DATE: November 3, 2000

Congress Temporarily Postpones Work on BBA Relief Legislation

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Congress has effectively adjourned for the elections without final action on legislation to provide relief to Medicare providers and beneficiaries from the effects of the Balanced Budget Act (BBA) of 1997. This measure includes some very modest relief for ambulance providers. It is expected that Congress will reconvene on November 13 to complete action on the BBA relief legislation, as well as a number of other unresolved issues.

As the situation stands, the House passed a BBA relief bill on October 26 on a largely party line vote, but the Senate has yet to act. The President has threatened to veto the House-passed bill in its current form. He objects to the amount of funding in the bill dedicated to managed care plans at the expense of beneficiaries, as well as providers who serve low-income communities. The Administration has not commented one way or the other on the ambulance provisions in bill. The ambulance provisions in the bill are as follows

Payment Adjustment

The bill would provide for the full inflation update in ambulance payments for 2001. It would also specify that any phase-in of the ambulance fee schedule would provide for full payment of national mileage rates in states where separate mileage payments were not made prior to implementation of the fee schedule.

GAO and MedPAC Studies

Provision would require the Comptroller of the General Accounting Office (GAO) to conduct studies on the costs of providing emergency and medical transportation services across the range of acuity levels of conditions and the costs of providing ambulance services to beneficiaries in rural areas.

The Secretary of Health and Human Services (HHS) would be required to take the findings of the rural study into consideration and adjust payments accordingly. Costs of rural ambulance services would also be reviewed in a study conducted by the Medicare Payment Advisory Commission (MedPAC).

Rural Mileage Bump

The bill would provide for rural trips (non-MSA/Goldsmith) get a 25% bump for each mile between 17 and 50 miles. ($6.25 vices $5.00 per mile.) This would be in addition to the $7.50 per mile they will receive under the fee schedule for the first 17 miles.

Consolidated Billing Repeal

Consolidated Billing for Part B residents of nursing facilities is repealed, except for therapy services.

Critical Access Hospitals

Ambulance services provided by a critical access hospital (CAH) or provided by an entity that is owned or operated by a CAH would be paid on a reasonable cost basis if the CAH or entity is the only provider or supplier of ambulance services that is located within a 35-mile drive of the CAH. The provision would be effective for cost reporting periods beginning on or after implementation of the fee schedule.

As you know, the comment period for the fee schedule proposed rule ends on November 13. Our highest current priority as an association continues to be getting the maximum number of comment letters into HCFA along the lines described in previous messages. Please mail your comments to HCFA as soon as possible.

In addition, however, most members of Congress are now in their districts and states campaigning for re-election and are highly attuned to their constituents', i.e. voters', needs. If you have an opportunity to speak to your congressmen or senator over the next week, please press him or her on the urgent need for more funding for ambulance services in the BBA relief bill.