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.

Contact the White House About Ambulance Funding

Congressional leaders and White House senior officials remain deeply divided in negotiating an additional stimulus package in response to the COVID-19 pandemic. Last week, Senate Republicans unveiled a smaller, limited package of COVID-19 relief. This “skinny” bill failed in the Senate in a 52-47 vote, with all Republicans except Sen. Rand Paul of Kentucky supporting it, falling short of the 60 votes needed to advance.

Unfortunately, Democrats and Republicans in Congress remain far from a passable stimulus package, and little progress is expected until after the 2020 election. Until then, the American Ambulance Association remains focused on ensuring ambulance service providers and suppliers have the resources they need to continue combating the coronavirus. The AAA is keeping in contact with Congressional and Administration officials as we push for expanded federal relief for the EMS industry.

Not over yet

While negotiations between Congress and the White House have stalled, there are still opportunities to advance the needs of EMS. The federal Department of Health and Human Services holds $50 billion in unappropriated stimulus dollars in its Provider Relief Fund. The AAA and our members have been doing a full-court press on the White House to allocate part of the $50 billion for ground ambulance services. We at the AAA strongly encourage you to use our platform to contact your federal elected officials and urge them to appropriate an additional $2.62 billion from the Provider Relief Fund directly to ambulance service providers and suppliers

We would like to thank the hundreds of AAA members who have already written their elected officials about the need for increased funding for EMS using our new platform which makes contacting your federal elected officials as easy as a few clicks.

Help us help you

If you have not already done so, please use our platform to contact your Members of Congress and the White House to ensure EMS voices are heard during these unprecedented times.

Contact your Elected Officials

 

Amid Stimulus Impasse, Bipartisan Group Offers $1.5 Trillion Compromise

From the New York Times

Members of the House Problem Solvers Caucus plan to map out a recovery package they hope can push top Democrats and White House officials back to the negotiating table…

A bipartisan group of 50 centrist lawmakers plans on Tuesday to present a $1.5 trillion plan to prop up the coronavirus-ravaged economy, making a last-ditch attempt to broach a compromise in hopes of breaking a stalemate in stimulus talks before November’s elections.

The proposal faces long odds amid partisan divisions over what should be included in such a package, and members of the group — which calls itself the House Problem Solvers Caucus — concede privately that their framework stands little chance of becoming law. But the decision to offer it up publicly reflects frustration among rank-and-file lawmakers in both parties at the failure by their leaders to agree to another round of pandemic aid, and a reluctance to return home weeks before Election Day without cementing such help.

Continue Reading

KHN | With No Legal Guardrails for Patients, Ambulances Drive Surprise Medical Billing

This week’s Kaiser Health News piece on surprise coverage includes less than a paragraph of the information provided by AAA Executive Director Maria Bianchi and Communications Chair Rob Lawrence. AAA is deeply disappointed by the lack of balance and inadequate representation of the EMS perspective in this coverage.

Read the article

Public Comment Requested for COVID-19 Vaccine Allocation

On September 1, 2020, the National Academies of Sciences, Engineering, and Medicine invited public comment on the Discussion Draft of the Preliminary Framework for Equitable Allocation of COVID-19 Vaccine, commissioned by the Centers for Disease Control and the National Institutes of Health. Input from the public, especially communities disproportionately affected by the COVID-19 pandemic, is essential to produce a final report that is objective, balanced, and inclusive. The public comment period will be open for 4 days, from 12:00 p.m. ET on Tuesday, September 1, until 11:59 p.m. ET on Friday, September 4.

Learn More or Comment

Department of Health and Human Services Extends Deadline to Apply for Provider Relief Funds

The Department of Health and Human Services (HHS) recently announced that it would be extending the deadline for health care providers to apply to receive general distribution funding from the HHS Provider Relief Fund.  The deadline to apply for these funds was previously June 3, 2020.

