10.27.16

Daines, Zinke Work to Ensure Healthcare Delivery for Rural Montanans

U.S. CONGRESS —U.S. Senator Steve Daines and U.S. Representative Ryan Zinke today worked to ensure equitable healthcare delivery for rural Montanans. 

In a letter to Centers for Medicare and Medicaid Services (CMS) Acting Administrator Andy Slavitt, Daines and Zinke seek to clarify why certain Montana zip codes are not designate as rural for ground ambulances despite meeting qualifications and having rural designations for most other Medicare programs. 

There are currently 16 zip codes throughout Montana, which meet criteria, but have not been designated as rural for purposes of ground ambulance reimbursement. 

“With lower population density and increased travel times, it is important that rural areas have the appropriate designation,” Daines and Zinke wrote. “Without this, it puts access to care for not only the Medicare patients but all who are served by the provider in jeopardy. We urge CMS to apply a methodology consistent with ORHP [Office of Rural Health Policy] and other Medicare programs for ambulance service providers and the patients they serve.”

Daines’ and Zinke’s letter is available to download HERE and below:

Dear Acting Administrator Slavitt,

 We are concerned that the Centers for Medicare and Medicaid Services (CMS) has not altered the designation of zip codes under the Medicare ambulance fee schedule to appropriately account for rural census tracts to align with methodology utilized by nearly all Department of Health and Human Service programs, including most Medicare payment systems. In particular, it is concerning that CMS has not taken into consideration 132 rural census tracts that the Health Resources & Services Administrations’ Office of Rural Health Policy (ORHP) designates as rural due to having a land area greater than 400 square miles and a population density no more than 35 persons per square mile despite having a Rural Urban Community Area Code (RUCA) of 2 or 3 in guidance issued November 20, 2015. 

In Montana, there are 16 zip codes that would be considered rural if CMS were to properly align the census tracts with the designations put forward by ORHP.

On December 30, 2014, CMS issued a final rule for CY2015 that included a revised list of the zip codes to change on January 1, 2015 from being rural to urban, and urban to rural.  The changes were a result of an update based on 2010 census data, but failed to use the ORHP methodology. Again, the methodology was not used in the final rule for CY2016, despite ORHP’s guidance. 

A zip code being rural has a significant impact on the services that are able to be provided to Medicare beneficiaries due to reimbursement under the Medicare ambulance fee schedule. With lower population density and increased travel times, it is important that rural areas have the appropriate designation. Without this, it puts access to care for not only the Medicare patients but all who are served by the provider in jeopardy.

We urge CMS to apply a methodology consistent with ORHP and other Medicare programs for ambulance service providers and the patients they serve.

Sincerely,

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