Senators Release Draft Balanced Billing Legislation

On Tuesday, September 18, 2018 Senators Bill Cassidy, M.D. (R-LA), Michael Bennet (D-CO), Chuck Grassley (R-IA), Tom Carper (D-DE), Todd Young (R-IN), and Claire McCaskill (D-MO) released draft legislation that aims to protect patients from surprise medical bills. The discussion draft (view the entire draft) of this proposed legislation tackles three main aspects of balanced billing: Emergency services provided by an out-of-network provider in an out-of-network facility Non-Emergency services following an emergency service from an out-of-network facility Non-Emergency services performed by an out-of-network provider at an in-network facility The discussion draft outlines legislation that would prevent balanced billing of patients for emergency medical services and instead require insurers to pay the difference between out-of-network and in-network costs. This discussion draft was likely fueled, in part, by some recent headlines highlighting extremely high bills received by patients. In his press release, Senator Cassidy references two stories in particular, one of a patient who received a bill of nearly $109,000 for care after a heart attack, and another of a patient who received a bill for $17,850 for a urine test. The AAA knows that balanced billing is a major issue for our members and will be monitoring this legislation closely. The AAA and (more…)

Government Affairs Update

Government Affairs Update: What We’re Working On The AAA continues to press policy initiatives with Congress and the Administration that are important to our members. While not as high-profile as our successful efforts earlier this year on the five-year extension of the Medicare ambulance add-ons, the AAA is working hard on ambulance legislation and regulations that impact the EMS industry and ambulance services across the country. Here is a snapshot of those current efforts. Over the next month, we will be providing weekly in-depth updates highlighting these issues. Ambulance Cost Data Collection System The AAA was successful in getting our preferred language of an ambulance cost data collection system using a survey and random sample methodology included with the extension of the add-ons in the Bipartisan Budget Act of 2018. However, that was just the first key step in the process. We now need to ensure that CMS gets the details right as the agency develops the structural specifics and data elements for the system. It is critical that the system is designed in a way that ambulance service suppliers and providers will submit the most accurate data possible. The data will ultimately provide the information necessary for Congress, the...

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Notice of Proposed Change to OSHA Injury Reporting

Notice of Proposed Change to OSHA Electronic Injury Reporting Regulations The Occupational Safety and Health Administration (OSHA) announced on July 27, 2018 that it has published a Notice of Proposed Rulemaking (NPRM) that would change the Electronic Injury Reporting Regulations (29 CFR Part 1904) for employers with 250 or more employees. OSHA is proposing this change due to a heightened concern that employee Personally Identifiable Information may be at risk of disclosure through the Freedom of Information Act (FOIA). Currently, all EMS employers must submit their annual injury and illness data to OSHA through the Injury Tracking Application (ITA). Historically, employers were required to track all workplace injuries and illnesses and maintain records of those incidents in the workplace on the OSHA Form 300, 301, and 300A. Each year, employers are required to post a Summary of Workplace Injuries and Illnesses on the Form 300A from February 1st through April 30th. In May 2016, OSHA amended the regulations requiring all employers to submit their Form 300A Summary electronically through the Injury Tracking Application (ITA). Employers with 250 or more employees were required to electronically report all injury and illness data from Forms 300, 301, and 300A each year. Initially OSHA...

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CMS Non-Emergency Ambulance Transport Open Door Forum 7/26

CMS Issues Data Elements and Templates for Non-Emergency Ambulance Transports (NEAT): Open Door Forum for Thursday, July 26, 2018 Just Announced As part of its Patients Over Paperwork Project, the Centers for Medicare & Medicaid Services (CMS) Provider Compliance Group (PCG) has been hosting quarterly listening sessions and reviewing the Request for Information submissions. The American Ambulance Association has been actively engaged in these efforts, highlighting the recommendations we submitted to CMS and the House Ways & Means Committee last year. These recommendations included suggestions as to how CMS could streamline regulatory requirements to eliminate duplicative requirements and reduce regulatory burdens.  In addition to these efforts, CMS has been working to standardize documentation data elements and establish templates that providers and suppliers can use to help make the current documentation processes less burdensome as well. On July 24, CMS released draft documentation-related clinical data elements and clinical templates that could be used for the Physician Certification Statement, Progress Notes, and Prior Authorization requests. View the Documents. These documents are not intended to change current law. CMS also announced yesterday that it will discuss the templates on a Special Open Door Forum which is scheduled for July 26 at 2-3 pm ET. ...

