COVID-19 employee Travel FAQ

Over the last week, we have received several questions from AAA members about various COVID-19 impacts on EMS organizations.  As the infection numbers around the country are on the rise, many new issues have arisen that are posing issues with many EMS employers.

  1. Travel Orders

What can I do when our employee voluntarily chooses to travel out of state and, due to state level travel orders which require mandatory quarantine for 14 days upon their return, the employee cannot work and is seeking to be paid emergency leave under the Families First Coronavirus Act (FFCRA) or take additional unpaid leave during the quarantine period?

As an employer, you have several options.  One of the most important things to know is that your employee does have to abide by any federal, state, or local quarantine order.  However, this does not mean that the employer is helpless in addressing this the issue of employee voluntary travel.  The last few months have been incredibly trying on all of us, particularly those who are on the front lines battling the COVID-19 pandemic, it is understandable that employees are looking to take vacations out of state.  While this is understandable, the employee is still making a decision that can impact their health and their employment, as well as, the health of their coworkers and patients.

Employer Option 1

As an EMS employer, the FFCRA specifically permitted EMS agencies the right to exclude emergency responders from the group of employees who are eligible to take emergency leave under the FFCRA. Despite this, many EMS employers have decided to provide their employees with emergency paid leave under the FFCRA.  The employer can choose to pay the employee emergency leave under the FFCRA during the mandatory travel quarantine.

Employer Option 2

As stated in Option 1, the FFCRA specifically permitted EMS agencies the right to exclude emergency responders from the group of employees who are eligible to take emergency leave under the FFCRA. Most of those employers who have decided to provide emergency leave under the FFCRA, their intent was to provide the emergency leave to employees who, through no fault of their own, were exposed to COVID-19 and required to quarantine.  However, an employer has the right to exclude some employees, such as those who decide to voluntarily travel outside state, and as a result, required to quarantine upon return.  The key is to ensure that you have an established policy, it is applied consistently, and has been meaningfully communicated to your employees.  This is the best practice for mitigating any discrimination or disparate treatment claims.

Employer Option 3

The employer can choose to discipline the employee for choosing to leave the state, despite the travel order.  If an employee knowingly travels out of state, despite the existence of a mandatory travel quarantine order, the employer can discipline that employee for any quarantine related attendance issues.  The employer cannot let that employee return to work unless they have abided by any travel orders.  Several of the states who have issued orders, include an option to avoid a 14-day quarantine order if they have a negative COVID-19 test within three days of returning to their home state.  Alternatively, they can end the 14-day quarantine period if they receive a negative test after returning to their home state.

Employer Best Practice

The best bet for employers is to contemplate the possible issues that could arise with your employees as a result of the local travel orders.  Employers should draft a policy that delineates the work-related implications of employee travel.  This policy should be communicated through multiple channels, and ideally, be acknowledged in writing by your employees.  This will provide your employees with a clear understanding of the implications of deciding to travel out of state during the pandemic.

  1. COVID-19 Parties

Several member organizations have asked what actions they can or should take when they learn that an employee has attended a COVID-19 party.  These events, which defy logic, particularly for those of us who consider EMS, healthcare and EMS personnel, healthcare workers, are parties where uninfected people go to a party with known infected people to mingle and see who becomes infected.

Option 1

Under the General Duty clause of the Occupational Health and Safety Act (OSHA), an employer has an obligation to provide a workplace which is “free from recognized hazards that are causing or are likely to cause death or serious physical harm to his employees”.  This includes if an employer is aware that there are employees who are engaging in behavior that may create a workplace hazard, like attending events such as a COVID-19 party.

If an employer discovers that an employee has attended an event like a COVID-19 party or a large scale event where protective measures were not taken, such as mandatory mask wearing and social/physical distancing, the employer has a duty to investigate and take action.  This would include requiring that the employee remain out of work for the recommended quarantine time or upon a negative COVID-19 test.  The employer could pay for this test but is not required to.  If the employee voluntarily took part in this event and the exposure was not work-related, they would not be obligated to pay for the COVID-19 test.

Option 2

For the many reasons stated above, the employer has an obligation to the rest of its workforce to ensure that this potentially infected employee does not expose the rest of the workforce.  The employer would be justified in addressing this issue through their disciplinary process.  As is always recommended, I recommend that employers communicate with their employees to let them know that the choices they make outside of the workplace have implications inside the workplace.  While this should be obvious to our employees, not all operate by the same playbook.

