EMS.gov | Leveraging DOT Grant Funds for EMS Crash Response Improvement
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Author: AAA Staff
GAO | Roll Out of IDR Process for Out-of-Network Claims Has Been Challenging
GAO-24-106335Published: Dec 12, 2023. Publicly Released: Dec 12, 2023.
Fast Facts
Individuals with private health insurance can receive “surprise bills” for the difference between what a provider charged and what their insurance paid.
A 2021 law prohibits surprise billing for some services, and directed the Departments of Health and Human Services, Labor, and Treasury to give providers and insurers a forum to resolve disputes about how much insurers should pay for out-of-network care.
But the rollout has been challenging. As of June 2023, over 490,000 disputes have been submitted, a much larger number than anticipated by the agencies.
And 61% of the disputes are unresolved as of June 2023.
Highlights
What GAO Found
The No Surprises Act directed the departments of Health and Human Services (HHS), Labor, and Treasury to establish a federal independent dispute resolution process. The process, which was effective April 2022, is a voluntary forum for health care providers and health insurance issuers to resolve disputes about how much should be paid for out-of-network care. The payment determinations are made by certified dispute resolution entities, which serve as arbiters. The Centers for Medicare & Medicaid Services (CMS)—an agency within HHS—administers the independent dispute resolution process.
The three departments reported that parties submitted nearly 490,000 disputes from April 2022 through June 2023. About 61 percent of these disputes remained unresolved as of June 2023. According to officials from the departments, a primary cause of the large number of unresolved disputes is the complexity of determining whether disputes are eligible for the process.
Number of Out-of-Network Disputes in the Federal Independent Dispute Resolution Process by Calendar Quarter, April 15, 2022—June 30, 2023
The groups GAO interviewed described a challenging roll out of the independent dispute resolution process, including a higher-than-expected dispute volume. For example, the departments anticipated about 22,000 disputes in 2022, but received nearly 490,000 through June 2023. Four groups told GAO the departments did not account for the experience of states with similar processes when making the estimate. Disputing parties and certified entities also described the broader effects of those challenges, such as backlogs resulting in delays in payment determinations. The departments have taken some actions to address challenges, such as conducting pre-eligibility reviews on submitted disputes.
To address concerns from insurers and providers, CMS and Labor look into complaints; however, stakeholder groups expressed concern with what they describe as a lack of response to submitted complaints. The departments reported limited ability to increase enforcement efforts due to budget constraints. HHS has requested a budget increase for the process, and the departments are revisiting the administrative fee amount, which is intended to cover the costs of the process, and plan to issue updated program rules.
Why GAO Did This Study
About two thirds of individuals in the United States receive their health coverage through private health plans. Balance billing is when insured patients receive a bill from a health care provider for the difference between the amount charged and the payment received from the health insurance issuer. An unexpected balance bill is referred to as a “surprise bill” and may create a financial strain for patients. For individuals with private health insurance, the No Surprises Act prohibits providers from balance billing in certain circumstances and directed the three departments to establish the federal independent dispute resolution process.
The Consolidated Appropriations Act, 2021, includes a provision for GAO to review the federal independent dispute resolution process. This report describes (1) the number and types of disputes submitted between April 2022 and June 2023, and the status of their resolution; (2) selected stakeholders’ experiences with the process, and agency actions to address challenges; and (3) how federal agencies oversee the process.
GAO reviewed published reports, relevant federal laws, regulations, and guidance; and interviewed officials from CMS and Labor. GAO also interviewed five selected health care providers or their representatives, which accounted for nearly half of all submitted disputes as of December 2022. In addition, GAO interviewed three issuers, three certified entities that arbitrate the disputes, and 10 stakeholder groups.
For more information, contact John E. Dicken at (202) 512-7114 or dickenj@gao.gov.
NHTSA Request for Information: Emergency Medical Services Education Agenda 2050
NHTSA published a request for information on October 13, 2023, seeking comments from all sources (public, private, government, academic, professional, public interest groups, and other interested parties) on the planned re-envisioning of the 2000 EMS Education Agenda for the Future: A Systems Approach. Due to the limited comments received and some informal feedback indicating that the initial comment period was too short, NHTSA is announcing the reopening of the comment period for the RFI in order to solicit additional comments and request responses to specific questions provided in the document. The comment period for the RFI was originally scheduled to end on October 31, 2023. It will now be reopened and will end on March 31, 2024.
