We are honored to share that AIMHI is now part of the Modern Medicaid Alliance.
The mission of the Alliance is to educate policymakers and the public about the benefits of Medicaid to the American people in terms of cost savings, health outcomes, and social impact.
The alliance highlights how Medicaid is innovating in the delivery of care – especially for America’s most vulnerable citizens – and accountability of the program.
AIMHI Excellence in EMS Integration Award Winners Announced
To Be Recognized at the AAA Annual Conference & Trade Show
Mechanicsburg, PA—The Academy of International Mobile Healthcare Integration (AIMHI) is excited to announce the winners of the 2025 AIMHI Excellence in EMS Integration Awards. These prestigious honors celebrate agencies, people and programs that integrate high-performance, high-value EMS into the overall healthcare system.
2025 Award Winners are:
2025 Honorable Mentions include:
“The 2025 Excellence in Integration Award winners represent the very best in mobile integrated healthcare. We are proud to honor these exceptional programs and individuals,” said AIMHI President Rob Lawrence.
This year’s winners will be celebrated at the American Ambulance Association Annual Conference & Trade Show in Lexington, KY on June 21, 2025.
Click below for a full description of the award winners, and notable honorable mentions.
It is increasingly crucial that EMS agencies, and their stakeholders, pay close attention to legislative initiatives that could impact reimbursement for ambulance services.
We recommend active engagement with professional associations advocating for appropriate reimbursement for vital ambulance services!
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Senate GOP proposes bigger Medicaid cuts than House
By: Michael McAuliff
June 16, 2025 06:03 PM
https://www.modernhealthcare.com/politics-regulation/mh-one-big-beautiful-bill-senate-provider-tax/
Senate Republicans are eying even deeper Medicaid cuts and stricter limits on the provider taxes states use to finance the program under legislation introduced Monday.
The House-passed version of the One Big Beautiful Bill Act of 2025 would establish a moratorium on new provider taxes. The Senate Finance Committee portion of the upper chamber’s bill would go further by ordering the District of Columbia and the 40 states that expanded Medicaid under the Affordable Care Act of 2010 to reduce their provider taxes.
States tax providers to help raise their share of funding for the state-federal health program for low-income people. Providers tend to come out ahead because this financing mechanism enables states to maintain Medicaid benefits and reimbursements.
The catch is states may only pay back up to 6% of a provider’s revenue in what’s known as a “safe harbor.” Rather than freezing provider taxes at 6% and barring new ones, as the House bill would do, the Senate measure would start rolling back the safe harbor in 2027 and cap it at 3.5% in 2031.
The nonpartisan Congressional Budget Office has not evaluated the new legislation. But the nonpartisan health policy research institution KFF previously estimated that restricting the provider tax “safe harbor” to 5% would reduce federal spending by $48 billion over 10 years and that limiting it to 2.5% would cut expenditures $241 billion.
The Finance Committee similarly targets so-called state-directed payments in Medicaid expansion states. States utilize this policy to set minimum provider reimbursements for Medicaid managed care insurers. Under the Senate measure, those payments could not exceed Medicare rates in expansion states, while the remaining 10 states could set payments up to 110% of Medicare.
The Senate bill notably doesn’t include an increase in Medicare payments to physicians.
In a news release, Finance Committee Chair Mike Crapo (R-Idaho) does not address the healthcare provisions but said the legislation could change as Congress strives to deliver it to President Donald Trump by July 4.
“I look forward to continued coordination with our colleagues in the House and the administration to deliver President Trump’s bold economic agenda for the American people as quickly as possible,” Crapo said.
The chief purposes of the bill are to extend tax cuts Trump enacted during his first term and to slash spending across the government, which a particular emphasis on healthcare programs. According to the CBO, the House bill would cut healthcare funding by more than $1 trillion, with more than 80% coming from Medicaid.
Finance Committee ranking member Ron Wyden (D-Ore.) slammed the Senate bill in a news release. “The House Republican version of this bill was already a class war, but Senate Republicans decided to inflict even more devastation on the lives of working Americans to give even larger handouts to the top,” he said.
“The biggest winners here are wealthy corporations who would get hundreds of billions of dollars in additional tax breaks on top of what they got in the House Republican bill,” Wyden said. “Senate Republicans would pay for those new corporate tax breaks by making even deeper cuts to Medicaid, slashing funding for rural hospitals and other essential healthcare providers, and throwing cash-strapped states off a funding cliff.”