Employers should be aware that there are state laws that limit the level at which an employer can dictate an employee’s “off duty” time.  For example, an employer in New York cannot take work action against an employee for their personnel time political activities.  However, an employer may address the employee if that off duty conduct involves their employee’s failure to be safe by wearing a mask and maintaining social/physical distancing while attending a political event or political-based protest.  As previously mentioned, employers have obligation to provide a workplace that is free from “recognized hazards”.

Employer Best Practice

I recommend that employers consult with their local attorneys if they faced with taking work-related action for an employee’s off duty conduct if they are in a state with off duty conduct laws.  The best way to ensure you protect your workforce is to ensure that the organization has a comprehensive policy and procedure manual that is updated every year.  Additionally, all employees, including supervisory personnel, should sign an acknowledgement annually. Lastly, it is recommended that the organization highlight a few policies throughout the year.  Specifically, I recommend that organizations log all incidents, complaints, and discipline to permit trending of workplace activity which suggest which policies and procedures need to be highlighted.

CISA Guidance on Essential Critical Infrastructure Workers

ADVISORY MEMORANDUM ON IDENTIFICATION OF ESSENTIAL CRITICAL
INFRASTRUCTURE WORKERS DURING COVID-19 RESPONSE

As the Nation comes together to slow the spread of COVID-19, on March 16th the President issued updated Coronavirus Guidance for America that highlighted the importance of the critical infrastructure workforce.

The Cybersecurity and Infrastructure Security Agency (CISA) executes the Secretary of Homeland Security’s authorities to secure critical infrastructure. Consistent with these authorities, CISA has developed, in collaboration with other federal agencies, State and local governments, and the private sector, an “Essential Critical Infrastructure Workforce” advisory list. This list is intended to help State, local, tribal and territorial officials as they work to protect their communities, while ensuring continuity of functions critical to public health and safety, as well as economic and national security. Decisions informed by this list should also take into consideration additional public health considerations based on the specific COVID-19-related concerns of particular jurisdictions.

This list is advisory in nature. It is not, nor should it be considered, a federal directive or standard. Additionally, this advisory list is not intended to be the exclusive list of critical infrastructure sectors, workers, and functions that should continue during the COVID-19 response across all jurisdictions. Individual jurisdictions should add or subtract essential workforce categories based on their own requirements and
discretion. The advisory list identifies workers who conduct a range of operations and services that are typically essential to continued critical infrastructure viability, including staffing operations centers, maintaining and repairing critical infrastructure, operating call centers,
working construction, and performing operational functions, among others. It also includes workers who support crucial supply chains and enable functions for critical infrastructure. The industries they support represent, but are not limited to, medical and
healthcare, telecommunications, information technology systems, defense, food and agriculture, transportation and logistics, energy, water and wastewater, law enforcement,  and public works.

State, local, tribal, and territorial governments are responsible for implementing and executing response activities, including decisions about access and reentry, in their communities, while the Federal Government is in a supporting role. Officials should use their own judgment in issuing implementation directives and guidance. Similarly, while adhering to relevant public health guidance, critical infrastructure owners and operators are expected to use their own judgement on issues of the prioritization of business processes and workforce allocation to best ensure continuity of the essential goods and
services they support. All decisions should appropriately balance public safety, the health and safety of the workforce, and the continued delivery of essential critical infrastructure services and functions. While this advisory list is meant to help public officials and employers identify essential work functions, it allows for the reality that some workers engaged in activity determined to be essential may be unable to perform those functions
because of health-related concerns.

CISA will continue to work with our partners in the critical infrastructure community to
update this advisory list if necessary as the Nation’s response to COVID-19 evolves.
Should you have questions about this list, please contact CISA at CISA.CAT@cisa.dhs.gov.

Download as a PDF

WEBINAR: EMS Patient Care and Operations | Monday, May 4

NHTSA Office of EMS Director Jon Krohmer, MD, will be moderating the next COVID-19 Clinical Rounds: EMS webinar, co-hosted by our partners at the HHS Office of the Assistant Secretary for Preparedness and Response. See below for more information and links to register. And be sure to access the latest COVID-19 information for EMS at the updated COVID-19 Resources for EMS.

