Author: AAA Staff

NAEMSP Survey on Drug Shortages: Impact on Fire Departments and EMS Agencies

Written by AAA Staff on May 1, 2024. Posted in Operations, Patient Care, Professional Standards.

NAEMSP is currently conducting a vital survey aimed at understanding the effects of drug shortages on Emergency Medical Services (EMS) agencies. As esteemed leaders in the field of EMS, your insights are invaluable in comprehending the challenges faced by frontline responders due to medication scarcities.

In recent years, the healthcare sector has grappled with an increasing number of drug shortages, presenting significant hurdles for EMS agencies and fire departments. These shortages not only disrupt standard protocols but also pose potential risks to patient care and safety. As such, it is imperative to gather comprehensive data to address these issues effectively.

Your participation in this survey will contribute to a deeper understanding of the following:

The frequency and severity of drug shortages experienced by EMS agencies and fire departments.
The impact of drug shortages on patient care, treatment protocols, and outcomes.
Strategies employed by EMS agencies and fire departments to mitigate the effects of drug shortages.

By sharing your expertise and experiences, you will play a crucial role in shaping strategies to address drug shortages and enhance emergency medical services nationwide. Your input will inform policymakers, healthcare providers, and stakeholders about the challenges faced on the ground, enabling us to develop targeted solutions to safeguard patient care and optimize resource allocation.

Thank you in advance for your participation and commitment to advancing the quality and effectiveness of prehospital patient care.


	Take the Survey

Emergency Medical Products for First Responders Since 1977

Written by AAA Staff on April 16, 2024. Posted in Marketing & PR, Operations.

What is the Life-Assist Difference?
Life-Assist has been serving First Responders with emergency medical products and equipment since 1977.

We Offer a Personal Touch in an Automated World

Our genuine care for our customers is demonstrated through the quality of service we provide and the important connections we maintain with our First Responder customers. When you call Life-Assist at 1-800-824-6016 during business hours, you are never be greeted by an automated phone system. Instead, you will speak with one of our friendly and knowledgeable Customer Care Specialists.

Life-Assist is an Employee-Owned Company

Thriving as a family-owned business for 45 years by following the philosophy that the customer always comes first, in July 2022, Life-Assist went one step further, giving its employees a vested interest in serving others by becoming an ESOP company (Employee Stock Ownership Plan).

Charitable Giving is Part of our DNA

Life-Assist takes pride in our support for those who selflessly serve others and contribute to the betterment of the community at large. We partner with First Responders Children’s Foundation, who support children who have lost a First Responder parent in the line of duty.

Life-Assist’s Project Pink was founded in response to the loss of one of our own, Debbie Lang. Debbie’s charity of choice was METAvivor. We honor her by donating a portion of all Project Pink proceeds to this organization every year.

We Offer a Grant Assistance Program to First Responders

More than $600 billion in nationwide grants are available to public safety agencies and local government each year. With our Grant Assistance Program, Life-Assist can help First Responders find the grants they need for EMS equipment.

Same Day Shipping Available

Orders placed by 4pm (M-F) local time will be shipped the same day.

Our National Account Manager Provides Extra Value

Chad Marsh’s experience in the EMS industry spans over 30 years. The key to the longevity of his success is his ability to create relationships with customers and provide valuable information relating to products, protocols and procedures used in the industry.

To contact Chad Marsh, call (503) 936-1879, or email: chad.marsh@life-assist.com

www.Life-Assist.com

Customer Care: 800.824.6016

Homeland Security | Homeland Threat Assessment 2024

Written by AAA Staff on April 13, 2024. Posted in Operations.

Download PDF

The Department of Homeland Security (DHS) Intelligence Enterprise Homeland Threat Assessment reflects the insights from across the Department, the Intelligence Community, and other critical homeland security stakeholders. It focuses on the most direct, pressing threats to our Homeland during the next year and is organized into four sections. We organized this assessment around the Department’s missions that most closely align or apply to these threats—public safety, border and immigration, critical infrastructure, and economic security. As such, many of the threat actors and their efforts cut across mission areas and interact in complex and, at times, reinforcing ways.

Going forward, the annual Homeland Threat Assessment will serve as the primary regular mechanism for articulating and describing the prevailing terrorism threat level, which has previously been done through our issuance of National Terrorism Advisory System (NTAS) bulletins. In the future, the issuance of NTAS bulletins will be reserved for situations where we need to alert the public about a specific or imminent terrorist threat or about a change in the terrorism threat level.

