- The Biden Administration is forming a new federal committee to find ways to protect consumers from surprise medical bills incurred while using ground ambulance services, which was a notable exception in legislation prohibiting surprise out-of-network billing beginning next year, according to a Friday release from CMS.
- Recommendations from the committee will help inform policy changes to improve how charges and fees for ground ambulance services are disclosed to consumers, and to address what steps can be taken for legislation and enforcement at state and federal levels, according to the release.
- Those interested in serving on the Ground Ambulance and Patient Billing Advisory Committee can nominate themselves or be nominated by an organization, and must submit applications by Dec. 13. Following the selection process, the committee will meet at least twice and its final report will be issued no later than 180 days after the first meeting, CMS said.
While air ambulances are included in the No Surprises Act that Congress passed last year to shield patients from surprise medical bills, ground ambulances are not.
Both services can strap patients seeking emergency care with exorbitant surprise bills — an ongoing issue for American consumers receiving care from hospitals or doctors outside of their insurance networks, even if the care is given at an in-network facility.
Slightly more than half of emergency ground ambulance rides resulted in an out-of-network bill, a June report from the Kaiser Family Foundation using 2018 data found. In seven states — Washington, California, Florida, Colorado, Texas, Illinois and Wisconsin — more than two-thirds of emergency ambulance rides resulted in out-of-network billing.
But the way air ambulances and ground ambulances operate is markedly different.
The air ambulance market is characterized by high and fast-growing prices with limited in-network contracting among carriers often owned by private equity firms and publicly-traded companies, according to research from the Brookings Institution and the University of Southern California.
Meanwhile, 62% of ground ambulance rides were provided by local fire departments and other government agencies, the KFF report found.
Emergency medical transport services operated by municipal and county governments may be subject to additional types of state and local regulation, which was reportedly one reason that Congress did not include ground ambulances in the No Surprises Act, according to the KFF report.
At the same time, a number of state and local governments stepped up to try to regulate patient billing, though they can't touch the self-funded employer plans that cover roughly two-thirds of U.S. workers. Many states protect patients from getting a ground ambulance surprise bill if they're covered by fully-insured plans, though many regulations only apply to a subset of ambulance companies, KFF said.
"Protecting people from devastating surprise medical bills, especially for something beyond their control like needing an ambulance during an emergency, is a top priority for the Biden-Harris Administration," CMS Administrator Chiquita Brooks-LaSure said in the release.
"We invite subject matter experts to apply for membership on the GAPB Advisory Committee and provide thoughtful recommendations that will help prevent balance billing and alleviate burdensome financial challenges for consumers," Brooks-LaSure said.
The advisory committee's recommendations will be issued to HHS and the Labor and Treasury secretaries, along with various House and Senate committees, according to the release.
Payers and providers must start complying with the federal ban on surprise billing by Jan. 1.
The ban has received pushback from provider groups objecting to what they think is a favoring of insurers in the arbitration process. They take issue with the qualifying payment amount — determined by a plan's median in-network contracted rate for a geographic area — that is used to arrive at rates for out-of-network providers.
The Association of Air Medical Services filed a lawsuit in federal court challenging the rules Tuesday, claiming reliance on a QPA strays from Congress' intent when passing the law that "no single statutory factor receives special weight" in the arbitration process.
Other groups have also sued, including the Texas Medical Association, which claims the dispute resolution process will be skewed toward payers because the final rules give too much weight to the QPA.
Congress, too, is wrestling over the fine print of the regulations, with 152 lawmakers penning a letter Nov. 5 stating the latest rules "do not reflect the way the law was written, do not reflect a policy that could have passed Congress, and do not create a balanced process to settle payment disputes."