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Advocacy Principles (Adopted by the AAMS Board of Directors, March 2009)

January 2, 2013
Congress passes “fiscal cliff” bill including a 6-month extension of the air ambulance rural zip code hold harmless 

After a contentious day of closed door discussions, the House of Representatives has voted to approve the "fiscal cliff" legislation passed early yesterday by the Senate.  The bill will now immediately be sent to the President, who is expected to sign the bill as early as this afternoon. 

This package will extend the air ambulance rural zip code hold harmless provision for 6 months.  AAMS has spent the better part of this past year lobbying for this extension, capped off by a hugely successful Capitol Hill “Fly-In” earlier in December.  Thank you again to all those members that were actively involved in the effort, either here in Washington DC, or from your home location.  

Also of note, the bill included the AAMS supported extension for the 2% urban/3% rural and the Super Rural Medicare add-on payments for ground ambulance transports for one-year in conjunction with a study by the Department of Health and Human Services that would: 

(A) analyze data on existing cost reports for ambulance services furnished by hospitals and critical access hospitals, including variation by characteristics of such providers of services.

(B) study the feasibility of obtaining cost data on a periodic basis from all ambulance providers of services and suppliers for potential use in examining the appropriateness of the Medicare add-on payments for ground ambulance services furnished under the fee schedule under section 1834(l) of the Social Security Act (42 U.S.C. 1395m(l)) and in preparing for future reform of such payment system.

In conducting the study, the bill calls for the HHS Secretary to:

(A) consult with industry on the design of such cost collection efforts;

(B) explore use of cost surveys and cost reports to collect appropriate cost data and the periodicity of such cost data collection;

(C) examine the feasibility of development of a standard cost reporting tool for providers of services and suppliers of ground ambulance services;

(D) examine the ability to furnish such cost data by various types of ambulance providers of services and suppliers, especially by rural and super-rural providers of services and suppliers.

The passing of the fiscal cliff package effectively wraps up the work of the 112th Congress.  The 113th Congress will be sworn in tomorrow. 

December 23, 2012
GSA delays cancellation of the KKK standard until October of 2015

Based on an effort led by NASEMSO, in which AAMS, NAEMT, and other industry organizations were active participants, we are pleased to announce that the cancellation of the General Services Administration “KKK” specs for ground ambulances has been delayed until October of 2015.  

Initially scheduled for retirement in October of 2013, this delay allows the EMS community additional time to provide input into the NFPA 1917 standards for the construction of ground ambulances.  The NFPA proposed specifications hold concerns for our community, specifically surrounding costs and safety. 

Through the NASEMSO’s Model Rules for Ambulance and Vehicle Design working group, AAMS will continue to stay involved in the effort to develop model rules for ambulance vehicle design, and identify options for ground vehicle specs to be included for state dissemination.  The next meeting is scheduled for the April/May timeframe.

December 4, 2012
AAMS members set to converge on Capitol Hill on Wednesday, December 5th

The issue at stake are the 2 percent urban/3 percent rural add-on payment for ground transports, the "super rural" add-on payment for ground transport, and the hold harmless for air transports that allows those zip codes reclassified from urban to rural in 2006 to maintain the rural rate on reimbursement for air transports originating in those zip codes. The Medicare Payment Advisory Commission (MedPAC) is recommending that these payment provisions be allowed to expire with no replacement for the air transport hold harmless provision. These provisions will expire at the end of the year unless Congress acts! A number of AAMS members have made the commitment to take to Capitol Hill tomorrow to educate their representatives on this critical issue. The advance briefing will take place today at 6 p.m. at the at the Marriott Courtyard Crystal City (at Reagan National Airport.) 
For those of you unable to come to Washington, we need your help to kick-start discussions on our issues before our delegation hits the Hill tomorrow. Any buzz created now will only serve to make our in-person meetings that much more effective. Here's how you can help

July 25, 2012
AAMS leaders hit Capitol Hill 

Recently, AAMS President Tim Pickering, CEO Rick Sherlock, and Government Relations Manager Greg Lynskey took to
Capitol Hill to reach out to key members of Congress and high-level staff that heavily influence policies important to the AAMS community. With only a few months left before this Congress adjourns for the elections, AAMS is undertaking a concerted effort to garner new relationships and strengthen old ones as we look ahead to the end-of-year lame-duck sessions and new policy challenges in the year ahead. 