Download PDF

GoAERO Prize Updated Guidelines

Written by AAA Staff on April 12, 2024. Posted in News, Patient Care, Press.

Today, we are excited to announce our Updated Guidelines. The GoAERO blog provides a high-level review of these changes and the complete guidelines are available at https://www.herox.com/goaero.

For a more in-depth review of the updated GoAERO technical rules, guidelines, and timeline, please join our next webinar on Wednesday April 24th at 9 am PST/12 pm EST.

Please note: we have extended the Stage 1 Submission Deadline to December 11, 2024. You can review the complete timeline here.

We look forward to transforming the future of emergency response technology together!

Thank you,
The GoAERO Team

We would also appreciate it if you would forward this email, or share the webinar details with your network and encourage them to join GoAERO.

4/11 CMS Ambulance Open Door Forum

Written by AAA Staff on April 9, 2024. Posted in Regulatory.

The next CMS Ambulance Open Door Forum scheduled for:
Date: Thursday, April 11, 2024
Start Time: 2:00pm-3:00pm PM Eastern Time (ET);
Please dial-in at least 15 minutes before call start time.
Conference Leaders: Jill Darling, Maria Durham

**This Agenda is Subject to Change**
I. Opening Remarks
Chair- Maria Durham, Director, Division of Data Analysis and Market Based Pricing
Moderator – Jill Darling (Office of Communications)
II. Announcements & Updates
1. Medicare Ground Ambulance Data Collection System (GADCS)
III. Open Q&A

**DATE IS SUBJECT TO CHANGE**
Next Ambulance Open Door Forum: TBA
ODF email: AMBULANCEODF@cms.hhs.gov
———————————————————————
This Open Door Forum is open to everyone, but if you are a member of the Press,
you may listen in but please refrain from asking questions during the Q & A portion of
the call. If you have inquiries, please contact CMS at Press@cms.hhs.gov. Thank
you.

NEW and UPDATED Open Door Forum Participation Instructions:
This call will be a Zoom webinar with registration and login instructions below.
Register in advance for this webinar:
https://cms.zoomgov.com/webinar/register/WN_vfsU5LSKR3atiW9T_AhrDg
Meeting ID: 160 823 4591
Passcode: 200020
After registering, you will receive a confirmation email containing information about
joining the webinar. You may also add the webinar to your calendar using the dropdown arrow on the “Webinar Registration Approved” webpage after registering.’

Although the ODFs are now a Zoom webinar, we will only use the audio function, no need for cameras to be on.
For ODF schedule updates and E-Mailing List registration, visit our website at http://www.cms.gov/OpenDoorForums/.

Were you unable to attend the recent Ambulance ODF call? We encourage you to visit our CMS Podcasts and Transcript webpage where you can listen and view the most recent Ambulance ODF call. The webinar recording and transcript will be posted to: https://www.cms.gov/Outreach-andEducation/Outreach/OpenDoorForums/PodcastAndTranscripts.html.

CMS provides free auxiliary aids and services including information in accessible formats. Click here for more information. This will point partners to our CMS.gov version of the “Accessibility & Nondiscrimination notice” page. Thank you.

EMS.gov | New Resources Address Important EMS Issues

Written by AAA Staff on March 24, 2024. Posted in News, Press.

New Resources Address Important EMS Issues

The Latest Updates on Highway Safety Regulations, Rural EMS Education and Special Pathogens

Updating the Highway Safety Improvement Program

The Federal Highway Administration has announced a notice of proposed rulemaking to update the Highway Safety Improvement Program (HSIP) regulations. These regulations address provisions in the Infrastructure Investment and Jobs Act (IIJA), also known as the “Bipartisan Infrastructure Law” (BIL), and reflect current priorities and state-of-practice. The proposed changes would strengthen and advance the safety and equity priorities of the Department of Transportation’s National Roadway Safety Strategy (NRSS) and help states make safety gains to eliminate fatalities and serious injuries on our roadways. Comments must be received on or before April 22, 2024.

Learn More

Quality Improvement Course for Rural EMS

The Rural EMS Quality Improvement Basics Course, from Stratis Health, introduces rural EMS providers to the concept of quality improvement (QI). The program, which was initially designed for the staff of healthcare organizations, has been modified to meet the needs of rural EMS by dividing the QI concept into three distinct levels that build upon each other. The Rural EMS Quality Improvement Basics Course links to the relevant portions of the original healthcare program, while also providing content and examples relevant to rural EMS providers.

