10/22 CMS Ambulance ODF Updated Agenda

From CMS on October 20, 2020

Open Door Forum Dial-In

October 22, 2020 at 1:00–2:30pm ET
Dial: 1-888-455-1397
Conference Passcode: 9375124

The next CMS Ambulance Open Door Forum scheduled for:

Date:  Thursday October 22, 2020

Start Time:  1:00pm-2:30pm PM Eastern Time (ET);

Please dial-in at least 15 minutes before call start time.

Conference Leaders: Jill Darling, Susanne Seagrave

**This Agenda is Subject to Change**

1. Opening Remarks

  • Acting Chair- Susanne Seagrave, Acting Director, Division of Data Analysis and Market-Based Pricing (Center for Medicare)
  • Moderator – Jill Darling (Office of Communications)

2. Announcements & Updates

  • Repetitive, Scheduled Non-Emergent Ambulance Transport (RSNAT) Prior Authorization Model Update

– https://www.cms.gov/newsroom/press-releases/cms-expand-successful-ambulance-program-integrity-payment-model-nationwide

  • ET3 Overview and Update

– ET3Model@cms.hhs.gov for inquiries

– ET3 Model Listserv for Model updates:            https://public.govdelivery.com/accounts/USCMS/subscriber/new?topic_id=USCMS_12521

– COVID-19 Frequently Asked Questions (FAQs) on Medicare Fee For Service (FFS) Billing document is available at: https://www.cms.gov/files/document/03092020-covid-19-faqs-508.pdf.  Ambulance services FAQs begins on page 41.

-CMS is using its statutory authority under section 1135(b)(5) of the Act to modify the data collection and reporting period for ground ambulance organizations that were selected to report in year 1 of the Medicare Ground Ambulance Data Collection System. This modification has been issued on page 30 in the following document: https://www.cms.gov/files/document/summary-covid-19-emergency-declaration-waivers.pdf

3. Open Q&A

**DATE IS SUBJECT TO CHANGE**

Next Ambulance Open Door Forum: TBA

ODF email: AMBULANCEODF@cms.hhs.gov

———————————————————————

This Open Door Forum is open to everyone, but if you are a member of the Press, you may listen in but please refrain from asking questions during the Q & A portion of the call. If you have inquiries, please contact CMS at Press@cms.hhs.gov. Thank you.

 

Open Door Participation Instructions:

This call will be Conference Call Only.

To participate by phone:

Dial: 1-888-455-1397 & Reference Conference Passcode: 9375124

Persons participating by phone do not need to RSVP. TTY Communications Relay Services are available for the Hearing Impaired.  For TTY services dial 7-1-1 or 1-800-855-2880. A Relay Communications Assistant will help.

Instant Replay: 1-866-448-2572; Conference Passcode: No Passcode needed

Instant Replay is an audio recording of this call that can be accessed by dialing 1-866-448-2572 and entering the Conference Passcode beginning 1 hours after the call has ended. The recording is available until October 24, 11:59PM ET.

For ODF schedule updates and E-Mailing List registration, visit our website at http://www.cms.gov/OpenDoorForums/.

Were you unable to attend the recent Ambulance ODF call? We encourage you to visit our CMS Podcasts and Transcript webpage where you can listen and view the most recent Ambulance ODF call. Please allow up to three weeks to get both the audio and transcript posted to: https://www.cms.gov/Outreach-and-Education/Outreach/OpenDoorForums/PodcastAndTranscripts.html.

CMS provides free auxiliary aids and services including information in accessible formats. Click here for more information. This will point partners to our CMS.gov version of the “Accessibility & Nondiscrimination notice” page. Thank you.

Legislative Update: EMS Counts Act

While negotiations for a fourth Stimulus package to address the impacts of the coronavirus remain at an impasse, the AAA continues to monitor Congressional activity for other legislation which impacts ambulance service providers and suppliers:

H.R. 8592 – EMS Counts Act of 2020

Introduced on October 13, 2020, by Rep. Susan Wild (D-PA-07) H.R. 8592 requires the Secretary of Labor to revise the Standard Occupational Classification System to accurately count the number of emergency medical services practitioners in the United States.

The Standard Occupational Classification system is a statistical standard used by federal agencies to classify workers into occupational categories for the purpose of collecting, calculating, or disseminating data. All workers are classified into one of 867 detailed occupations according to their occupational definition.

H.R. 8592 has been referred to the House Committee on Education and Labor for consideration.

The AAA will continue to press the Congress and federal agencies for help to ensure ambulance service organizations, and our paramedics and EMTs serving on the front lines of the COVID-19 pandemic, have the necessary resources and financial assistance to serve their communities.

If you have any questions about the AAA’s advocacy efforts, please do not hesitate to contact us at Info@Ambulance.org.

CMS Ambulance Open Door Forum Oct 22

From CMS on October 16

Open Door Participation Instructions:

October 22, 1:00–2:30 on ET

This call will be Conference Call Only.

To participate by phone:

Dial: 1-888-455-1397 & Reference Conference Passcode: 9375124

Persons participating by phone do not need to RSVP. TTY Communications Relay Services are available for the Hearing Impaired.  For TTY services dial 7-1-1 or 1-800-855-2880. A Relay Communications Assistant will help.

