On February 9, 2018, the President signed into law the Bipartisan Budget Act of 2018 which included a five-year extension of the Medicare ambulance add-ons. The President signed the legislation hours after the House and Senate passed the bill and ended a short-lived partial government shutdown. The new law provides long-term certainty as to the duration of the add-ons and begins the process of obtaining ambulance cost data for future reform of the Medicare ambulance fee schedule.
The specifics of the ambulance provisions in the Bipartisan Budget Act:
- A 5-year extension, retroactive to January 1, 2018, of the Medicare ambulance add-ons comprised of the 2% urban, 3% rural and super rural bonus increases.
- The preferred system of the American Ambulance Association (AAA) on the collection by the Centers for Medicare and Medicaid Services (CMS) of cost data from ambulance service providers and suppliers. The Secretary of Health and Human Services (HHS) could use a survey methodology and will develop the system in consultation with industry stakeholders. The system strikes the appropriate balance between obtaining meaningful data while placing the minimum burden on the industry.
- The penalty for failing to report required cost data, if selected to do so, would be a reduction in payment up to 10% for the year following the year in which the data should have been submitted. A clause is included to waive the penalty in cases of hardship.
- The offset for the 5-year extension of the add-ons is a 13% cut (in addition to the current 10% for a total of 23%) in reimbursement for BLS non-emergency transports to and from dialysis facilities. The AAA had objected to the offset and pushed for a cut targeted to just those entities which abuse the dialysis transport benefit. The AAA was successful in reducing the initial cut from 22% to 13% and is looking into other potential offset options that would replace the cut.
Next Steps
The next step is for CMS to develop with stakeholder input a system to collect cost data from ambulance service providers and suppliers. Once CMS has the proposed framework for a system, the Agency will release a proposed rule outlining the details and request comments from the industry. Knowing that the industry would need at some point to provide CMS with cost information, the AAA has been working with The Moran Company, a well-respected health care analytical firm in DC, on the best way to collect ambulance cost data.
End Goal of Data Collection
The goal of the data collection is for the Congress, CMS and industry stakeholders to have the necessary information to further substantiate the need to make the Medicare ambulance add-ons permanent. The data will also be helpful in future reform of the Medicare ambulance fee schedule including potential policy changes addressing mobile integrated health, treatment with referral and no transport and transport to alternative destinations. The five-year extension is intended to provide the industry with the time necessary to obtain and analyze the data.
