Make reimbursement permanent

To the editor:

On March 10, Congress passed the American Rescue Plan Act, which provides the Department of Health and Human Services (HHS) with the authority to issue an emergency waiver of the requirements for ground ambulance providers and suppliers to allow reimbursement for the healthcare services provided when a community-wide EMS protocol prohibiting transport is in place.

As with the other COVID-19 waivers, Congress has not restricted the timing of the waiver, so it can be implemented retroactive to March 1, 2020, as Centers for Medicare & Medicaid Services has done when implementing similar waiver authority passed by Congress during this pandemic. The EMS profession appreciates Congress for taking this action to implement the waiver during the public health emergency but advocates for reimbursement for EMS treatment in place be made permanent. 

Ground ambulance service providers and suppliers, paramedics and EMTs have been on the front lines of the pandemic responding to emergency medical calls. They often are the first healthcare professionals that patients fighting COVID-19 encounter. In areas overwhelmed by COVID-19, community-wide EMS protocols have been issued restricting the transport of patients who can safely be treated at home to protect these patients from risking exposure to infection or infecting others, as well as to keep hospital beds open for higher acuity patients. 

While these practices are standard nationwide, the Medicare program does not reimburse ground ambulance service providers or suppliers for these healthcare services when the patient is not transported to a hospital. Some ambulance service providers and suppliers have seen 30% to 40% of their emergency call volume shift to these treatment in place responses. Without reimbursement, the provision of this care is not sustainable. Communities risk losing the very emergency medical providers and suppliers they have relied upon to help reduce hospital surge and decrease the infection rate.

Section 9832 of the American Rescue Plan Act addresses this problem during the public health emergency by giving the Centers for Medicare & Medicaid Services the authority they need to waive the transportation requirement for reimbursing ground ambulance service providers and suppliers when responding to a 911 emergency call when there is a community-wide EMS protocol in place restricting the transport of patients. 

However, ground ambulance service providers and suppliers have provided treatment-in-place care to their patients for decades without reimbursement. Examples include ambulance crews stabilizing a diabetic emergency by administering glucose; or stabilizing an asthma attack by administering a breathing treatment. In these types of scenarios, it is often clinically appropriate for the patient to seek follow-up care through their regular physician without the need to be transported by ambulance to an emergency department.

Care provided to Medicare beneficiaries by ground ambulance providers and suppliers should be reimbursed, regardless of whether the patient is transported to a hospital. 

Sincerely,

John McFarland

Portland