How to increase EMS funding in three clicks

Ask your senators and representative to make Treatment in Place permanent, increase SIREN Act funding, count every EMS provider and extend Medicare add-ons


Funding, really the lack of funding, is always raised by EMS providers and leaders in any discussion or survey about the top challenges facing EMS now, next month and next year. More funding – through reimbursement, tax collection or grant funding – is also a top solution to the other top challenges facing EMS, including recruitment, retention, pandemic preparedness and response, replacing out-of-date equipment and meeting annual training requirements.

Respondents to the 2020 EMS Trend Report, a collaboration of Fitch & Associates, the National EMS Management Association and EMS1, ranked “Reimbursement” as the second most significant challenge facing EMS. For the first time, reimbursement ranked ahead of "Recruitment of qualified personnel.” A stunning 82% of respondents disagreed or strongly disagreed with the statement, “Current reimbursement rates for EMS adequately cover the cost of service.”

EMS on the Hill Day requests to Congress

For 11 years, EMS on the Hill Day has brought EMS professionals to Washington, D.C., to advocate for the EMS profession. This week, 292 EMS providers and leaders, the highest number in the program’s history, from all 50 states and Puerto Rico, are meeting virtually with their senators and representatives as part of EMS on the Hill Day.
For 11 years, EMS on the Hill Day has brought EMS professionals to Washington, D.C., to advocate for the EMS profession. This week, 292 EMS providers and leaders, the highest number in the program’s history, from all 50 states and Puerto Rico, are meeting virtually with their senators and representatives as part of EMS on the Hill Day. (Photo/Getty Images)

Today, EMS providers and leaders have an immediate and pressing opportunity to improve federal EMS funding. The National Association of EMTs, in collaboration with the International Association of Fire Chiefs, the International Association of Firefighters and the American Ambulance Association, is asking our senators and representatives to support four legislative initiatives that will directly or indirectly improve EMS funding. Those initiatives are:

  1. Permanent Reimbursement for EMS Treatment in Place (TIP)
  2. FY2022 Funding for The Supporting and Improving Rural EMS Needs (SIREN) Law
  3. H.R. 2354, EMS Counts Act of 2021
  4. H.R. 2454, Protecting Access to Ground Ambulance Medical Services Act of 2021

For 11 years, EMS on the Hill Day has brought EMS professionals to Washington, D.C., to advocate for the EMS profession. This week, 292 EMS providers and leaders, the highest number in the program’s history, from all 50 states and Puerto Rico, are meeting virtually with their senators and representatives as part of EMS on the Hill Day. Participants will meet with more than 85 senators and more than 135 representatives. 

I joined other Wisconsin EMTs and paramedics to meet with legislative aids from the offices of Sen. Tammy Baldwin, Sen. Ron Johnson and Rep. Ron Kind. During our Zoom meetings, we were able to discuss the importance of our legislative priorities for EMS, the ongoing need to improve EMS funding and reimbursement, and answer questions the aids had about EMS.

Chief Jon Cohn, Greenfield (Wis.) Fire Department, told the Wisconsin delegation, “They want to hear what we have to say. We are the experts.”

The top question we were asked during our meetings was, “What are specific ways the pandemic has impacted EMS providers and agencies in our state?”

Act now to advocate for EMS funding

One of the best ways to improve EMS funding is to visit with, call or email your senators and representatives. The NAEMT Online Legislative Service makes it easy for you to send an email in support of this year’s EMS on the Hill Day legislative priorities. Every message from an EMT, paramedic, EMS officer or chief, or friend of EMS makes a difference. Please help the 292 EMS on the Hill Day participants in supporting these initiatives.

1. Permanent reimbursement for Treatment in Place (TIP)

On March 10th, Congress passed the American Rescue Plan Act of 2021 (P.L. 117-2). Section 9832 (S.149/H.R. 1609) of the legislation provides HHS with the authority to issue an emergency waiver of the requirements for ground ambulance providers and suppliers to allow reimbursement for the healthcare services provided when a community-wide EMS protocol prohibiting transport is in place. As with the other COVID-19 waivers, Congress did not restrict the timing of the waiver, so it can be implemented retroactive to March 1, 2020, as CMS has done when implementing similar waiver authority passed by Congress during this pandemic. We thank Congress for taking this action and greatly appreciate this waiver during the Public Health Emergency (PHE). We request that reimbursement for EMS treatment in place be made permanent.

Act now to share your support for the permanency of TIP.

