US Treasury | Coronavirus State and Local Fiscal Recovery Funds to Deliver $350 Billion

From the US Treasury on May 10, 2021

Aid to state, local, territorial, and Tribal governments will help bring back jobs, address pandemic’s economic fallout, and lay the foundation for a strong, equitable recovery 

 

WASHINGTON — Today, the U.S. Department of the Treasury announced the launch of the Coronavirus State and Local Fiscal Recovery Funds, established by the American Rescue Plan Act of 2021, to provide $350 billion in emergency funding for state, local, territorial, and Tribal governments.  Treasury also released details on the ways funds can be used to respond to acute pandemic-response needs, fill revenue shortfalls among state and local governments, and support the communities and populations hardest-hit by the COVID-19 crisis. Eligible state, territorial, metropolitan city, county, and Tribal governments will be able to access funding directly from the Treasury Department in the coming days to assist communities as they recover from the pandemic.

“Today is a milestone in our country’s recovery from the pandemic and its adjacent economic crisis. With this funding, communities hit hard by COVID-19 will able to return to a semblance of normalcy; they’ll be able to rehire teachers, firefighters and other essential workers – and to help small businesses reopen safely,” said Secretary Janet L. Yellen.  “There are no benefits to enduring two historic economic crises in a 13-year span, except for one: We can improve our policymaking. During the Great Recession, when cities and states were facing similar revenue shortfalls, the federal government didn’t provide enough aid to close the gap. That was an error. Insufficient relief meant that cities had to slash spending, and that austerity undermined the broader recovery. With today’s announcement, we are charting a very different – and much faster – course back to prosperity.”

While the need for services provided by state, local, territorial, and Tribal governments has increased —including setting up emergency medical facilities, standing up vaccination sites, and supporting struggling small businesses—these governments have faced significant revenue shortfalls as a result of the economic fallout from the crisis. As a result, these governments have endured unprecedented strains, forcing many to make untenable choices between laying off educators, firefighters, and other frontline workers or failing to provide services that communities rely on. Since the beginning of this crisis, state and local governments have cut over 1 million jobs.

The Coronavirus State and Local Fiscal Recovery Funds provide substantial flexibility for each jurisdiction to meet local needs—including support for households, small businesses, impacted industries, essential workers, and the communities hardest-hit by the crisis. Within the categories of eligible uses listed, recipients have broad flexibility to decide how best to use this funding to meet the needs of their communities. In addition to allowing for flexible spending up to the level of their revenue loss, recipients can use funds to:

  • Support public health expenditures, by – among other uses – funding COVID-19 mitigation efforts, medical expenses, behavioral healthcare, mental health and substance misuse treatment and certain public health and safety personnel responding to the crisis;
  • Address negative economic impacts caused by the public health emergency, including by rehiring public sector workers, providing aid to households facing food, housing or other financial insecurity, offering small business assistance, and extending support for industries hardest hit by the crisis
  • Aid the communities and populations hardest hit by the crisis, supporting an equitable recovery by addressing not only the immediate harms of the pandemic, but its exacerbation of longstanding public health, economic and educational disparities
  • Provide premium pay for essential workers, offering additional support to those who have borne and will bear the greatest health risks because of their service during the pandemic; and,
  • Invest in water, sewer, and broadband infrastructure, improving access to clean drinking water, supporting vital wastewater and stormwater infrastructure, and expanding access to broadband internet.

Insufficient federal aid and state and local austerity under similar fiscal pressures during the Great Recession and its aftermath undermined and slowed the nation’s broader recovery. The steps the Biden Administration has taken to aid state, local, territorial, and Tribal governments will create jobs and help fuel a strong recovery. And support for communities hardest-hit by this crisis can help undo racial inequities and other disparities that have held too many places back for too long.

For an overview of the Coronavirus State and Local Fiscal Recovery Funds program including an expanded use of eligible uses, see the fact sheet released today. Find additional details on the state, local, territorial, and Tribal government allocations on the Coronavirus State and Local Fiscal Recovery Funds Webpage.

 

HR2454 | Protecting Access to Ground Ambulance Medical Services Act of 2021

From Representative Terri Sewell

Rep. Sewell Introduces Legislation to Protect Access to Ground Ambulance Medical Services for Rural and Underserved Communities

Washington, D.C. – This Congress, U.S. Rep. Terri Sewell (AL-07), along with Reps. Devin Nunes (CA-22), Peter Welch (VT-AL), and Markwayne Mullin (OK-02), introduced H.R. 2454, the Protecting Access to Ground Ambulance Medical Services Act of 2021. The bill would ensure that ambulance service providers, including rural providers and those in underserved communities, are able to continue delivering quality critical first responder and health care services.