Learn More

EMS Model Procedural Guidelines for Special Pathogens

The National Emerging Special Pathogens Training & Education Center (NETEC) has launched a new set of model procedural guidelines designed to manage high-consequence infectious disease (HCID) patient encounters. EMS Model Procedural Guidelines for Special Pathogens is designed to improve the safety of EMS professionals as well as safeguard public health. EMS agencies are encouraged to use the guidelines to create SOPs for transporting and managing patients with a HCID. The guide features step-by-step instructions that can be incorporated into EMS agencies’ existing policies and procedures.

View The Guidelines

Sign up to receive the latest news from the Office of EMS, including webinars, newsletters and industry updates.

Contact Us

1200 New Jersey Avenue, SE
Washington, DC 20590
nhtsa.ems@dot.gov

JEMS | Remembering Mike Touchstone

Written by AAA Staff on March 18, 2024. Posted in News.

Jonathon Feit eulogizes Mike Touchstone for making significant contributions to advance EMS and fire leadership.

Mike Touchstone’s Joie de Vivre: Obituary to Everyone’s Friend, Mentor and Muse

by Jonathon S. Feit, MBA, MA on 03.17.2024

Read a thoughtful memorialization of Mike Touchstone on the JEMS website.

EMS.gov Webinar | EMS Harm Reduction and SUD Treatment

Written by AAA Staff on March 15, 2024. Posted in Operations, Patient Care, Webinars.

WEBINAR

EMS Harm Reduction and SUD Treatment

Hosted by NHTSA’s Office of EMS on March 22 at 2 PM ET / 11 AM PT

According to the National Harm Reduction Coalition, “harm reduction is a set of practical strategies and ideas aimed at reducing negative consequences associated with drug use.” This can include improving access to naloxone (Narcan) to prevent death from opioid overdose, providing sterile syringes to reduce the spread of HIV and hepatitis C, and fentanyl testing programs, among other types of help.

EMS clinicians are often on the frontline of addiction and the unintended consequences of both legal and illicit drug use and substance use disorder (SUD). In addition, drug use greatly impacts the larger context of our nation’s roads and highways through impaired driving and the resulting risks to the impaired driver, other drivers, passengers, bicyclists, and pedestrians. A 2022 NHTSA study of seven trauma centers around the U.S. found that nearly 56% of people injured or killed on roadways tested positive for one or more drugs, including alcohol. The most prevalent drug category was cannabis, and opioids made up 8.5% of cases at the trauma centers.

In this EMS Focus webinar, panelists will discuss:

Harm reduction and SUD treatment in the context of EMS care
Recent research
How innovation and intervention can drive overdose prevention in your community and reduction of other health risks, including traffic crashes that may be a result of impaired driving

REGISTER NOW

Panelists Include:

Kate Elkins, Emergency Medical Services/911 Specialist, NHTSA’s Office of EMS (moderator)
Gerard Carroll, M.D., EMS Medical Director, Cooper University Health Care; Division Head of EMS/Disaster Medicine; and Program Director, EMS Fellowship Program
John Ehrhart, Paramedic; EMS Manager, San Diego Health Connect; Co-Founder, California Paramedic Foundation; and Founder, Mission Critical Protocols
Simon Taxel, Paramedic Crew Chief and Public Safety Diver, Pittsburgh Bureau of EMS; Bloomberg Fellow, Johns Hopkins Bloomberg School of Public Health

About EMS Focus

EMS Focus provides a venue to discuss crucial initiatives, issues and challenges for EMS stakeholders and leaders nationwide. Be sure to visit ems.gov for information about upcoming webinars and to view past recordings.

We are committed to providing equal access to this webinar for all participants. Persons with disabilities in need of an accommodation should contact nhtsa.ems@dot.gov to request an accommodation no later than Friday, March 15, 2024.

Sign up to receive the latest news from the Office of EMS, including webinars, newsletters and industry updates.

Contact Us

1200 New Jersey Avenue, SE
Washington, DC 20590
nhtsa.ems@dot.gov

GoAERO Competition + Informational Webinar Details

Written by AAA Staff on March 13, 2024. Posted in News, Operations, Patient Care, Press.