Dates
The comment period for the RFI published on October 13, 2023 at 88 FR 71081 is reopened and extended to March 31, 2024.
For Further Information Contact
Clary Mole, EMS Specialist, National Highway Traffic Safety Administration, U.S. Department of Transportation is available by phone at (202) 868–3275 or by email at Clary.Mole@dot.gov.
Addresses
Comments must be submitted by one of the following methods:
• Federal eRulemaking Portal: go to http://www.regulations.gov. Follow the online instructions for submitting comments.
• Mail: Docket Management Facility, M–30, U.S. Department of Transportation, West Building, Ground Floor, Rm. W12–140, 1200 New Jersey Avenue SE, Washington, DC 20590.
• Hand Delivery or Courier: West Building Ground Floor, Room W12–140, 1200 New Jersey Avenue SE, between 9 a.m. and 5 p.m. Eastern Time, Monday through Friday, except Federal holidays. To be sure someone is there to help you, please call (202) 366–9322 before coming.
Regardless of how you submit your comments, you must include the docket number identified in the heading of this document.
Note that all comments received, including any personal information provided, will be posted without change to http://www.regulations.gov. Please see the “Privacy Act” heading below.
You may call the Docket Management Facility at (202) 366–9322. For access to the docket to read background documents or comments received, go to http://www.regulations.gov or the street address listed above. We will continue to file relevant information in the docket as it becomes available. To be sure someone is there to help you, please call (202) 366–9322 before coming. We will continue to file relevant information in the Docket as it becomes available.
Privacy Act: In accordance with 5 U.S.C. 553(c), DOT solicits comments from the public to inform its decision-making process. DOT posts these comments, without edit, including any personal information the commenter provides, to http://www.regulations.gov, as described in the system of records notice (DOT/ALL–14 FDMS), which can be reviewed at https://www.transportation.gov/privacy. Anyone is able to search the electronic form of all comments received into any of our dockets by the name of the individual submitting the comment (or signing the comment, if submitted on behalf of an association, business, labor union, etc.). You may review DOT’s complete Privacy Act Statement in the Federal Register published on April 11, 2000 ( 65 FR 19477–78 ).
Supplementary Information
On October 13, 2023, NHTSA published a RFI to obtain public comments to inform EMS Education Agenda 2050, and request responses to specific questions provided in this document. For convenience purposes, NHTSA is republishing introductory information, background materials and questions from its RFI in this notice.
I. Introductory Information
In 2012, the National EMS Advisory Council (NEMSAC) convened a national roundtable meeting on EMS Education Agenda for the Future: A Systems Approach. In a 2014 report on these proceedings, NEMSAC advised that stakeholders at the State and local level had just begun to experience the full impact of the evolution toward a national integrated system of education for EMS personnel. While stakeholders were reticent to move forward with a new education agenda, they did provide feedback about themes that should be considered in the future publication. From the feedback collected at the meeting, NEMSAC developed recommendations to be used in the eventual re-envision of the agenda for EMS. These recommendations are summarized below:
- Educational content should retain the flexibility accorded by the National EMS Education standards, but programs should use nationally recognized evidence-based guidelines to drive local curriculum development.
- The National EMS Information System data, evidence-based research, and practice analyses should be sourced in developing evidence-based guidelines and curriculum.
• Mobile Integrated Healthcare has received considerable attention from the EMS Community. This and other alternative community-based healthcare delivery models (of the future) should evoke an expanded foundational knowledge and critical thinking capabilities that will poise future EMS practitioners to be able to evolve with the changing healthcare system or rapidly adjust to emerging healthcare crises.
- EMS educators should begin a career in academia with expertise in adult learning, educational theory, curriculum development, and competency evaluation but also possess experiential knowledge in evidence-based care.