“When tragedy strikes and medical emergencies happen, we should feel confident that our first responders have the resources they need to deliver life-saving care,” said Rep. Sewell. “Unfortunately, inadequate Medicare reimbursement rates are putting a strain on ambulance service providers in the most vulnerable communities across the country and making it harder for them to care for our neighbors.”

“The problem is particularly severe for rural communities and has been worsened by the demands of the COVID-19 pandemic,” continued Sewell. “That is why I am proud to introduce the Protecting Access to Ground Ambulance Medical Services Act of 2021. This bill would permanently adjust Medicare reimbursement practices so that vital ambulance services remain vibrant and available to all Americans.”

“This bipartisan bill includes key reforms to ensure that rural Americans are not harmed by the delay in updating the Medicare ground ambulance fee schedule due to the COVID-19 pandemic,” said Rep. Nunes, Lead Republican Co-Sponsor. “Extending these temporary Medicare ground ambulance add-on payments for another five years and expanding coverage for those who live in zip codes with fewer than 1,000 people per square mile will keep ambulance costs affordable for Americans when they need ground ambulance transportation.”

“Rural ambulance services save lives and provide needed care in underserved areas every day,” said Rep. Peter Welch, Lead Democratic Co-Sponsor. “This bipartisan bill will ensure that patients in rural areas have access to critical ambulance services and that the providers of these services receive fair, consistent reimbursement for their important work. It’s time for Congress to pass this bill and give ambulance services the certainty they need to continue serving all Americans.”

“Ambulance services are critically important to rural Americans who may live close to an hour away from the nearest emergency room,” said Rep. Mullin, Lead Republican Co-Sponsor. “Providing this care literally means the difference between life and death for many people. As we continue to battle the closures of critical access hospitals across Oklahoma, ambulance services are more important now than ever before. We must ensure that rural Americans receive the care they need. I’m proud to join my colleagues in support of this bill which would enhance and increase resources for first responders in Oklahoma.”

Currently, ambulance service providers across the country are reimbursed by Medicare at rates below the cost of providing services, as determined by the Government Accountability Office (GAO). Consequently, providers rely on “add-on” payments to continue providing services. Add-on payments vary depending on whether a provider is located in an urban, rural, or “super rural” ZIP Code.

Congress has extended current add-on payment rates through December 31, 2022, and planned to review Medicare cost data in considering whether they should be made permanent. However, due to the upcoming ZIP Code reclassification which will occur following the 2020 Census, providers are faced with uncertainty regarding the future of these payments. Additionally, the COVID-19 pandemic forced the Centers for Medicare and Medicaid Services (CMS) to delay the first two rounds of data collection, compounding this uncertainty.

Background on the Protecting Access to Ground Ambulance Medical Services Act of 2021

H.R. 2454, the Protecting Access to Ground Ambulance Medical Services Act of 2021, would end the band-aid approach and make permanent adjustments to the reimbursement methodology for services in urban, rural, and “super rural” areas by building the temporary add-ons into the base rate fee. Specifically, it would extend the current temporary Medicare ground ambulance increases of 2% urban, 3% rural, and the super rural bonus payments for five years and would ensure that rural zip codes continue to be classified as rural following the ZIP Code reclassification.

These payments are vital to the financial viability of the ambulance community and have been extended numerous times on a bipartisan basis, most recently for 5 years. This five-year extension would allow a new data cost collection system time to be put into place and collect meaningful data following the delays caused by the COVID-19 pandemic.

“NRHA applauds Representative Terri Sewell for her leadership in working to preserve ground ambulance services in rural America. Throughout the pandemic ambulance services have provided critical first responder services in our most rural communities. Passing H.R. 2454, the Protecting Access to Ground Ambulance Medical Services Act of 2021, is critical to ensuring that these important services remain in their communities long after the public health emergency,” said Alan Morgan, Chief Executive Officer of the National Rural Health Association.

“The Alabama Rural Health Association lends its full support behind the ‘Protecting Access to Ground Ambulance Medical Services Act of 2021’ (H.R. 2454).  As rural EMS transportation is one of the greatest challenges for quality access to care in rural Alabama, support is greatly needed to reinforce the existing emergency transportation system.  With additional funding and flexibility created in the system, states like Alabama will have the ability to provide improved emergency transportation in critically rural and underserved areas and allow patients to receive the care that they need in a timely manner.  We are thankful for Rep. Sewell’s introduction of this language, and we encourage support for H.R. 2454,” said Ryan Kelly, Administrator of the Alabama Rural Health Association. 