Relevant Background

On March 27, 2020, President Trump signed into law the Coronavirus Aid, Relief, and Economic Security Act (CARES Act).  As part of that Act, Congress allocated $100 billion to the creation of a “CARES Act Provider Relief Fund,” which will be used to support hospitals and other healthcare providers on the front lines of the nation’s coronavirus response.  An additional $75 billion was allocated as part of the Paycheck Protection Program and Health Care Enhancement Act, bringing the total “Provider Relief Fund” up to $175 billion.  This $175 billion will be distributed to health care providers and suppliers to fund healthcare-related expenses or to offset lost revenue attributable to COVID-10.

HHS ultimately elected to allocate these funds through a $50 billion “general allocation,” and multiple smaller “targeted allocations.”

Under its general allocation program, HHS intended to provide health care providers with funds roughly equal to 2% of the provider’s 2018 “net patient revenue,” i.e., the provider’s total revenues from patient care minus provisions for bad debt, contractual write-offs, and certain other adjustments.   This general allocation was made in two tranches, with the first tranche being distributed to all providers in mid-April.  This first tranche was made based on provider’s 2019 Medicare revenues.  As a result, any provider that received payments from the Medicare Fee-for-Service Program in 2019 automatically received an initial relief payment.  However, HHS required providers to submit an application to receive relief funding as part of the second tranche.  The deadline for applying for the second tranche of relief funding was June 3, 2020.

Scope of New Extension

 HHS indicated that the new extension is limited to health care providers that missed the June 3, 2020 deadline to apply for the second tranche of relief funding.  The extension also applies to providers that were ineligible for the first tranche of relief funding due to a recent change of ownership.  The specific situations that HHS indicated would meet the requirements for the extension include:

  • Health care providers who were ineligible for the first tranche of relief funding because: (1) they underwent a change in ownership in calendar year 2019 or 2020 under Medicare Part A and (2) did not have Medicare Fee-for-Service revenues in calendar year 2019;
  • Health care providers who received a payment in the first tranche of funding but: (1) missed the June 3, 2020 deadline to submit revenue information or (2) did not receive funds in the first tranche that total approximately 2% of their net patient revenue; or
  • Health care providers who received a payment in the first tranche of funding, but who ultimately elected to refund that payment (e.g., because they did not believe they met the eligibility requirements), and who are now interested in reapplying.

Health care providers that meet one of the requirements listed above will have until August 28, 2020 to submit an application for additional relief funds.  This deadline aligns with the extended deadline for other eligible Phase 2 providers, such as Medicaid, Medicaid Managed Care, CHIP, and dental providers.

Applications should be submitted through the CARES Provider Relief Fund webpage, which can be found at: https://cares.linkhealth.com/#/.

President Trump Engages on Ambulance Relief during Press Conference

Letter from AAA President Aarron Reinert
August 5, 2020

At last night’s White House press conference with President Trump, a reporter asked the President about the need for ambulance services to be fully reimbursed for their work related to the COVID-19 public health emergency. President Trump responded that ambulance services are doing an incredible job which is a very tough and dangerous one. The President stated he would look into the issue. The fact that the President of the United States was engaged in a public dialogue about the need for our work to be fully reimbursed is a significant development.

To view the YouTube clip of the ambulance dialogue during the press conference, please click here. The dialogue begins at 1:05:40.

The AAA continues to elevate the profile of the need for ambulance service providers to receive additional funding under the Provider Relief Fund. While we are extremely grateful for the relief we have received thus far, it represents only a small portion of the total $2.89 billion we need to offset the impact of being front line health care responders during the COVID-19 public health emergency.

We are directly requesting the Department of Health and Human Services (HHS) to distribute a portion of the funds remaining in the Provider Relief Fund to ambulance services. We are also advocating for Congress to include in the economic stimulus package currently being developed an allocation of more funds for ambulance service providers.

The AAA will continue to fight for our members and the financial relief necessary to combat the pandemic and maintain a strong EMS infrastructure for the future.

If you have not already done so, I ask that you write your members of Congress using the AAA’s new online letter writing tool about the need for more financial relief.

Thank you.

Aarron Reinert
President
American Ambulance Association

Use AAA’s New Online System to Contact Your Members of Congress on EMS Funding

The American Ambulance Association is pleased to announce our new advocacy software to make contacting your Members of Congress even easier. With just a few clicks, you can contact your Senators and Representative without hassle.

