NEMSAC | Meeting August 9-10
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Washington, DC— While the Centers for Medicare & Medicaid Services (CMS) has decided to end the Emergency Triage, Treat, and Transport (ET3) Model two years early on December 31, 2023, the American Ambulance Association (AAA) remains committed to working with CMS on all future efforts to design programs that fully utilize the ground ambulance services in the delivery of mobile healthcare services. CMS made the decision to end the model “due to lower than expected participation and lower than projected interventions.”
The AAA is encouraged that CMS has stated that, “the lessons learned from the ET3 Model can aid in the development of potential future initiatives.” Our members are committed to supporting such future efforts to make sure that the requirements support true treatment in place and recognize the unique needs of rural ground ambulance services and the communities they serve. Moreover, we encourage CMS to work with the AAA to move forward with alternative destination as a permanent policy based not only on the lessons learned from the ET3 model, but also those garnered as a result of the Public Health Emergency (PHE) waiver. The AAA continues to support efforts to refine the Medicare ground ambulance emergency benefit to support delivering pre-hospital services to the patients who need them at the time they need them and where they need them.
From CMS on July 19, 2023
The next CMS Ambulance Open Door Forum scheduled for:
Date: Thursday, July 27, 2023
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**
Chair- Maria Durham, Director, Division of Data Analysis and Market Based Pricing
Moderator – Jill Darling (Office of Communications)
Announcements & Updates
III. Open Q&A
**DATE IS SUBJECT TO CHANGE**
Next Ambulance Open Door Forum: TBA
ODF email: AMBULANCEODF@cms.hhs.gov
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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 ID: 161 099 7532
Passcode: 131371
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 drop-down 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/
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-
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.
Thank you to Rob Lawrence of Pro EMS, EMS1, and the California Ambulance Association for connecting with #Ambucon23 keynote Anna Liotta and Royal Ambulance’s Steve Grau!
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This June—and every month—EMS is proud to care for YOU! #Pride #pride2023 #pridemonth pic.twitter.com/Qk52Gai50S
— AmericanAmbulanceAsc (@amerambassoc) June 9, 2023
Contact Congress ►https://www.votervoice.net/Ambulance/…
Annual Conference & Trade Show June 26–28, 2023 in Las Vegas ► https://annual.ambulance.org/
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The COVID-19 Public Health Emergency is to end on May 11, 2023. The ending of the Public Health Emergency may impact an individual’s coverage of COVID-19 tests. We encourage you to know these changes and share the New Consumer Fact Sheet on COVID-19 tests.
Consumer Fact Sheets:
Before May 11, 2023
If you have any type of health insurance, you can get up to eight over-the-counter tests per month with no out-of-pocket costs. Over-the-counter tests are available in most pharmacies and may also be available online for delivery.
After May 11, 2023
Laboratory tests for COVID-19 that are ordered by your provider will still be covered with no out-of-pocket costs for people with Medicare. Over-the-counter tests will still be available, but there may be out-of-pocket costs. Coverage of over-the-counter tests may vary by your insurance type, as described below.
What does this mean for Medicare Beneficiaries?
Generally, Medicare doesn’t cover or pay for over-the counter products. The demonstration that has allowed us to offer coverage for COVID-19 over-the-counter tests at no cost ends on May 11, 2023.
However, if you are enrolled in Medicare Part B, you will continue to have coverage with no out-of-pocket costs for appropriate laboratory-based COVID-19 PCR and antigen tests, when a provider orders them (such as drive-through PCR and antigen testing or testing in a provider’s office).
If you are enrolled in a Medicare Advantage plan, you may have more access to tests depending on your benefits. Check with your plan.
What does this mean for people with Medicaid or Children’s Health Insurance Program?
If you have coverage through Medicaid or the Children’s Health Insurance Program, you will have access to COVID-19 over-the-counter and laboratory testing through September 30, 2024. After that date, coverage of testing may vary by state.
What does this mean for people with Private Insurance?
If you have private insurance, coverage will vary depending on your health plan. However, private plans won’t be required by federal law to cover over-the counter and laboratory-based COVID-19 tests after
May 11, 2023. If your insurance chooses to cover COVID-19 testing, they may require cost sharing, prior authorization, or other forms of medical management.