Following a casual breakfast with Rep. Bobby Schilling, Ill.-17, organized by the American League of Lobbyists, the AAMS contingent attended individual meetings with Rep. Patrick Meehan, Pa.-07, and Senator John Thune from South Dakota. Rep. Meehan serves on the House Transportation and Infrastructure Subcommittee on Aviation and is widely expected to become more involved in healthcare issues in the next Congress. Likewise, Senator Thune serves on the Senate Finance Committee and is the ranking member of the Aviation Subcommittee of the Senate Commerce, Science, and Transportation Committee. In addition to these key Members, the AAMS contingent was also able to have productive discussions with the Staff Director of the House Ways & Means Committee and the top health staffers for Speaker of the House John Boehner and House Majority Leader Eric Cantor. 

In each of these meetings, we provided a brief overview of AAMS, discussed the important role that air medical and critical care ground transport plays in the healthcare safety net, and outlined the resources AAMS can provide to policy makers through its position as the trade association representing the entire air medical industry as well as critical care ground providers. More specifically, we discussed our ongoing dialogue with the Medicare Payment Advisory Commission (MedPAC) regarding the ground and air ambulance rural extenders, and our broader concerns over the inadequate growth of Medicare reimbursements in the face of rapidly rising operational and safety enhancement costs. 

These meetings are just the beginning. AAMS will be scheduling additional meetings over the next few months in anticipation of an active lame-duck session and the numerous policy challenges that undoubtedly lie ahead. 

July 10, 2012
AAMS Submits White Paper to MedPAC

The Medicare Payment Advisory Commission (MedPAC) is a 17-member independent Congressional agency established in 1997 to advise the U.S. Congress on issues affecting the Medicare program.  In addition to advising the Congress on payments to health plans and providers participating in Medicare, MedPAC also analyzes access to care, quality of care, and other issues affecting Medicare.

As has been previously discussed, as part of legislation containing the latest extension of a provision maintaining the rural Medicare reimbursement rate for those zip codes reclassified as urban in 2007 and the rural ground ambulance add-ons, Congress instructed the Medicare Payment Advisory Commission (MedPAC) to study the air and ground ambulance fee schedules to determine whether these add-on payments are still justified and whether any permanent changes to the fee schedules should be recommended.  Pursuant to the study, a small group of AAMS leaders met with MedPAC staff for a lengthy discussion to provide background information on the industry and an overview of the financial landscape as it pertains to Medicare.  AAMS promised to provide MedPAC with detailed data to demonstrate the rate of growth of operating costs compared to the mostly stagnant rate of Medicare reimbursement.

The specially-formed group worked diligently for months to prepare the comprehensive report, which was delivered to MedPAC on Friday.  In its report, the group compiled independent, justifiable data and industry’s best estimates to demonstrate the rapid increase in a variety of operating costs over the past 10 years as compared to the average 2.2% inflationary updates to the Medicare Air Ambulance Fee Schedule.  The group examined the varying costs of a number of different business models and also illustrated the large discrepancy between urban and rural costs and reimbursements.  AAMS looks forward to continuing dialogue with MedPAC as it continues its study into the ground and air ambulance fee schedules.      

House Committee Hearing to Focus on Veterans’ Transition to Civilian EMTs.
On Wednesday, the House Energy & Commerce Committee’s Subcommittee on Health will hold a hearing entitled “Helping Veterans with Emergency Medical Training Transition to Civilian Service.”    The hearing will be based upon H.R. 4124, the Veteran Emergency Medical Technician Support Act, introduced by Representative Adam Kinzinger (R-IL).  The bill seeks to utilize federal demonstration grants given to States that demonstrate a shortage of emergency medical technicians (EMTs) to streamline state requirements and procedures in order to assist veterans who completed military EMT training while serving in the Armed Forces to meet state EMT certification, licensure, and other requirements.

