DOL Electronic Injury & Illness Reporting

Proposed Changes to the OSHA Electronic Injury & Illness Reporting Requirements

The U.S. Department of Labor’s Occupational Safety and Health Administration (OSHA) is proposing amendments to its occupational injury and illness recordkeeping regulation, 29 CFR 1904.41. The current regulation requires certain employers to electronically submit their summary injury and illness data (Form 300A) to OSHA annually. OSHA uses these reports to identify and respond to emerging hazards and makes aspects of the information publicly available.

In addition to reporting their Annual Summary of Work-Related Injuries and Illnesses, the proposed rule would require certain establishments in certain high-hazard industries to electronically submit additional information from their Log of Work-Related Injuries and Illnesses, as well as their Injury and Illness Incident Report (Form 300, 300A, & 301). The latest proposed rule will require certain employers to submit more detailed information and is a return to the original electronic data submission rule that was proposed in 2016 and rolled back in 2017, prior to the rule taking effect. EMS organizations will be included in those industries that are considered high-hazard and thus, required to submit this information.

As we reported last month, OSHA reported that there was a 249% increase in illnesses and injuries reported by healthcare employers in 2020. This is no surprise given that this was at the heart of the pandemic. OSHA believes this rule will improve the agency’s ability to use the information in its enforcement and compliance assistance efforts to identify workplaces where workers are at high risk.

The proposed rule would:

  • Require establishments with one hundred (100) or more employees in certain high-hazard industries to electronically submit information from their OSHA Forms 300, 301, and 300A to OSHA once a year. Currently, only the Form 300A summary data is submitted electronically.
  • Update the classification system used to determine the list of industries covered by the electronic submission requirement.
  • Remove the current requirement for establishments with 250 or more employees not in a designated industry to electronically submit information from their Form 300A to OSHA annually.
  • Require establishments to include their company name when making electronic submissions to OSHA.

Under the proposed rule, establishments with 20-99 employees in certain high-hazard industries would continue to be required to electronically submit information from their OSHA Form 300A annual summary to OSHA annually.

Those interested can submit comments must do so by May 30, 2022. If you have questions about your organization’s reporting requirements under the OSHA Regulations, be sure to contact the AAA at hello@ambulance.org for assistance.

DOL COVID-19 Exposure Rule-Making

The United States Department of Labor (US DOL) has published a notice of intent to partially reopen the rule-making process to permit additional comment and a public hearing on certain aspects of the OSHA Emergency Temporary Standard for Healthcare employers which was originally published in June 2021. OSHA is seeking further input from stakeholders as they develop a final standard. The public hearing will begin on April 27, 2022.

The agency is reopening the rulemaking record to allow for new data and comments on topics, including the following:

  • Alignment with the Centers for Disease Control and Prevention’s recommendations for healthcare infection control procedures.
  • Additional flexibility for employers to permit less prescriptive requirements
  • Removal of scope exemptions.
  • Tailoring controls to address interactions with people with suspected or confirmed COVID-19.
  • Employer support for employees who wish to be vaccinated.
  • Limited coverage of construction activities in healthcare settings.
  • COVID-19 recordkeeping and reporting provisions.
  • Triggering requirements based on community transmission levels.
  • The potential evolution of SARS-CoV-2 into a second novel strain.
  • The health effects and risk of COVID-19 since the ETS was issued.

OSHA made it clear that it is not proposing mandatory COVID-19 vaccination for healthcare workers. However, they are seeking comments regarding how it could help employers further support healthcare worker employees in their vaccination and boosting efforts. This could include paid leave, including travel time, for those seeking vaccinations or boosters.

The notice in the Federal Register had a slightly more relaxed tone as many areas in the country have seen a significant drop-off in cases.  If you are interested in submitting comments, you can do so electronically at www.regulations.gov.  If you wish to attend the video-based public hearing, you must file a notice of intention to appear with the US DOL within 14 days of the notice being officially published in the Federal Register.

If you have any questions about your current obligations under the OSHA rules, please email the AAA at hello@ambulance.org.