Please either Join!
orMarch 28, 2023
The Honorable Bernie Sanders
Chair
Health, Education, Labor, & Pensions Committee
United States Senate
Washington, DC 20510
The Honorable Bob Casey
Health, Education, Labor, & Pensions Committee
United States Senate
Washington, DC 20510
The Honorable Bill Cassidy
Ranking Member
Health, Education, Labor, & Pensions Committee
United States Senate
Washington, DC 20510
The Honorable Mitt Romney
Health, Education, Labor, & Pensions Committee
United States Senate
Washington, DC 20510
Dear Chair Sanders, Ranking Member Cassidy, Senator Casey, and Senate Romney,
I am writing on behalf of the American Ambulance Association (AAA) to provide comments on policies the Committee should consider during the reauthorization of the Pandemic and All- Hazards Preparedness Act (PAHPA).
The members of the AAA provide mobile health care services to more than 75 percent of Americans. These essential mobile health care services include the local operation of the 9-1- 1 emergency medical services (EMS) system, as well as both emergent and non-emergency interfacility care transition ambulance services and transportation. Often ground ambulance service organizations are the first medical professionals to interact with individuals in need of a health care encounter. These organizations also serve as the health care safety net for many small communities, especially those located in rural areas where other providers and suppliers have reduced their hours of operation or left the community altogether. As such, these organizations play a critical and unique role in the country’s health care infrastructure.
Ground ambulance services are essential to our nation’s emergency medical response system, whether they are needed for a pandemic, natural disaster, or terrorist attack. The country’s EMS system requires federal support to ensure the availability of a well-trained workforce to provide these ground ambulance services. Ground ambulance services are also essential to protecting patient access to the right level of facility-based treatment options.
The AAA supports continued funding for the Hospital Preparedness Program (HPP). Our members have been working closely with the Assistant Secretary for Planning and Evaluation (ASPR) to find ways to direct some of the currently allocated HPP dollars to support ground ambulance services, particularly to address the workforce crisis and support expanded recruitment and training for emergency medical technicians (EMTs) and paramedics. During these discussions, it has become clear that more direct language authorizing the use of a specified portion of the HPP funds to support non-governmental and governmental ground ambulance services would allow ASPR to tackle this issue in a timelier manner.
Ground ambulance service organizations are facing crippling staffing challenges that threaten the provision of crucial emergency healthcare services at a time of maximum need. As we face a pandemic that waxes and wanes but does not end, our 9-1-1 infrastructure remains at risk due to these severe workforce shortages. The 2022 Ambulance Employee Workforce Turnover Study by the American Ambulance Association (AAA) and Newton 360 – the most sweeping survey of its kind involving nearly 20,000 employees working at 258 EMS organizations — found that overall turnover among paramedics and EMTs ranges from 20 to 30 percent annually with organizations on average having 30% of their paramedic positions open and 29% of their EMT positions.
The Congress and the President recognized the crisis and the FY23 Consolidated Appropriations called on ASRP to address this shortage by implementing a grant program to support non- governmental and governmental ground ambulance suppliers and providers through the HPP to address emergency medical services preparedness and response in light of the workforce shortage. While this language is helpful, the AAA recognizes that authorizing authority would provide a more sustainable approach to support an EMS workforce grant program.
Such a program would be consistent with the goals of ASRP. The FY24 HHS Budget in Brief highlights to goal of making “transformative investments in pandemic preparedness and biodefense across HHS public health agencies to enable an agile, coordinated, and comprehensive public health response to future threats and protect American lives, families, and the economy.” (HHS Budget in Brief 142). Ground ambulance medical services are an essential part of this preparedness and response goal.
Our nation’s ground ambulance service organizations, EMTs, and paramedics need Congress to address the EMS workforce challenges facing these front-line health care workers by including direct authority to use $50 million of the HPP funding to establish an EMS workforce grant program to address the crippling EMS workforce shortage, including in underserved, rural, and tribal areas and/or address health disparities related to accessing prehospital ground ambulance healthcare services, including critical care transport. The grants would be available to governmental and non-governmental EMS organizations to support the recruitment and training of emergency medical technicians and paramedics. The program would emphasize ensuring a well-trained and adequate ground ambulance services workforce in underserved, rural, and tribal areas and/or addressing health disparities related to accessing prehospital ground ambulance health care services.
