Sample E-mail to Members of Congress on Zip Code Issue
Dear XXXX,
I respectfully request that you ask the Centers for Medicare and Medicaid Services (CMS) to delay implementation under the Medicare ambulance fee schedule of changes to zip codes which would lose rural status starting on January 1, 2015. Our service would be adversely impacted by the changes and had very little notice as to the specific zip codes affected. In addition, approximately half of the zip codes CMS has designated as switching from rural to urban should maintain their rural status.
On July 3, CMS placed the proposed rule on “Revisions to Payment Policies under the Physician Fee Schedule, Clinical Laboratory Fee Schedule, Access to Identifiable Data for the Center for Medicare and Medicaid Innovation Models & Other Revisions to Part B for CY 2015” on display at the Federal Register. The proposed rule also included changes to the Medicare ambulance fee schedule for 2015. In the proposed rule, CMS stated only 122 zip codes would switch from rural to urban as a result of updating information based on the 2010 census. However, in the final rule placed on display on October 31, CMS indicated 3,023 zip codes would switch from rural to urban.
Under the Medicare ambulance fee schedule, transports that originate in a rural area receive a 50% increase in their mileage payment for the first seventeen miles of the trip. The American Ambulance Association has determined that this mileage bump on average is 8% of the payment for these transports. Rural transports also receive an additional 1% more than urban to the base and mileage rates as a result of the current temporary Medicare add-on payments. Thus, we stand to lose 9% in Medicare reimbursement for services provided in areas currently designated as rural but will become urban in a month.
Only about 1,600 rural zip codes should change from rural to urban but because CMS incorrectly applied a modification of determining rural areas in large urban counties, the Agency has cited that 3,023 zip codes will lose their rural status. It is critical that CMS delay implementation of the change in rural to urban zip codes for one-year to correct this error and to give providers more than two months notice that they will lose a significant percentage of their Medicare reimbursement.
I therefore again respectfully request that you contact CMS to ask for a one-year delay in the change in rural to urban zip codes. I have attached a sample letter.
Please do not hesitate to contact me if you have any questions.
Thank you.
Sincerely,
XXXX XXXX
November __, 2014
Marilyn Tavenner
Administrator
Centers for Medicare and Medicaid Services
200 Independence Avenue, SW
Washington, DC 20201
Dear Administrator Tavenner,
I am writing to express my concern with the manner in which the Centers for Medicare and Medicaid Services (CMS) has proposed and finalized changes to the designation of ambulance services providers as “rural.” I am particularly concerned that the Agency indicated in the preamble to the proposed rule that only 122 ZIP codes (less than 0.3 percent) would change from rural to urban; yet, in the final rule issued in the Federal Register on November 13, the Agency indicates that the status of more than 3,000 ZIP codes will switch from rural to urban.
I have reason to believe that the Agency also improperly applied the Goldsmith Modification that determines rural areas in large urban counties. It appears that CMS applied the modification to rural counties thereby incorrectly designating an additional approximately 1,400 rural zip codes as urban. It is clear from statements in the proposed rule, “Revisions to Payment Policies Under the Physician Fee Schedule, Clinical Laboratory Fee Schedule, Access to Identifiable Data for the Center for Medicare and Medicaid Innovation Models & Other Revisions to Part B for CY 2015”, the Modification should only pertain to urban counties.
The designation of rural status is extremely important to ambulance services. The GAO has recognized in two reports that the current Medicare rates without the add-ons reimburse ambulance services below the costs they incur to provide care. Congress has consistently recognized the need to increase the current payment rates, especially for rural ambulance services, through the extension of the ambulance add-ons. These payments allow ambulance services in rural areas to continue providing life-saving and life-sustaining services.
I agree that as population demographics change over time, the designation of rural status should be updated. However, it is critically important that ambulance services, whose margins are on average negative without the add-ons, be given sufficient time to prepare for a change that could reduce their overall Medicare revenues by as much as 9 percent.
CMS has simply not provided sufficient notice for the change to take effect in Calendar Year 2015. We appreciate that CMS believes that stakeholders would have had access to the data necessary to determine the impact of the proposed change. However, the preamble to the proposed rule is misleading at best. Any provider or supplier that took the Agency at its word would have seen no need to engage in further analysis of the proposal because the preamble clearly stated there would be no change in the status of rural providers or suppliers. Additionally, if stakeholders had access to this information, CMS should have been more transparent in the proposed rule in describing the impact as well.
Therefore, I strongly urge you to delay implementation until calendar year 2016 the changes for those zip codes that would switch from rural to urban. This delay will allow CMS to correct the improper application of the Goldsmith Modification and provide a glide path for ambulance service providers and suppliers to adjust to the changes from rural and urban status. Alternatively, the Agency could phase-in the modifications during a four-year period. Either way, it is important to protect beneficiary access to ambulance services, which are a critical component of our health care system.
Please do not hesitate to contact me if you have any questions or would like to discuss our concerns in greater detail.
Sincerely,
Member of Congress