From GoAEROprize.com

Heroes who look past danger to help people in need,

Heroes to step in to be the difference between triumph and tragedy,

And Heroes who use their minds to create technology that saves lives.

We need those Heroes.

GoAERO is offering $2+ Million in prizes for the best thinkers, creators and inventors to build Emergency Response Flyers and stretch and challenge their minds to unlock a new era of disaster and rescue response.

By unleashing the power of autonomy, speed, and precision, GoAERO is looking for the brightest, boldest and bravest to change the way we rescue and respond to disaster.

This is your chance to make history and save lives.

Register for Informational Webinars

Tuesday, March 19th, 3pm PT/ 6pm ET: https://shorturl.at/fvCG5

CMS Statement on Continued Action to Respond to the Cyberattack on Change Healthcare

Written by AAA Staff on March 11, 2024. Posted in Legislative, News, Private Insurance.

From the Centers for Medicare & Medicaid Services on March 9

The Centers for Medicare & Medicaid Services (CMS) is continuing to monitor and assess the impact that the cyberattack on UnitedHealth Group’s subsidiary Change Healthcare has had on all provider and supplier types. Today, CMS is announcing that, in addition to considering applications for accelerated payments for Medicare Part A providers, we will also be considering applications for advance payments for Part B suppliers.

Over the last few days, we have continued to meet with health plans, providers and suppliers to hear about their most pressing concerns. As announced previously, we have directed our Medicare Administrative Contractors (MACs) to expedite actions needed for providers and suppliers to change the clearinghouse they use and to accept paper claims if providers need to use that method. We will continue to respond to provider and supplier inquiries regarding MAC processes.

CMS also recognizes that many Medicaid providers are deeply affected by the impact of the cyberattack. We are continuing to work closely with States and are urging Medicaid managed care plans to make prospective payments to impacted providers, as well.

All MACs will provide public information on how to submit a request for a Medicare accelerated or advance payment on their websites as early as today, Saturday, March 9.

CMS looks forward to continuing to support the provider community during this difficult situation. All affected providers should reach out to health plans and other payers for assistance with the disruption. CMS has encouraged Medicare Advantage (MA) organizations to offer advance funding to providers affected by this cyberattack. The rules governing CMS’s payments to MA organizations and Part D sponsors remain unchanged. Please note that nothing in this statement speaks to the arrangements between MA organizations or Part D sponsors and their contracted providers or facilities.

For more information view the Fact Sheet: https://www.cms.gov/newsroom/fact-sheets/change-healthcare/optum-payment-disruption-chopd-accelerated-payments-part-providers-and-advance

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GoAERO Competition + Informational Webinar Details

Written by AAA Staff on February 22, 2024. Posted in News, Operations, Patient Care, Press.

From GoAEROprize.com

Heroes who look past danger to help people in need,

Heroes to step in to be the difference between triumph and tragedy,

And Heroes who use their minds to create technology that saves lives.

We need those Heroes.

By unleashing the power of autonomy, speed, and precision, GoAERO is looking for the brightest, boldest and bravest to change the way we rescue and respond to disaster.

This is your chance to make history and save lives.

Register for Informational Webinars

Thursday, February 29th, 6am PT/ 9am ET: https://shorturl.at/rtOS0
Tuesday, March 19th, 3pm PT/ 6pm ET: https://shorturl.at/fvCG5

EMS.gov | HHS Announces New Performance Goals to Enhance Cybersecurity

Written by AAA Staff on February 19, 2024. Posted in Regulatory, Technology.

HHS Announces New Cybersecurity Performance Goals to Enhance Cybersecurity

The U.S. Department of Health and Human Services (HHS), through the Administration for Strategic Preparedness and Response (ASPR), announced on January 24, 2024, the release of new voluntary Cybersecurity Performance Goals (CPGs). These guidelines are specifically designed for the Health Care and Public Health (HPH) sector. Additionally, HHS launched a gateway website to streamline the implementation of these cybersecurity measures and facilitate access to extensive resources provided by HHS and its federal partners.

The HPH CPGs are designed to better protect the healthcare sector from cyberattacks, improve response when events occur and minimize residual risk. HPH CPGs include both essential goals to outline minimum foundational practices for cybersecurity performance and enhanced goals to encourage adoption of more advanced practices.