This program is critically important to supporting the non-governmental and governmental ground ambulance service organizations that are the backbone of the country’s first emergency medical response system. The dollars would be used to provide grants directly to non- governmental and governmental ground ambulance service organizations to support training and retention programs, such as paying for initial training; providing tuition for community colleges EMT/ paramedic training courses; paying for required continuing education courses; supporting costs related to licensure and certification; and supporting individuals in underserved areas with transportation, child care, or similar services to promote accessing training.
The most significant gap in PAHPA and HHS on preparedness and readiness activities is the exclusion of non-governmental entities from many of the federal programs targeted to first responders and EMS. This oversight results in more than one-third of local communities and their citizens not being able to access or benefit from the programs and funding that Congress intended be provided to support them. The AAA requests that the Committee recognize the decision-making authority to rely on non-governmental ground ambulance service organizations and provide access to programs that are currently available to governmental organizations.
During the pandemic, non-governmental local community ground ambulance organizations were not permitted to apply for or participant in many of the federal grant programs in place during the pandemic. As a result, these programs fell short of the goal of supporting preparedness and response activities at the local level.
The distinction between governmental and non-governmental appears to be based on outdated assumptions that first responders are only governmental or not-for-profit entities. This assumption ignores the decisions of state and local governments to contract with private ground ambulance service providers and suppliers to provide 911 or equivalent services. The federal government should respect these local decisions and support all ground ambulance services as first-responders and EMS.
One example of this problem is the FEMA public assistance grant program that reimbursed “first responders” for PPE and other expenses related to the response to COVID-19. When non- governmental (including not-for-profit) emergency ambulance service organizations sought direct reimbursement under the program, they were turned away. This differential treatment impacts communities across the United States, including those in Arkansas, California, Colorado, Florida, Georgia, Indiana, Louisiana, Massachusetts, Mississippi, Nevada, New York, Oregon, Texas, and Wisconsin, among others.
Appendix A includes list of some of the program the AAA has identified that should reviewed and updated to include non-governmental entities.
The solution to this problem is to use the more inclusive language that the Congress adopted in the Homeland Security Act of 2002 (6 U.S.C. § 101) on non-governmental and governmental entities within the definition of “emergency response providers.” This language provides access to all ground ambulance services and the communities they serve to funding when available to support preparedness and response activities.
On behalf of ground ambulance service organizations of the AAA, I want to thank you for the opportunity to provide comments on the PAHPA. We look forward to working with your team as you continue develop these policies.
Sincerely,
Randy Strozyk President
http://www.firegrantsupport.com/afg/faq/08/faq_emer.aspx#q1
The grant program prohibits “for-profit” organizations from applying for grant funding.
Retrieved from http://www.firegrantsupport.com/safer/faq/08/faq_elig.aspx#q1
Only fire departments and volunteer firefighter interest organizations are eligible for SAFER grants.
$45B to reimburse activities such as medical response, procurement of PPE National Guard deployment, coordination of logistics, implementation of safety measures, and provision of community services. According to FEMA, these funds will cover overtime and backfill costs; the costs of supplies, such as disinfectants, medical supplies and PPE; and apparatus usage. (The federal government will cover 75% of these costs.) NAEMT recommends FEMA’s new sheet on FEMA’s Simplified Public Assistance Application. In addition, you should consult with their state emergency managers to begin the process of being reimbursed. Eligible to apply: Public and some non-profit services.
The Emergency Management Baseline Assessment Grant (EMBAG) program provides non- disaster funding to support developing, maintaining, and revising voluntary national-level standards and peer-review assessment processes for emergency management and using these standards and processes to assess state, local, tribal, and territorial emergency management programs and professionals.
The Nonprofit Security Grant Program (NSGP) provides funding support for target hardening and other physical security enhancements and activities to nonprofit organizations that are at high risk of terrorist attack.
The Siren Act supports public and non-profit rural EMS agencies through grants to train and recruit staff, fund continuing education, and purchase equipment and supplies from naloxone and first aid kits to power stretchers or new ambulances.
Eligibility requirements exclude for-profit private EMS.
Public Safety Officers’ Benefits Improvements Act of 2011 (S. 1696).
Added non-profits (but still excluded for profits) in the Public Safety Officers’ Benefit (PSOB) program. This legislation extended the federal death benefit coverage to paramedics and emergency medical technicians (EMTs) who work for a private non-profit emergency medical
services (EMS) agency and die in the line of duty and thank you for including the language of the Dale Long Emergency Medical Service Providers Protection Act (S. 385) in this new bill. Congress established the Public Safety Officer Benefit program to provide assistance to the survivors of police officers, firefighters and paramedics and emergency medical technicians in the event of their death in the line of duty. The benefit, however, currently only applies to those public safety officers employed by a federal, state, or local government entity and non-profits.