May 24, 2012
Senate Passes FDA Bill Addressing Drug Shortages

Today, the United States Senate is scheduled to pass S. 3187, the Food and Drug Administration Safety and Innovation Act.  While the primary purpose of the bill is to reauthorize and extend various fees relating to brand name and generic drugs, the bill also contains important changes that directly address the critical drug shortages that are affecting EMS agencies across the country. 

Under current law, manufacturers of life-saving and life-sustaining drugs must report a discontinuation of production of the drug to the Department of Health and Human Services only if they are the sole source of that particular drug.  Under the changes contained in S. 3187, drugs used in emergency services, as well as all sterile injectable drugs, will be added to the list of drugs requiring reporting.  In addition, the reporting requirements will apply to all manufacturers of the drugs and will pertain to significant disruptions in production in addition to a complete discontinuation of production.   The bill would also require the FDA to establish a task force to monitor and respond to pending drug shortages, allow expedited review of potential alternatives to drugs facing potential shortages, and require the FDA to work with the Secretary of HHS to improve communication to the healthcare community of potential shortages and appropriate alternatives.  These changes were driven by the EMS community, including AAMS.  

The House Energy and Commerce Committee reported out of committee a similar bill addressing FDA fees and drug shortages.  However, it has yet to be considered or passed by the full House of Representatives.  Once the House passes its bill, the House and Senate must work together to agree on a final version of the bill.  Given the momentum we have recently, fueled in large part by a strong and unified advocacy effort by the EMS community, we are confident that drug shortages will be addressed in the eventual final bill. 

May 14, 2012

AAMS files joint comments to the FAA on proposed changes to HTAWS and EMS installation systems
AAMS, AMOA, and HAI came together to file joint comments to the Federal Aviation Administration (FAA) on its “Proposed Changes to ACs 27-1 and 27-2, MG18, Helicopter Terrain Awareness and Warning Systems” and “Proposed Changes to ACs 27-1 and 27-2, MG 6, EMS Installation Systems”.   The proposed changes intend to update the Advisory Circulars providing installation guidance to EMS systems to accommodate changes outlined in the Notice of Proposed Rulemaking (NPRM) released in 2010.  The final rules resulting from the NPRM are expected to be released in late August. Although not regulatory in nature, ACs are relied upon heavily by FAA field inspectors.  For this reason, any changes to HEMS-related ACs must be done carefully and thoroughly in order to avoid ambiguity and misinterpretation by field inspectors.  AAMS appreciates the cooperative effort with AMOA and HAI and looks forward to continued discussions with them and the FAA on these Advisory Circular updates.  Click here to view comments.

April 24, 2012
Work continues on the critical drug shortage issue
Initially raised at the AAMS Spring Conference in Washington, AAMS has remained highly involved on the issue of the critical drug shortages that are facing pre-hospital EMS crews worldwide, and affecting the delivery of patient care.  Drafted collectively with 13 of our industry partners, view a sample of the letter sent to Congressional leaders outlining the issue and asking for legislative action.  Click here to view a copy of the white paper, on which AAMS is a co-signee, that went one step further and asked that shortage notification requirements be expanded to include all critical care drugs, as well as include disruptions in service and not just discontinuation.  To date, the House Energy & Commerce Committee and the Senate Health, Education, Labor, and Pensions committee are both in the process of reauthorizing the Prescription Drug User Fee Act (PDUFA).  The intent is to address drug shortage in these bills.  The House Committee recently held a hearing on the drug shortage and released a new draft of the legislation that will be considered by the Committee.  The new language included many of the changes requested by the collective efforts of the healthcare community. 

April 17, 2012
AAMS Participates in Drug Shortage Stakeholder Meeting 
On April 16, AAMS participated in a stakeholder meeting to discuss the effects of the medical drug shortages on the emergency response system.  The informative meeting was hosted by the Emergency Care Coordination Center, within the Office of the Assistant Secretary for Preparedness and Response of the Department of Health and Human Services.