There is little Democrats can do impede the GOP majority in Congress, which is using expedited procedures under so-called budget reconciliation rules that allow bills to pass the Senate on simple majority votes and don’t permit filibusters.
However, at least four Republicans have raised concerns about Medicaid cuts in recent weeks. The GOP has a 53-47 majority, meaning Majority Leader John Thune (R-S.C.) can afford to lose three votes and still advance the legislation.
Ambulance agencies should continue to work with national and state advocacy associations to monitor the developments related to the One Big Beautiful Bill Act of 2025, as well as CMS’s May 12, 2025 Preserving Medicaid Funding for Vulnerable Populations – Closing a Health Care-Related Tax Loophole Proposed Rule, and the status of the ongoing CMS OIG audits of Medicaid ambulance supplemental payment programs (GEMT).
These developments could have a significant impact on things like payer mixes, supplemental payment programs, and potential Medicare payment reductions through the Statutory Pay‑As‑You‑Go Act of 2010 (S-PAYGO) sequestration provisions.
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GOP tax bill will cost health sector $1T: CBO
Michael McAuliff
June 04, 2025
https://www.modernhealthcare.com/politics-policy/tax-bill-medicaid-cuts-cbo-gop
The Republican tax-and-spending-cuts legislation speeding through Congress would take more than $1 trillion out of the healthcare system over a decade, according to an analysis the Congressional Budget Office published Wednesday.
The nonpartisan agency’s fullest accounting of the House-passed One Big Beautiful Bill Act of 2025 details how President Donald Trump and the GOP-led Congress intend to slash federal spending to partially offset trillions of dollars in tax cuts. In healthcare, Medicaid would be subject to the lion’s share of the cuts and see its federal budget diminish by $864 billion. The work requirement provisions alone would reduce spending by $344 billion.
The CBO projects that the Medicaid cuts and other policies would lead to 10.9 million people becoming uninsured, including 7.8 million who would lose Medicaid benefits.
The estimated Medicaid cuts and the increase in the uninsured are higher than under previous CBO reports because the House made last-minute changes to the measure before sending it to the Senate last month, such as moving the start date for Medicaid work requirements from 2029 to 2026.
Most of the healthcare cuts come from the section of the bill authored in the House Energy and Commerce Committee, which total $1 trillion. The House Ways and Means Committee’s part of the bill includes several policies targeted at the Affordable Care Act of 2010 that would crimp premium tax credits for migrants and step up eligibility checks for everyone to save about $230 billion. Those provisions account for about 2.3 million people losing insurance.
Democrats were quick to blast the bill based on the new score.
“We’ve said from the beginning that the numbers would only get worse,” Energy and Commerce Committee ranking member Frank Pallone (D-N.J.) said in a news release.
“It’s shocking House Republicans rushed to vote on this bill without an accounting from CBO on the millions of people who will lose their healthcare or the trillions of dollars it would add to the national debt,” Pallone said. “The truth is Republican leaders raced to pass this bill under cover of night because they didn’t want the American people or even their own members to know about its catastrophic consequences.”
Another 4.2 million people would become uninsured if Congress and Trump don’t extend the enhanced health insurance exchange subsidies due to expire at the end of the year, according to a separate analysis the CBO presented to Pallone, Ways and Means Committee ranking member Richard Neal (D-Mass.) and Senate Finance Committee ranking member Ron Wyden (D-Ore.) on Wednesday.
An additional 900,000 would lose exchange coverage as a result of a proposed rule the Centers for Medicare and Medicaid Services issued in March, which would shorten the annual enrollment period, require stricter eligibility reviews and make other changes to the marketplaces, the CBO reported to the Democratic lawmakers.
The combined effects of those policies and the One Big Beautiful Bill Act would result in 16 million more uninsured people by 2024, the CBO concluded.
The Senate is working on the tax bill now, with GOP senators holding meetings on how they would like to modify the bill. While nearly every Republican has embraced cutting waste, fraud and abuse in healthcare, some have raised concerns about how deep the Medicaid cuts will be, and have signaled they will listen to constituents to determine if they go too far.
Republican Sens. Susan Collins (Maine), Lisa Murkowski (Alaska) and Josh Hawley (Mo.) have been the most vocally resistant to the steep Medicaid cuts.
On Tuesday, Hawley expressed unease in particular about proposed limits on the provider taxes states levy to help finance their share of Medicaid spending, which he described as essential for rural hospitals. Hawley also said he disliked the provisions that would impose cost-sharing requirements on some Medicaid enrollees, dubbing it a “sick tax.”