The legislation is also supported by the following organizations:

  • American Ambulance Association (AAA)
  • International Association of Fire Chiefs (IAFC)
  • International Association of Fire Fighters (IAFF)
  • National Association of Emergency Medical Technicians (NAEMT)
  • National Volunteer Fire Council (NVFC)

H.R. 2454 can be found here.

Thank you to Representatives Rep. Terri Sewell, Congressman Devin Nunes, Peter Welch, and Congressman Markwayne Mullin…

May 6, 2021
Press Release

 

Exec Order to Raise the Minimum Wage to $15 for Federal Contractors

From the White House Briefing Room on April 27

Biden-Harris Administration Issues an Executive Order to Raise the Minimum Wage to $15 for Federal Contractors

Today, President Biden is issuing an executive order requiring federal contractors to pay a $15 minimum wage to hundreds of thousands of workers who are working on federal contracts. These workers are critical to the functioning of the federal government: from cleaning professionals and maintenance workers who ensure federal employees have safe and clean places to work, to nursing assistants who care for the nation’s veterans, to cafeteria and other food service workers who ensure military members have healthy and nutritious food to eat, to laborers who build and repair federal infrastructure.

This executive order will:

Increase the hourly minimum wage for federal contractors to $15. Starting January 30, 2022 all agencies will need to incorporate a $15 minimum wage in new contract solicitations, and by March 30, 2022, all agencies will need to implement the minimum wage into new contracts. Agencies must also implement the higher wage into existing contracts when the parties exercise their option to extend such contracts, which often occurs annually.
Continue to index the minimum wage to an inflation measure so that every year after 2022 it will be automatically adjusted to reflect changes in the cost of living.

Eliminate the tipped minimum wage for federal contractors by 2024. Federal statute allows employers of tipped workers to pay a sub-minimum wage as long as their tips bring their wage up to the level of the minimum wage. The Obama-Biden executive order raised the wages for tipped workers, but didn’t completely phaseout the subminimum wage for these workers. This executive order finishes that work and ensures tipped employees working on federal contracts will earn the same minimum wage as other employees on federal contracts.

Ensure a $15 minimum wage for federal contract workers with disabilities. To ensure equity, similar to the Obama-Biden minimum wage executive order for federal contractors, this executive order extends the required $15 minimum wage to federal contract workers with disabilities.

Restore minimum wage protections to outfitters and guides operating on federal lands by revoking President Trump’s executive order 13838 “Exemption From Executive Order 13658 for Recreational Services on Federal Lands.”
This order will build on the Obama-Biden Executive Order 13658, issued in February 2014, requiring federal contractors to pay employees working on with federal contracts $10.10 per hour, subsequently indexed to inflation. The minimum wage for workers performing work on covered federal contracts is currently $10.95 per hour and tipped minimum wage is $7.65 per hour.

This executive order will promote economy and efficiency in federal contracting, providing value for taxpayers by enhancing worker productivity and generating higher-quality work by boosting workers’ health, morale, and effort. It will reduce turnover, allowing employers to retain top talent and lower the costs associated with recruitment and training. It will reduce absenteeism, a change that has been linked to higher productivity, not just by the employees who are more present, but by their co-workers, too. And, it will reduce supervisory costs. One recent study focusing on warehouse workers and customer service representatives at an online retailer found that raising hourly wages by $1 yields a return of approximately $1.50 through increased productivity and reduced costs. As a result of raising the minimum wage, the federal government’s work will be done better and faster.

At the same time, the executive order ensures that hundreds of thousands of workers no longer have to work full time and still live in poverty. It will improve the economic security of families and make progress toward reversing decades of income inequality. Extensive, high-quality research shows that higher minimum wages have the intended effect of raising wages without significantly reducing employment outcomes. Higher minimum wages increase earnings growth for workers at the bottom of the income distribution, and those gains persist for years. A higher minimum wage, and an elimination of the tipped minimum wage, will benefit many women and people of color who likely have children and are the breadwinners in their households. It will help improve the economic security of their families and narrow racial and gender disparities in income. In addition to directly lifting the wages of hundreds of thousands of contract workers, the executive order will have impacts beyond federal contracting, as competitors in the same labor markets as federal contractors may increase wages, too, as they seek to compete for workers. Employers may seek to raise wages for workers earning above $15 as they try to recruit and retain talent. And, research shows that when the minimum wage is increased, the workers who benefit spend more, a dynamic that can help boost local economies.

The U.S. Department of Labor’s Wage and Hour Division and the Federal Acquisition and Regulatory Council will engage in rulemaking to implement and enforce this Executive Order.

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NYT | Rural Ambulance Crews Have Run Out of Money and Volunteers

From the New York Times by Ali Watkins on April 25, 2021

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Strained by pandemic-era budget cuts, stress and a lack of revenue, at least 10 ambulance companies in Wyoming are in danger of shuttering — some imminently.