Follow the button below to send messages to Congress within minutes:

Contact Congress Today

As we reach the end of Congressional negotiations, it is critical now more than ever that you contact your Senators and Representative and ask them to support increased funding for ambulance service providers under the Public Health and Social Services Emergency Fund specifically for the increased costs, loss of revenue and uncompensated care facing ground ambulance service organizations due to COVID-19.

In addition to advocating for Congress to include funding specifically for ground ambulance services in the next COVID-19 economic relief package, the AAA is pressing for the Department of Health and Human Services to allocate more funding to EMS under the $75 billion already appropriated to the PHSSEF through the Paycheck Protection Program and Health Care Assistance Act.

The AAA will continue to fight for our members as your paramedics and EMTs are on the front lines of combating the Coronavirus.

 

NY Daily News | Tom Ridge: First Responders Need Us Now

From Tom Ridge’s op-ed in the NY Daily News

By the time the EMTs reached my hotel room in Austin, Tex., I was already unconscious on the floor. Moments earlier I had dragged myself to the phone and called for help as chest pains began to overwhelm me. I later learned those first responders resuscitated me more than once as they used their medical training to keep me alive until we arrived at the hospital. That’s where doctors and nurses and a lot of machines took over. I had suffered a major heart attack. The care I received at that medical center was extraordinary. But not for the immediate care I received from that small team of EMTs, I never would have made it.

That was back in 2017. I’ve since recovered and feel great, often thinking about  those heroic first responders, whom I was lucky enough to meet and personally thank a year later. I especially think of them and their colleagues today as COVID-19 creates huge budget problems for local governments that threaten their jobs and our nation’s ability to respond to this and future crises.

Ridge was governor of Pennsylvania and first U.S. Secretary of Homeland Security. He co-chairs the Bipartisan Commission on Biodefense.

URGENT: Ask Congress to Support EMS-Specific Relief

Ambulance services, please follow the instructions below. Members of the community, please click here to send an email!

Contact Your Members of Congress Today on Ambulance Specific Funding!

Congress returned this week from recess and has three weeks in which to get another COVID relief package passed before their August recess.

Please contact your Senators and Representative today and ask that they advocate for a funding program under the Public Health and Social Services Emergency Fund specifically for the increased costs, loss of revenue and uncompensated care facing ground ambulance service organizations due to COVID-19.

Please e-mail your Senators and Representative today!

 It will take you only a few minutes per Congressional office to email a letter. Just follow these steps.

 1. USE LETTER TEMPLATE: CLICK HERE to access a draft letter. Please customize your letter including the cities and towns you serve, and any additional details as to services you are providing during the COVID-19 outbreak and the financial impact on your operation.

2. LOOK UP YOUR SENATORS AND THEIR WEBFORM ADDRESS: CLICK HERE to access a list of the webform addresses of your Senators.

3. LOOK UP YOUR REPRESENTATIVE AND THEIR WEBFORM ADDRESS: CLICK HERE and enter your zip code to find the online contact form of your Representative.

4. SEND LETTERS TO MEMBERS: Follow the webform link into your Internet browser and you will be directed to the webpage for contacting your member of Congress. Fill in your contact information, cut and paste your letter into the comments box and hit submit.

In addition to advocating for Congress to include funding specifically for ground ambulance services in the next COVID-19 economic relief package, the AAA is pressing for the Department of Health and Human Services to allocate more funding to EMS under the $75 billion already appropriated to the PHSSEF through the Paycheck Protection Program and Health Care Assistance Act.

The AAA will continue to fight for our members as your operation and paramedic and EMTs are on the front lines of combating the Coronavirus.

AAA Sends Vaccine Prioritization Request Letter to President Trump

On July 13, the American Ambulance Association was joined by the Congressional Fire Services Institute, International Association of Fire Chiefs, International Association of Fire Fighters, National Association of Emergency Medical Technicians, National Fire Protection Association, and the National Volunteer Fire Council in sending a letter to President Donald Trump requesting that firefighters and emergency medical services (EMS) personnel are placed on the highest priority tier for receiving COVID-19 vaccinations when they are available.

