The Centers for Medicare & Medicaid Services (CMS) will extend the Community Health Access and Rural Transformation (CHART) Model Community Transformation Track application deadline by one month to March 16, 2021.
This extension is in response to feedback received from stakeholders, including comments about the challenges of preparing an application during the coronavirus disease 2019 (COVID-19) public health emergency. Extending the application deadline will allow interested applicants additional time to prepare their applications.
The Community Transformation Track will provide up-front funding to up to 15 rural communities across the country. The rural communities will be awarded seed money to work with health care providers and payers across the community to design systems of care that improve access to high quality care that is sustainable and value-based.
From the Washington Post by William Wan on December 3, 2020
Pandemic is pushing America’s 911 system to ‘breaking point,’ ambulance operators say
Surging demand, financial strain are leaving ambulance teams exhausted and running out of funds
The coronavirus pandemic has pushed America’s 911 system and emergency responders to a “breaking point,” with ambulance operators exhausted and their services financially strained, according to the group that represents them.
The situation since the novel coronavirus struck last winter has grown so dire that the American Ambulance Association recently begged the Department of Health and Human Services for $2.6 billion in emergency funding.
Due to the Public Health Emergency declared for the COVID-19 pandemic, CMS issued a blanket waiver in May 2020 to delay the data collection and reporting for those ground ambulance organizations selected to report in year 1 by one year. They were concerned that the unpredictability of the winter influenza season when combined with the COVID-19 pandemic would further strain the capacity of ground ambulance organizations in 2021.
CMS is delaying the data collection and reporting period for ground ambulance organizations selected to participate in year 1 for two years and for one year for ground ambulance organizations selected to participate in year 2. With this modification, the data collection period for year 1 and year 2 selected ground ambulance organizations will begin between January 1, 2022 and December 31, 2022.
AAA will send out a more detailed member advisory to assess the impact of the delay on the other requirements imposed in the legislation that mandated cost data collection for ambulance services.
What EMS organizations need to know about the Coronavirus vaccine.
Market research firm Technavio says the ambulance services market is poised to grow by $7.77 billion during 2020-2024. The report offers an up-to-date analysis regarding the current market scenario, latest trends and drivers and the overall market environment.
Impact of COVID-19
The COVID-19 pandemic continues to transform the growth of various industries, however, the immediate impact of the outbreak is varied. While a few industries will register a drop in demand, numerous others will continue to remain unscathed and show promising growth opportunities. COVID-19 will have a low impact on the ambulance services market. The market growth in 2020 is likely to increase compared to the market growth in 2019.
This annual survey of employers provides a detailed look at trends in employer-sponsored health coverage, including premiums, employee contributions, cost-sharing provisions, offer rates, wellness programs, and employer practices. The 2020 survey included 1,765 interviews with non-federal public and private firms.
Annual premiums for employer-sponsored family health coverage reached $21,342 this year, up 4% from last year, with workers on average paying $5,588 toward the cost of their coverage. The average deductible among covered workers in a plan with a general annual deductible is $1,644 for single coverage. Fifty-five percent of small firms and 99% of large firms offer health benefits to at least some of their workers, with an overall offer rate of 56%.
Survey results are released in several formats, including a full report with downloadable tables on a variety of topics, a summary of findings, and an article published in the journal Health Affairs.
From EMS.gov on October 9, 2020
American Ambulance Association members are advised that these grants are regrettably open ONLY to public and non-profit non-hospital-based EMS providers.
FEMA is providing an additional chance for volunteer and combination fire departments to apply for funding under this year’s Assistance to Firefighters COVID-19 Supplemental grant.
FEMA made $100 million available in funding for personal protective equipment (PPE) and related supplies. This includes reimbursement for expenditures made since Jan. 1, 2020.
Volunteer and combination fire departments are eligible to apply in this round even if they had a successful application in the first round earlier this year. Departments that applied in the first round but were unsuccessful must reapply to be considered for funding in this round. Applications from the first round will not automatically carry over to this round for consideration.
FEMA will host live webinars on Tuesday, Oct. 13, and Thursday, Oct. 15, demonstrating the application process and walking through the questions. Access the full training schedule and information on how to login to the webinars here.
FEMA will accept applications until 5 p.m. ET on Nov. 13. More information on eligibility requirements and how to apply is available on the FEMA website.
New recoupment terms allow providers and suppliers one additional year to start loan payments
The Centers for Medicare & Medicaid Services (CMS) announced amended terms for payments issued under the Accelerated and Advance Payment (AAP) Program as required by recent action by President Trump and Congress. This Medicare loan program allows CMS to make advance payments to providers and are typically used in emergency situations. Under the Continuing Appropriations Act, 2021 and Other Extensions Act repayment will now begin one year from the issuance date of each provider or supplier’s accelerated or advance payment. CMS issued $106 billion in payments to providers and suppliers in order to alleviate the financial burden healthcare providers faced while experiencing cash flow issues in the early stages of combating the coronavirus disease 2019 (COVID-19) Public Health Emergency (PHE).