EMS: Patient Care and Clinical Operations

Monday, May 4, 2020
12:00 PM EDT / 9:00 AM PDT

Webinar Agenda

Welcome and Introductions
Jon R. Krohmer, MD, FACEP, FAEMS, Director, Office of EMS, National Highway Traffic Safety Administration

Patient Care and Operations
David Gerstner, EMT-P, Regional MMRS Coordinator, West Central Ohio, Dayton Fire Department & Wright State University Boonshoft School of Medicine

Carol A. Cunningham, MD, FAAEM, FAEMS, State Medical Director, Ohio Department of Public Safety, Division of EMS

Q & A and Discussion

Register Now

EMS Education Pipeline

Read as a PDF
National Highway Traffic Safety Administration (NHTSA) staff prepared this summary document on the
status of the Emergency Medical Services (EMS) education pipeline during a series of recent conference
calls with EMS stakeholder organizations. Included is a list of national, state, and local considerations
for EMS stakeholders. These considerations do not necessarily reflect official policy positions of the
organizations that participated during the conference calls. This document is intended to serve as an
informational resource for EMS stakeholders. This summary does not establish legal requirements or
obligations, and its content does not necessarily reflect agency recommendations or policy.

Contributors to its content included representatives from the National Registry of Emergency Medical
Technicians (NREMT), the National Association of EMS Educators (NAEMSE), the Committee on
Accreditation for the EMS Professions (CoAEMSP), the Commission on Accreditation for Pre-Hospital
Continuing Education, the National Association of State EMS Officials, the International Association of
Fire Chiefs, the American Ambulance Association, the National Association of Emergency Medical
Technicians, the American College of Surgeons, and the Interstate Commission for EMS Personnel
Practice.

Challenges Facing EMS Education
Nationwide social distancing measures have led to closures, delays, and other impacts on the national
EMS education system. National, State, and local EMS organizations are collaborating to address these
challenges, but prolonged delays are likely in the education, certification, and licensing of tens of
thousands of entry-level EMS clinicians.

EMS Education Programs Closed
Community colleges, universities, fire academies, and other programs that provide EMS education
throughout the country closed in response to social distancing measures. Many of these institutions
created distance learning programs to help current students complete their didactic education.
However, not every EMS education program has the resources to support online or distance learning
alternatives.

To assist EMS education programs, NAEMSE has led a webinar series on transitioning to the online
classroom2 and is collaborating with NREMT to develop best practices for distance education.
EMS students must also complete in-hospital and pre-hospital clinical rotations to graduate.
Unfortunately, most clinical and field internship sites remain closed to students based on a combination
of factors, such as government restrictions and recommendations on traveling and social distancing, lack
of personal protective equipment (PPE) for students, or the decision of the clinical site to restrict
student access.

CoAEMSP acknowledged the need for its 706 accredited paramedic education programs to modify
current graduation requirements.

On April 5th, 2020, the CoAEMSP Board of Directors issued a
statement regarding Coronavirus Disease 2019 (COVID-19) to clarify that Paramedic educational programs may employ a broad array of approaches, including simulation, in determining competency in
didactic, laboratory, clinical, field experience, and capstone field internship.
Another option suggested by stakeholders for increasing the number of competent, entry-level EMS
clinicians to enter the workforce with advanced life support (ALS) skills may be allowing paramedic
students to graduate early and be tested as Advanced EMTs (AEMTs).

Testing and Certification Delayed
NREMT is the national certification agency for EMS clinicians. NREMT testing and certification (after
completion of approved education) is a requirement for EMS clinician licensure in most States. NREMT’s
cognitive (computer-based written) exam is administered by Pearson VUE. On March 17, 2020, Pearson
VUE closed most of its nearly 700 testing centers nationwide. Over the subsequent weeks,
approximately 450 of Pearson VUE’s testing centers have re-opened at reduced capacity, with more
projected to open in the future. Many testing sites remain closed under State government orders that
closed State colleges and universities. Allowing sites to remain open for the sole purpose of testing EMS
and other healthcare professionals would help alleviate the lack of testing capacity. Open testing centers
are operating at approximately 50% capacity due to social distancing measures.

NREMT is temporarily not requiring the psychomotor (hands-on skills) examination due to social
distancing guidelines. It is offering a provisional certification that requires only the successful completion of
the EMS education course and the cognitive exam. NREMT has accelerated plans for remote proctoring
of the cognitive exam, which will be available for the AEMT examination and the EMT examination in
May 2020. These emergency measures will help to continue certifying new EMS professionals.

Historically, the NREMT tests over 60,000 EMS clinicians in the spring season. NREMT projects that a
significantly lower number of EMS clinicians will be tested this year due to the cancellation of EMS
education courses. Consequently, local EMS agencies will face a severe workforce supply shortage
within the next three months.

Recertification Deadlines Extended
NREMT has approved a 90-day extension on EMS certifications that were due to expire on March 31,
2020, and waived continuing education requirements for face-to-face instruction. States are beginning
to modify relicensing requirements in line with NREMT’s actions.