View Resource

As healthcare continues to embrace digital transformation, the importance of cybersecurity has never been more critical. We urge the EMS community to engage with this significant development. The new CPGs represent a proactive step by ASPR and HHS to fortify the healthcare sector’s defenses against cyber threats.

Sign up to receive the latest news from the Office of EMS, including webinars, newsletters and industry updates.

Contact Us

1200 New Jersey Avenue, SE
Washington, DC 20590
nhtsa.ems@dot.gov

Ninth Brain: Unleashing Power-Packed Features with Open API, Single Sign-On, and Advanced Tools!

Written by AAA Staff on February 14, 2024. Posted in Marketing & PR, News.

FOR IMMEDIATE RELEASE

In the ever-evolving landscape of workforce management, Ninth Brain emerges as a pioneering force, dedicated to delivering innovative solutions that prioritize cutting-edge technology, user-friendly features, and steadfast compliance.

As Ninth Brain continues its journey, they are thrilled to unveil insights into key functionalities that position them as a leader in the industry.

Developer Open API: Seamless Integration

Central to Ninth Brain’s commitment to seamless data integration is their Developer Open API. Features like the Forms Module API Endpoint enables management to effortlessly retrieve form responses, facilitate in-depth analysis and examine with external dashboard utilization. The Run Log Module API Endpoint empowers management to monitor and analyze debriefs, chart reviews, and utilization responses, providing invaluable insights into its patient care.

OSHA Logs and Electronic Reporting: Simplified Compliance

In the realm of Emergency Medical Services, compliance with OSHA regulations is paramount. Ninth Brain’s Employee Health module streamlines the management of workplace injuries, illnesses, and incidents. This not only ensures compliance but also enhances reporting efficiency, enabling EMS agencies to focus on their life-saving missions.

Captain Grey Matter/Co-Owner, Lisa Tedford, underscores the commitment: “Our team is dedicated to researching regulations and finding innovative ways to enhance our platform. We aim to alleviate tasks for busy administrators, making our partners more efficient and ensuring ongoing compliance. The recent update to the Employee Health module was driven by the need to keep agencies compliant with the new 2024 electronic reporting mandate, designed to simplify the submission process.”

Single Sign-On: Effortless Access

Ninth Brain’s adoption of Single Sign-On (SSO) has revolutionized the user experience, providing a simplified and secure login process. Centralizing authentication, SSO reduces password fatigue, enhances security, and streamlines administrative management. Password Administrators are encouraged to explore the benefits of SSO with their tech teams, as enabling this feature is an impactful and positive change.

Accreditation Assistant: Streamlined Process

Notably, Ninth Brain recently introduced the Accreditation Assistant, revolutionizing the compliance journey for EMS leaders with features tailored for accreditation and reaccreditation, streamlined processes, and intelligent recommendations, reinforcing Ninth Brain’s commitment to comprehensive solutions.

Co-Owner Holly Taylor emphasizes, “At Ninth Brain, we’re all about making things better. Our latest software enhancements? They’re like your personal efficiency boosters, helping our partners get things done smarter and keeping them in the compliance sweet spot. We’re not just here to deliver software; we’re here to make their work life a whole lot easier!”

By highlighting these features, Ninth Brain reaffirms its commitment to supporting EMS agencies in optimizing workforce management, ensuring compliance, and contributing to the successful delivery of life-saving services. As they look ahead, Ninth Brain remains at the forefront of industry compliance, continuously enhancing its software to meet the evolving needs of its clients.

About Ninth Brain: Ninth Brain’s mission is to be a long-standing partner with First Responder agencies by providing quality and intuitive software solutions that evolve with the industry. They bundle comprehensive software with a fun, devoted, and knowledgeable support team that make their clients their top priority. Throughout the past 20+ years of their journey, Ninth Brain has continuously developed enhancements to provide efficiencies, aid in industry compliance, and ultimately elevate patient care practices. Ninth Brain offers Credential Tracking, Learning Management System, Workforce Scheduling, Quality Improvement Tracking, Digital Forms and Checklists, and more! To learn more, visit www.ninthbrain.com

Contact: Holly Taylor, Chief Hat Holder

Phone: 888-364-9995 ext. 320

Email: Holly@ninthbrain.com

AAA President Strozyk to Testify Before Congressional Committee

Written by AAA Staff on February 13, 2024. Posted in Government Affairs, Legislative, Uncategorized.

