Table of Contents

Update on Medicare Ambulance Proposed Rule
By David M. Werfel, Esq.

AAA Call for Candidates

Medicare Reference Manual 2006 Update Information

AAA Call for Volunteers: Recruitment and Retention Task Force

2006 Summer Reimbursement Conference Register NOW!

Member Update: AAA Website Changes!!!

Call for Articles - Summer 2006 Edition of Ambulance Service Journal

“Secrets of Successful EMS Leaders” by Mike Taigman and Stephen Dean Now Available on AAA-Link

Mark Your Calendar: August Audioconference

ASM 2007 Session

Update on Medicare Ambulance
Proposed Rule
By David M. Werfel, Esq.

On June 9, 2006, representatives of the AAA and the Centers for Medicare and Medicaid Services (CMS) held a conference call to discuss the proposed rule on Medicare ambulance services that was published in the Federal Register on May 26, 2006.  This update summarizes the important points that were raised and the responses from the CMS representatives and provides you with an approximate timetable with respect to the AAA comments which are now being drafted.

As reported in my initial summary of the proposed rule, the following four issues are covered:
 - Specialty Care Transport (SCT) - origin/destination requirement;
 - Emergency Definition;
 - Rural Determination; and,
 - Conversion Factor Review.

SCT

With respect to SCT, the proposed rule would change the requirement to “inter-hospital”, rather than “inter-facility”.  The definition of SCT was discussed during the negotiated rule making process for the fee schedule and the AAA will be commenting on the fact that the entire negotiated rule making committee agreed the requirement for SCT be “inter-facility”.  We will be expanding our comments on SCT to address other concerns which we identified in your feedback on the recent AAA SCT online survey.  This will include a definition for “critical ill or injured” which CMS representatives confirmed on the call does not currently exist for ambulance transportation.

Emergency Definition

The proposed definition for emergency adds the language of “responds immediately…to…radio calls within a hospital system when the ambulance entity is owned and operated by the hospital.”  CMS confirmed that, despite the wording in the proposed rule, they are referring to ambulances already waiting at the hospital, regardless of the entity that owns the ambulance.  The AAA will be commenting as well on this issue.

Rural Determination

With respect to the new determination of “rural”, the intent is for CMS to use the same definition for determining ambulance adjustments for rural pick-ups as they currently use for adjustments under Part A for facilities.  The new determination is based on more recent census information which because of the growing U.S. population has more counties included in Metropolitan Statistical Areas (MSAs) and thus identified as urban.  We believe that this will result in more transports being identified as urban and thus not eligible for the bonus rural mileage adjustment.  The AAA is currently evaluating different options that we can include in our comments to minimize the loss of the rural mileage adjustment for those providers who are in areas reclassified as urban.

The new rural determination will also use Rural Urban Commuting Areas (RUCAs) as part of the Goldsmith Modification for determining rural areas within large urban counties.  The AAA has been pushing for CMS to use RUCAs as the primary definition of rural instead of the current MSA/Non-MSA definition so while it will not be THE final determination, it is a step in the right direction.

The AAA has requested, and CMS agreed to provide, the list for all areas designated as rural under the proposed rule.  That list is available to CMS at present, but it must be reviewed by CMS before releasing it as some zip codes overlap rural and urban counties.

Conversion Factor Review

As to the issues of the annual reviews by CMS of the conversion factor and air ambulance rates, the proposed rule is only intended to relieve CMS of the obligation of publishing an analysis annually.  They still would have the right to review the data.

AAA Comments

The AAA will have its comments ready, at least in draft form, for you by the end of June.  Since comments are not due to CMS before July 25, 2006, that will afford you plenty of time to formulate and submit your own comments using the AAA comments as a guideline.  I urge you not to submit your comments until you see those provided to you by the AAA.  It is important that the ambulance industry provide CMS with a clear, consistent message regarding our thoughts on the proposed rule.

In the meantime, if you have any questions concerning the proposed rule, please submit them via e-mail to Tristan North at tnorth@the-aaa.org or call me at (631) 582-3283.

AAA Call for Candidates

To:      AAA Membership
From: The 2006 Nominating Committee:  Brian Walker, Chairman; Mike Woronka, Region I; Benny Atkins , Region II; Lauren Rubinson, Region III;   Rachel Harracksingh, Region IV; and Fred Sundquist, RegionV.

In accordance with the By Laws of the American Ambulance Association, it is time to call for members in good standing that wish to serve as an Officer, a Regional Director, or a member of the Ethics Committee.  For specific qualifications, please visit the AAA website (www.the-aaa.org) and review the current bylaws, located in the drop down menu when you move your curser to “About the AAA” (http://www.the-aaa.org/about/bylaws.htm).  We are now seeking candidates for the following positions
President-Elect (6 year commitment) two-year term, two years as President and two years as Immediate Past President
Secretary – two-year term
Treasurer – two-year term
Regional Director (all regions) – two-year term
Member, Ethics Committee – two-year term
Anyone who wishes to be considered for an elected position as an Officer or as a Regional Director must:

1. Be the designated representative of a member of the AAA, in good standing;
2. Commit to attend at least five meetings per year, be ready to devote time and effort to matters which concern the Board of Directors and to actively participate in all Board activities;
3. Be prepared to assist other AAA members with concerns and problems which relate to the ambulance industry and the workings of the AAA; and,
4. Understand that these positions provide no compensation for time or reimbursement for expenses.  All travel-related expenses, including transportation, lodging and food are the responsibility of the individual and/or their sponsoring organization.

