[Congressional Record Volume 155, Number 74 (Thursday, May 14, 2009)]
[Extensions of Remarks]
[Page E1158]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




     INTRODUCTION OF THE MEDICARE AMBULANCE ACCESS PRESERVATION ACT

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                          HON. RICHARD E. NEAL

                            of massachusetts

                    in the house of representatives

                         Thursday, May 14, 2009

  Mr. NEAL of Massachusetts. Madam Speaker, I rise today to introduce 
the Medicare Ambulance Access Preservation Act. This bill would ensure 
that my constituents in Massachusetts, and people across the country, 
continue to have access to ambulance services. Ambulance service 
providers are a critical part of our country's first responder and 
health care systems. In fact, as we discuss how to reform our health 
care system I can think of nothing more fundamental than ensuring that 
people have access to life-saving emergency ambulance care.
  We all know the importance of ambulance services. Many of us see them 
every day transporting ill or injured individuals to the hospital. Some 
of us have even been transported and received pre-hospital care in an 
ambulance. Dedicated, skilled professionals work in these ambulances, 
ensuring that patients receive the care they need and ensuring that 
communities are prepared in the case of a disaster. The need to ensure 
the availability of these services is clear. Yet, Medicare 
reimbursement policy has harmed rather than helped to reach this goal.
  Under the Balanced Budget Act of 1997, Congress authorized the 
Centers for Medicare and Medicaid Services (CMS) to develop a Medicare 
ambulance fee schedule. The rates developed under the fee schedule were 
significantly below what it cost many providers in Massachusetts to 
deliver services. In May 2007, the Government Accountability Office 
(GAO) confirmed this problem by determining that Medicare reimburses 
ambulance service providers on average 6 percent below their costs and 
17 percent below cost in ``super rural'' areas. Ambulance providers 
aren't even breaking even in Medicare--Medicare reimburses ambulance 
providers below their costs for every person they transport.
  Congress has recognized this shortfall and included temporary 
Medicare ambulance relief provisions in both the Medicare Modernization 
Act (MMA) and the Medicare Improvements for Patients and Providers Act 
(MIPPA). However, all of these provisions expire at the end of 2009. To 
address this problem, I have worked with ambulance service providers in 
my state to develop a permanent Medicare relief package.
  My legislation would increase reimbursement to rural and urban 
ambulance suppliers by 6 percent, and super rural providers by 17 
percent. These numbers are consistent with the GAO report. This package 
will ensure not only continued availability of ambulance services, but 
also that ambulance service providers will be able to maintain 
standards of providing quality health care to patients.
  As we address health care reform, we must begin by remembering the 
basics. Ambulance services are a fundamental part of our health care 
system. Congress must ensure that all Americans continue to have access 
to ambulance services and that the dedicated men and women who provide 
ambulance services have the tools and resources they need to serve 
patients when timely, expert medical care is needed most. I ask my 
colleagues to join me in this effort by cosponsoring this important 
legislation.

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