2. Increased funding for SIREN Act grants in FY2022

The SIREN Act passed both Houses of Congress as part of the Agriculture Improvement Act of 2018 and was signed into law on Dec. 20, 2018. This law creates a grant program for public and non-profit EMS agencies and fire departments in rural areas to support the recruitment, retention, education and equipment for EMS personnel. Rural EMS agencies and fire departments often lack the resources to pay for even basic operational needs. The pandemic has exacerbated these challenges, creating a crisis for EMS in many rural areas.

The Labor, Health and Human Services, Education and Related Agencies (LHHS) Appropriations bills for Fiscal Year 2020 and 2021 provided $5 million and $5.5 million respectively for SIREN grants; however, to seriously address existing needs, the program will require additional funds. In Fiscal Year 2020, the HHS Substance Abuse and Mental Health Services Administration (SAMHSA) received 66 applications, but only 27 were able to be funded, ranging from $92,000 to $200,000. Twenty million would provide 100 grants nationwide or two per state.

Ask your lawmakers in the Senate and House to share their support with the Senate and House Appropriations Committees to fund the SIREN Act grants at $20 million for FY2022.

3. Secure U.S. House support for the EMS Counts Act of 2021

The EMS Counts Act of 2021 will require the Secretary of Labor to revise the Standard Occupational Classification System by dividing the general occupational category of Firefighter into four sub-categories. Specifically, the bill directs the Bureau of Labor Statistics (BLS) to revise the broad description under the occupational series ‘‘33-2011 16 Firefighters’’ of the 2018 Standard Occupational Classification System of the BLS to include the following new occupations:

  •  Firefighters
  •  Firefighter/EMTs
  • Firefighter/Paramedics
  •  Firefighters, All Other

These changes will address the chronic miscounting of EMS personnel by allowing firefighters to identify themselves as cross-trained EMS practitioners.

The BLS collects data on and releases a monthly jobs report, which includes job creation and loss information. Unfortunately, the Department of Labor’s current occupational classification system does not accurately classify firefighters who are cross trained as a paramedic or EMT. Given the fact that at least 62% of all fire departments provide EMS, this failure to recognize cross-trained fire and EMS personnel leads to a significant and chronic undercount of EMS personnel.

The BLS estimated that roughly 248,000 paramedics and EMTs serve in the U.S., whereas the true number of EMS personnel is over 1 million according to the 2020 National EMS Assessment. The BLS’ flawed estimate led to a dramatic shortfall in the number of COVID-19 vaccination doses actually needed to protect all EMS personnel across the nation during the pandemic. Implementing the correct classification will enable the U.S. to track gaps in emergency medical services and meet the emergency healthcare needs of communities, including planning for daily needs and major disasters and public health emergencies.    

Ask your representative to support H.R. 2354 the EMS Counts Act of 2021.

4. Extend Medicare add-ons until CMS completes cost collection survey analysis

Ask your U.S. House Representative to support H.R. 2454 Protecting Access to Ground Ambulance Medical Services Act of 2021. This legislation seeks to address two major problems related to Medicare reimbursement for ground ambulance services: the extension of the ground ambulance add-ons and a technical fix to the policies defining rural and super-rural areas.

The bill will extend the Medicare add on payments until CMS completes the analysis of the ambulance cost collection survey that is just commencing. Ambulance service providers and suppliers currently receive temporary 2% urban, 3% rural and “super rural” Medicare add-on payments. The current add-ons are valid through Dec. 31, 2022.

The bill also seeks to have Medicare provide an appeals process for reconsidering a change in a ZIP code’s status as rural or super-rural. It would create a new exception under Medicare that maintains rural ZIP codes in large urban counties as rural or super-rural, if there are 1,000 or fewer people per square mile in the ZIP code.

Ask your representative to support H.R. 2454 the Protecting Access to Ground Ambulance Medical Services Act of 2021.

Be an EMS advocate

Visit the EMS on the Hill Day website for more information on the requests to Congress, additional resources and to view a video briefing for EMS on the Hill Day participants. Remember your insights and experiences matter to your elected officials and speaking on behalf of EMS can especially make a difference to the 15 senators who have chosen to not schedule meetings with EMS providers and leaders. Supporting the legislative priorities only takes three clicks:

  1. Click to open the NAEMT Online Legislative Service
  2. Click the button to take action
  3. Click the button to send

If you are participating in EMS on the Hill or have already sent messages with the NAEMT Online Legislative Service, share information with your EMS colleagues and ask them to advocate for EMS. “We need to advocate for advocacy,” Pam Lane, NAEMT executive director, urged the Wisconsin delegation.

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