Washakie County’s conundrum is reflective of a troubling trend in Wyoming and states like it: The ambulance crews that service much of rural America have run out of money and volunteers, a crisis exacerbated by the demands of the pandemic and a neglected, patchwork 911 system. The problem transcends geography: In rural, upstate New York, crews are struggling to pay bills. In Wisconsin, older volunteers are retiring, and no one is taking their place.

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Pascrell Leads Call to Modernize 9-1-1 Infrastructure

U.S. Congressman Bill Pascrell, Jr.
For Immediate Release
April 20, 2021

Media Contact:

Mark.greenbaum@mail.house.gov

Pascrell Leads Call to Modernize 9-1-1 Infrastructure

Letter to House Leadership urges inclusion of Next Generation 9-1-1 Act in upcoming infrastructure package

WASHINGTON, DC – U.S. Rep. Bill Pascrell, Jr. (D-NJ-09), the co-chair of the House Law Enforcement Caucus and the co-chair of the House Fire Services Caucus, today led a letter to House leadership urging inclusion of the Next Generation 9-1-1 Act in the upcoming infrastructure package. The legislation would provide $15 billion to update America’s 9-1-1 infrastructure, protect against cyber threats, and ensure that first responders will be able to efficiently use upgraded 9-1-1 technology to save lives. The letter was also signed by Fire Services Caucus co-chairs Steny Hoyer (D-MD-05), Brian Fitzpatrick (R-PA-01), and Mike Bost (R-IL-12), and Law Enforcement Caucus co-chair John Rutherford (R-FL-04).

“As the Co-Chairs of the Congressional Fire Services and Law Enforcement Caucuses, we write to express our strong support for the Next Generation 9-1-1 Act of 2021,” the Members wrote. “This legislation will provide critical updates to our nation’s 911 infrastructure, protect it from cyber threats, and ensure that first responders are able to efficiently use Next Generation 9-1-1 technology to save lives. We request the lifesaving benefits of this legislation be realized by incorporating it into any infrastructure package considered by the House of Representatives.”

The Members continued, “[a]s Next Generation 9-1-1 technology evolves and is deployed around the country, law enforcement, fire, and EMS agencies in urban, suburban, and rural areas will encounter varying issues. To ensure that Next Generation 9-1-1 technology is utilized optimally, stakeholders representing multiple agencies and geographic areas across the country must be frequently consulted. We are glad this legislation includes a Next Generation 9-1-1 Advisory Board to accomplish this critical coordination and collaboration. The board’s 16 members from various law enforcement, fire and rescue, and EMS agencies will provide valuable input to ensure Next Generation 9-1-1 is always meeting the needs of its users and the general public.”

The full letter to House leadership is available here.

As co-chair of both the House Law Enforcement Caucus and Fire Services Caucus, Rep. Pascrell has made supporting America’s first responders a top priority. He authored the FIRE Act, which provides hundreds of thousands in federal support to New Jersey firefighters each year and millions to fire departments nationwide. Last August, he led legislation to ensure that public safety officers who contract COVID-19 in the line of duty are eligible for benefits for their families should they become disabled or die from the virus. Rep. Pascrell also helped pass the CARES Act and the American Rescue Plan, both of which provided billions to communities to prevent layoffs of first responders amid the pandemic’s economic fallout.

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CMS | Sequestration | Claims Hold Lifted

CMS Confirms Suspension of Medicare Sequester Through End of 2021; Announces Lifting of Claims Hold

On April 16, 2021, CMS published a notice on the MLNConnects webpage announcing the passage of the Act to Prevent Across-the-Board Direct Spending Cuts, and for Other Purposes. The law, enacted on April 14, 2021 extends the suspension of the Medicare “sequester” through December 31, 2021.

In anticipation of the legislation’s passage, CMS announced on March 30, 2021 that it had instructed its Medicare Administrative Contractors (MACs) to hold Medicare Fee-For-Service claims with dates of service on or after April 1, 2021. With the passage of the bill, CMS further indicated that it has instructed its MACs to release any claims currently being held, and to reprocess any claims paid with the sequester applied. CMS indicated that no action is required on the part of health care providers and suppliers.

Medicare 2% Cut Freeze Extended

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.

ASPR TRACIE Newsletter April 2021

From HHS ASPR TRACIE Healthcare Emergency Preparedness Information Gateway

This issue of The Express highlights the following new/updated resources:

Please continue to access our Novel Coronavirus Resources Page, the National Institutes of Health Coronavirus Disease 2019 (COVID-19) Treatment Guidelines, and CDC’s Coronavirus webpage, and reach out if you need technical assistance (TA).