Specialty certification courses (such as Cardio Pulmonary Resuscitation, Pediatric Advanced Life Support,
Pre-Hospital Trauma Life Support, Advanced Cardiac Life Support, etc.) are often required as part of EMS
education, certification, licensure, or affiliation. Many specialty certification course providers have
created online courses for didactic materials, and either waived hands-on skills requirements or
provided guidance on safely facilitating in-person instruction. Most have also extended or waived
current expiration dates.

Licensure Modifications Underway
State EMS offices license EMS clinicians, regulate local EMS agencies, and support EMS system
development. Many State EMS staff are currently deployed to state operations centers supporting the
COVID-19 response, including guiding statewide efforts to support crisis standards of care (CSC) planning
for EMS. Multiple States have temporarily waived or modified licensure policies to streamline licensure.

Emergency Medical Service (EMS) Education Pipeline
Twenty States are accepting NREMT provisional certification as a condition of licensure; however, some
States4 have reported that their laws and rules prohibit issuing licenses to holders of the NREMT
provisional certification.

A few states require fingerprinting and a criminal background check as a condition for licensure;
however, social distancing measures and public building closures have made fingerprinting services
largely unavailable. Some States5 are offering provisional licensure that defers a criminal background
check until the public health emergency ends. Employers cannot assume a provisional licensee had a
background check and may now need to do this as part of their hiring process. States are also
reactivating expired licenses within specified time frames.

Twenty States are members of the Interstate EMS Licensure Compact (Compact), which was formally
activated in response to COVID-19. The Compact will enable interstate recognition of EMS clinician
licensure between member States. However, the Compact does not address practice by EMS clinicians in
non-traditional settings, such as hospitals. Many States6 grant physicians authority to delegate certain
aspects of medical practice, which may give hospitals flexibility to use EMS personnel in an expanded
clinical role.

Service Impact
In the United States, more than 18,200 EMS agencies, staffed by a total licensed workforce of more than
1.03 million EMS clinicians, provide ubiquitous 24/7 coverage of the entire Nation. In 2019, these EMS
agencies responded to more than 28.5 million 911 dispatches.

Stakeholders have reported an average 30 percent decline in EMS transports in areas not yet severely
impacted by the public health emergency, which they attribute to less public willingness to be
transported to hospitals. This decline in EMS transports has led to a decline in insurance reimbursement
revenue9 accompanied by an anticipated decline in State and local tax revenue. As a result, EMS
stakeholders have reported widespread hiring freezes and potential future furloughs and layoffs.
Despite the need for 24/7 service, stakeholders anticipate that the inability to hire, coupled with
workforce supply shortages (attributed to the shutdown of EMS education programs), will lead to
prolonged EMS staffing shortfalls. In some cases, these staffing shortfalls may take effect as COVID-19
peaks locally resulting in potentially insufficient staffing to respond to an expected surge of EMS calls.
As components of the workforce pipeline partially resume operations, employers will face additional
challenges, such as delays in fingerprint-based background checks and remedial education and testing
for provisionally certified and licensed EMS personnel.

The long-term impact of system accommodations (e.g., deferred background checks, proctored exams,
provisional certification and licensing) is unknown. In addition, there is also growing concern that the
pandemic may increase EMS workforce turnover.
State and Local Considerations for EMS Stakeholders
Based on the issues and challenges discussed above, stakeholders may consider the following
measures at the State and local levels:
1. Enable EMS clinicians with a NREMT provisional certification to pursue provisional State
licensure.
2. Enable EMS clinicians with expired licenses to pursue provisional State licensure.
3. Prioritize the reopening of EMS clinical skills labs when reopening educational institutions.
4. Encourage EMS education programs to provide distance learning resources to all students. Front-load didactic education for EMS students until clinical skills labs, clinical internships, and field
internships can resume.
5. Enable States, colleges, and educational programs to allow modified approaches to clinical skills
labs, clinical internships, and field internships, when they can be conducted safely.
6. Encourage the sharing of best practices by State and local authorities.
7. Encourage collaboration between educational programs to develop online education
capabilities.
8. Permit public and private education testing centers to administer the NREMT examination
within local jurisdictions, while following strict social distancing protocols.
9. Explore the ability to verify course completion and/or testing paramedic students at the AEMTlevel,
provided the state has approved an AEMT course.

