Congressional Victory- Medicare Add-Ons Receive New Life!

Minutes Ago…

We’re writing this piece on the morning of Friday, February 9, 2018. Remember this day, as just minutes ago the United States Congress passed a bill to keep the government’s doors open for another month and with it they passed important provisions affecting the ambulance industry.

Congressional Victory- Medicare Add-Ons Receive New Life!
Literally hours after Congress approved the measure, the President signed it into law.

Congress just passed a 5-year extension of the Medicare ambulance add-on payments!

The American Ambulance Association issued a quick notice to the industry celebrating this passage which was part of a two-year budget deal reached by congressional leaders and finally passed by the Senate early this morning and ratified by a favorable vote in the House of Representatives soon thereafter.


By now, most everyone recalls that over fifteen years ago it was determined that the Medicare National Ambulance Fee Schedule was underfunding the ambulance industry by a pretty wide margin. At the time, Congress decided to put in place a “temporary” stop-gap measure that amounted to an add-on payment factor of +2% for urban area reimbursements, +3% in rural areas and +22.6% in the most remote geographical areas designated as super-rural. Additionally, in the rural and super-rural areas per mile reimbursements were increased by an additional 50% for the first 17 loaded mileage of each transport.

The catch was that each year these add-ons had to be renewed by Congress. After a while, Congress extended the add-ons for a period of multiple years with the last extension expiring on December 31, 2017 with no action to extend decided by Congress prior to expiration of the current term.

Lobbying groups like the AAA pushed hard for the reinstatement of the add-ons and finally, today, those efforts paid off. The industry anticipates that these add-ons will be made retroactive back to January 1st and applied to payments moving forward.

In Exchange

In exchange for conceding a 5-year extension which costs additional Medicare dollars, Congress placed some future conditions on releasing the purse strings.

Cost Data Collection

This was inevitable.

Congress needs to be supplied proof that we deserve these extra dollars. So, for the first time in our history, the ambulance industry will be required to submit periodic Cost Data reports to CMS.

The good news is that the ambulance industry will have direct input on the structure and implementation of the Cost Data report. This is a concession brokered by the AAA so there is input from our side. Congress is requiring this so there is an “appropriate balance” between obtaining useful data without overburdening or “onerously penalizing” ambulance services.

However, it is written into the provision that there will be a 10% reimbursement deduction penalty assessed in each year following an ambulance service’s failure to report cost data when requested. This is considerably a better option than the original plan of taking payments back or an outright withholding of payments which was on the table in the first draft of the legislation.

Additional Cuts in Dialysis Transports

In order to pay for the extension, Congress will assess an addition 13% reimbursement deduction to non-emergent dialysis transports. Again, this is a reduction from the 22% proposal in the first draft.

Of course, this adds the 10% reduction from a few years ago that is already in place.

While unfortunate, we all know that dialysis transports are continually on the radar screen for the Feds and the target of many a fraud and abuse investigation. So, it comes as no surprise that this provision rides in on the coattails of the extension legislation.

President Signed Immediately!

Literally hours after Congress approved the measure, the President signed it into law. Now, some administrative formalities will take place in order to implement the changes. We hope to see CMS release a Public Use File (PUF) listing the new reimbursement fee schedule in the days coming.

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