AAA President Randy Strozyk will testify tomorrow, February 14, at 10:00 am (eastern) before the Health Subcommittee of the Energy and Commerce Committee of the U.S. House of Representatives. The hearing is on “Legislative Proposals To Support Patients And Caregivers” and Randy will speak to the SIREN Reauthorization Act (H.R. 4646), EMS for Children Reauthorization Act (H.R. 6960) and legislation to reauthorize the Traumatic Brain Injury program (H.R. 7208) and certain poison control programs (H.R. 7251).

The hearing will be live streamed online at https://youtu.be/Zy-4NCuheGM.
The hearing will provide the AAA and Randy with a platform to voice support for the EMS proposals on the agenda as well as raise the need for the Committee to address our Medicare ambulance add-on payments and the EMS workforce shortage. For a copy of Randy’s written testimony and other details of the hearing, please go to the Committee website for the hearing.

JEMS | Adapting to Survive EMS Workplace Shortages, Part I

Written by AAA Staff on February 7, 2024. Posted in Human Resources.

From the Journal of Emergency Medical Services on February 1, 2024

Why are females and individuals who identify as Black, indigenous and/or People of Color underrepresented in EMS?

Knolan Rawlins, PhD

EMS providers and leaders across all levels of care reported staffing to be one of the top challenges facing the industry. A recent study reported over 86% of providers experienced recruitment and retention challenges in the past three years.¹

Fitch (2023) reported that many EMS providers have lowered educational requirements, lowered the minimum age, and eliminated certification before hiring (i.e., paid time for training) to overcome workforce shortages. Despite these efforts, maintaining an adequate workforce in EMS organizations and agencies across the country is a growing concern.

Providers continue to evaluate and adjust recruitment strategies to maintain their critical role in the public health and safety system in the United States; however, little is known about the efforts to recruit from underrepresented populations.

HHS/ASPR Project ECHO Clinical Readiness Rounds are Returning

Written by AAA Staff on February 7, 2024. Posted in Patient Care, Quality.

The U.S. Department of Health and Human Services Office of the Administration for Strategic Preparedness and Response (ASPR) and Project ECHO have launched this program designed to create peer-to-peer learning networks where clinicians who have more experience treating patients in emergency situations share their challenges and successes with clinicians across the U.S. and around the world with a wide variety of experience of these situations. Topics for sessions are based on new and emergent information around emergency preparedness, as well as topics requested by participants.

Certification & Credits

Sessions will be eligible for CME credits.

Contact Information

Please contact C19ECHO@salud.unm.edu for more information.

CMS Finalizes Rule to Expand Access to Health Information and Improve the Prior Auth Process

Written by AAA Staff on January 17, 2024. Posted in Regulatory.

From CMS.gov

Final rule modernizes the health care system and reduces patient and provider burden by streamlining the prior authorization process

As part of the Biden-Harris Administration’s ongoing commitment to increasing health data exchange and strengthening access to care, the Centers for Medicare & Medicaid Services (CMS) finalized the CMS Interoperability and Prior Authorization Final Rule (CMS-0057-F) today. The rule sets requirements for Medicare Advantage (MA) organizations, Medicaid and the Children’s Health Insurance Program (CHIP) fee-for-service (FFS) programs, Medicaid managed care plans, CHIP managed care entities, and issuers of Qualified Health Plans (QHPs) offered on the Federally-Facilitated Exchanges (FFEs), (collectively “impacted payers”), to improve the electronic exchange of health information and prior authorization processes for medical items and services. Together, these policies will improve prior authorization processes and reduce burden on patients, providers, and payers, resulting in approximately $15 billion of estimated savings over ten years.

“When a doctor says a patient needs a procedure, it is essential that it happens in a timely manner,” said HHS Secretary Xavier Becerra. “Too many Americans are left in limbo, waiting for approval from their insurance company. Today the Biden-Harris Administration is announcing strong action that will shorten these wait times by streamlining and better digitizing the approval process.”

“CMS is committed to breaking down barriers in the health care system to make it easier for doctors and nurses to provide the care that people need to stay healthy,” said CMS Administrator Chiquita Brooks-LaSure. “Increasing efficiency and enabling health care data to flow freely and securely between patients, providers, and payers and streamlining prior authorization processes supports better health outcomes and a better health care experience for all.”

