The national ambulance fee schedule is in the first year of the 5-year implementation schedule designed to "level the field" by adjusting Medicare fees for all ambulance companies across the country. The House and Senate have each produced plans that would alter the current fee schedule process.House Plan
The House proposal would create a new regional payment system that would result in any new funds going to ambulance providers in only 33 states. The proposal would provide $600 million over ten years in new funds for ambulance providers in those states. The way the formula works, those new monies would go to providers in 33 states and exclude providers in17 states and D.C. These excluded states (AL, DE, D.C., FL, GA, IL, IN, KY, MD, MI, MS, NC, OH, SC, TN, VA, WI, WV) have historically received Medicare payments below their costs. The proposal divides the country into nine regions for reimbursement purposes. Any new funds would be distributed to only those states whose historical reimbursement average was above the national fee schedule rate. The 17 states whose reimbursement average is both below cost and the national fee schedule would receive none of the new funds.Ways and Means Committee staff argues that providers in the 33 states are being harmed by having their reimbursement reduced over several years to the rates imposed by the national ambulance fee schedule. Therefore, they need more money to "ease their pain" during the transition period. Committee staff also says that the providers in the 17 states are "not hurt" by this provision because they are having their rates increase under the new national fee schedule.Ambulance providers in the 17 states believe that they have been "in pain" over the past 15 years, because their reimbursement rates have been so low - well below their costs. If any states need help, it is the states whose ambulance providers are delivering care and being reimbursed at significantly below cost.Senate Plan
The Senate proposal provides a 5 percent increase in the fee schedule for ambulance providers in rural (non-MSA) areas and a 2 percent increase for urban services. This plan has been scored at about $163 million over 10 years. This plan does NOT exclude any providers.Recommendation to the House-Senate Conference Committee on Medicare Reform
The 17 states of the National Ambulance Coalition support the following compromise:
1. We support the Senate approach of benefiting providers in all states. We don't believe there should be a rural-urban differential, but would not oppose this.
2. We support the House plan of providing $600 million over ten years to services in all states. All new funds should be added to the existing fee schedule.  *The National Ambulance Coalition represents ambulance providers in Alabama, Delaware, D.C., Florida, Georgia, Illinois, Indiana, Kentucky, Maryland, Michigan, Mississippi, North Carolina, Ohio, South Carolina, Tennessee, Virginia, Wisconsin, and West Virginia. Contact: Julie Rose, 440-992-7302

Posted 8/03