HHS PRF | EMS Funding Letter to Secretary Becerra

Download PDF Letter

March 24, 2022

The Honorable Xavier Becerra
Secretary of Health and Human Services
Department of Health and Human Services
200 Independence Avenue, SW
Washington, DC 20201

Dear Secretary Becerra:

Ground ambulance service organizations and fire departments continue to struggle financially from the enduring economic effects of the COVID-19 public health emergency (PHE). Our respective members face sharp increases in the costs of fuel, equipment, medical supplies, and staffing as we deal with a severe shortage of paramedics and emergency medical technicians (EMTs) which has been an issue for years but exacerbated by the pandemic. We implore you to help ensure communities around the country have access to 9-1-1 emergency and non-emergency ground ambulance services through the remainder of the PHE and beyond with an infusion of $350 million from returned and/or unspent money in the Provider Relief Fund (PRF).

We greatly appreciate the funding that ground ambulance service organizations and fire departments have already received from the PRF. The funds have been a lifeline for many of our respective members and their ability to continue to serve their communities. However, as the Phase 4 distribution of funds demonstrated, more funding is needed for ground ambulance services. Our members indicate the funds they received in Phase 4 covered approximately 50% of their lost reimbursement and increased costs from July 1, 2020, to March 31, 2021, whereas previous distributions were closer to 88%. We therefore respectfully request an immediate distribution of $350 million or 10% of the annual Medicare expenditure on ground ambulance services.

We request that the funds be distributed in a similar manner as the Tranche 1 distribution from the PRF. The automatic, across-the-board deposit of funding was especially helpful for small and rural ground ambulance service organizations. These rural organizations provide care in underserved areas and are often daunted even by an abbreviated application process. To ensure equity for all communities, we support universal direct deposit.

Additionally, we encourage HHS to make these payments based on the National Provider Identification (NPI) number of the ground ambulance service organization or fire department rather than Tax ID Number (TIN). In the case of moderate and large cities, many municipal departments may share a TIN while maintaining distinct NPIs. Providing these payments according to TIN may unintentionally comingle funds intended for different departments such as fire departments, public health departments, and local government-run hospitals or clinics.

The American Ambulance Association (AAA), International Association of Fire Chiefs (IAFC), International Association of Fire Fighters (IAFF), National Association of Emergency Medical Technicians (NAEMT), and National Volunteer Fire Council (NVFC) represent the providers of vital emergency and non-emergency ground ambulance services and the paramedics, EMTs and firefighters who deliver the direct medical care and transport for every community across the United States.

Our members take on substantial risk every day to treat, transport, and test potential COVID-19 patients, and play a vital role in providing vaccinations to individuals in their homes. Ground ambulance service organizations and fire departments, however, urgently need the additional

$350 million to help offset the increased costs and lower reimbursement resulting from our vital response to the pandemic.

Thank you in advance for your consideration of this request.

Sincerely,

American Ambulance Association

International Association of Fire Chiefs

International Association of Fire Fighters

National Association of Emergency Medical Technicians

National Volunteer Fire Council

Student Loan Forgiveness for Frontline Health Workers Act (S. 3828) Introduced

This week, Senator Sheldon Whitehouse (D-RI) along with Senator Alex Padilla (D-CA), introduced the Student Loan Forgiveness for Frontline Health Workers Act (S. 3828), which provides loan forgiveness to individuals working in frontline healthcare responding to the Covid-19 pandemic. The legislation broadly defines healthcare workers and includes those who work in both public and private EMS. It provides relief to those who participate in both Federal student loans and private loans. We are very pleased to see the introduction of this legislation as it represents the kind of broad-based coverage for both governmental and non-governmental EMS that we have been advocating for. The legislation specifically covers paramedic certification programs that are accredited as part of CoAEMSP which requires college affiliation and makes them eligible for relief as federal student loans.  The bill has broader standards than the current Public Safety Loan Forgiveness program.  S. 3828 covers front-line healthcare workers regardless of their length of service as long as they are providing Covid healthcare-related services and specifically covers “an emergency medical services worker who responds to health emergencies or transports patients to hospitals or other medical facilities”.  In addition, the student loan forgiveness for those working in EMS, would be exempt from inclusion in that individual’s taxable income.