Read the Letter

IRS Guidance on Taxation of HHS Provider Relief Funds

On July 7, 2020, the Internal Revenue Service published a series of Frequently Asked Questions that address the taxation of payments to health care providers under the HHS Provider Relief Fund.

As part of the Coronavirus Aid, Relief and Economic Security Act (CARES Act), Congress appropriated $100 billion to reimburse eligible health care providers for health care-related expenses and/or lost revenue attributable to the COVID-19 pandemic.  The Paycheck Protection Program and Health Care Enhancement Act appropriated an additional $75 billion to the Provider Relief Fund.

The first FAQ addressed the issue of taxation for for-profit health care providers.  Specifically, the IRS was asked whether a for-profit health care provider is required to include HHS Provider Relief Fund payments in its calculation of “gross income” under Section 61 of the Internal Revenue Code (Code), or whether such payments were excluded from gross income as “qualified disaster relief payments” under Section 139 of the Code.

The IRS indicated that payment from the Provider Relief Fund do not qualify as qualified disaster relief payments under Section 139 of the Code.  As a result, these payments are includible in the gross income of the entity.  The IRS further indicated that this holds true even for businesses organized as sole proprietorships.

The second FAQ addressed the issue of taxation for tax-exempt organizations.  The IRS indicated that health care providers that are exempt from federal income taxation under Section 501(a) would normally not be subject to tax on payments from the Provider Relief Fund.  Notwithstanding this general rule, the IRS indicated that the payment may be subject to tax under Section 511 of the Code to the extent the payment is used to reimburse the provider for expenses or lost revenue attributable to an unrelated trade or business as defined in Section 513 of the Code.

The IRS FAQ can be viewed in its entirety by clicking here.  Members are advised to discuss the issue of potential taxation of any relief funding they received with their tax professionals.

For-profit providers have to pay taxes on COVID-19 relief grants

From Modern Healthcare on July 13, 2020

The IRS clarified that for-profit healthcare providers will have to pay taxes on the grants they received from the COVID-19 Provider Relief Fund.

The two laws that set aside $175 billion in grants to help providers cover lost revenue and coronavirus-related expenses didn’t explicitly state that the funds would be taxable. However, the IRS issued guidance stating that the grants are taxable income days before a tax filing deadline on July 15. The change means that grants to for-profit healthcare providers including hospitals and independent physician practices will be subject to the 21% corporate tax rate.

Continue reading►

July 22 | EMS Advocacy Facebook Livestream


July 22, 2020 | 14:00 ET | Register Now for a Reminder!

Join AAA advocacy experts for a fast-paced informal dialogue on Facebook Live! Learn first-hand about EMS advocacy initiatives in the face of COVID-19.

Register to receive a reminder email one hour in advance of the live broadcast on the American Ambulance Association Facebook page!

Panelists

  • Randy Strozyk, Secretary, AAA
  • Jamie Pafford-Gresham, Chair, AAA Government Affairs Committee
  • Asbel Montes, Chair, AAA Payment Reform Committee
  • Rob Lawrence, Chair, AAA Communications Committee
  • Maria Bianchi, AAA Executive Director
  • Tristan North, AAA SVP of Government Affairs
  • Mercury Group Public Affairs

Register Now

House Passes PPP Extension

On July 1, The U.S. House of Representatives unanimously passed a bill to extend the deadline to apply for forgivable small business loans through the Paycheck Protection Program. The legislation was previously passed by the Senate and President Trump is expected to sign the bill into law.

The bill extends the deadline to request Paycheck Protection Program loans to August 8 from June 30. The U.S. Small Business Administration (SBA), which oversees the program with the Treasury Department, stopped accepting loan applications at midnight Tuesday. The extension is intended to provide more time for small businesses to apply for the approximately $129 billion in PPP funding remaining.

The program provides forgivable loans that small businesses and other qualifying entities can use to cover payroll and other select costs.

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.

Government Affairs Update: What We’re Working On

With the U.S. Senate on track to consider a fourth economic stimulus package before their August recess, the AAA is working hard to promote legislative language that positively impact the EMS industry and ambulance services across the country. Here is a snapshot of those current efforts.