Following opening remarks by Dr. Nicole Lurie, HHS's Assistant Secretary for Preparedness and Response, the group heard from a number of speakers representing perspectives across the full spectrum of the medical drug landscape.  Dr. Sandra Kweder, Deputy Director, Office of New Drugs, U.S. Food and Drug Administration, spoke about the FDA's team that is solely dedicated to monitoring the drugs in shortage and actively seeking mitigation strategies while guaranteeing the safety and efficacy of the drug supply.  Dr. Sherry Glied, HHS Assistant Secretary for Planning and Evaluation, discussed the economics of the sterile injectable drug market and the economic causes of the shortages.  In addition, a representative from Pfizer discussed the medical drug market from the pharmaceutical manufacturing perspective.

The meeting also provided the opportunity for the government officials to learn from the EMS community through a broad range of interactive panel discussions examining the impact of drug shortages in emergency care, the hospital-based pharmacy perspective, and coping and mitigation strategies within EMS & Emergency Care.  Topics discussed included the risks surrounding the use of expiring drugs and the problems inherent with substituting medicines, including limited training, inflexible state protocols and scope of practice restrictions.  

While there is no timely solution on the horizon, AAMS was pleased to represent the critical care transport community in this effort and appreciate the opportunity to bring government officials together with a broad representative of the EMS community for a full discussion of the drug shortage issue, the problems being faced in the field by EMS providers, and the serious patient care issues the shortages are presenting. 

March 20, 2012
AAMS’ Leaders Meet with Congressional agency, MedPAC
The Medicare Payment Advisory Commission (MedPAC) is an independent Congressional agency established to advise Congress on issues affecting the Medicare program.  As part of the Middle Class Tax Relief and Job Creation Act, which also extended Medicare add-on payments for ground and air ambulances, MedPAC was instructed to study the ground and air ambulance  Medicare fee schedule and report to Congress on any conclusions or suggested policy changes it may have.
Last week, at MedPAC’s request, a delegation of AAMS’ Leadership, met with MedPAC’s Executive Director and top research analysts to begin educating them on the air medical industry, its varying financial structures, and the history and current status of Medicare reimbursements.  Under the legislation, MedPAC has until June 2013 to issue its report.  The AAMS delegation will continue to work together to collect the necessary justifying data and prepare a formal response to MedPAC.  Members should be assured that AAMS will continue to work with MedPAC to effectively represent air medical transport throughout this process.    

AAMS Members Bring Awareness to Critical Drug Shortages
In conjunction with AAMS Spring Legislative Conference, AAMS members from across the nation, took to Capitol Hill to bring awareness to the critical drug shortages rapidly consuming the EMS Community.  While many Hill staffers were generally aware of the shortages in the hospital settings, fewer were aware that the issues created by the shortages were being felt out in the field by EMS responders.  While there are no quick fixes on the horizon, there are collaborative efforts underway to address the medicinal shortages.  AAMS will continue to participate with interested parties and allies on the Hill to raise awareness of these issues and the many complications that may arise from it. 

February 28, 2012

AAMS Board of Directors Addresses Legislative Proposals
During its February 13 meeting, the AAMS Board of Directors took action on two separate legislative proposals that were submitted to AAMS by affiliated organizations who were seeking AAMS’ support.

The first piece of legislation considered was S. 1407, the Air Ambulance Medicare Accreditation and Accountability Act.  This bill was introduced in the U.S. Senate by Senator Olympia Snowe (R-ME) on July 22, 2011.  In short, the bill would establish an accreditation program for air ambulance services participating in the Medicare program.  Part of the accreditation program would require a basic uniform level of patient care capabilities in order to participate in Medicare.  The bill would also call for a 3-tiered reimbursement system wherein the level of Medicare reimbursement would be determined by the aviation and patient-care capabilities of the aircraft and medical crews.  The bill requires the existing funds spent on air ambulance reimbursement to be reallocated to fit into the newly established 3-tier system. 

After much deliberation, the AAMS Board unanimously approved the following motion along with the accompanying explanatory statement:

S. 1407 - Motion Approved: AAMS cannot support the legislation as written.

Discussion: AAMS needs to better understand how the 3-tiered reimbursement system will affect our members that fit into the lower level categories and how this tiered system will impact an industry with operational costs rising faster than the current government reimbursement. AAMS would also like to see more emphasis on clinical standards, accountability, medical oversight and control of the air medical environment avoiding any language that could impact the ADA.