The AAA supports this legislation and applauds Senator Whitehouse and Senator Padilla for their efforts to assist our frontline healthcare workers.

NASEMSO | Model EMS Clinical Guidelines v3

From NASEMSO on March 23, 2022

The NASEMSO Model EMS Clinical Guidelines project team is delighted to unveil Version 3 of the National Model EMS Clinical Guidelines. In completing Version 3, the project team has reviewed and updated all existing guidelines, as well as added four new guidelines. Version 3 of the Guidelines, similar to the original version released in 2014, was completed by a team of EMS and specialty physicians comprised of members of the NASEMSO Medical Directors Council and representatives from six EMS medical director stakeholder organizations. In addition, all guidelines were reviewed by a team of pediatric emergency medicine physicians, pharmacologists and other technical reviewers.

Overview

The National Model EMS Clinical Guidelines Project was first initiated by NASEMSO in 2012 and has produced three versions of model clinical guidelines for EMS: the first in 2014, a revision 2017, and now this third version in 2022. The guidelines were created as a resource to be used or adapted for use on a state, regional or local level to enhance prehospital patient care and can be viewed here. These model protocols are offered to any EMS entity that wishes to use them, in full or in part. The model guidelines project has been led by the NASEMSO Medical Directors Council in collaboration with six national EMS physician organizations, including: American College of Emergency Physicians (ACEP), National Association of EMS Physicians (NAEMSP), American Academy of Emergency Medicine (AAEM), American Academy of Pediatrics, Committee on Pediatric Emergency Medicine (AAP-COPEM), American College of Surgeons, Committee on Trauma (ACS-COT) and Air Medical Physician Association (AMPA). Co-Principal Investigators, Dr. Carol Cunningham and Dr. Richard Kamin, led the development of all three versions. Countless hours of review and edits are contributed by subject matter experts and EMS stakeholders who responded with comments and recommendations during the public comment period.

NASEMSO gratefully acknowledges the Technical Expert Panel, the Technical Reviewers, and many others who volunteered their time and talents to ensure the success of this project.

The comprehensive review and revision of these guidelines was made possible by funding support from the National Highway Traffic Safety Administration Office of EMS and the Health Resources and Services Administration Maternal and Child Health Bureau EMS for Children Program.

For More Information

Andy Gienapp, MS, NRP
Deputy Executive Director
andy@nasemso.org

HHS IEA | COVID-19 Update for March 21, 2022

HHS Office of Intergovernmental and External Affairs COVID-19 Update for
March 21, 2022  
CASE UPDATE
New Cases (based on 7-day rolling average)

  • 79,571,321 U.S. cases
  • 17.3% decrease in new cases (7-day average), as of March 18, 2022

Testing

  • 837,949,940 tests completed (3/21)
  • 2.3% positive test rate as of the week of 3/11 – 3/17/22 (was 2.7 % last week)

Hospitalizations

  • 4,581,254 total COVID hospital admissions (3/18)
  • The 7-day average (3/12 – 3/18) number of new confirmed COVID-19 admissions decreased from 2,642 to 2,010 admissions per day

Deaths

  • 969,114 total U.S. deaths
  • The 7-day average (3/12 – 3/18) number of reported deaths decreased from 1,199 to 973 deaths per day

Vaccines

  • 558,678,770 vaccine doses administered (3/21/22)
  • 76.8% (255 million people) of the population has received 1 or more doses and 65.4% (217.1 million people) of the population have been fully vaccinated
  • 81.6% of people five years and older have received at least 1 dose and 69.5% have been fully vaccinated
VACCINE UPDATES
COVID-19 Vaccines Continue to Protect Against Hospitalization and Death Among Adults: CDC released a statement that COVID-19 vaccination continues to help protect adults against severe illness with COVID-19, including hospitalizations and death, according to two reports released in last week’s MMWR . During Omicron, COVID-19-associated hospitalization rates increased for all adults, regardless of vaccination status, but rates were 12 times higher among adults who were unvaccinated compared to adults who received a booster or additional doses. Hospitalization rates were also highest among non-Hispanic Black adults and nearly 4 times as high among Black adults than White adults during the peak of Omicron. CDC continues to recommend that everyone 5 years and older stay up to date on their COVID-19 vaccines, including a booster dose for those who are eligible. We also must work to ensure everyone has equitable access to vaccines and treatments by focusing efforts on reaching people who have been disproportionately affected, so that they can be protected from the effects of the virus, including severe illness, hospitalization, and death.