Retrieved from http://www.iowahomelandsecurity.org/Portals/0/CountyCoordinators/Grants/FFY09HSGPguida nce.pdf
DHS requires State and local governments to include emergency medical services (EMS) providers in their State and Urban Area homeland security plans. In accordance with this requirement, and as States, territories, localities, and tribes complete their application materials for the FY 2009 HSGP, DHS reminds our homeland security partners of the importance for proactive inclusion of various State, regional, and local response disciplines who have important roles and responsibilities in prevention, deterrence, protection, and response activities. Inclusion should take place with respect to planning, organization, equipment, training, and exercise efforts. Response disciplines include, but are not limited to: governmental and nongovernmental emergency medical, firefighting, and law enforcement services; public health; hospitals; emergency management; hazardous materials; public safety communications; public works; and governmental leadership and administration personnel.
Retrieved from http://www.fema.gov/government/grant/iecgp/index.shtm
Eligibility and Funding
The Governor of each State and territory has designated a State Administrative Agency (SAA), which can apply for and administer the funds under IECGP. The SAA is the only agency eligible to apply for IECGP funds.
Retrieved from http://ojp.usdoj.gov/odp/docs/cedap_factsheet_2008.pdf
Eligibility
Eligible applicants include law enforcement agencies, fire, and other emergency responders who demonstrate that the equipment will be used to improve their ability and capacity to respond to a major critical incident or work with other first responders. Awardees must not have received technology funding under the Urban Areas Security Initiative, or the Assistance to Firefighters Grants program since Oct. 1, 2006. Organizations must submit applications through the Responder Knowledge Base (RKB) website at www.rkb.us.
Please contact the American Ambulance Association at info@ambulance.org.
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Please either Join!
orThe 2023 EMS Trend Survey explores issues tied to provider recruitment and retention, including leadership; health and wellness support; and the impact of staffing shortages on providers’ work and job-related stress. We invite EMS field providers, supervisors, senior leadership and educators from all service types and response areas to participate and share the survey with their colleagues. The questionnaire will only take about 10 minutes to complete. Share your input by March 15, and you’ll be entered for a chance to win a $50 Amazon gift card. Your response is confidential and the results, including expert analysis from industry experts from all walks of EMS, will be published in the EMS Trend Report “What paramedics want in 2023” Digital Edition in July, 2023, and shared at the 2023 Pinnacle EMS Leadership Forum. The EMS Trend Report is produced by Fitch & Associates and EMS1, in partnership with EMS Survey Team, and the National EMS Management Association. If you have any questions, please email emstrends@fitchassoc.com
March 15th // 12-1pm ET
The COVID-19 pandemic has had a significant impact on the healthcare system and has highlighted the need for healthcare reform. As the world moves forward from the pandemic, it is likely that the future of healthcare will be shaped by the need for cost containment while continuing to shift the healthcare delivery system to a more value-based care model.
For the past three years, we have seen new innovative approaches to healthcare delivery including the rapid adoption of telemedicine, and it is expected that this trend will continue in the post-pandemic world. Reimbursement reform continues to be an important issue for Emergency Medical Services (EMS) systems, as it affects their ability to provide high-quality care to patients. Despite the disruption that we have seen for the last three years, the EMS industry has continued to push forward with new innovative approaches to service delivery including the expansion of community paramedicine programs and the implementation of alternative programs like the Emergency Triage, Treat, and Transport (ET3) model. During this session, the panelists will discuss the current healthcare landscape, including what innovative programs may be here to stay and what it means for EMS Systems.
