Running an ambulance service is expensive, this is obvious to EMS agencies, fire based ambulance squads and several legislators. But there is a dispute about how to remedy this in Albany for fire based-EMS. However, what may benefit each agency may also have a devastating effect on the people that these agencies service.
According to New York’s current law, fire departments do not have the right to bill insurance companies for transporting patients to hospitals even if the ambulance response is provided by their department. Fire departments that are most impacted by this law are seeing the money designated to train and staff EMS crews dwindling. Their argument is that without the additional revenue, it is less likely to be able to continue timely response to emergency calls.
The NYS Association of Fire Chiefs president John Sroka said, “EMS calls require a significant investment in time, training and personnel, and it is critical that fire departments are able to recover the associated costs, just as every other EMS provider in New York state already can.” Other associations and politicians across the state have added similar comments alluding to declining volunteerism and rising operating costs.
The conundrum exists though because there is an existing law on the books (more than a decade old) that states, “Fees and charges prohibited. Emergency and general ambulance service authorized pursuant to this section shall be furnished without cost to the person served.” These words are part of the NYS General Municipal Law 209B regarding fire department based ambulance service.
“Currently, fire districts are prohibited from billing Medicare for EMS services rendered. Because this prohibition exists, Advanced Life Support agencies who “intercept” with Basic Life Support agencies, in rural communities, are permitted to bill Medicare for this service (Medicare ALS intercept exemption). If this legislation be passed, this Medicare exemption is no longer in effect resulting in thousands of elderly and disabled citizens losing their Medicare ALS intercept benefit,” according to the NYS Volunteer Ambulance and Rescue Association (NYSVARA) 2017 Statement of Opposition to Changes in General Municipal Law 209-B. “NYSVARA believes this legislation would place undue hardship on rural residents of the state who, as a result of this change, would now be responsible to pay the ALS agency out of their pockets which could be hundreds of dollars.”
In February, 2018, NYSVARA’s Michael J. Mastrianni, Jr., past President and Director of Legislative Affairs, sent out a plea for help from colleagues. Here’s a few quotes from his letter, “There was an agreement reached many years ago with Medicare that they would pay ALS services for ALS Intercept in rural counties in New York (over 20 counties). The stipulation was that fire districts would not bill for EMS service. This prohibition is in General Municipal Law Section 209-B. Bills have been introduced in the Legislature, S363B/A07717B, that will change one word … prohibit to permit. Should these bills be enacted, and fire districts are permitted to bill, the Medicare patients in rural counties will lose this Medicare benefit. There are tens of thousands of senior citizen Medicare patients who can least afford it, and who need it the most, will have to pay for ALS service out of their pockets, or worse, not call EMS.”
Mastrianni continues, “What the fire service is not telling anyone is that there is a way they can bill. They can change their governance and separate out their EMS administratively and they can bill. Many fire services have done this already. They are billing and the Medicare benefit is not affected. It takes a little bit of time and there is some cost for an attorney. The Bureau of EMS can provide assistance. …Again, it does not matter to us who bills. It DOES matter who is hurt in the process.”
As of the writing of this article, S363B/A07717B is still pending. Constituents should contact their legislators to express their concerns and preferences. New York residents deserve reliable and skilled EMS response, and they also deserve the ability to afford vital life-saving care.