We are very pleased to report that Congress has extended the temporary Medicare ambulance relief for another year as part of the package to avert the fiscal cliff. This includes the 2% urban, 3% rural and super rural increases. In addition, Congress delayed the 2% cut to Medicare providers as part of sequestration. Congress did, however, also target nonemergency basic life support transports of ESRD patients with a 10% cut in response to concerns cited by MedPAC, the GAO and OIG. The President has stated he will sign the bill as soon as it reaches his desk. A detailed summary of the ambulance provisions contained in the package, the American Taxpayer Relief Act (H.R. 8), is listed below.

NAEMT worked closedly with the American Ambulance Association for the ambulance extensions and to prevent the cut under sequestration. We are extremely pleased to deliver another success to our members and thank all of you who reached out to your members of Congress on this issue. This was a team effort. We would also like to thank our champions in Congress including Senators Charles Schumer (D-NY), Pat Roberts (R-KS), Kent Conrad (D-ND) and Congressmen Charles Boustany, MD (R-LA) and Richard Neal (D-MA) who spearheaded efforts on ambulance relief legislation and the extensions. We would like to also thank Senator Max Baucus (D-MT), Chairman of the Senate Finance Committee, and all the other members of Congress who were also extremely supportive and helped ensure the relief was extended.

The ambulance related provisions are as follows:

Ground Ambulance Add-On Payments
• Extends the 2% urban base rate and mileage increase until December 31, 2013;
• Extends the 3% rural base rate and mileage increase until December 31, 2013; and,
• Extends the 22.6% super rural base rate increase until December 31, 2013.

Air Ambulance Add-On Payments
• Extends the expanded rural designation for air ambulance services until June 30 2013.

Studies of Ambulance Costs
Ambulance Cost Study 1
• Directs the HHS Secretary to conduct a study which analyzes data on existing cost reports for hospital-based ambulance providers.
• HHS Secretary to submit report to Congress by October 1, 2013 on findings and any recommendations for legislative or administrative action.
Ambulance Cost Study 2
• Directs the HHS Secretary to conduct a study of the feasibility of periodically obtaining cost data from all ambulance service providers and supplier s to examine the appropriateness of the ground ambulance add-on payments.
• HHS Secretary to submit report to Congress by July 1, 2014 on findings and recommendations for legislative or administrative action;
• HHS Secretary shall consult the industry on design and collection efforts;
• Explore the use collecting cost data using cost surveys and cost reports;
• Explore the feasibility of developing a standard cost reporting tool; and,
• Examine the ability for providers to furnish data by provider type, especially rural and super rural.

Medicare Payment Adjustment for Transport of ESRD Patients
• Reduces Medicare reimbursement by 10% for the nonemergency basic life support transport of an end-stage renal dialysis (ESRD) patient.

The Medicare Payment Advisory Commission (MedPAC) had recommended a 5.7% cut in Medicare reimbursement for all nonemergency basic life support transports. The recommendation was in large part to target the growth in BLS nonemergency transports especially in ESRD transports. Also, MedPAC, the HHS Office of Inspector General (OIG) and the Government Accountability Office (GAO) have all noted recently the fraud and abuse problem with the ambulance transport of ESRD patients. Congress therefore targeted a cut in payments for ESRD transports instead of all nonemergency basic life support transports.

Sequestration: 2% Reduction for Medicare Providers
• The reduction of 2% in reimbursement rates for all health care providers, including ambulance service providers, was scheduled to take effect on January 1, 2013. The reduction has been delayed until March 1, 2013.

Again, thank you to all of you who helped with this success. We especially want to thank our state advocacy coordinators for all of their work in advocating for the extension.