New: COVID-19 and the Changing Healthcare Delivery Landscape (Speaker Series)
Paul Biddinger, MD, FACEP, Medical Director, Emergency Preparedness, Mass General Brigham; Mark Jarrett, MD, MBA, MS, Chief Quality Officer, SVP & Deputy Chief Medical Officer, Northwell Health; and Meghan Treber, MS, ICF TRACIE Program Director, HHS ASPR highlight the impact of COVID-19 on healthcare delivery (e.g., supply chain, patients delaying emergency care, the delay of elective procedures, and financial impacts to the healthcare system) in this brief recording. Access the rest of the Healthcare Operations during the COVID-19 Pandemic speaker series for more information.
Updated: Healthcare Delivery Impacts Tip Sheet and Summary Document
This updated tip sheet describes the short- and long-term effects of COVID-19 related community mitigation measures on the healthcare system, including morbidity and mortality from chronic health conditions and lack of access. The accompanying summary document can help healthcare system planners prepare to mitigate these potential healthcare delivery impacts.
New: Acute Care Delivery at Home Tip Sheet
Some healthcare providers and systems have been providing hospital-level care in patient’s homes for years; others have implemented acute care delivery at home models in response to overcrowding at hospitals due to COVID-19. This tip sheet provides an overview of characteristics of various types of acute care delivery at home programs to help healthcare providers better understand this care model.
Issue 12: COVID-19 and Healthcare Professional Stress and Resilience
The articles in Issue 12 of The Exchange focus on three categories: understanding acute and chronic stressors in the healthcare worker population, identifying at-risk employees, and promising practices in building resilience. Be on the lookout for Issue 13, which will focus on the significant contributions made by supportive care providers and healthcare engineering representatives during the COVID-19 pandemic.
Mind Over Matter: Strategies to Help Combat the Coronavirus Blues
This document (created by the COVID-19 Schools Task Force, FEMA Region VII, and HHS Region 7) summarizes the contents of the Mind Over Matter Resource Guide, which can be used to support messaging for college and university campus communities to help combat COVID-19 fatigue and promote general wellness, both during and after the pandemic.
UCSD Health Medical Cyber Disaster Preparedness Study
The University of California San Diego (UCSD) is interested in better understanding how cybersecurity and cyber attacks impact our hospital systems and how we can better prepare in the future. This brief survey will provide a basic understanding of where we stand nationally on healthcare cyber preparedness. Your responses will be kept confidential and all data will be deidentified and reported in FEMA regions. The survey should take approximately five minutes to complete. You will receive no compensation for your participation and participation in this research is voluntary. The principal investigator of this study can be contacted at:

 

Dr. Christian Dameff, MD

University of California San Diego

Department of Emergency Medicine

200 W. Arbor Dr. #8676

San Diego, CA 92103

 

COVID-19 Clinical Rounds Peer-to-Peer Virtual Communities of Practice are a collaborative effort between ASPR, the National Emerging Special Pathogen Training and Education Center (NETEC), and Project ECHO. These interactive virtual learning sessions aim to create a peer-to-peer learning network where clinicians from the U.S. and abroad who have experience treating patients with COVID-19 share their challenges and successes; a generous amount of time for participant Q & A is also provided. These webinar topics are covered every week:

  1. EMS: Patient Care and Operations (Mondays, 12:00-1:00 PM ET)
  2. Critical Care: Lifesaving Treatment and Clinical Operations (Tuesdays, 12:00-1:00 PM ET)
  3. Emergency Department: Patient Care and Clinical Operations (Thursdays, 12:00-1:00 PM ET)

Access previous webinars and special topic sessions and sign up today to receive information on upcoming events.

Medicare Ambulance Relief Bill Introduced in House

Yesterday, Congresswoman Terri Sewell (D-AL) introduced the Protecting Access to Ground Ambulance Medical Services Act of 2021 (H.R. 2454). Congresswoman Sewell was joined by Congressmen Devin Nunes (R-CA), Peter Welch (D-VT) and Markwayne Mullin (R-OK) as primary cosponsors and leads on the legislation.

H.R. 2454 would extend the temporary Medicare ground ambulance increases of 2% urban, 3% rural and the super rural bonus payment for five years. The increases are currently scheduled to expire on December 31, 2022. The five-year extension would allow for the increases to remain in place during the two-year delay on ambulance data collection period due to the COVID-19 public health emergency.  It would also permit the cost collection program to move forward so that the statutorily mandated MedPAC analysis could be completed before the Congress would have to act to either further extend the add-ons or make them permanent through reforming the Medicare ambulance fee schedule.