FDA to Hold Advisory Committee Meeting on COVID-19 Vaccines to Discuss Future Boosters: The U.S. Food and Drug Administration (FDA) announced a virtual meeting of its Vaccines and Related Biological Products Advisory Committee (VRBPAC) on Wednesday, April 6, to discuss considerations for future COVID-19 vaccine booster doses and the process for selecting specific strains of the SARS-CoV-2 virus for COVID-19 vaccines to address current and emerging variants. Along with the independent experts of the advisory committee, representatives from the U.S. Centers for Disease Control and Prevention and the National Institutes of Health will participate in the meeting.

One-Year Anniversary of Health Center COVID-19 Vaccine Program: Today, the U.S. Department of Health and Human Services (HHS) recognized the one-year anniversary of the Health Resources and Services Administration’s (HRSA)  Health Center COVID-19 Vaccine Program , which received funding from President Biden’s American Rescue Plan and has provided COVID-19 vaccines directly to thousands of HRSA-supported health center sites nationwide. To date, health centers have administered more than 20 million vaccines in underserved communities across the country through the HRSA program and partnerships with states.

TESTING AND TREATMENT
FDA Safety Communication on At-Home COVID-19 Tests: The FDA  issued a safety communication  to alert people of the potential for harm if FDA-authorized at-home COVID-19 tests are not used according to the manufacturer’s test instructions. The FDA is also reminding people to keep the tests out of reach from children and pets. The FDA has received reports of injuries caused by the incorrect use of at-home COVID-19 tests, such as people putting the test chemicals in their eyes, due to the small vials of test solution were mistaken for eye drops. The FDA is also aware of children putting small plastic vials in their mouth and swallowing test solution. This safety communication provides:

  • Recommendations for people using FDA-authorized at-home COVID-19 diagnostic tests
  • Background on the issue and the FDA’s actions
  • Instructions for reporting problems with at-home COVID-19 testing to the FDA

EUA for At-Home Test: The FDA issued an emergency use authorization (EUA) for PHASE Scientific International, Ltd.’s INDICAID COVID-19 Rapid Antigen At-Home Test, an OTC #COVID19 antigen diagnostic on March 16. The FDA is committed to increase the availability of appropriately accurate and reliable at-home COVID19 diagnostic tests, and to facilitate consumer access to these tests.

RESEARCH
COVID-19-Associated Hospitalizations Among Adults During SARS-CoV-2 Delta and Omicron Variant Predominance: CDC released an MMWR on COVID-19-associated hospitalizations among adults during SARS-CoV-2 Delta and Omicron variant predominance by race/ethnicity and vaccination status from fourteen states between July 2021 – January 2022. SARS-CoV-2 infections can result in COVID-19–associated hospitalizations, even among vaccinated persons. In January 2022, unvaccinated adults and those vaccinated with a primary series, but no booster or additional dose, were 12 and three times as likely to be hospitalized, respectively, as were adults who received booster or additional doses. Hospitalization rates among non-Hispanic Black adults increased more than rates in other racial/ethnic groups. All adults should stay up to date with COVID-19 vaccination to reduce their risk for COVID-19–associated hospitalization. Implementing strategies that result in the equitable receipt of COVID-19 vaccinations among persons with disproportionately higher hospitalizations rates, including non-Hispanic Black adults, is an urgent public health priority.

