Reps. Axne, Hill, and Larson Lead Call For Fair Reimbursements for Firefighters, EMS First Responders

June 29, 2020
Press Release
Letter urges federal health agencies to issue reimbursements for ‘treatment in place’ care provided on scene in medical emergencies

WASHINGTON, D.C. – Today, Rep. Cindy Axne (IA-03), Rep. French Hill (AR-02), and Rep. John Larson (CT-01) led a bipartisan letter seeking fair reimbursements for firefighters, emergency medical services (EMS), and other medical first responders. Firefighters and EMS have been called upon with increasing frequency during the coronavirus (COVID-19) crisis to help keep American communities healthy and safe. 

Currently, firefighters and medical first responders are only repaid for supplies and services they provide if they transport a patient to the hospital. They are not reimbursed for these services when provided on scene. Additionally, even though many ambulances have the technology to facilitate emergency telehealth consultations, lack of clear and consistent reimbursement has prevented this service from being fully utilized.

In their bipartisan letter to the U.S. Department of Health and Human Services (HHS) and Centers for Medicare and Medicaid Services (CMS), the members urge the agencies to expand reimbursements to include care provided on the scene of an emergency, known as ‘treatment in place’ (TIP), and provide direct reimbursement for ambulance telehealth use. 

“Our fire departments and EMS first responders have gone above and beyond to respond to the COVID-19 public health emergency. As health care providers limited face-to-face medical visits and patients voiced concerns about in-person care, our first responders stepped up to continue to deliver emergency care and response for the illnesses and injuries that our communities face,” said Rep. Axne. “Just as our firefighters and EMTs are here for us, we need to ensure federal health agencies are here for them. Even if a patient isn’t transported to a hospital, or if the care is provided using telehealth, CMS reimbursements should still be available for those agencies who are helping our citizens – especially with looming budget shortfalls at our state and municipal levels.”

“First responders across the nation have provided extraordinary service during the current public health crisis, but increasingly they are being put in a difficult position during emergencies:  take someone to the hospital no matter what, overburdening an already burdened emergency health care system, or run the risk of not being reimbursed for their services,” said Rep. Hill. “Fire fighters and EMS personnel should not be faced with this choice in a serious situation, which is why I am proud to lead this effort with 36 Members of Congress to get resolution and let our first responders return their full focus to keeping their community health.”

"The COVID-19 pandemic had rapidly changed our health care landscape. Our first responders and particularly EMS personnel have stepped up and took on a bigger share of emergency pre-hospital and tele health care during this pandemic,” said Rep. Larson. “They bravely serve on the front lines and answer every emergency call. I'm proud to co-lead a letter with Reps. Axne, and Hill urging the Center for Medicare and Medicaid Services to reimburse EMS for their critical service in our communities.”

The members highlight the risk that COVID-19 already poses to state and municipal budgets, potentially threatening budget cuts and layoffs for fire departments and emergency response if current reimbursement structures are not updated.

The letter was signed by over thirty House members from both sides of the aisle: Reps. Don Bacon (NE-02), Anthony Brindisi (NY-22)Susan W. Brooks (IN-05), Cheri Bustos (IL-17), Andre Carson (IN-07), Ed Case (HI-01), Angie Craig (MN-02), Jason Crow (CO-06), Sharice Davids (KS-03), Lloyd Doggett (TX-35), Jeff Duncan (SC-03), Abby Finkenauer (IA-01), Brian Fitzpatrick (PA-08), Anthony Gonzalez (OH-16), Jahana Hayes (CT-05), Eleanor Holmes Norton (DC-AL), Sheila Jackson Lee (TX-18), Conor Lamb (PA-17), Doug Lamborn (CO-05), Al Lawson (FL-05), Susie Lee (NV-03), Dave Loebsack (IA-02), Roger Marshall (KS-01), Grace Napolitano (CA-32), Joe Neguse (CO-02), Tom O'Halleran (AZ-01), Max Rose (NY-11), Terri Sewell (AL-07), Paul Tonko (NY-20), Bennie G. Thompson (MS-02), Xochi Torres Small (NM-02), Marc Veasey (TX-33), and Jennifer Wexton (VA-10).

The member’s letter was sent today with the support of the International Association of Fire Chiefs (IAFC), International Association of Fire Fighters (IAFF), National Association of EMTs, National Volunteer Fire Council, Congressional Fire Service Institute, Association of Air Medical Services, and American Ambulance Association.

“The IAFC is grateful for Rep. Axne’s work to highlight fire departments’ urgent need for reimbursement when caring for patients on-scene and not transporting them to the hospital. The current federal reimbursement mechanism is woefully antiquated and fails to keep pace with the ability of fire departments to provide the most medically appropriate care to patients. Both patients and fire departments benefit from when patients are given the most medically appropriate treatment,” said Fire Chief Gary Ludwig, IAFC President and Chairman of the Board. “Reimbursing fire departments for providing patient care on-scene will yield significant savings to the healthcare system and ensure more firefighters and EMS personnel are available to respond to the next emergency. The IAFC looks forward to continuing to work with Rep. Axne to ensure fire departments are properly reimbursed for the medical care that they provide to their communities.”