“In the throes of an unprecedented pandemic, providers and suppliers on the frontlines needed a lifeline to help keep them afloat,” said CMS Administrator Seema Verma. “CMS’ advanced payments were loans given to providers and suppliers to avoid having to close their doors and potentially causing a disruption in service for seniors. While we are seeing patients return to hospitals and doctors providing care we are not yet back to normal,” she added.
CMS expanded the AAP Program on March 28, 2020 and gave these loans to healthcare providers and suppliers in order to combat the financial burden of the pandemic. CMS successfully paid more than 22,000 Part A providers, totaling more than $98 billion in accelerated payments. This included payments to Part A providers for Part B items and services they furnished. In addition, more than 28,000 Part B suppliers, including doctors, non-physician practitioners, and Durable Medical Equipment (DME) suppliers, received advance payments totaling more than $8.5 billion.
Providers were required to make payments starting in August of this year, but with this action, repayment will be delayed until one year after payment was issued. After that first year, Medicare will automatically recoup 25 percent of Medicare payments otherwise owed to the provider or supplier for eleven months. At the end of the eleven-month period, recoupment will increase to 50 percent for another six months. If the provider or supplier is unable to repay the total amount of the AAP during this time-period (a total of 29 months), CMS will issue letters requiring repayment of any outstanding balance, subject to an interest rate of four percent.
The letter also provides guidance on how to request an Extended Repayment Schedule (ERS) for providers and suppliers who are experiencing financial hardships. An ERS is a debt installment payment plan that allows a provider or supplier to pay debts over the course of three years, or, up to five years in the case of extreme hardship. Providers and suppliers are encouraged to contact their Medicare Administrative Contractor (MAC) for information on how to request an ERS. To allow even more flexibility in paying back the loans, the $175 billion issued in Provider Relief funds can be used towards repayment of these Medicare loans. CMS will be communicating with each provider and supplier in the coming weeks as to the repayment terms and amounts owed as applicable for any accelerated or advance payment issued.
Health Care Accounting and Auditing: Fall 2020 Update from MossAdams
Join us for a webcast covering the most critical developments in auditing and accounting standards that impact health care organizations, including the following:
From the HRSA Federal Office of Rural Health Policy
The Health Resources and Services Administration’s Federal Office of Rural Health Policy has released the Notice of Funding Opportunity (NOFO) for the Rural Health Care Services Outreach Program (Outreach) (HRSA-21-027). HRSA plans to award 60 grants to rural communities as part of this funding opportunity.
The Outreach Program administered by HRSA’s FORHP focuses on expanding the delivery of health care services to include new and enhanced services exclusively in rural communities. Applicants are required to deliver health care services through a consortium of at least three health care provider organizations, use an evidence-based or promising practice model to inform their approach, and demonstrate health outcomes and sustainability by the end of the four-year performance period.
In addition to funding Outreach programs through the regular Outreach track, in FY 21, FORHP will also afford applicants a unique opportunity to take part in a national effort that targets rural health disparities through a second track called the “Healthy Rural Hometown Initiative.” This initiative was created through the HHS Rural Task Force and driven by findings from a report published by the Centers of Disease Control and Prevention (CDC) that noted that the number of preventable death from the five leading cause of death in rural areas was higher than those in urban areas. Unfortunately, these findings echo earlier CDC research on the rural disparities in avoidable or excess death in 2017.
The Healthy Rural Hometown Initiative (HRHI) is an effort that seeks to address the underlying factors that are driving growing rural health disparities related to the five leading causes of avoidable death (heart disease, cancer, unintentional injury/substance use, chronic lower respiratory disease, and stroke). The goal of the HRHI track is to demonstrate the collective impact of projects that better manage conditions, address risk factors and focus on prevention that relate to the leading causes of death in rural communities. This track should be a good fit for applicants who want to identify and bridge the gap between the social determinants of health and other systemic issues that contribute to achieving health equity with regards to excess death in rural communities. Furthermore, this is a rural-specific and community-based approach to addressing these disparities and represents a new and more targeted strategy given the enduring health gaps between rural and urban populations.
Of the successful 60 award recipients, HRSA aims to award approximately 45 to regular Outreach track applicants and at least 15 to HRHI applicants for a ceiling amount of up to $200,000 (Regular Outreach) or $250,000 (HRHI) total cost (includes both direct and indirect, facilities and administrative costs) per year (and final numbers will be subject to how applicants score).
The HRHI is part of an ongoing multi-year effort by FORHP to highlight how rural community health efforts can improve health at the local level. We are encouraging rural health stakeholders to join us in this broader effort while also taking on the challenge of addressing these long-standing rural health disparities related to the five leading causes of death.
NOTE: The eligibility criteria for this program has changed and now includes all domestic public and private, nonprofit and for-profit entities with demonstrated experience serving, or the capacity to serve, rural underserved populations. Urban-based organizations applying as the lead applicant should ensure there is a high degree of rural control in the project. The applicant organization must represent a network that includes at least three or more health care provider organizations and, at least 66% (or two-thirds) of consortium members must be located in a HRSA-designated rural area.
Please review the guidance in its entirety for more information about eligibility criteria and specific program requirements. Visit www.grants.gov to review the Outreach NOFO and apply. Learn about the Outreach Program.