In the 10 years since NEMSAC’s roundtable meeting, the national EMS education system continued to evolve—especially during the COVID–19 pandemic. In late 2021, the Federal Interagency Committee on EMS (FICEMS) began sponsoring listening sessions to inform a consensus-driven, national report entitled, FICEMS: EMS and 911 COVID–19 Response White Paper. This publication cited challenges and solutions collected during stakeholder listening sessions for the EMS education system. Among the challenges, EMS education stakeholders cited scarcity (in some cases deficits) in resources for education, rigidity of curriculum delivery modalities, the increased employer demands on students, and inconsistent or delayed responses to the needs of the national EMS education system as major contributors that led to the breakdown in the EMS workforce pipeline.
Prior to the COVID–19 pandemic, NHTSA published EMS Agenda 2050: A People-centered Vision for the Future of EMS (Agenda 2050). This collaborative project set a vision for a people-centered EMS systems that serves every individual in every community across the Nation. Later this year, NHTSA and its partners will begin a new project to develop EMS Education Agenda 2050. This project will not replace but build upon the achievements of the 2000 EMS Education Agenda for the Future: A Systems Approach to lead a national conversation around the future vision for EMS Education and EMS as a profession.
II. Background
NHTSA, in partnership with Health Resources and Services Administration, published EMS Education Agenda for the Future: A Systems Approach ( Education Agenda ) in 2000. This document was founded on the broad national EMS education system concepts introduced in the EMS Agenda for the Future (1996). The Education Agenda described a consensus vision of an EMS education system with a high degree of structure, coordination, and interdependence. It proposed a less prescriptive system that offered educators flexibility in creating a student-centered learning environment and a process for accommodating future advancements in technology and medicine. The proposed system maximized efficiency, consistency in instructional quality, and entry level graduate competency by prescribing a high degree of structure, coordination, and interdependence. To achieve this vision, the education system of the future centered on five integrated primary components:
- National EMS Core Content
- National EMS Scope of Practice Model
- National EMS Education Standards
- National EMS Education Program Accreditation
- National EMS Certification
After the Education Agenda was published, stakeholders began implementing their respective integrated system components. Almost 25 years later, the national EMS education system has successfully evolved into one that exemplifies both consistency and flexibility. System interdependencies have helped to avoid duplication of effort in curriculum and education program development, evaluating the minimum competencies of graduates, certification and licensing processes, and facilitation of practitioner reciprocity.
In 2020, the EMS education system interdependencies modernized by the Education Agenda were tested. Challenges presented by the COVID–19 pandemic forced a variety of adaptations. Traditional education programs reported a lag in students’ capabilities of achieving the programmatic competencies requirements for graduation. The lag was attributed to a variety of causes including a focus on pandemic response activities over training and education, employer demands on working students, and the rigidity of in-person, classroom-based education delivery models. After the majority of programs adjusted to the challenges, lags in graduation were cured, and students achieved programmatic competencies at rates similar to those pre-pandemic. The response to the pandemic did not impact education programs only. The impact to EMS agency daily operations was felt as well. During the COVID pandemic, agencies experienced increases in EMS activation and response rates which created additional stressors for student EMS practitioners already working in a high stress job environment but also enrolled in an EMS education program. These stressors were a major contributor to a migration of practitioners away from the EMS workforce. Agencies and organizational stakeholders asserted that it could be education program graduation requirements causing breakdown in the workforce pipeline; however, there were no observed decreases in graduation or certification testing rates. These observations prompt two questions: If graduation and certification testing rates have remained unchanged, why have agencies reported recruitment and retention issues? If graduates are not entering the EMS workforce, where are they finding jobs?
With agencies experiencing increased demand and a deficiency in qualified EMS practitioners to respond to it, service delivery models had to evolve. To bridge the gap in community-based care resources, community paramedicine and mobile integrated healthcare (CP–MIH) service delivery models increased in prevalence, and improvised training programs were used to close new job-specific competency gaps among existing EMS practitioners and individuals in training. Other themes brought to the forefront during the pandemic include addressing healthcare disparities; the use of EMS data as a tool for surveillance and nationwide quality of care improvements; and a greater value to having an EMS workforce that is not only equitable, inclusive, and accessible, but as diverse as the community it serves. These themes, evolving service delivery models, and the subsequent evolution of competencies needed by practitioners suggest that it is time for NHTSA to gather our partners to begin a new conversation about the future of EMS Education and EMS as a profession in the United States.