The legislation would help address potential problems that rural zip codes in large urban counties could face as a result of the 2020 census data.  As we saw after the 2010 Census, the new Census data collection methodology resulted in geographical changes under the fee schedule that shifted rural ZIP codes to urban, despite there being no significant change in their population. The current definition using rural urban commuting areas (RUCA) in Goldsmith Modification areas would be modified to ensure ZIP codes with 1,000 people or less per square mile would remain rural. Ground ambulance service providers and suppliers could also petition the Centers for Medicare and Medicaid Services (CMS) to make the argument that a specific ZIP code should remain rural. It is vital that this provision be implemented before CMS makes changes from the 2020 Census data which will likely occur in 2023.

The AAA has been leading the effort on the legislation with the support of the Congressional Fire Services Institute, International Association of Fire Chiefs, International Association of Fire Fighters, National Association of EMTs and the National Volunteer Fire Council.

The AAA is working with champions of the effort in the Senate on introduction of a companion bill. We expect the bill to be introducing in the coming weeks.

The legislation is one of the policy issues being raised as part of EMS on the Hill Day and the AAA will be launching a Call To Action shortly requesting AAA members to ask their members of Congress to cosponsor the bill.

We greatly appreciate the leadership of Representatives Sewell, Nunes, Welch and Mullin on this vital issue.

CMS | 4/13 Webinar | HRSA COVID-19 Uninsured Program

From CMS on April 12, 2021

Upcoming Webinar for Providers on the HRSA COVID-19 Uninsured Program: Interested in learning more about the HRSA COVID-19 Uninsured Program? Participating providers are reimbursed at Medicare rates for testing, treating and administering COVID-19 vaccines to uninsured individuals.

Providers who have conducted COVID-19 testing to uninsured individuals, provided treatment for uninsured individuals with a COVID_19 diagnosis on or after February 4, 2020, or administered COVID-19 vaccines to uninsured individuals can begin the process to file claims for reimbursement. Providers can familiarize themselves with this process at https://www.hrsa.gov/coviduninsuredclaim, and learn more and file claims at https://coviduninsuredclaim.linkhealth.com/. Providers can also view Frequently Asked Questions about the program.

Join us on Tuesday April 13, 2021 at 2PM ET for an informational webinar.

Register Now

Feel free to share this with others who may be interested!

2019 National EMS Scope of Practice Model, Change Notices

Download Change Notice

Date:               March 29, 2021

To:                  State EMS Directors

From:              Jon R. Krohmer, M.D., FACEP, Director, Office of Emergency Medical Services

RE:                  2019 National EMS Scope of Practice Model, Change Notices

The National EMS Scope of Practice Model (model) was first published in February 2007 by the National Highway Traffic Safety Administration’s (NHTSA’s) Office of Emergency Medical Services (EMS). The most recent version of the model was published by NHTSA in February 2019. The model was developed by the National Association of State EMS Officials (NASEMSO) with funding provided by NHTSA and the Health Resources and Services Administration (HRSA). Over the past 14 years, the model has provided guidance for States in developing their EMS Scope of Practice legislation, rules, and regulation. While the model provides national guidance, each State maintains the authority to regulate EMS within its border, and determine the scope of practice of State-licensed EMS clinicians.

Recognizing that the model may impact States’ ability to urgently update their Scope of Practice rules, in 2016 the National EMS Advisory Council (NEMSAC) recommended that NHTSA develop a standardized urgent update process for the model. The Rapid Process for Emergent Changes to the National EMS Scope of Practice Model (rapid process) was developed by NASEMSO and published by NHTSA in September 2018.

Using the rapid process, in March 2021 NHTSA convened a subject matter expert panel (panel) to respond to the following questions: 1) Should immunizations via the intramuscular (IM) route be added to the emergency medical responder (EMR) and emergency medical technician (EMT) scope of practice levels?; 2) Should monoclonal antibody (MCA) infusion be added to the advanced EMT (AEMT) and paramedic scope of practice levels?; and 3) Should specimen collection via nasal swabbing be added to the EMR, EMT, AEMT, and paramedic scope of practice levels?

The panel considered the ability of EMRs and EMTs to perform the psychomotor skill of medication administration via the IM route and recommended that IM medication administration be added only to the EMT scope of practice as part of their common daily practice.

The panel considered the ability of EMRs and EMTs to administer medical director approved immunizations and recommended that immunizations during a public health emergency be added only to the EMT scope of practice.

The panel considered the ability of EMRs, EMTs, AEMTs, and Paramedics to perform the psychomotor skill of specimen collection via nasal swab and recommended that specimen collection via nasal swab be added only to the EMT, AEMT, and Paramedic scopes of practice as part of their common daily practice.

The panel did not issue a recommendation on MCA infusion.