A webinar for applicants is scheduled on Tuesday October 13, from 3-4:30 p.m., EST. A recording will be made available for those who cannot attend.
For more information about this funding opportunity, contact the Program Coordinator, Alexa Ofori, at RuralOutreachProgram@hrsa.gov.
The online portal for ambulance service providers and suppliers to submit applications for additional funding under the HHS Provider Relief Fund is now open.
Apply Soon for Funds!
While providers and suppliers have until November 6 to apply for funding, we strongly recommend that AAA members submit applications as soon as you are prepared as funding is on a first-come, first-served basis. HHS allocated a total of $20 billion for this round of funding.
Attend Today’s AAA Funding Webinar
The AAA will be hosting a webinar today, Monday, October 5, at 11:00 am (eastern), on how to apply for the funds and what information you will need in applying.
Thank You AAA Members!
As reported by the AAA on October 1, the additional funds are a direct result of the efforts of the AAA and our members and we thank all of you who reached out to the White House or your members of Congress advocating for the funds.
by Kathy Lester, J.D., M.P.H.
As the American Ambulance Association (AAA) reported yesterday, President Trump issued an Executive Order (EO) “An America-First Healthcare Plan.” The EO includes several provisions, including related to drug importation generally and for insulin specifically. It also includes statements that indicate if the Congress does not act before the end of the year, the President will have the Department of Health and Human Services (HHS) “take administrative action to prevent a patient from receiving a bill for out-of-pocket expenses that the patient could not have reasonably foreseen.” It does not mention ground ambulances.
In addition to suggesting action if the Congress does not pass legislation, the EO also states that within 180 days, the Secretary will update the Medicare.gov Hospital Compare website to inform beneficiaries of hospital billing quality, including:
The narrative related to balance billing (surprise coverage) reads as follows:
My Administration is transforming the black-box hospital and insurance pricing systems to be transparent about price and quality. Regardless of health-insurance coverage, two‑thirds of adults in America still worry about the threat of unexpected medical bills. This fear is the result of a system under which individuals and employers are unable to see how insurance companies, pharmacy benefit managers, insurance brokers, and providers are or will be paid. One major culprit is the practice of “surprise billing,” in which a patient receives unexpected bills at highly inflated prices from providers who are not part of the patient’s insurance network, even if the patient was treated at a hospital that was part of the patient’s network. Patients can receive these bills despite having no opportunity to select around an out-of-network provider in advance.
On May 9, 2019, I announced four principles to guide congressional efforts to prohibit exorbitant bills resulting from patients’ accidentally or unknowingly receiving services from out-of-network physicians. Unfortunately, the Congress has failed to act, and patients remain vulnerable to surprise billing.
In the absence of congressional action, my Administration has already taken strong and decisive action to make healthcare prices more transparent. On June 24, 2019, I signed Executive Order 13877 (Improving Price and Quality Transparency in American Healthcare to Put Patients First), directing certain agencies — for the first time ever — to make sure patients have access to meaningful price and quality information prior to the delivery of care. Beginning January 1, 2021, hospitals will be required to publish their real price for every service, and publicly display in a consumer-friendly, easy-to-understand format the prices of at least 300 different common services that are able to be shopped for in advance.
We have also taken some concrete steps to eliminate surprise out‑of-network bills. For example, on April 10, 2020, my Administration required providers to certify, as a condition of receiving supplemental COVID-19 funding, that they would not seek to collect out-of-pocket expenses from a patient for treatment related to COVID-19 in an amount greater than what the patient would have otherwise been required to pay for care by an in-network provider. These initiatives have made important progress, although additional efforts are necessary.
Not all hospitals allow for surprise bills. But many do. Unfortunately, surprise billing has become sufficiently pervasive that the fear of receiving a surprise bill may dissuade patients from seeking appropriate care. And research suggests a correlation between hospitals that frequently allow surprise billing and increases in hospital admissions and imaging procedures, putting patients at risk of receiving unnecessary services, which can lead to physical harm and threatens the long-term financial sustainability of Medicare.
Efforts to limit surprise billing and increase the number of providers participating in the same insurance network as the hospital in which they work would correspondingly streamline the ability of patients to receive care and reduce time spent on billing disputes.
The AAA will continue to advocate for the resources necessary to sustain life-saving mobile healthcare.
Section 1834(l)(3)(B) of the Social Security Act mandates that the Medicare Ambulance Fee Schedule be updated each year to reflect inflation. This update is referred to as the “Ambulance Inflation Factor” or “AIF”. The AIF is calculated by measuring the increase in the consumer price index for all urban consumers (CPI-U) for the 12-month period…
American Ambulance Association Medicare Consultant Brian Werfel, Esq provides a brief update on the HHS COVID-19 Provider Relief Fund.
Prepared by Page, Wolfberg, and Wirth Overview Emergency Medical Service (EMS) agencies nationwide still widely report that hospitals and other healthcare providers refuse to share patient information with them, citing concerns under the Health Insurance Portability and Accountability Act (HIPAA).1 Misconceptions about HIPAA have created an artificial barrier to legitimate, approved bidirectional data exchange between…