The second proposal was submitted by the California AAMS Chapter with a request that AAMS adopt the measure and take the lead in sponsoring and seeking introduction of the legislation.  Recognizing that the fixed costs of doing business have increased much faster than the Medicare reimbursements since the implementation of the Air Ambulance Medicare Fee Schedule in 2006, this proposal essentially seeks an across-the-board increase for all Medicare air ambulance transports.  The legislation also seeks an additional increase for an isolated number of specialty transports that require the highest levels of equipment and medical care capabilities.  

Again, after much deliberation, the AAMS Board approved the following motion along with the accompanying explanatory statement:

AAMS Draft Language for increased reimbursement - Motion Approved:  The AAMS Board thanks CalAAMS for the proposed legislation.  AAMS will verify the numbers and provide talking points in time for the AAMS Spring Conference, ultimately seeking sponsorship through the Air Medical Caucus for appropriate legislation.

Discussion: There is overall support from the AAMS board to look for an effective method to improve reimbursement, and that AAMS should be the lead association. AAMS Executive Committee is considering all the recommendations and materials gathered by the AAMS Government Relations Committee in relationship to the legislation, and is drafting language to introduce to and seek support from key Congressional contacts.

February 6, 2012
Congress Passes FAA Reauthorization
AAMS is extremely pleased that Congress has reached agreement on legislation that will provide a four-year authorization for the Federal Aviation Administration (FAA) running through fiscal year 2015.  The FAA has been without a formal long-term authorization since 2007, operating under a series of approximately 23 temporary short-term extensions.  Enacting this 4-year authorization will provide the FAA with the stability needed for better long term planning and investments on such things as implementing the Next Generation Air Traffic Control System and badly needed investments in infrastructure improvements.

Most importantly, the legislation includes language that specifically addresses the safety concerns of the HEMS community.  AAMS has been working with Congress on this language for the past several years and we are pleased that many of our concerns and suggestions are reflected in this package.  Section 306 of H.R. 658 contains provisions that closely mirror the rule proposed by the FAA in October 2010 that is expected to be finalized mid-year 2012.  The bill requires the FAA to complete the rulemaking to address such things as: 
  • Abiding by Part 135 criteria whenever medical crew is on board
  • Flight request and dispatch procedures
  • Pilot Training 
  • Operational Control Centers
  • Safety Equipment
  • Data Collection
Also of note, Section 317 of the bill requires the FAA Administrator to conduct a review of off-airport, low-altitude aircraft weather observation technologies and submit a report to Congress within a year.   The insufficient state of off-airport weather reporting, particularly in rural areas, has been a primary agenda item for AAMS government relations efforts for the past several years.  During the past two Spring Conferences, AAMS members have taken this message directly to their Congressmen and Senators.  We are very pleased to see that our efforts have paid off.  The required study is a great first step in identifying and correcting the inefficiencies of the current weather reporting system.  

Similarly, Section 318 requires the Administrator to study the feasibility of requiring pilots of helicopters providing air ambulance services to use night vision goggles during nighttime operations, again with a report to Congress due within a year.

AAMS thanks all of those who have taken to the Hill or otherwise acted to educate federal policy makers over the past several years!  

The text of the full FAA Reauthorization package can be accessed here.  The HEMS-relevant sections of H.R. 658 include Sections 306, 317, and 318.

Update on Medicare Extenders and FAA Reauthorization
Just prior to the New Year, Congress agreed to a two-month extension of the payroll tax holiday as well as a number of other program extensions.  Of particular interest to AAMS members, the legislation provided a two-month extension for Medicare physician fee protection, the 2% urban/3% rural Medicare add-on payment for ground ambulance transports, and the rural zip code hold harmless protection for air ambulance transports (maintaining the rural reimbursement rates for those zip codes reclassified as urban in 2006).  As part of the agreement for the two-month extension, a formal conference committee was organized to negotiate a long-term package between the House and Senate.  Without a long-term package, these provisions will again expire at the end of February.   While discussions have already begun on the staff level, the members of the conference committee are expected to convene formally sometime next week.  The members named to the conference committee are as follows:


Sen. Jon Kyl (Arizona)
Sen. John Barrasso (Wyoming)
Sen. Mike Crapo (Idaho)

Rep. Dave Camp (Michigan)
Rep. Fred Upton (Michigan)
Rep. Tom Reed (New York)
Rep. Renee Ellmers (North Carolina)
Rep. Tom Price (Georgia)
Rep. Nan Hayworth (New York)
Rep. Kevin Brady (Texas)
Rep. Greg Walden (Oregon)

Sen. Max Baucus (Montana)
Sen. Ben Cardin (Maryland)
Sen. Bob Casey (Pennsylvania)
Sen. Jack Reed (Rhode Island)

Rep. Xavier Becerra (California)
Rep. Sander Levin (Michigan)
Rep. Allison Schwartz (Pennsylvania)
Rep. Chris Van Hollen (Maryland)
Rep. Henry Waxman (California)

In addition, the current extension for the FAA’s authorization is set to expire at the end of January.   It is considered unlikely that Congress will be able to agree to a long-tern FAA reauthorization before that date.  It is expected that yet another short-term extension will be enacted prior to the expiration date.

December 13, 2011

Air Ambulances are in danger of losing rural zip code protections.

The House of Representatives is expected today to consider end-of-the-year legislation to address a number of outstanding issues.  The Middle Class Tax Relief and Job Creation Act of 2011, just released this past Friday, includes provisions providing a two-year fix to the Medicare physician payments, and a one-year extension for ground ambulance rural add-on payments, including the Super Rural add-on payment.   

However, unlike previous Medicare Extender bills, the current language does NOT extend rural payment hold harmless language for air ambulances.  

In 2006, when CMS adopted a different methodology for designating rural vs. urban areas, over 2000 zip codes were reclassified from rural to urban (meaning that transports originating in these zip codes would receive the lower urban payment rate).  In 2008, “hold harmless” language was enacted directing that areas considered rural in 2006 continue to be considered rural for the purposes of air ambulance Medicare reimbursement.  The provision was extended last year through the end of 2011. 

Without an extension, this provision will expire at the end of December and the affected areas will see an approximate 33% reduction to the Medicare reimbursement rate.

Since the legislation was publicly released on Friday, AAMS has been working diligently with allies in the House and Senate to ensure that the air ambulance hold harmless provision is included in the final legislation.  But we need your help….

Representatives Mike Thompson (D-CA) and Cathy McMorris Rodgers (R-WA) have drafted a letter to House leadership asking that the legislation include ALL Medicare extenders, which would include the air ambulance language.  They are circulating the letter among their House colleagues seeking additional signatories.  AAMS would like to see as many members of the House sign this letter as possible. 

Please immediately call, fax or e-mail your member of Congress to:

1.  Express the critical need for the air ambulance rural zip code protections to be maintained.

2.  Encourage your member to co-sign the Thompson-McMorris Rodgers Medicare Extender letter to the House leadership.

3.  Demand that all steps be taken to ensure that air ambulance protections be extended in the final legislation.  

Contact information for your Member of Congress can be accessed here

Also, please immediately contact your state’s two Senators to: 

1.  Make them aware that the House legislation omits the air ambulance zip code hold harmless from the Medicare extender provisions.

2.  Express the critical need for the air ambulance rural zip code protections to be maintained.

3.  Demand that all steps be taken to ensure that the air ambulance protections be extended in the final legislation.  

Contact information for your Senators can be accessed here

You may access "template copy" for a letter you can use to communicate with your Representatives on this issue here.  If you have any questions or receive any feedback from your calls, please feel free to contact AAMS’ Government Relations Manager Greg Lynskey at 703-836-8732 or glynskey@aams.org


AAMS meets with EMS Stakeholders 
Recently, AAMS was an invited participant in a EMS stakeholders meeting sponsored by the Emergency Care Coordination Center (ECCC), housed within the Office of the Assistant Secretary for Preparedness and Response at the Department of Health and Human Services. This day-long meeting brought together representatives from the full spectrum of the EMS system to provide input as to how the federal government could be a better partner with the EMS community and how we all could move closer to reaching an ideal EMS system. The ECCC will be preparing a proceedings document for public release. AAMS appreciates the opportunity to participate in this collaborative industry effort and looks forward to more opportunities to work with the ECCC in the future. 