Ambulance Funding in Response to COVID-19

As the Senate develops its next economic stimulus legislation to address the impact of COVID-19, the AAA has met with leaders and staff on Capitol Hill to increase the percentage of the general allocation of funds under the Public Health and Social Services Emergency Fund (PHSSEF) for ground ambulance services providers and suppliers to equal a total of $2.89 billion in funds for our industry. The $2.89 billion reflects $48,000 per ambulance with an estimated 60,000 registered vehicles. We greatly appreciate the recent payments under the Fund which will help with our current situation. However, the ground ambulance services industry is only 0.90% of Medicare fee-for-service annual outlays which resulted in $270 million for our industry in round one of PHSSEF payments. This figure is disproportional to the large role of ground ambulance service providers and suppliers in responding to COVID-19 and our increased costs and reduced revenues during the public health emergency (PHE).

The AAA has highlighted the increased costs, uncompensated care and lost revenue related to COVID-19 and hope to see ambulance-specific funding in the Senate’s 4th stimulus package.

Expand Public Safety Officer Benefits (PSOB)

Since the beginning of the pandemic, the AAA has advocated to add COVID-19 as an infectious disease under the Public Safety Officers’ Benefit (PSOB) and extend coverage during the pandemic to paramedics and EMTs employed by a private ambulance service who die from COVID-19.

On April 9, the AAA and the National Association of Emergency Medical Technicians (NAEMT) sent a letter to U.S. Attorney General William Barr requesting the Department of Justice extend coverage under the Public Safety Officers’ Benefits (PSOB) program to all paramedics and EMTs during the COVID-19 national health emergency.

On May 22, the AAA received a written response from the DOJ denying any expansion of the PSOB program stating that paramedics and emergency medical technicians employed by private for-profit EMS agencies do not meet the definition of “public safety officers” for purposes of PSOB eligibility.

To push for a legislative fix, AAA Staff and consultants have continued to advocate that all paramedics and EMTs be covered by the program regardless of their employer.

Expansion of Treatment in Place

The AAA has sent several letters asking the Centers for Medicare and Medicaid Services (CMS) to reimburse ground ambulance service providers and suppliers for performing protocol-driven treatments in place during the PHE.

This coverage will help limit the spread of COVID-19 by keeping patients with mild cases of COVID-19 at home and out of overcrowded hospitals or other facilities where they could expose others to the virus. With mostly positive response on our proposed regulatory fixes, the AAA will continue to follow up and address any roadblocks to full coverage of Treatment in Place.

Allow Private For-Profit EMS Providers to Apply Directly for FEMA Grants

The AAA has long advocated to allow private for-profit EMS agencies to apply directly to the Federal Emergency Management Agency (FEMA) for Public Assistance program grants during the PHE and waive the matching requirement for emergency response providers. During the COVID-19 pandemic, it is more necessary than ever that EMS agencies receive the funding the deserve for their role in the COVID-19 response. This will allow all EMS agencies to apply for financial assistance and for state and local governments to focus their limited resources on directly combating the pandemic.

We have been met with positive response from key Senators serving on Committees and Subcommittees of jurisdiction.

Other Legislation

The AAA was pleased to see the introduction of the Pandemic Responder Service Award Act (S. 3763) by Sen. Casey (D-PA) which provides front-line healthcare workers with awards up to $10,000 based on days of eligible service during the PHE. In the case of any qualified health care worker who was hospitalized or died as a result of contracting COVID–19, the award would be the full $10,000. This bill specifically includes private for-profit ambulance service providers, in a well-needed recognition of the work they provide on the frontlines of COVID-19. The AA will continue to work with Sen. Casey’s office as well as push for the inclusion of private for-profit providers in the House companion bill.

The AAA is also pleased to announce the introduction of H.R. 7292 by Rep. Marcy Kaptur (OH-09) which would provide forgiveness of certain accelerated and advanced payments under Medicare parts A and B. While the funding provided by the CARES Act was critical at keeping ambulance service providers operating, the Medicare Accelerated and Advanced Payment Program has the potential to cripple health care providers in the near future as Medicare payments are withheld until those advanced payments are repaid. H.R. 7292 would forgive the repayments and help ensure financial stability for ambulance service providers across the country.

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.