National Considerations for EMS Stakeholders
In addition, stakeholders may consider the following measures at the national level to the extent
permitted by applicable law:
1. Permit fingerprinting centers to open to support criminal background checks for EMS clinicians
as a condition of licensure or employment. Explore other innovative solutions for conducting
criminal background checks.
2. Continue convening national EMS organizations to facilitate collaborative and innovative
problem-solving. Engage additional stakeholders, such as the Accreditation Council for Graduate
Medical Education, to coordinate healthcare education efforts.
3. Consider, as essential critical infrastructure workers, those workers involved in the certification,
licensing, and credentialing of EMS personnel and other healthcare workers.
4. Consider, as essential critical infrastructure workers, those workers supporting public and
private education testing centers for EMS personnel and other healthcare workers.
5. Share EMS educational best practices nationally.
6. Support technology for EMS education programs to conduct remote training, high-fidelity
simulation and other tools for effective training while also supporting social distancing.

2020 Medicare Reference Manual & Medicare Update Webinar

The 2020 Medicare Reference Manual and the 2020 Medicare Update Webinar are both available for purchase. Please see details below!

2020 Medicare Update Webinar

Thursday, April 30, 2020 | 2:00pm EST
Presenter: Brian Werfel, Esq.
$99 for AAA-Members | $198 for Non-Members

Join A.A.A. Medicare Consultant Brian S. Werfel, Esq. for an update on recent changes to Medicare’s coverage of ambulance services. This webinar coincides with the American Ambulance Association’s release of its 2020 Medicare Reference Manual. Brian will discuss recent changes in Medicare policy, including changes to the rules governing the enforcement of fraud and abuse, the appeals process, etc. We will also discuss Medicare’s proposed plan for the ET3 Program, the national expansion of the prior authorization model for scheduled non-emergency transports, and much more.

Of course, we will also discuss Medicare’s coverage of ambulance services during the current COVID-19 process. This will include a frank discussion of the issues related to medical necessity for the transportation of known or suspected COVID-19 patients, the coverage of transports to field hospitals and other alternative destinations, the current status of certain administrative rules like the Medicare patient signature requirement and the Notice of Privacy Practices, etc.

The session will include an extended Q&A period to address any and all questions from attendees. Purchase Webinar► 

*2020 Medicare Reference Manual Sold Separately* 

 

2020 Medicare Reference Manual 

$200 for AAA-Members | $400 for Non-Members
By David Werfel, Esq & Brian Werfel, Esq

The American Ambulance Association’s 2020 Medicare Reference Manual is a must-have for ambulance services that bill Medicare for transports.

Cyber Week Sale

This week only (through 12/2/16), take advantage of 25% off all AAA publications and our upcoming Webinar “I Really Can’t Stay… Managing Employee Leave” by HR Consultant, Scott Moore.

2016 Medicare Reference Manual

The American Ambulance Association’s 2016 Medicare Reference Manual is a must have for billing offices that deal with ambulance transports. Also included is the AAA’s 2015 HIPAA Guide, keep your staff up to date on patient signature requirements, levels of ambulance service, payment for ambulance services, claims processing, and much more! With margins tighter than ever, this manual will be sure to save your company money.

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Non-Member Price: $300.00
Member Price: $150.00

2015 Human Resources Handbook

The AAA Human Resources Policy & Procedure Toolkit is an essential resource for HR teams around the country. The AAA’s HR Handbook is designed to help keep ambulance services compliant with ever-increasing federal legal requirements for employers. This handbook can serve as an outline for your service to draft or update its own human resource policy manual. Don’t leave your service exposed, use the AAA’s HR handbook to keep your HR policies and procedures up to date.

hr-cover

Non-Member Price: $195.00
Member Price: $97.50

Bundle: 2015 Compliance Manual and 2014 Documentation Guide

The AAA’s 2015 Compliance Manual provides a model for ambulance services to use in developing their own compliance program. This manual can also be used to provide training and educational material to your service’s compliance team. With government regulations becoming stricter, it is crucial for your service to have a solid compliance program.

The American Ambulance Association’s 2014 Documentation Guide is designed to assist ambulance service organizations and EMS training institutions in educating their emergency medical technicians, paramedics, personnel, and students in the appropriate standards for documentation. The healthcare field demands a higher and more consistent quality of documentation and this guidebook will help your service with gathering and submitting the proper information demanded by regulatory agencies, insurance payors, and consumers.

compliance-documentation

Non-Member Price: $325.00
Member Price: $162.50

(Don’t need the full bundle? Compliance Manual and Documentation Guide are available separately for $190 (n0n-member)/$95 (member) each)

Guide to ICD-10 for Ambulance Services

Authored by experienced practitioners, the Guide to ICD-10 for Ambulance Services, is a billing department must have. The guide covers condition codes, payor specific information, ICD-9—ICD-10 crosswalk and other practical documentation and compliance information for billing and coding. This guide is an excellent tool for companies that deal with ambulance billing.

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Non-Member Price: $240.00
Member Price: $120.00