“Fire fighters and emergency medical personnel are the first link in the public health system, providing pre-hospital treatment and care in patients’ homes and businesses.  This important role has been highlighted more than ever during the COVID-19 pandemic,” said Harold Schaitberger, General President International Association of Fire Fighters. “Unfortunately, antiquated rules prevent reimbursement for emergency calls if a patient is not transported to a hospital.  Reimbursing fire and EMS departments for treatment in place and telehealth services will ensure patients receive the care they need while reducing load on hospitals. The IAFF joins Representatives Axne, Hill and Larson in support of these important updates.”

“EMS agencies providing ‘treatment in place’ are instrumental in preserving precious healthcare resources needed for the most severely ill patients, and have saved the healthcare system a great deal of money,” said Matt Zavadsky, MS-HSA, President of the National Association of Emergency Medical Technicians. “Amazingly, however, CMS does not reimburse EMS agencies for this care, and this needs to change.”

The full letter can be found below:

Dear Secretary Azar and Administrator Verma:

During this COVID-19 health crisis, fire departments and Emergency Medical Service (EMS) agencies are providing invaluable service to our communities across the United States. We already knew that our first responders are heroes, but now our first responders are also having to provide emergency pre-hospital healthcare to COVID-19 patients. We are writing because our EMS and first responders are receiving inadequate reimbursements from the Center for Medicare and Medicaid Services (CMS).

As you are aware, these agencies are prohibited from seeking reimbursement opportunities that would support their operations while reducing strain on the overall healthcare system. Fire departments and EMS agencies transport tens of millions of patients to hospitals each year and treat countless others on-scene. However, CMS does not provide any reimbursements to ambulance service “suppliers” when a patient is not transported to a hospital.

While fire departments and EMS agencies have long struggled with incomplete federal reimbursements, the problem is becoming worse as the spread of COVID-19 is driving greater numbers of patients to refuse ambulance transportation to hospitals because they fear exposure to the SARS-CoV-2 virus. Because of CMS’ reimbursement policies, this large reduction in ambulance transports is placing an enormous financial burden on fire departments and EMS agencies who have to maintain required levels of service and minimum response times while receiving significantly decreased reimbursements. Traditional local government budgets look like they will fall short this year across the country, as state and local revenues have been drastically limited due to the response to COVID-19. This failure to provide accurate reimbursements to fire departments and EMS agencies is forcing these agencies to consider actions such as laying off first responders in order to close budgetary gaps.

The health care landscape has changed with the arrival of COVID-19. That is why we encourage CMS to allow fire departments and EMS agencies to receive payments for providing treatment-in-place (TIP) to their patients as well as providing these agencies with direct reimbursement for facilitating emergency telehealth consultations. This request also includes providing TIP reimbursements for fire departments and EMS agencies which provide on-scene assessment and care but do not provide ambulance transportation.

CMS recently launched the “Hospitals Without Walls” program which offers flexibilities like expanded telehealth and the provision of care in non-traditional settings. We are concerned that CMS did not go further and permit Medicare-enrolled ground ambulance service “suppliers” to provide TIP or to facilitate emergency telehealth consultations. Emergency medical technicians and paramedics are highly trained and skilled healthcare providers who can efficiently assess and care for a variety of illnesses and injuries. CMS should recognize the abilities of these healthcare professionals by providing them with reimbursement for TIP-services to their patients. Providing TIP for these low-acuity patients will allow them to receive care at a more appropriate level in the healthcare system and reduce the strain that low acuity patients place on hospitals.

Furthermore, the concept of providing reimbursement for TIP already is recognized as a treatment option under the Center for Medicare and Medicaid Innovation’s Emergency Triage, Treat, and Transport (ET3) program. Additionally, some commercial insurers utilize the A0998 HCPCS Code to provide reimbursement when their beneficiaries receive emergency response and treatment, without transportation, from fire departments and EMS agencies. CMS should consider this precedent and provide reimbursement opportunities to fire departments and EMS agencies providing emergency triage and treatment without transportation to low acuity Medicare and Medicaid beneficiaries.

CMS also should improve the financial reimbursements available to Medicare-enrolled ambulance service “suppliers” by allowing them to receive direct reimbursement for facilitating emergency telehealth consultations. In Section II(E) of CMS’ recent interim final rule with comment (IFC), CMS recognized the value of EMS personnel as it pertains to telehealth by recommending that physicians consider collaborating with these agencies to facilitate telehealth consultations. However, the IFC leaves it up to the individual physicians to reimburse these personnel for these services. CMS should develop a payment methodology to reimburse these EMS agencies for facilitating the telehealth consultations associated with CPT codes such as 99281 99282, 99283, 99284, and 99285. As is the case with TIP-options, directly reimbursing fire departments and EMS agencies for facilitating telehealth consultations will provide much needed relief to these agencies and decrease the patient load on already over-stretched hospitals.

We appreciate your efforts to support our frontline firefighters and EMS personnel as they continue to serve in communities across the United States. We look forward to working with you to develop additional policies and funding opportunities to ensure fire departments and EMS agencies have the resources to continue confronting COVID-19 and caring for critically ill and injured patients.