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Author: Tristan North

Updates on the VA Final Rule and NDAA Workforce Amendment

Written by Tristan North on . Posted in Uncategorized.

House Passes Language to Stop FY2025 Start of VA Final Rule

On June 5, the U.S. House of Representatives passed the FY2025 MilCon-VA-Related Agencies Appropriations bill. Included in the bill was language championed by Subcommittee Chair John Carter (R-TX) and Representatives Ryan Zinke (R-MT), Michael Guest (R-MS), Val Hoyle (D-OR), Brad Finstad (R-MN) and John Rutherford (R-FL) amongst numerous others that would prohibit the Department of Veterans Affairs from using funding during FY2025 (October 1, 2024 through September 20, 2025) to implement the Final Rule on Special Modes of Transportation. The Rule would reduce reimbursement under the VA travel pay program to Medicare rates for noncontracted ambulance services.

The Association of Air Medical Services, and several air and ground ambulance service organizations, as well as the AAA had submitted requests to several of the offices on language. In addition, the Committee included report language directing the VA to work with stakeholders to identify appropriate levels of reimbursement and to report to Congress on those efforts.

FY25 VA Approps Special Modes Language

Perez/Finstad Offer NDAA EMS Workforce Amendment

Representatives Gluesenkamp Perez (D-WA) and Finstad (R-MN) have submitted a bipartisan amendment (No. 809) to the National Defense Authorization Act (NDAA) (H.R. 8070) that would provide states with funding to help cover the transition costs of a military medic becoming a civilian paramedic or EMT when leaving the Armed Services. The language of the amendment is a modified version of the provision included in the PARA-EMT bill (H.R. 6433) being championed by Gluesenkamp Perez and Finstad.

The AAA along with the National Association of EMTs and National Rural Health Association worked with the two congressional offices on the revised legislative text. The House Rules Committee is expected to meet the week of June 10 to determine the rule for floor consideration of H.R. 8070 and decide on allowed amendments.

Also, NAEMT working with the House Armed Services Committee was able to get report language to accompany the NDAA directing the Department of Defense to provide a report to the Committee on efforts to help ensure that EMTs and paramedics are better positioned to make the transition to the civilian workforce upon leaving the military

NDA EMS Workforce Amendment

AAA Submits Paramedic Expedited Visa Comments in Line with PARA-EMT Act

Written by Tristan North on . Posted in Legislative, Regulatory, Workforce Shortage.

On May 13, the AAA submitted a Comment Letter to the Department of Labor (DOL) in response to their Request for Information (RFI) on modernizing the process and updating the occupations that fall under the Schedule A program. Schedule A is a program administered by DOL which allows for expedited visa processing for occupations with a predetermined workforce shortage. The AAA advocated in our letter for the DOL to add paramedics and EMTs to Schedule A which currently includes nurses, physical therapists and individuals with exceptional abilities in the sciences and arts.
The comment letter by the AAA is in line with a provision of the PARA-EMT Act (H.R. 6433) by Congresswoman Gluesenkamp Perez (D-WA) and Congressman Brad Finstad that would direct DOL to conduct a study on the EMS workforce shortage and report to Congress on consideration by the Department to add paramedics and EMTs to the list of occupations under Schedule A.

Gluesenkamp Perez and Finstad Introduce EMS Workforce Shortage Bill

Written by Tristan North on . Posted in Government Affairs, Legislative, News, Recruitment & Retention, Workforce Shortage.

Yesterday, November 15, Congresswoman Marie Gluesenkamp Perez (D-WA) and Congressman Brad Finstad (R-MN) introduced the Preserve Access to Rapid Ambulance Emergency Medical Treatment (PARA-EMT) Act (H.R. 6433). H.R. 6433 is the first broad, stand-alone piece of legislation specifically designed to focus solely on helping address the EMS workforce shortage.

“We greatly appreciate the leadership of Congresswoman Gluesenkamp Perez and Congressman Finstad on introducing this momentous legislation to assist with the hiring and retention of paramedics and EMTs,” stated AAA President Randy Strozyk. “We look forward to working with them on passage of the bill.”

H.R. 6433 would establish a pilot grant program under the Assistant Secretary for Preparedness and Response (ASPR) at the Department of Health and Human Services (HHS) for the recruitment and training of paramedics and EMTs. The grant program would be authorized from 2024 through 2028 with $50 million a year in funding.

The legislation would also provide states with funding to help facilitate and expedite the transition of medics coming out of military service with the requirements of becoming a civilian paramedic or EMT. The program would be authorized from 2024 through 2028 with $20 million a year in grant funding for states.