Based on the panel’s recommendations NHTSA used the rapid process to develop the two attached change notices on IM medication administration, vaccinations during a public health emergency, and specimen collection via nasal swab.

It should be noted that, although the recommendations address the psychomotor skills associated with these specific activities, the assumption of the panel in making the recommendations was that all associated educational activities, knowledge of indications and potential contraindications, other potential skills (e.g.: drawing the appropriate dose of medication up from an ampule or vial [single or multi-dose], supervised assessment of skill competency, and quality improvement activities) would be components of the entire program.

I hope you find these change notices useful to you in meeting the urgent needs of your patients and the practitioners you regulate. In the very near future we will publish a revised version of the model which incorporates these change notices. Please feel free to contact me should you have any questions.

Download Change Notice

CMS | Repayment of COVID-19 Accelerated & Advance Payments Began 3/30

Repayment of COVID-19 Accelerated and Advance Payments Began on March 30, 2021

CMS issued information about repayment of COVID-19 accelerated and advance payments. If you requested these payments, learn how and when we’ll recoup them:

  • Identify payments we recovered
  • Prepare your billing staff

More Information:

NAEMT Survey | Impact of COVID-19

A year has passed since NAEMT released a national survey on the impact of the COVID-19 pandemic. The 2020 survey captured real time data on how EMS agencies and fire departments were being affected by the pandemic. It allowed NAEMT to share with elected officials the story of EMS, serving on the frontlines of this public health crisis. This data motivated Congress, state legislatures, and government agencies to take action to support EMS.

We believe that EMS agency and fire department leaders should be surveyed again to collect data on how the last twelve months of the pandemic have affected their workforce, finances, operations, equipment and supplies.

We kindly ask for less than 10 minutes of your time to respond to this survey to help us provide a clear picture for federal and state leaders on the areas of greatest concern that need to be addressed.

Take NAEMT Survey

To collect and analyze the data in a timely fashion, we ask that you complete this short survey by Monday, April 19. Please be sure that only one leader from your agency completes the survey.

Thank you for your continued dedication to advancing EMS.

Sincerely,

Bruce Evans, MPA, NRP, CFO, SPO

President, NAEMT

CMS | Sequestration Update | Temporary Claims Hold

From CMS on March 30, 2021

Temporary Claims Hold Pending Congressional Action to Extend 2% Sequester Reduction Suspension

In anticipation of possible Congressional action to extend the 2% sequester reduction suspension, we instructed the Medicare Administrative Contractors (MACs) to hold all claims with dates of service on or after April 1, 2021, for a short period without affecting providers’ cash flow. This will minimize the volume of claims the MACs must reprocess if Congress extends the suspension; the MACs will automatically reprocess any claims paid with the reduction applied if necessary.

Senate Passes Sequestration Suspension Extension Bill

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.

GAO | Appointments to State All Payer Claims Databases Advisory Committee

From the General Accountability Office

WASHINGTON, DC (March 29, 2021) – Gene L. Dodaro, Comptroller General of the United States and head of the U.S. Government Accountability Office (GAO), today announced the appointment of six members to the newly created State All Payer Claims Databases Advisory Committee (SAPCDAC).

“At almost $4 trillion dollars annually and growing, health care spending poses significant challenges for both the economy as a whole as well as federal and state budgets. State All Payer Claims Databases can assist a wide variety of stakeholders—policymakers, consumers, providers, and payers—in monitoring health care costs, access, and quality,” Dodaro said. “We had a number of exceptional candidates interested in serving on the committee, and the experiences and perspectives of today’s appointees should greatly benefit SAPCDAC as it advises the Secretary of Labor on data standards for voluntary reporting to State All Payer Claims Databases.”

The newly appointed members are Niall Brennan, Cheryl Damberg, Emma Hoo, Frederick Isasi, Mike Kapsa, and Josephine Porter.

Congress established the committee in December 2020 to make recommendations to the Secretary of Labor on the standardized format and associated guidance for the voluntary reporting by group health plans to State All Payer Claims Databases. The Comptroller General is responsible for naming six committee members. Additionally, the Secretary of Labor has responsibility for appointing nine committee members representing various agencies within the Departments of Labor and Health and Human Services, as well as one chair and one representative of a State All Payer Claims Database.

The No Surprises Act, enacted as part of the Consolidated Appropriations Act of 2021, requires the committee to provide recommendations to the Secretary of Labor within 180 days.

For more information, please visit the SAPCDAC website, or email the Department of Labor at SAPCDAC@dol.gov. Other calls should be directed to Chuck Young in GAO’s Office of Public Affairs at (202) 512-4800.