III. Questions Regarding EMS Education Agenda 2050
Responses to the following questions are requested to help plan the revision of the Education Agenda. Please be as specific as possible and as appropriate please provide references.
1. What are the most critical issues facing EMS education system that should be addressed in the revision of the EMS Education Agenda ? Please provide specific examples.
2. What progress has been made in implementing the EMS Education Agenda since 2000?
3. How have you used EMS Education Agenda ? Please provide specific examples.
4. As an EMS Stakeholder, how might a revised EMS Education Agenda be most useful to you?
5. What significant changes have occurred in the EMS education system at the national, Federal, State, and local levels since 2000?
6. What significant changes will impact the EMS education system in the next 25 years?
7. How might the revised EMS Education Agenda contribute to enhanced EMS for children?
8. How might the revised EMS Education Agenda support and/or promote data-driven and evidence-based improvements in EMS education systems and EMS practitioner practice?
9. How could the revised EMS Education Agenda enhance collaboration among EMS systems, health care providers and facilities, public safety answering points, public health, public safety, emergency management, insurers, and others?
10. How could the revised EMS Education Agenda be used to promote community sustainability and resilience?
11. How could the revised EMS Education Agenda contribute to improved coordination for disaster response, recovery, preparedness, and mitigation?
12. How could the revised EMS Education Agenda enhance the exchange of evidence-based practices between national, Federal (and military), State, and local levels?
13. How could the revised EMS Education Agenda support the seamless and unimpeded transfer of military EMS personnel to roles as civilian EMS providers?
14. How could the revised EMS Education Agenda support interstate credentialing of EMS personnel?
15. How could the revised EMS Education Agenda support improved patient outcomes in rural and frontier communities?
16. How could the revised EMS Education Agenda lead to improved EMS systems in tribal communities?
17. How could the revised EMS Education Agenda promote a culture of safety among EMS personnel, agencies, and organizations?
18. Are there additional EMS attributes that should be included in the revised EMS Education Agenda ? If so, please provide an explanation for why these additional EMS attributes should be included.
19. Are there EMS attributes in the 2000 EMS Education Agenda that should be eliminated from the revised edition? If so, please provide an explanation for why these EMS attributes should be eliminated.
20. What are your suggestions for the process that should be used in revising the EMS Education Agenda ?
21. What specific agencies/organizations/entities are essential to involve, in a revision of the EMS Education Agenda ?
22. Do you have any additional comments regarding the revision of the EMS Education Agenda ?
(Authority: 23 U.S.C. 403(b)(1)(A)(iv); 49 CFR 1.95; 501.8)
Issued in Washington, DC.
Nanda Narayanan Srinivasan,
Associate Administrator, Research and Program Development.
[FR Doc. 2023–25551 Filed 11–17–23; 8:45 am]
BILLING CODE 4910–59–P
Ambulance Anti-Theft Devices
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GAPBAC | Materials from Oct 31, Nov 1 meeting posted
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Webinar | HHS Roadmap for Cybersecurity in Health Care
On Wednesday, December 6, 2023, the Department of Health and Human Services (HHS) Office of Intergovernmental Affairs (IEA) will host a webinar on healthcare sector cybersecurity from 4:30 p.m. to 5:00 p.m. EST. HHS IEA stated speakers will discuss “the Department’s roadmap for cybersecurity in health care and answer questions on how HHS can help protect patient safety, secure our hospitals, and improve cyber resiliency in health care.”
HHS IEA indicated the event will feature the following speakers:
- HHS Deputy Secretary Andrea Palm; and
- Speakers from the Administration of Strategic Preparedness and Response (ASPR).
Registration for the event can be found at: Webinar Registration.
National Biodefense Science Board (NBSB) Public Meeting on November 30, 2023
The next public meeting of the National Biodefense Science Board (NBSB) will be held virtually on Thursday, November 30, 2023, from 12:30 to 4:00 p.m. ET. Advanced registration is required. To register for the webinar and for additional meeting information, visit the NBSB public meeting page. We encourage you to share this engagement opportunity broadly across your network.