Recent law includes provisions creating tax credits for businesses that hire unemployed veterans 
Recently, President Obama signed into law, legislation that included provisions creating new tax credits for businesses who hire unemployed veterans. The measure will provide businesses with a "Returning Heroes" tax credit for calendar years 2012 and 2013. Business would earn a $2,400 credit for hiring an unemployed veteran who has been unemployed for at least a month. That credit doubles to $4,800 for hiring a veteran who has been unemployed for six months or longer. In addition, the bill also includes a two-year extension of the "Wounded Warriors" tax credit. This program gives companies that hire veterans with service-related disabilities a $4,800 credit. If the veteran has been unemployed for six months or more, the tax credit increases to $9,600. 

AAMS Statement regarding H.R. 1117 
At its meeting at the Air Medical Transport Conference (AMTC), the AAMS Board of Directors approved the following statement regarding H.R. 1117, the Air Ambulance Patient Safety, Protection, and Coordination Act:

"The AAMS Board of Directors supports efforts to clarify state and federal regulatory authority over air medical transport. For this reason, AAMS has spearheaded the Model State Guidelines project, and continues to pursue this endeavor in the interest of clarification. The stated intent and a significant portion of HR 1117 is directed at the same goal of clarifying state versus federal oversight. However, HR 1117 also seeks to change the application of the Airline Deregulation Act to air medical transport. The AAMS Board is not in a position to support such a change, without further deliberate consideration of the impact on access to and the provision of safe, high-quality air medical services. The AAMS Board requests the opportunity to continue working with the authors and supporters of HR 1117 to find broadly acceptable non-legislative appropriate and effective solutions to the issues it seeks to address and then if still necessary, specific and limited legislation necessary to meet these goals."

The AAMS Government Relations Committee is now examining S. 1407, the Air Ambulance Medicare Accreditation and Accountability Act. A special task force has been formed to work in an expedited manner to examine the legislation. Any recommendations by the task force will be reviewed by the full Government Relations Committee before a briefing document is provided to the AAMS Board of Directors. 

CMS issues new reporting requirements for air ambulance Medicare providers 

On Nov. 29, The Centers for Medicare and Medicaid Services issued a final rule that affects reporting requirements of fixed-wing and helicopter air ambulance providers participating in the Medicare program. Under the new rule, effective Feb. 3, 2011, air ambulance providers must report any revocation or suspension of any federal or state license or certification, including FAA certifications, to the appropriate Medicare contractor within 30 days of the revocation or suspension of the license or certification.

The CMS transmittal regarding the new rule can be accessed here.  

Air Ambulance Medicare Accreditation and Accountability Act Introduced in Congress 
On July 26, Senator Maria Cantwell (D-WA) and Senator Olympia Snowe (R-ME) introduced S.1407, the Air Ambulance Medicare Accreditation and Accountability Act.  The legislation seeks to require the Centers for Medicare & Medicaid Services (CMS) to develop an Air Ambulance accreditation system that would require certain safety standards to be met in order to participate in the Medicare and Medicaid programs.  Furthermore, it would direct CMS to revise the reimbursement system for air ambulances to create a tiered-reimbursement system tied to safety enhancements.   

The AAMS Government Relations Committee will be reviewing this legislation.

AAMS Joins Industry to Provide Input on Heliport Advisory Circular
AAMS participated in a two and a half day industry meeting, sponsored by the Helicopter Association International (HAI), to provide input to the Federal Aviation Administration (FAA) as it works to revise its Advisory Circular (AC) on Heliport design.  The industry became concerned when what was originally intended to be minor updates morphed into major changes that would have had tremendous unintended consequences for many heliports.  While the AC is not a regulatory requirement in itself, many state and local authorities require adherence to the provisions of the AC for licensure and approval of the helipad. 