Lastly, H.R. 6433 would direct the Secretary of Labor to conduct a study on the EMS workforce shortage and issue a report to Congress. The report would include an analysis on potentially adding paramedics and EMTs to the list of health care occupations which benefit from an easier hiring process of professionals outside the U.S.

The American Ambulance Association, National Rural Health Association and Washington Ambulance Association have endorsed H.R. 6433. In the coming days, the AAA will be launching a Call to Action to encourage and assist our members in contacting their U.S. Representatives in support of cosponsoring H.R. 6433.

Thank you to all of the AAA members and volunteer leaders who worked tirelessly to push for the introduction of this important EMS legislation!

Notice on Ground Ambulance and Patient Billing Advisory Committee

Written by Tristan North on . Posted in Executive, Government Affairs, News, Regulatory.

The Centers for Medicare and Medicaid Services (CMS) has filed for publication in the Federal Register the Solicitation of Nominations Notice for the Ground Ambulance and Patient Billing (GAPB) Advisory Committee. The Notice is scheduled to be included in the Federal Register for tomorrow, Tuesday, November 23.

The Congress created the GAPB Advisory Committee as part of The No Surprises Act enacted last year and currently being implemented by the Departments of Health and Human Services, Labor and the Treasury. The American Ambulance Association, International Association of Fire Chiefs, International Association of Fire Fighters, National Association of Emergency Medical Technicians, and the National Volunteer Fire Council successfully advocated that the Congress take into consideration the unique characteristics of ground ambulance services when determining balance billing policy for our services. The Congress excluded ground ambulance services from the provisions of The No Surprises Act and created the GAPB Advisory Committee to address balance billing.

The AAA has identified candidates, including AAA President Baird, who we will be supporting for inclusion on the Advisory Committee who we believe are well-positioned to represent the AAA membership. Once formed, the Advisory Committee has 180 days in which to report its recommendations to the Congress. The directive of the Committee is to review options to “improve the disclosure of charges and fees for ground ambulance services, better inform consumers of insurance options for such services, and protect consumers from balance billing.” We will be keeping the AAA membership continually informed of the actions and deliberations of the GAPB Advisory Committee.

Should you have any questions regarding the GAPB Advisory Committee, please contact AAA Senior Vice President of Government Affairs Tristan North. He can be reached at tnorth@ambulance.org.

Medicare 2% Cut Freeze Extended

Written by Tristan North on . Posted in Legislative.

Yesterday, Presiden Biden signed into law legislation (H.R. 1868) to extend the current temporary freeze on the 2% Medicare sequestration cut. H.R. 1868 extends the deadline of the freeze from today until December 31. Contractors had been holding Medicare claims to avoid any issues but will again start processing claims. The AAA as well as other national EMS and fire organizations had pushed for the extension of the freeze.

Senate Passes Sequestration Suspension Extension Bill

Written by Tristan North on . Posted in Government Affairs.

Last week, the Senate by a vote of 90 to 2 passed legislation (H.R. 1868) to further extend the suspension of the 2% Medicare sequestration cut. H.R. 1868 would extend the suspension from March 31 to December 31. The Senate amended the bill so it goes back to the House which will likely consider the legislation the week of April 12 when it returns from the Easter holiday break. The House is expected to easily pass the bill. CMS will hold claims until the House passes the bill to avoid any retroactivity issues.

The House had previously passed a version of H.R. 1868 which would not only extend the sequestration suspension until December 31 but also prevent a potential 4% sequestration cut later this year. The additional cut is the result of a provision in the Budget Control Act which was triggered with passage of the American Rescue Plan. Senate Republicans objected to addressing the additional cut as part of the legislation and a compromise was reached to just extend the 2% cut suspension for the time being.

The AAA as well as the IAFC, IAFF, NVFC, CFSI and NAEMT had written to congressional leaders in support of passage of the House-passed version of H.R. 1868.

Senate Passes Ambulance Treatment in Place Language

Written by Tristan North on . Posted in Legislative.

On Saturday, the U.S. Senate passed language for Medicare coverage of emergency treatment in place of lower acuity patients by ground ambulance services providers and suppliers during the COVID-19 public health emergency (PHE). The language is from S. 149 by Senators Cortez Masto (D-NV) and Cassidy (R-LA) and passed as part of the $1.9 Trillion American Rescue Plan (H.R. 1319). The House is scheduled to vote and expected to pass the package tomorrow.

The American Ambulance Association along with the International Association of Fire Chiefs, International Association of Firefighters, National Association of EMTs and National Volunteer Fire Council pushed for passage of the bill language.

