{"database": "press", "table": "releases", "rows": [["http://defazio.house.gov//media-center/press-releases/defazio-walden-fight-to-keep-rural-ambulance-service-intact", "DeFazio, Walden Fight to Keep Rural Ambulance Service Intact", "2014-12-24", "2014", "2014-12", "Democrat", "House", "OR", "Peter DeFazio", "D000191", "defazio.house.gov", null, null, "legacy", "Washington, DC- Oregon Reps. Peter DeFazio and Greg Walden have called on the Centers for Medicare and Medicaid Services (CMS) to delay a rule \u2013 scheduled to take effect next month - that could have a devastating impact on emergency medical services in rural communities across Oregon.\n  \n\tIn the letter to CMS Administrator Marilyn Tavenner, Reps. DeFazio and Walden brought attention to a possible technical error that reduces reimbursement rates to ambulance providers by reclassifying some rural areas as urban. Reducing these rates makes it very difficult for ambulance providers to serve rural communities without losing money.\nDeFazio and Walden have requested that CMS delay any reimbursement changes for one year so errors can be identified and ambulance providers have sufficient time to prepare for changes.\nThe letter from DeFazio and Walden states: \u201cThese payments allow ambulance services in rural areas to continue providing life-saving and life-sustaining services. We 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.\u201d\nThe full letter to CMS is below.\n\u00a0\n\u00a0\n\u00a0\nDecember 23, 2014\nMarilyn Tavenner\nAdministrator\nCenters for Medicare and Medicaid Services\n200 Independence Avenue, SW\nWashington, DC\u00a0 20201\n\u00a0\nDear Administrator Tavenner,\n\u00a0\nWe are writing to express our concern about the Final Ambulance Fee Schedule for Calendar Year 2015, and the devastating impact it will have on rural transports in our state and across the country. We are particularly concerned about the final changes to the designation of ambulance service from \u201crural\u201d to \u201curban.\u201d In the preamble to the proposed rule, the Centers for Medicare and Medicaid Services (CMS) indicated that only 122 ZIP codes (less than 0.3 percent) would change from rural to urban. Subsequently, in the final rule, issued in the Federal Register on November 13, the Agency indicated that the status of more than 3,000 ZIP codes would switch from rural to urban. This drastic change was alarming to our local ambulances due to the severe cut they would face come January 2015.\nFollowing inquiries from local stakeholders and concerned Members of Congress, the Agency found a technical error in its calculations and issued a revised list of ZIP codes that would change from rural to urban. As a result about 1,500 zip codes that would have changed to urban will remain rural. While we appreciate the effort the Agency put into making these updates, we are still concerned that rural ambulances in the remaining 1,600 ZIP codes still do not have adequate time to prepare for the change. In addition, we did not see any formal communication by CMS notifying ambulance service providers of the revised list.\u00a0 So while we are aware of it, a vast majority of ambulance services providers likely are not.\u00a0 It is crucial that ambulance service providers, especially those in the affected areas, be notified of such a significant change well prior to implementation.\nWe also believe that some of these ZIP codes may still be incorrectly designated as urban.\u00a0For example, in Josephine County, Oregon, there are five ZIP codes identified as urban even though the population did not change significantly in those ZIP codes and apparently changed only because neighboring Grants Pass was designated as a Metropolitan Statistical Area (MSA).\u00a0Additionally, as Members of Congress representing Josephine County, our experiences with local economies and demographics lead us to question this urban designation. We do not know if this mistake is due to a technical error or an unfitting definition of \u201curban,\u201d but we do believe that the designation is incorrect and further time is needed to assess these changes.\nThe designation of rural status is extremely important to ambulance services.\u00a0 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.\u00a0 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.\u00a0 These payments allow ambulance services in rural areas to continue providing life-saving and life-sustaining services.\u00a0\nWe agree that as population demographics change over time, the designation of rural status should be updated.\u00a0 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.\nCMS has simply not provided sufficient notice for the change to take effect in Calendar Year 2015.\u00a0 We appreciate that CMS believes that stakeholders would have had access to the data necessary to determine the impact of the proposed change and that the Agency revised the change for 1,500 ZIP codes.\u00a0 However, the preamble to the proposed rule was misleading at best.\u00a0 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.\u00a0\n\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Therefore, we strongly urge you to delay implementation of the changes for those zip codes which would switch from rural to urban until Calendar Year 2016.\u00a0 This delay will allow CMS and other stakeholders to assess the changes and make sure that the changes are indeed appropriate. Additionally, it will provide a path for ambulance service providers and suppliers to adjust to the changes from rural and urban status if that change is found to be warranted.\nAccess to ambulances can be the difference between life and death in rural areas. It is crucial to protect beneficiary access to ambulance services, which are a critical component of our health care system.\u00a0\n\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 We look forward to working with you on this issue and thank you for your consideration of our request.\nSincerely,\n\u00a0\n\t\t\t\t\u00a0\n\t\t\t\t_________________________________\n\t\t\t\tPeter DeFazio\n\t\t\t\tMember of Congress\n\t\t\t\n\t\t\t\n\t\t\t\t\u00a0\n\t\t\t\n\t\t\t\n\t\t\t\t\u00a0\n\t\t\t\t_________________________________\n\t\t\t\tGreg Walden\n\t\t\t\tMember of Congress\n\t\t\t\n\t\t\u00a0\n\u00a0\n\u00a0\n###", 1, "2026-03-30T12:14:52Z", "2026-03-30T12:14:52Z"]], "columns": ["url", "title", "date", "year", "month", "party", "chamber", "state", "member_name", "bioguide_id", "domain", "scraper", "source", "date_source", "text", "has_text", "collected_at", "updated_at"], "primary_keys": ["url"], "primary_key_values": ["http://defazio.house.gov//media-center/press-releases/defazio-walden-fight-to-keep-rural-ambulance-service-intact"], "units": {}, "query_ms": 2.2239750251173973, "source": "dwillis/congress-press", "source_url": "https://github.com/dwillis/congress-press", "license": "MIT", "license_url": "https://github.com/dwillis/congress-press/blob/main/LICENSE"}