HAI sponsored the meeting to bring a wide section of the industry together with the FAA’s Airport Division to discuss our concerns with the proposed revisions.  The FAA welcomed many of the industry’s thoughts, agreed to extend the public comment period by a month, and continue to work with the industry to revise the proposed revisions.  Meeting participants also worked through the draft document in order to redline the changes the group felt were necessary.  The redline draft will be provided back to the FAA in order to continue the dialog on this important revision effort. 

AAMS PAC supports Aviation Subcommittee Chairman Tom Petri
Recently, through the AAMS Political Action Committee (PAC), Government Relations Manager Greg Lynskey attended a breakfast fundraiser for Representative Tom Petri, R-Wis. Representative Petri is the Chairman of the House Transportation & Infrastructure Committee's Aviation Subcommittee. Lynskey joined approximately ten other participants for an intimate sit-down breakfast with Rep. Petri. The Congressman's Chief of Staff was also in attendance. Throughout the hour-long event, participants were able to discuss a number of pressing issues, including the status of the FAA Reauthorization legislation, budget negotiations, and the emerging landscape for next year's Presidential election. Events such as these are an essential tool in AAMS' advocacy efforts as it allows us to reinforce AAMS' status as a standing resource to federal policymakers on any issues affecting our community. We thank all the AAMS members who have supported AAMS PAC.

AAMS GR Committee reviews H.R. 1117
The AAMS Government Relations Committee is in the process of reviewing H.R. 1117, the Air Ambulance Patient Safety, Protection, and Coordination Act (http://www.gpo.gov/fdsys/pkg/BILLS-112hr1117ih/pdf/BILLS-112hr1117ih.pdf) H.R. 1117 has been introduced in the House of Representatives by Rep. Candice Miller (R-MI) and Rep. Jason Altmire (D-PA).  Its stated purpose is “To recognize and clarify the authority of the States to regulate the medical aspects of intrastate air ambulance services pursuant to their authority over health care services, patient safety and protection, emergency medical care, the quality and coordination of medical care, and the practice of medicine within their jurisdictions.”

The AAMS GR Committee has urged its members to carefully review the legislation and bring forward any comments, questions, or concerns they may have.  Once discussion in the committee is completed, a summary of comments raised, along with any other supporting material, will be forwarded to the AAMS Board of Directors.  

FAA Issues Final CRM Rule
The Federal Aviation Administration (FAA) has published a final rule that will require Part 135 operators to develop an ongoing program to educate pilots and crews on Crew Resource Management (CRM).  This training would examine such things as levels of authority, teamwork and communications, and managing time and workloads.

To view the FAA’s press release on the final rule, see http://www.faa.gov/news/press_releases/news_story.cfm?newsId=12299

The entire Rule is available at: http://www.gpo.gov/fdsys/pkg/FR-2011-01-21/pdf/2011-1211.pdf

AAMS Provide Comments on Duty Time Reinterpretation
AAMS has filed public comments with the FAA in response to its Notice of Revised Interpretation addressing duty time restrictions for Part 135 operators.  Under the reinterpretation, flexibility would be removed from all previous interpretations and would prohibit Part 135 operators from departing on any leg that would knowingly take the pilot over their 14 hour duty time restrictions.  Previously, if missions were reasonably planned to be completed within the 14 hour requirement, some flexibility was given to complete missions that were delayed by unforeseen circumstances beyond the control of the pilot or operator.  This new interpretation has the potential to negatively impact air medical operations that are naturally susceptible to unpredictable scheduling and unforeseen delays relating to patient stabilization or accident scene extractions.  View AAMS comments to the FAA here.

AAMS Files Comments with the FAA on the NPRM on Air Medical Safety posted to the Federal Register on October 12, 2010 - see full document

AAMS Advocacy Principles (Adopted by the AAMS Board of Directors, March 2009) 

Where there is general consensus, strongly advocate on a position.  Where there is no consensus, try to find compromise or create alternative.  If consensus is reached, advocate.  Where no consensus and no agreement can be reached, options are:

1.  Commit to represent (not advocate) the various interests
2.  Preserve AAMS' position as a source of expert advice or insight.
3.  Provide opportunities for all opinions (pro and con) to be heard.