“I don’t want to see Medicaid benefit cuts in the state, and I don’t want to see rural hospitals close,” Hawley said.
Yet Republicans including Sens. Mike Lee (Utah), Dr. Rand Paul (Ky.) and Ron Johnson (Wis.) are pushing for bigger cuts.
Senate Majority John Thune (R-S.D.) said Republicans are working through the issues, and may identify other possible cuts while satisfying the senators who want to soften the Medicaid provisions.
“We have an agenda that everybody campaigned on, most notably the president of the United States, and we’re going to deliver on that agenda. And the legislation that was passed by the House will be approved here, strengthened in the Senate,” Thune said Tuesday. “When it’s all said and done, we’ll send it back to the House and hope that they can pass it and put it on the president’s desk.”
EMS agencies should pay close attention to the potential Medicaid and Medicare changes proposed in this bill that will likely impact reimbursements to EMS agencies. Specifically:
Medicaid –
– Reduces the number of Medicaid beneficiaries through work requirements and other eligibility limitations.
– Bars states from using State Directed Payments to require Medicaid HMOs from reimbursing more than 100% of Medicare reimbursement for similar services, or 110% of Medicare in non-Medicaid expansion states.
– Mandates cost-sharing up to $35 for services provided to Medicaid expansion enrollees with incomes above the federal poverty level, which is $15,650 for a single person.
– Limits retroactive provider reimbursements for newly enrolled Medicaid recipients to one month instead of three.
Medicare –
– Triggers Medicare cuts under the Statutory Pay As You Go Act of 2010 that could include reductions in provider reimbursements.
Also recall that CMS released a proposed rule last week, that according to the language in CMS’ release, “would end states’ ability to exploit a health care-related tax loophole currently used by seven states to generate billions in federal Medicaid payments—without contributing their fair share or expanding care for Medicaid enrollees”.
We recommend strong engagement with local and national EMS advocacy organizations and keeping abreast of these potential legislative and regulatory changes.
Special thanks to Dan Pedersen from PWW|AG for his insightful (and entertaining!) presentation on the Top 10 Best Practices for Medicare Compliance for the AIMHI Reimbursement Committee!
A recording of the presentation can viewed at the link below, as is a link to his handout:
AIMHI Presentation – Pedersen.pdf
Two actions this week in DC may be signaling the future of GEMT programs.
First, CMS released a proposed rule Monday, that according to the language in CMS’ release, “would end states’ ability to exploit a health care-related tax loophole currently used by seven states to generate billions in federal Medicaid payments—without contributing their fair share or expanding care for Medicaid enrollees”.
Second, the House Energy and Commerce Committee released their 160 page heath package for the Budget Reconciliation Act. The legislation would limit states’ ability to levy taxes on providers to finance Medicaid programs and changes Medicaid eligibility to reduce the number of Medicaid enrollees.
The “Provider Tax” limitation language starts on page 64, line 19 of the document here.
News reports related to these two actions are below.
Recall that the CMS OIG is still auditing GEMT cost reports, and are due to release the results from their audits this year (https://oig.hhs.gov/reports-and-publications/workplan/summary/wp-summary-0000786.asp),
The OIG initiated these audits following a notice from CMS to state Medicaid offices detailing their concerns about non-allowable costs being included in some GEMT cost reports (https://www.medicaid.gov/federal-policy-guidance/downloads/cib08172022.pdf).
Providers who are currently participating in GEMT programs, or are awaiting State Plan Amendment approvals from CMS, should monitor these development closely.
Many EMS agencies across the country are struggling financially, leading to challenges retaining and recruiting staff, resulting in service delivery challenges and even closures of EMS agencies.
PWW Advisory Group (PWW|AG), in partnership with EMS|MC, is launching a new EMS Financial Index: Driving Change Through Data and Best Practices.
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This inaugural report, with a foreword written by the Rob Lawrence, the President of the Academy of International Mobile Healthcare Integration (AIMHI), reveals data broken down by region of the country such as:
The index report will be released quarterly, highlighting various benchmark revenue cycle data from the over 1,500 agencies serviced by EMS|MC across the U.S. and will focus on several consistent themes, as well as specialized content each period.
It is our hope that sharing benchmark data, along with best practice recommendations, will help EMS agencies assess their revenue cycle management (RCM) practices and outcomes to improve their financial health.