While prior authorization can help ensure medical care is necessary and appropriate, it can sometimes be an obstacle to necessary patient care when providers must navigate complex and widely varying payer requirements or face long waits for prior authorization decisions. This final rule establishes requirements for certain payers to streamline the prior authorization process and complements the Medicare Advantage requirements finalized in the Contract Year (CY) 2024 MA and Part D final rule, which add continuity of care requirements and reduce disruptions for beneficiaries. Beginning primarily in 2026, impacted payers (not including QHP issuers on the FFEs) will be required to send prior authorization decisions within 72 hours for expedited (i.e., urgent) requests and seven calendar days for standard (i.e., non-urgent) requests for medical items and services. For some payers, this new timeframe for standard requests cuts current decision timeframes in half. The rule also requires all impacted payers to include a specific reason for denying a prior authorization request, which will help facilitate resubmission of the request or an appeal when needed. Finally, impacted payers will be required to publicly report prior authorization metrics, similar to the metrics Medicare FFS already makes available.

The rule also requires impacted payers to implement a Health Level 7 (HL7®) Fast Healthcare Interoperability Resources (FHIR®) Prior Authorization application programming interface (API), which can be used to facilitate a more efficient electronic prior authorization process between providers and payers by automating the end-to-end prior authorization process. Medicare FFS has already implemented an electronic prior authorization API, demonstrating the efficiencies other payers could realize by implementing such an API. Together, these new requirements for the prior authorization process will reduce administrative burden on the healthcare workforce, empower clinicians to spend more time providing direct care to their patients, and prevent avoidable delays in care for patients.

In response to feedback received on multiple rules and extensive stakeholder outreach HHS will be announcing the use of enforcement discretion for the Health Insurance Portability and Accountability Act of 1996 (HIPAA) X12 278 prior authorization transaction standard to further promote efficiency in the prior authorization process. Covered entities that implement an all-FHIR-based Prior Authorization API pursuant to the CMS Interoperability and Prior Authorization Final Rule (CMS-0057-F) who do not use the X12 278 standard as part of their API implementation will not be enforced against under HIPAA Administrative Simplification, thus allowing limited flexibility for covered entities to use a FHIR-only or FHIR and X12 combination API to meet the requirements of the CMS Interoperability and Prior Authorization final rule. Covered entities may also choose to make available an X12-only prior authorization transaction. HHS will continue to evaluate the HIPAA prior authorization transaction standards for future rulemaking.

CMS is also finalizing API requirements to increase health data exchange and foster a more efficient health care system for all. CMS values public input and considered the comments submitted by the public, including patients, providers, and payers, in finalizing the rule. Informed by these public comments, CMS is delaying the dates for compliance with the API policies from generally January 1, 2026, to January 1, 2027. In addition to the Prior Authorization API, beginning January 2027, impacted payers will be required to expand their current Patient Access API to include information about prior authorizations and to implement a Provider Access API that providers can use to retrieve their patients’ claims, encounter, clinical, and prior authorization data. Also informed by public comments on previous payer-to-payer data exchange policies, we are requiring impacted payers to exchange, with a patient’s permission, most of those same data using a Payer-to-Payer FHIR API when a patient moves between payers or has multiple concurrent payers.

Finally, the rule also adds a new Electronic Prior Authorization measure for eligible clinicians under the Merit-based Incentive Payment System (MIPS) Promoting Interoperability performance category and eligible hospitals and critical access hospitals (CAHs) in the Medicare Promoting Interoperability Program to report their use of payers’ Prior Authorization APIs to submit an electronic prior authorization request. Together, these policies will help to create a more efficient prior authorization process and support better access to health information and timely, high-quality care.

The final rule is available to review here: https://www.cms.gov/files/document/cms-0057-f.pdf.

The fact sheet for this final rule is available here: https://www.cms.gov/newsroom/fact-sheets/cms-interoperability-and-prior-authorization-final-rule-cms-0057-f.

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Author: AAA Staff

New Resources Address Important EMS Issues

Contact Us

EMS Harm Reduction and SUD Treatment

Panelists Include:

About EMS Focus

Contact Us

Register for Informational Webinars

Register for Informational Webinars

HHS Announces New Cybersecurity Performance Goals to Enhance Cybersecurity

Contact Us

Certification & Credits

Contact Information

Recent Announcements

TODAY: Rural Emergency Medical Service (EMS) Training Grant Pre-Application Webinar

New Resources Available on EMS.gov

Contact Us

Statement from Global Medical Response

About the National EMS Quality Alliance

Stay In Touch!