Brief biographies of the new committee members follow:

Niall J. Brennan, MPP, is the President and CEO of the Health Care Cost Institute in Washington, DC, where he leads one of the largest multi-payer claims databases in the country, with 100 million covered lives across the commercial and Medicare sectors. Prior to that role, he held numerous positions involving health care data analytics, including as Chief Data Office at the Centers for Medicare & Medicaid Services, and as a Senior Analyst at the Medicare Payment Advisory Commission. Mr. Brennan advises Congressional staff and other key health system stakeholders on important health policy and transparency topics, and he has testified before Congress on these issues. He also serves on the Board of Directors of the National Association of Health Data Organizations and was a cofounder and member of the All Payer Claims Database Council. Mr. Brennan received his MPP from Georgetown University.

Cheryl L. Damberg, PhD, is a Principal Senior Economist and Distinguished Chair in Healthcare Payment Policy at the RAND Corporation in Santa Monica, CA. She is also Professor at the Pardee RAND Graduate School. She leads health economic and health services research studies focused on health system performance, alternative payment models, price transparency, and the use of incentives to drive system improvement. Before joining RAND, Dr. Damberg held numerous positions, including Director of Research and Quality at the Pacific Business Group on Health. She is an international expert on health system redesign and has advised Congress, federal agencies, and the governments of Great Britain, Germany, and South Korea on the use of incentives and ways to measure provider performance. Dr. Damberg was appointed by California’s governor Newsom as Vice-Chair of the California Healthcare Payments Database (HPD) Review Committee to establish a plan for California’s all payer claims database. She now serves as a member of the HPD Advisory Committee that is guiding the implementation of the California APCD. Dr. Damberg received her PhD in Public Policy from RAND.

Emma Hoo is the Director of Pay-for-Value at the Purchaser Business Group on Health in San Francisco, CA. In that role, she works closely with employer and purchaser groups as well as health plan, provider, and consumer stakeholders to advance health care data availability and transparency. Her focus areas include advancing common Accountable Care Organization quality and efficiency measures, measurement-based behavioral health care, and adoption of patient-reported outcomes measures. She has managed data analytics and evaluation for several pilot programs to test payment reform and health delivery redesign, including an Intensive Outpatient Care Program under a Centers for Medicare & Medicaid Services Innovation Award. She also supported the Better Quality Information initiative that aggregated Medicare and commercial claims data to assess the quality of care at various levels of the delivery system. Previously, Ms. Hoo was the Director of Operation at Baycare Medical Group, Inc., where she managed overall operations and management information systems for a 200-member primary care group. She also serves on numerous committees, including the California Healthcare Payments Data Review Committee, which supports the planning and development of a statewide all payer claims database. Ms. Hoo received her BA cum laude in Social Studies from Harvard University.

Frederick Isasi, JD, MPH, is the Executive Director of Families USA in Washington, DC. In that role he directs national, state, and local initiatives to ensure accessible and affordable health care for all consumers. He has testified before congressional committees on the importance of establishing a national all payer claims database to improve the quality of health care, reduce costs, and provide transparency for consumers, policy makers, and other stakeholders. Prior to joining Families USA, Mr. Isasi held various leadership positions involving health care research and state multi-payer claims databases, including as Health Division Director at the National Governors Association and Vice President of Health Policy at The Advisory Board Company. Mr. Isasi received his JD from Duke University in Durham, NC, and his MPH from the University of North Carolina at Chapel Hill.

Michael J. KapsaPhD, is the Chief Financial Officer of SolidaritUS Health Inc. in Washington, DC, working with local exchanges that share claims databases to develop cost-effective primary care programs for employer and labor union employees. Dr. Kapsa is also Chief Economist for America’s Agenda, a national alliance of international labor unions and employers, where he helps develop federal and state health policy and primary care delivery models aimed at reducing costs and improving health care quality and outcomes. His prior experience includes leadership positions negotiating health and other benefits for various labor union employees, including the Coalition of Kaiser Permanente Unions, the Service Employees International Union, and the International Brotherhood of Teamsters. Dr. Kapsa received his PhD from the New School for Social Research in New York City.

Josephine Porter, MPH, is the Director of the Institute for Health Policy and Practice at the University of New Hampshire in Durham, NH, overseeing academic health care research and serving as Principal Investigator on a number of research projects. In addition, she is the Co-Chair of All Payer Claims Database (APCD) Council, a partnership with the National Association of Health Data Organizations, which serves as a national learning network for APCDs. In this role, she serves as a national authority on APCD issues, presenting on state and national panels with a focus on the use of APCDs to promote healthcare transparency. She was the lead author on an APCD Development Manual and has been actively involved in the development of a data submission standard to help bring data submission in line across the states. Prior to that, she held a variety of leadership positions in the private and public sectors. Ms. Porter received her MPH from Boston University.