Click below to download this free report:
Stay tuned for the next report in July, which will cover metrics including:
Is there national and regional data YOU would like to see included in future index reports? If so, click here and send us your request.
Nice to see the progressive leaders of an outstanding EMS agency implementing scientific, evidence-based system design changes to enhance patient care, improve employee morale, and reduce system costs!
An overview of the assessment that led to these changes, and how the KCEAA Team is implementing these them will be presented at the upcoming American Ambulance Association Conference and Trade Show in Lexington, KY June 22 – 24, 2025.
Response Reboot? Implementing Data Driven Decisions for System Sustainability – A Case Study
Left: Professor Freddie Lippert and the team from Copenhagen EMS, Denmark
Right: Paramedic Students from the Australian Catholic University, Canberra
Brazilian Trauma Surgeon, Dr Rod DeOlivera at the start of his Pan American Trauma Society Observership
FOR IMMEDIATE RELEASE
Contacts:
Rob Lawrence
804 205 2557
Richmond December 19, 2016 — As 2016 draws to a close, the Richmond Ambulance Authority (RAA) is reflecting on one of its busiest years ever, not only in terms of call volume, but also the number of visitors who made their way to Richmond. In 2016, RAA received international visitors in 16 separate visits from 12 countries on five continents.
RAA takes much pride in being ‘a major stop on the EMS World tour’ and in 2016, welcomed a range of visitors wishing to view RAA operations. Norwegian and Finnish Health ministry members spent time with RAA leadership to compare and contrast data and performance measuring processes. The entire Norwegian EMS performance monitoring and management system draws some of its roots from RAA’s way of doing business.
One of RAA’s aims as a 501c3, Not for Profit organization is to use its own learning and experience in the pursuit of high performing operational and clinical EMS to raise the bar of global EMS. This was evident in the summer when it hosted the leaders of Rwanda’s (Africa) SAMU Ambulance service for a week’s master class in EMS operations. SAMU’s Jean Camarade said, “Our time in RAA was a lifetime experience and undoubtedly will have an impact on ongoing quality improvement process of ambulance system in Rwanda. If you are a manager or clinical professional and want to learn from about world class EMS, your next stop should be RAA.”
RAA has also been central to the Pan American Trauma Society Observership program and in 2016 hosted visits from trauma surgeons and medical students from Central and South America for two- to three-week attachments to understand how a high value EMS system operates and take lessons back to assist with EMS development in their own countries. Dr. Rodrigo Gonçalves de Oliveira, a Sao Paulo, Brazil, surgeon said, “It was an amazing experience. The opportunity to learn from the best helps us to identify the gaps on our service, allowing us to propose changes to the entire system.”
RAA has also educated and influenced medical, paramedic and healthcare administration students. Individuals and groups from the Australian Catholic University campuses based in Canberra, Sydney and Brisbane enjoyed their RAA learning experience. The largest group of visitors every year is from the Masters in Healthcare Administration class from Taiwan’s Kaohsiung Medical University (KMU). Medical student Maria Jose Jaramillo from Quenca, Ecuador, said, “Every person at Richmond Ambulance Authority taught me something, not only high quality prehospital care, but also team work, kindness and love to every patient they take care of. I consider it one of the best experiences I’ve had by far, and I’ll keep this team forever in my heart.”
RAA’s international visit coordinator, who also began his own RAA career after an international visit from the UK, COO Rob Lawrence said, “We learn as much as we give with every visit and make lifelong friendships with those members of our international RAA family. Our staff certainly enjoys the opportunity to share their experiences, whether it is a surgeon from Sudan or a student from Sydney.”
As for the full count, RAA received visitors from Australia, Brazil, Chile, Denmark, Ecuador, Finland, India, Japan, Norway, Rwanda, Sudan and Taiwan.
About the Richmond Ambulance Authority
In 1991, the Richmond City Council and the city manager implemented an Emergency Medical Services (EMS) system that placed the patient first and guaranteed its performance to the City’s residents. Today, the Richmond Ambulance Authority responds to approximately 200 calls per day and transports, on average, 140 patients per day. RAA’s emergency response times are among the fastest in the nation with ambulances on the scene of life threatening emergencies in less than 8 minutes and 59 seconds in more than 90% of all responses. RAA is one of only 22 EMS agencies in North America accredited by both the Commission on the Accreditation of Ambulance Services and the National Academies of Emergency Dispatch. RAA is also a Commonwealth of Virginia Accredited Dispatch Center. For more information, see www.raaems.org.