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NAEMT Board Comments on Medicare and Medicaid Ambulance Differentiation Plan

Nov 15, 2010

The NAEMT Board of Directors has commented on various proposals set forth in the Proposed Rule titled “Medicare, Medicaid, and Children’s Health Insurance Programs; Additional Screening Requirements, Application Fees, Temporary Enrollment Moratoria, Payment Suspensions and Compliance Plans for Providers and Suppliers” (the “Proposed Rule”). 75 Fed. Reg. 58204 (September 23, 2010).

 

Taking a stance for all EMS practitioners, NAEMT strongly opposes the proposal to differentiate governmental and publicly-traded ambulance services from privately-held ambulance services for provider screening purposes.


Section 6401(a) of the Patient Protection and Affordable Care Act (Pub. L 111-148), as amended by the Health Care and Education Reconciliation Act of 2010 (Pub. L. 111-152), requires the Centers for Medicare and Medicaid Services (“CMS”), in consultation with the HHS Office of the Inspector General (the “OIG”), to establish procedures for screening providers and suppliers enrolled in the Medicare, Medicaid and Children’s Health Insurance Program (“CHIP”). The law authorized CMS to determine the level of screening to be conducted based on the risks of fraud, waste and abuse posed by each category of health care provider or supplier. These screening procedures would apply to newly enrolling providers and suppliers at the time they apply for participation in Medicare, Medicaid or CHIP, and would also apply to currently enrolled providers and suppliers at the time they revalidate their enrollment information.


In the Proposed Rule, CMS is proposing to establish three levels of risk (“limited”, “moderate” and “high”). The Proposed Rule also set forth the screening procedures that would apply to each of these levels of risk that are related to increasing levels of verification and screening.

 

In the Proposed Rule, CMS proposed to assign public or government owned or affiliated ambulance services to the “limited” level of risk. Ambulance services that are publicly traded on the New York Stock Exchange or NASDAQ system would also be assigned to the “limited” level of risk. By contrast, CMS proposed to assign non-public, privately-held ambulance services to the “moderate” level of risk.

 

The NAEMT Board notes that while NAEMT does not object to the proposed levels of risk, or the screening procedures that would be associated with each level of risk, it  strongly objects to the proposal to assign public ambulance services to the “limited” risk category, while relegating private ambulance services to the “moderate” risk category. The Board believes such a distinction to be arbitrary.

 

While NAEMT believes that all ambulance services should be placed in the “limited” risk category, it is strongly opposed to the proposal to assign public and private ambulance services to different risk categories. Accordingly, NAEMT respectfully requests that CMS reconsider its proposal, and assign all ambulance services, public or private, to the same risk category. 

 

View the full letter here.