for a long-term solution,Ó said AAA Senior Vice President of Government Affairs Tristan North.

AAA members began lobbying for the temporary-relief legislation in early May when they went to Washington, D.C., where the AAA recognized 107 EMS field providers from 34 states who had been named ˙Stars of Life.Ó The AAA members and Stars visited some 150 Congressional offices. ˙Probably 75% of the time, they met with a member [of Congress] for at least a photo op,Ó North said.

AAA is also asking Congress for an exemption from the federal fuel tax for ground ambulance services. ˙This is something we first addressed last year because of the rising fuel costs,Ó North said. ˙But this year, we made it a priority, and we_re looking for champions on the Hill for this issue.Ó

Some good news: When the Senate passed its FY 2008 budget resolution March 23 and the House passed its budget resolution March 29, neither resolution included any reduction in Medicare reimbursement for health-care providers. The president had proposed a 0.65% reduction in the annual inflation-based increase for ambulance services and other health-care providers.

First responder funds for EMS
Both the AAA and Advocates for EMS are pressing Congress to include language in the report accompanying the Department of Homeland Security appropriations bill stipulating that at least 10% of DHS first responder grants reach EMS.

˙We don_t want to take money from the fire guys; we just want Congress to give more money for grants to fund EMS,Ó said AEMS lobbyist Lisa Meyer.

˙Firefighting activities are crucial, but the EMS piece is missing,Ó said AEMS President Robert O_Connor, MD. ˙We want more funding for all EMS, including fire-based EMS.Ó

The FY 2007 DHS appropriations bill_s conference report required DHS to report to Congress by Jan. 26, 2006, how much EMS agencies received from first responder grants in FY 2006. However, DHS has yet to release that report. AAA and AEMS are asking for language requiring a similar report on FY 2007 funds. ˙We_ve asked that it now be conducted by the [DHS] Office of the Chief Medical Officer, which is Dr. Runge and Dr. Krohmer,Ó North said. He said several members of Congress are championing that effort.

FIRE & SAFER grants
Among the top priorities for the fire service including fire – based EMS organizations – is convincing Congress to fully fund the Assistance to Firefighter (or FIRE) grants and Staffing for Adequate Fire and Emergency Response (or SAFER) grants. The president„ proposed only $300 million for FIRE grants, which received $553 million in FY 2007, and zero for SAFER grants, which received $115 million in FY 2007 despite the president_s request to eliminate all SAFER funding.

Metropolitan Medical Response System
The president also proposed zero funding for the Metropolitan Medical Response System, which provides grants that benefit EMS systems in 143 high-risk municipalities. Congress appears ready to save the MMRS program, however. On May 10, the House Committee on Homeland Security announced that its FY 2008 DHS authorization bill authorizes $63 million for the program, which received $33 million in FY 2007.

NEMSIS funding
Another AEMS priority is to secure $3 million in the Department of Transportation appropriations bill to implement the National EMS Information System. NEMSIS received $250,000 in FY 2005, $1 million in FY 2006 and zero in 2007. Because Congress failed to pass a FY 2007 DOT appropriations bill, it merely funded programs at the levels authorized for FY 2006.

However, Meyer explained, ˙Because NEMSIS wasn_t in the president_s budget last year and wasn_t officially authorized, NEMSIS didn_t get anything in FY 2007. So the DOT had to find creative ways to fund it this year. ˙It was in the president_s budget this year,Ó she said. Although the president proposed only $250,000 for NEMSIS, ˙it_s a big deal to get mentioned, so we don_t have to start from scratch.Ó Meyer encourages the EMS community to go to the AEMS Web site, where they can download a sample letter to members of Congress asking for NEMSIS funding.

Volunteer incentives & protection
The National Volunteer Fire Council and International Association of Fire Chiefs support two bills that could help fire and EMS agencies recruit and retain volunteers. The House of Representatives passed the Volunteer Firefighter and EMS Personnel Job Protection Act (H.R. 1643) May 9, as part of the DHS authorization bill.

If the Senate agrees, this would require employers to protect the jobs of volunteer EMS and fire responders who are deployed (but not self-deployed) for up to 14 days after
the president declares an emergency.

According to NVFC, this legislation also benefits emergency managers who rely heavily on more than 800,000 volunteer first responders and emergency planners who would know that volunteer assets would be available when needed.

The Volunteer Responder Incentive Protection Act (H.R. 943) would amend federal tax laws to exclude property tax rebates and other incentives for fire and EMS volunteers from being counted as income for tax purposes. With nearly 150 co-sponsors, this bill stands a good chance of being passed by the House.

Trauma & EMS
In March, Congress passed legislation reauthorizing the Department of Health and Human Services_ Division of Trauma and EMS, and the president signed it into law. DTEMS disappeared two years ago after Congress went along with the president_s proposal to eliminate its funding. Among other things, this legislation would create a new, competitive grants program to help states create, improve and/or expand their trauma systems and to ˙improve communications between the trauma care system and emergency medical systems through improved equipment or a telemedicine system.Ó

However, authorizing the funding is not the same as appropriating the funding, so EMS and trauma leaders are working to convince Congress to follow through and actually appropriate the $12 million it authorized for the grants program for FY 2008. (Congress also authorized $10 million for FY 2009 grants, and $8 million for 2010, 2011 and 2012.)

For the text and status of these bills, visit„ For more information on how to influence Congress on this legislation, visit„,,„www.advocatesforems.orgor„