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Robert Wilkie Confirmed as VA Secretary

The Senate voted today to confirm Robert Wilkie as Department of Veterans Affairs secretary. Wilkie, previously an undersecretary at the Pentagon, was approved by the Senate 86-9. Of note, Wilkie becomes the fourth VA Secretary in the past five years. New VA Secretary, Robert Wilkie Senate confirms Robert Wilkie to be the next VA Secretary What To Know About Trump’s VA Secretary Nominee Robert Wilkie Wilkie takes over after Secretary David Shulkin was fired earlier this year. Wilkie is the second nominee put forward to replace Shulkin after White House physician, Ronny Jackson, withdrew his nomination in April.

Physician Fee Schedule Proposed Rule 2018

On Thursday, July 12, the Centers for Medicare & Medicaid Services (CMS) released the “Revisions to Payment Policies under the Physician Fee Schedule and Other Revisions to Part B for CY 2019; Medicare Shared Savings Program Requirements; Quality Payment Program; and Medicaid Promoting Interoperability Program” Proposed Rule (Proposed Rule). As you know, the American Ambulance Association worked closely with the Congress to ensure passage of the Bipartisan Budget Act of 2018 (BBA) (Pub. L. 115-123, enacted on February 9, 2018). The BBA not only extended the ambulance add-ons for 5 years, but also authorized a cost collection system that would not be overly burdensome on ambulance providers and suppliers, but would provide sufficient information ideally to support the permanent extension of the add-ons and set the basis for new payment models, including alternative destinations, treatment/assessment without transport, and community paramedicine. After passage of the BBA, the AAA engaged immediate with CMS to ensure the smooth implementation of these provisions. Those contacts resulted in guidance earlier this year implementing the add-ons retroactively to January 1, 2019. Consistent with the statute and already-released guidance, the Proposed Rule extends the three add-ons: the 2 percent urban, 3 percent rural, and 22.6 percent super-rural...

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Massachusetts Legislative Update

Last week the Senate passed a measure (HB 4640) that would raise the Massachusetts Minimum Wage to $15.00 per hour incrementally over the next five years. The Bill would also phase out the time and a half pay that some retail establishments who currently must pay employees who work on Sundays and certain holidays and establishes a permanent tax holiday. Governor Baker and Massachusetts law makers were eager to move this initiative in an effort to block a ballot initiative. The Bill would also establish a paid family and medical leave program for workers. The paid leave program will be funded by a new .63% payroll tax with contributions from both employers and employees. Businesses with fewer than 25 employees will not have to contribute to the fund. The program would go into effect on January 1, 2021 and would provide for up to 12 weeks of paid family leave, 20 weeks of medical leave, up to a total of 26 weeks in a year. Workers on leave would be paid a portion of their weekly wage with the average cost being $4.25 per employee per week. The Bill has been sent to Governor Baker’s office for consideration but will...

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July Brings Legal Changes for Employers in Many States

Oregon Statewide Transit Tax Important notice to ambulance service employers based in the state of Oregon: there is a new statewide transit tax taking effect on July 1, 2018. Beginning July 1st, employers must start withholding a tax of 1/10th of 1% from the wages of Oregon residents or from non-residents who perform services in Oregon. The Department of Revenue has published detailed information on the statewide tax with a list of available resources to assist employers with compliance. Iowa Lowers Standard for Positive Alcohol Tests Effective July 1, 2018, Iowa employers may lower their standard for taking employment action for positive alcohol tests from the old state standard of .04 to .02. Iowa has one of the strictest employment drug and alcohol testing requirements in the country. Employers are required to have a written policy that is distributed to all employees and job candidates for their review. Employers must establish a drug and alcohol awareness program alerting employees of the dangers of drug and alcohol use in the workplace, and most employees must be provided an option to enter a rehabilitation program instead of being disciplined. In addition, all supervisory staff must attend a two-hour initial drug and alcohol...

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