There are no restrictions against an individual running for more than one position in the same election cycle, though no person shall hold more than one position simultaneously. 
All those who wish to stand for election and believe they are qualified are requested to prepare a statement and answer Candidate’s Questionnaire which describes both their qualifications and reasons for wanting to participate either in the leadership of the AAA, or as a member of the Ethics Committee.  Both the statement and Candidate’s Questionnaire should be accompanied by a recent photograph that may be distributed, along with your statement and answers to the questionnaire, in the package containing official ballots sent to all AAA members who are eligible to vote in this election.
 
Honorary Membership Nominations
We are also accepting written nominations for worthy AAA members who have significantly contributed to the accomplishments of the AAA and should therefore be recognized through the granting of Honorary Membership.  The name(s) of anyone nominated for this category of membership, as well as the text of the nomination will be included in the election ballot as described above, and will provide a place for a vote of “YES”.  If the vote(s) of “YES” is expressed by at least seventy-five (75) percent of those voting, the individual(s) will be granted Honorary Membership. 

AMERICAN AMBULANCE ASSOCIATION

Volunteer Opportunities!

AAA is looking for more volunteers for the Recruitment and Retention Task Force! Please help determine better ways to recruit and retain EMS professionals for our industry.

In addition, the AAA is looking for any flyers, ads, newsletters and/or recruitment and retention tips for our Recruitment and Retention Toolkit for Ambulance Service Providers.

Please contact Staff Liaison Stacy Bromley at 1-800-523-4447 or sbromley@the-aaa.org for more information or if interested.

2006 Summer Healthcare Reimbursement Conference

July 11 - July 15, 2006

Join us in Indianapolis for the American Ambulance Association’s 2006 Summer Healthcare Reimbursement Conference.

Don't Wait! Fax your registration today!

Register now by clicking here and faxing the form to 703-610-9005.

Member Update:

The AAA Website will be undergoing some changes. Starting June 19th, the Members Only section of the website will be individually password protected. Your new member login and password are in the mail and will be sent to the main contact person on record at your organization. Also, the Information Repository Database will no longer require an additional login and will be accessible under the Members Only section. This is the database for entering your company information in anticipation of hurricane season so that you can be listed for deployment. Please direct any questions to Stacy Bromley at sbromley@the-aaa.org sbromley@the-aaa.org

AMERICAN AMBULANCE ASSOCIATION

Second Call for Articles -- Summer ASJ

The American Ambulance Association is now looking for articles for the Summer 2006 edition of the Ambulance Service Journal. Please contact Stacy Bromley at sbromley@the-aaa.org or 703-610-0247 with questions or articles. All articles to be considered should be submitted no later than June 30.

Secrets of Successful EMS Leaders

“What's Important to You?”

Presented By Mike Taigman and Stephen Dean

June 2006 lesson now available FREE on the AAA-LINK

The popular audio tape series “Secrets of Successful EMS Leaders” by Mike Taigman and Stephen Dean is being posted as a monthly series FREE of charge as a  member benefit on the AAA-LINK.   Each month a new module will be posted.  Listen to the series online or download to your MP3 Player.  The series is also being distributed to all AAA member companies who have set up private LINK systems with EMSED.COM.    You can access the AAA-LINK at:  http://key.emsed.com .  A userid and password are required.  For more information or to sign up for a FREE userid and password call EMSED.COM at 877-435-9309.

Mark Your Calendar!

Industry Expert Ron Thackery, American Medical Response, will share with you the latest advances in EMS worker and vehicle safety. Effective strategies for negotiation insurance premiums and the management of safety in an EMS organization.

ASM 2006 Spring -> SOLD OUT!

ASM 2006 Summer -> SOLD OUT!

NOW ACCEPTING REGISTRATIONS FOR ASM IN 2007

Now accepting enrollment for the 2007 session of the Ambulance Service Manager (ASM) Program.  Reserve your place today!

2007 Ambulance Service Manager (ASM)
The ASM Program is sponsored by the American Ambulance Association (AAA) and is for aspiring, new, and experienced managers who wish to develop their leadership competencies and sharpen essential management skills.  The program provides a broad foundational curriculum matching cutting edge management theory with real-life practical applications.

The ASM Program is a certification course designed to immerse participants in an engaging learning cohort.  A small group of 40 participants moves together through two weeks of face-to-face instruction and experiential learning led by industry leading faculty bridged by several weeks of online discussion and group project work.

ASM Graduates will:

Dates for the 2007 program are:

• Online Session Begins: January 29, 2007
• On-site Week 1: February 25-March 2, 2007
• On-site Week 2: April 29 - May 4, 2007
  

Go to http://www.fitchassoc.com/Services/conferences.htm to download the brochure and registration materials. 

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