Effectiveness of mRNA Vaccination in Preventing COVID-19-Associated Invasive Mechanical Ventilation and Death: CDC released an MMWR on the effectiveness of mRNA vaccination in preventing COVID-19-associated invasive mechanical ventilation and death in the United States from March 2021 – January 2022. COVID-19 mRNA vaccines provide protection against COVID-19 hospitalization among adults. However, how well mRNA vaccines protect against the most severe outcomes of COVID-19–related illness, including use of invasive mechanical ventilation (IMV) or death, is uncertain. Receiving 2 or 3 doses of an mRNA COVID-19 vaccine was associated with a 90% reduction in risk for COVID-19–associated IMV or death. Protection of 3 mRNA vaccine doses during the period of Omicron predominance was 94%. COVID-19 mRNA vaccines are highly effective in preventing the most severe forms of COVID-19. CDC recommends that all persons eligible for vaccination get vaccinated and stay up to date with COVID-19 vaccination.

Marvin B. Figueroa, Director
U.S. Department of Health and Human Services
Intergovernmental and External Affairs
200 Independence Ave., S.W.
Washington, D.C. 20201

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HHS OIG Report on Telehealth for Medicare Beneficiaries in COVID-19

From HHS Office of Inspector General on March 15, 2022

Telehealth Was Critical for Providing Services to Medicare Beneficiaries During the First Year of the COVID-19 Pandemic

WHY WE DID THIS STUDY

The COVID-19 pandemic created unprecedented challenges for how Medicare beneficiaries accessed health care. In response, the Department of Health and Human Services (HHS) and the Centers for Medicare & Medicaid Services (CMS) took a number of actions to temporarily expand access to telehealth for Medicare beneficiaries. CMS allowed beneficiaries to use telehealth for a wide range of services; it also allowed beneficiaries to use telehealth in different locations, including in urban areas and from the beneficiary’s home.

This data brief provides insight into the use of telehealth in both Medicare fee-for-service and Medicare Advantage during the first year of the COVID-19 pandemic, from March 2020 through February 2021. It is a companion to a report that examines the characteristics of beneficiaries who used telehealth during the pandemic. Another report in this series identifies program integrity concerns related to telehealth during the pandemic. Understanding the use of telehealth during the first year of the pandemic can shed light on how the temporary expansion of telehealth affected where and how beneficiaries accessed their health care. This information can help CMS, Congress, and other stakeholders make decisions about how telehealth can be best used to meet the needs of beneficiaries in the future.

HOW WE DID THIS STUDY

We based this analysis on Medicare fee-for-service claims data and Medicare Advantage encounter data from March 1, 2020, to February 28, 2021, and from the prior year, March 1, 2019, to February 29, 2020. We used these data to determine the total number of services used via telehealth and in-person, as well as the types of services used. We also compared the number of services used via telehealth and in-person during the first year of the pandemic to those used in the prior year.

WHAT WE FOUND

Over 28 million Medicare beneficiaries used telehealth during the first year of the pandemic. This was more than 2 in 5 Medicare beneficiaries. In total, beneficiaries used 88 times more telehealth services during the first year of the pandemic than they used in the prior year. Beneficiaries’ use of telehealth peaked in April 2020 and remained high through early 2021. Overall, beneficiaries used telehealth to receive 12 percent of their services during the first year of the pandemic. Beneficiaries most commonly used telehealth for office visits, which accounted for just under half of all telehealth services used during the first year of the pandemic. However, beneficiaries’ use of telehealth for behavioral health services stands out. Beneficiaries used telehealth for a larger share of their behavioral health services compared to their use of telehealth for other services. Specifically, beneficiaries used telehealth for 43 percent of behavioral health services, whereas they used telehealth for 13 percent of office visits.

WHAT WE CONCLUDE

Telehealth was critical for providing services to Medicare beneficiaries during the first year of the pandemic. Beneficiaries’ use of telehealth during the pandemic also demonstrates the long-term potential of telehealth to increase access to health care for beneficiaries. Further, it shows that beneficiaries particularly benefited from the ability to use telehealth for certain services, such as behavioral health services. These findings are important for CMS, Congress, and other stakeholders to take into account as they consider making changes to telehealth in Medicare. For example, CMS could use these findings to inform changes to the services that are allowed via telehealth on a permanent basis.