The NBSB will discuss and vote on two set of recommendations related to COVID-19 pandemic lessons; Project NextGen vaccine and therapeutic products, priorities for future medical countermeasure attributes as requested by the Biomedical Advanced Research and Development Authority; and disaster preparedness training. Drafts of the recommendations for public review will be on the NBSB webpage as soon as they are available.
Anyone may submit questions or comments to the board members by email to (NBSB@hhs.gov) ahead of the meeting. If time allows, the NBSB board members will address as many written comments as possible. Requests to speak during the public meeting should be sent to (NBSB@hhs.gov) by 5:00pm ET on November 23, 2023. Please provide the speaker’s full name, organization, and a full explanation of the intended topic. Presentations that contain material with a commercial bias, advertising, marketing, or solicitations will not be allowed. All meeting materials will be made publicly available on the NBSB public meeting page. For additional information or questions about this event, please contact (NBSB@hhs.gov).
American Sign Language translation and Communication Access Real-Time Translation will be provided during the meeting.
NCSL Podcast | Emergency Medicine in Rural America
Emergency Medicine in Rural America | OAS Episode 198
NOVEMBER 19TH, 2023 | 36:56 | E198
EPISODE SUMMARY
Two experts in emergency medical services joined the podcast to discuss a variety of challenges to providing care in rural areas, including long waits for ambulances and a serious workforce shortage. They also talked about the role of legislatures in addressing EMS needs.
EPISODE NOTES
Emergency medical services face significant challenges in rural America. Just one is the time it takes to summon an ambulance. While most people living in urban and suburban areas expect an ambulance to show up within minutes of making a 911 call, the situation is very different for about 4.5 million Americans who live in ambulance deserts, according to a nation study conducted by Maine Rural Health Research Center and the Rural Health Research & Policy Centers. Those folks can expect to wait 25 minutes or more for emergency services to arrive.
We sat down with two experts on the subject — Dia Gainor, executive director of National Association of State EMS Officials, and Davis Patterson, director of the WWAMI Rural Health Research Center at University of Washington—to discuss that and other challenges to EMS in rural areas. Other issues they discussed included the severe workforce challenges in staffing rural EMS services, the role of legislatures in addressing rural EMS needs and the promise of community paramedicine in addressing both emergency and nonemergency care in rural areas.
RESOURCES
- Ambulance Deserts: Addressing Geographic Disparities in the Provision of Ambulance Services, Rural Health Research Gateway (May 2023)
- Beyond 911: Expanding the Primary Care Role of First Responders through Community Paramedicine
- Community Paramedicine: Connecting Patients to Care and Reducing Costs
- EMS Legislative Database
- The EMS and Community Paramedic Workforces Respond to COVID-19, WWAMI Rural Health Research Center (June 2023)
- The National Association of State Emergency Medical Services Officials
- State Actions To Address EMS Workforce Shortages
- You might need an ambulance, but your state may not see it as ‘essential,’ Stateline (September 2023)
- WWAMI Rural Health Research Center
EMS.gov | Input Requested: EMS Education Agenda 2050
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CISA | Preventing Workplace Violence Infographic
The Preventing Workplace Violence: Security Awareness Considerations Infographic is a new CISA product designed for critical infrastructure leaders, human resources personnel, managers, and workers of any level. The infographic provides actionable recommendations and resources intended to prevent and mitigate workplace violence by cultivating a culture of awareness and support in the workplace.
For questions regarding this infographic, please email central@cisa.gov.
Register Now: FICEMS Meeting on December 6
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Prodigy Interview: Shawn Baird on GAPBAC
Recorded November 2023
Outside the US Capitol during 2023 Stars of Life, Prodigy’s Rob Lawrence caught up with American Ambulance Association Immediate Past President Shawn Baird. Shawn shared next steps following the last meeting of the Ground Ambulance Patient and Billing Advisory Committee.