Jose G. Cabañas, MD, MPH, FAEMS
President, NAEMSP
Jonathan Oberlander, PhD
Professor & Chair of Social Medicine and Professor of Health Policy & Management
University of North Carolina – Chapel Hill
Paul Hinchey, MD, MBA, FAEMS
COO for University Hospitals in Cleveland, Ohio
Larry McMillan, MHA
Chief Compliance Officer & ET3 Project Lead, Wake County EMS
Randy Strozyk, MBA
President, American Ambulance Association
Lekshmi Kumar, MD, MPH, FAEMS
Medical Director, Grady EMS
Melissa Kroll, MD
Washington University, St. Louis
In October 2022, The National EMS Museum Board of Directors made a progressive and far-reaching decision to re-image the function and direction of the Museum and its Board of Directors. At that time, the Board decided to announce an initiative to reach out to more communities to recruit a diverse and interested group of leaders that could aggressively move the Museum forward through new strategic initiatives. After an extensive search and interview process conducted by an independent review panel, The National EMS Museum is pleased to announce the new members of The National EMS Museum Board of Directors with skills in EMS, museum management, fundraising and sponsorship development:
Larry J. Appel, M.B.A., EMT joins the NEMSM Board of Directors with 45 years of experience in EMS as an EMT. His experiences include non-profit director, business owner, manager of several Maryland-based commercial ambulance services, paid 911 EMS provider, V.P. of Ambulance Sales for FR Conversions, and currently the EMS Business Development Manager for Bioquell (An Ecolab Solution).
Fred Claridge is retired and living in North Carolina after a 41-year career in EMS and emergency management. He served as a field provider, EMS instructor, and administrator, including directing one of the largest EMS systems in the country, as well as service as an emergency planner. Additionally, Fred has served as the inaugural editor of the EMS Historian: The Journal of The National EMS Museum.
Fred is serving at the National EMS Museum Vice President, 2023-2025
Elyssa Gonzales is a Master of Arts candidate at Johns Hopkins University for Museum Studies and Nonprofit Management with an additional focus on understanding museum operations and the continuing value to their communities. Her interests lay in supporting the building and/or restructuring museums from the ground up and to help museums find their unique way of supporting their communities.
J. Sam Hurley, MPH, EMPS, NRP currently serves as the Director of Maine’s Bureau of Emergency Medical Services. Sam began his career in EMS in North Carolina at a small rural volunteer fire department and subsequently continued his involvement with EMS throughout his undergraduate studies at the University of North Carolina at Chapel Hill and graduate school at Emory University, where he worked for Grady Health System in downtown Atlanta.
Cindy Kessler holds a Bachelors of Science in Design and has worked in various positions with museums, aquariums, and nonprofit organizations for the better part of three decades. Outside of her nonprofit work, Cindy is an avid singer, having performed at Carnegie Hall and The Kennedy Center. She is also a writer and artist, and enjoys directing youth theater performances in her spare time.
Cindy is serving at the National EMS Museum Secretary, 2023
Christopher Montera has more than 34 years of experience in Paramedic Services, Public Health, and the Fire Service. He is the Director of State and Federal Programs for ESO and the former Chief Executive Officer at Eagle County Health Service District and holds a Master’s in Health Leadership.
Chris is serving at the National EMS Museum Treasurer, 2023
Gary M. Schindele has been an EMT for 47 years and is a leading subject matter expert in the field of emergency preparedness design and implementation and serves as a member of the Central Florida Disaster Medical Coalition. Gary also volunteers as the Public Affairs Officer for the United States Naval Sea Cadet Corps youth program. Gary is also the President and Owner of Paladin Healthcare LLC which manufactures the original Fairfield Equipment Rail, once the standard for Equipment Management in most ambulances back in the late 70’s and 80’s.
Dave Zaiman has been in and around EMS for over 30 years. He spent 15 years working in the field as an EMT, EMD, and Paramedic. Dave finished his career at Hennepin County Medical Center in Minneapolis MN. Since then, Dave has held several leadership roles in the healthcare technology industry. Dave currently serves as Pulsara’s VP Sales – Midwest.
Dave is serving at the National EMS Museum President, 2023-2025
Alan DeYoung is the current Executive Director of the Wisconsin EMS Association with a passion for strategic development and business marketing. Alan will serve as an Ex-Officio member of the Board of Directors as the Immediate Past President, 2023-2025.
The Board of Directors will continue to be supported by Kristy Van Hoven (Museum Director), Tom Scott (Accounting), and the incredible volunteers of this organization. We invite anyone interested in volunteering to reach out to the Board of Directors at board@emsmuseum. org or Kristy at director@emsmuseum. org.
The National EMS Museum is a volunteer-led organization that collects, preserves, and shares the history of emergency medical response in the United States to celebrate the contributions of providers across the country and inspire future professionals to take up the call. To learn more about The National EMS Museum, please visit emsmuseum.org.