Instant Replay: 1-866-448-2572; Conference Passcode: No Passcode needed

Instant Replay is an audio recording of this call that can be accessed by dialing 1-866-448-2572 and entering the Conference Passcode beginning 1 hours after the call has ended. The recording is available until October 24, 11:59PM ET.

The next CMS Ambulance Open Door Forum is scheduled for:

Date:  Thursday October 22, 2020

Start Time:  1:00pm-2:30pm PM Eastern Time (ET);

Please dial-in at least 15 minutes before call start time.

Conference Leaders: Jill Darling, Susanne Seagrave

**This Agenda is Subject to Change**

1. Opening Remarks

  • Acting Chair- Susanne Seagrave, Acting Director, Division of Data Analysis and Market-Based Pricing (Center for Medicare)
  • Moderator – Jill Darling (Office of Communications)

2. Announcements & Updates

3. Open Q&A

**DATE IS SUBJECT TO CHANGE**

Next Ambulance Open Door Forum: TBA

ODF email: AMBULANCEODF@cms.hhs.gov

———————————————————————

This Open Door Forum is open to everyone, but if you are a member of the Press, you may listen in but please refrain from asking questions during the Q & A portion of the call. If you have inquiries, please contact CMS at Press@cms.hhs.gov. Thank you.

 

For ODF schedule updates and E-Mailing List registration, visit our website at http://www.cms.gov/OpenDoorForums/.

Were you unable to attend the recent Ambulance ODF call? We encourage you to visit our CMS Podcasts and Transcript webpage where you can listen and view the most recent Ambulance ODF call. Please allow up to three weeks to get both the audio and transcript posted to: https://www.cms.gov/Outreach-and-Education/Outreach/OpenDoorForums/PodcastAndTranscripts.html.

CMS provides free auxiliary aids and services including information in accessible formats. Click here for more information. This will point partners to our CMS.gov version of the “Accessibility & Nondiscrimination notice” page. Thank you.

 

NHTSA Office of EMS Annual Update

From the NHTSA Office of EMS

Find out more about what’s been accomplished in 2020 and how you can get involved in national efforts to improve EMS

This year has been like no other for each of you, and the same is true at the NHTSA Office of EMS. Since COVID-19 first hit the United States, we’ve been busy working with our partners at the federal, state and local levels to support EMS clinicians serving on the front lines of our healthcare system.

At the same time, our other important work to advance EMS systems nationwide has continued, from updating the National EMS Education Standards to developing evidence-based guidelines, and so much more. Many of you have continued to contribute to these efforts by serving on expert panels, attending virtual meetings and providing critical feedback. Thank you for these efforts to achieve the vision put forth in EMS Agenda 2050 even as you confront one of the most challenging years we have faced, professionally and personally.

Click here to read our annual summary of what has been accomplished in the last year and what projects are ongoing. You’ll also find links so you can learn more and find ways to participate.

CMS Announces New AAP Repayment Terms

CMS Announces New Repayment Terms for Medicare Loans made to Providers during COVID-19

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.

Rural Healthcare Grants from HRSA FORH

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.

Review the 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.

CMS Updates Medicare COVID-19 Snapshot

From CMS on October 2, 2020

Today, the Centers for Medicare & Medicaid Services (CMS) released our monthly update of data that provides a snapshot of the impact of COVID-19 on the Medicare population. The updated data show over 1 million COVID-19 cases among the Medicare population and over 284,000 COVID-19 hospitalizations.

Other key findings:

  • The rate of COVID-19 cases among Medicare beneficiaries grew 30% since the August release to 1,562 cases per 100,000 beneficiaries.
  • Similarly, the rate of COVID-19 hospitalizations among Medicare beneficiaries grew 32% since the August release to 444 hospitalizations per 100,000 beneficiaries.
  • The rate of COVID-19 cases and hospitalizations grew the most among rural beneficiaries, Hispanic beneficiaries, and Medicare-only beneficiaries (those who are not dually eligible for Medicaid).
  • Medicare Fee-for-Service (Original Medicare) spending associated with COVID-19 hospitalizations grew to $4.4 billion or just under $25,000 per hospitalization.
  • Data on discharge status and length of stay for COVID-19 hospitalizations remained similar to previously reported figures in the August release. 31% of beneficiaries went home at the end of their hospital stay and 22% died. Nearly half of the hospitalizations lasted 7 days or less while 5% lasted more than 31 days.

The updated data on COVID-19 cases and hospitalizations among Medicare beneficiaries covers the period from January 1 to August 15, 2020. It is based on Medicare Fee-for-Service claims and Medicare Advantage encounter data CMS received by September 11, 2020.

HHS Funding Portal Open for Tranche 3

The online portal for ambulance service providers and suppliers to submit applications for additional funding under the HHS Provider Relief Fund is now open.

Access Portal Now

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.

Register for the Webinar

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.

 

 

 

America First Healthcare Executive Order on Surprise Coverage

President Trump’s “An America-First Healthcare Plan” Executive Order on Surprise Billing Policy

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:

  • Whether the hospital is in compliance with the Hospital Price Transparency Final Rule;
  • Whether, upon discharge, the hospital provides patients with a receipt that includes a list of itemized services received during a hospital stay; and
  • How often the hospital pursues legal action against patients, including to garnish wages, to place a lien on a patient’s home, or to withdraw money from a patient’s income tax refund.

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.