S. 149 would authorize the Centers for Medicare and Medicaid Services (CMS) to waive the transport requirement under Medicare for treatment in place for 9-1-1 or equivalent ambulance responses in which community EMS protocols dictate that the patient not be transported to a facility. The waiver would apply during the public health emergency.

Similar to other waivers provided by Congress for Medicare coverage during the pandemic, CMS would not be required to implement the policy. However, CMS has done so in all other situations and has also made the coverage retroactive to the beginning of the PHE. Upon passage of the language, the AAA will strongly advocate for CMS to implement the waiver and make it retroactive.

The AAA will be offering educational services to our members on the requirements of the proposed new policy and how to bill for covered services.

Paycheck Protection Program Funding Update

Written by Tristan North on . Posted in Finance, Human Resources, Legislative, Wages & Timekeeping.

The Department of Treasury has announced that the $350 billion appropriated under the CARES Act for the Paycheck Protection Program has been exhausted. However, Congressional leaders are currently negotiating an economic stimulus package to act as a bridge between the CARES Act and the next comprehensive package stimulus package. A core provision of the bridge package is an allocation of an additional $250 billion for the Paycheck Protection Program. If your operation is in the process or plans to apply for a loan under the Paycheck Protection Program, you should move forward with your efforts. The AAA is advocating that the bridge package or next comprehensive package include more funding for ambulance services.

Member Advisory: CMMI Releases Initial List of ET3 Participants

Written by Tristan North on . Posted in ET3, Government Affairs, Member Advisories, Member-Only, News, Regulatory, Reimbursement.

The Centers for Medicare and Medicaid Services (CMMI) has released its initial list of applicants selected to participate in the ET3 pilot program. CMMI notes that the list is not final as it still needs to execute participation agreements with the applicants. CMMI will issue a final list once it completes the process.

Applicants from 36 states and the District of Columbia were selected to participate in the program. Approximately 200 applicants were approved with instances in which the same ambulance service organization submitted applications for multiple counties as well as more than one organization submitting an application for the same county. CMMI has sent notifications to each of the applicants letting them know to expect a follow up email with the partnership agreement, program guidance and additional details.

The ET3 program is a five-year voluntary pilot program designed to test the potential benefit to the Medicare program and patients of ambulance service providers and suppliers furnishing treatment in place as well as transport to alternative destinations. For more information about the ET3 program, please go the ET3 website.

House Committees Consider Balance Billing Proposals

Written by Tristan North on . Posted in Balance Billing, Member Advisories, Member-Only, News, Reimbursement.

This past Tuesday and Wednesday, respectively, the House Ways & Means and Education & Labor Committees marked up their proposals on balance or “surprise” billing. As we reported on Monday of this week, the Ways & Means Committee proposal, the Consumer Protections Against Surprise Medical Bills Act (H.R. 5826), did not include a provision on ground ambulance services. The House Education & Labor proposal, The Ban Surprise Billing Act (H.R. 5800), however, included a provision to create a federal advisory committee to recommend restrictions on the ability of ground ambulance service providers and suppliers to balance bill.

The Ways & Means Committee reported out H.R 5826 favorably by voice vote. While the Education & Labor Committee also reported out H.R. 5800 favorably, the vote was 30 to 13 as a block of its Committee members preferred the approach of the Ways & Means proposal on how to address balance billing for other providers. It is now up to House leadership to determine next steps on how the chamber will approach a final package on balance billing.

While H.R. 5800 as reported out by the Education & Labor Committee still includes the provision on ground ambulance services, Chairman Scott (D-VA) and Ranking Member Foxx (R-NC) prior to mark up had removed the most problematic language in the bill. As introduced, H.R. 5800 would have given the Department of Health and Human Services the authority to issue regulations to restrict balance billing based on the findings of the advisory committee. This would have eliminated federal lawmakers from being able to evaluate the recommendations prior to the changes being implemented. The language was removed in the chairman’s mark of the bill, and thus the Congress would now have an opportunity to debate and craft legislation on the recommendations.

The AAA along with the International Association of Fire Chiefs (IAFC), International Association of Firefighters (IAFF) and National Association of EMTs (NAEMT) had advocated against the ground ambulance provision. We thank Chairman Scott, Ranking Member Foxx and members of the Committee for listening to our concerns and removing the regulation authority language.

Only one of the four pieces of legislation on balance billing reported out by congressional committees includes a provision on ground ambulance services. We will continue to advocate to preserve the ability of local governments to determine the rates and standards for their EMS systems and against the inclusion of a ground ambulance provision in a final package on balance billing.

We will keep you apprised of new developments on the issue.

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