Crash Responder Safety Week, November 13–17, 2023
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National EMS Advisory Council Meeting November 15-16, 2023
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FICEMS DEIA Statement Now Available
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Prehospital Guidelines Consortium | EMS Research Reading List Submissions
The Prehospital Guidelines Consortium is collaborating with the National Registry of EMTs to continually identify current scientific literature to incorporate into certification activities. We seek input from the EMS community on peer-reviewed scientific articles (e.g., research studies, systematic reviews, or narrative review articles) published in 2021-2023 that can assist in improving the knowledge of EMS professionals regarding the most current science in EMS medicine.
Relevance to clinical care or operations within EMS medicine is requisite, and preference will be given to peer-reviewed literature, including reports of landmark clinical trials, systematic reviews of the literature, and scientific review articles.
The Prehospital Guidelines Consortium is separately engaging in an ongoing systematic review of published prehospital evidence-based guidelines (EBGs) as a related component of this effort. EBG-related publications may also be submitted to supplement the systematic search already in progress.
10/23 | US DOT Allies in Action Pedestrian Safety Month Webinar
In honor of Pedestrian Safety Month throughout October, the U.S. Department of Transportation Office of the Secretary will host a webinar to highlight USDOT and National Roadway Safety Strategy Allies in Action efforts and resources to forward pedestrian safety.
We hope you can join us!
Event: U.S. Department of Transportation Allies in Action Pedestrian Safety Month Webinar
When: Monday, October 23, 2023, from 1-2:30 p.m. ET
Where: Via Zoom (see registration link below)
Audience: Open to the public
Registration Link: Register now
Additional information on 2023 Pedestrian Safety Month and upcoming events can be found here and on the National Highway Traffic Safety Administration website.
CoAEMSP Accepting Applications for Site Visitors
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NAEMSP | Rest in Peace E. Brooke Lerner, PhD, FAEMS
NAEMSP is deeply saddened by the news that E. Brooke Lerner, PhD, FAEMS has passed away after a courageous battle with cancer. Over the past two decades, Brooke has dedicated her career to the advancement of prehospital care, from spending time in the field as a paramedic to serving on the NAEMSP Board of Directors and joining her alma mater, the University of Buffalo, as a tenured professor and vice chair for research in the Department of Emergency Medicine in the Jacobs School of Medicine and Biomedical Sciences.
Said NAEMSP President José G Cabañas MD, MPH, FAEMS: “We pay tribute to the extraordinary legacy of Dr. Brooke Lerner. Her service to our profession and NAEMSP was marked by honor and distinction, including the mentorship of countless clinicians devoted to building effective prehospital systems of care. Brooke’s transformative work played a pivotal role in advancing trauma and pediatric emergency care, leaving behind a body of work that was instrumental in enhancing prehospital care standards. May her enduring legacy serve as an inspiration to all of us, reminding us of the profound impact one person’s selfless dedication can have in elevating the practice of EMS medicine.”
Throughout her career, Brooke focused on research in a subspecialty with a relatively small literature base, authoring over 135 peer-reviewed publications and completing many federally funded grants to conduct EMS research. Much of her research addressed acute injury care and field/disaster triage, and she led the current national guideline for mass casualty triage.
Brooke also dedicated much of her time to pediatric emergency care, especially through the federally funded Pediatric Emergency Care Applied Research Network (PECARN), where she led the organization’s only prehospital node and served on its Executive Committee.
Following her diagnosis, Brooke worked with NAEMSP and the GMR Foundation to establish the E. Brooke Lerner Research Fund with the goal of supporting early career EMS researchers. “I’ve spent my career on improving prehospital care, and I wanted to leave something behind to keep that legacy moving forward,” Brooke said, speaking of the fund shortly after its creation.
In 2013, Brooke received NAEMSP’s Keith Neely Award, and ten years later, she was recognized with the Ronald D. Stewart Award for her illustrious career in EMS. It would be impossible to recount all the invaluable contributions to emergency medical services made by Brooke Lerner, and more impossible still to describe the impact she made on each person she met. NAEMSP will remember Brooke with the utmost admiration and is profoundly grateful for everything she has done to advance EMS.
NHTSA | Updated Ground Ambulance Crash Safety Materials Available
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