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
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:
As the Biden Administration unveils their plans for the nation’s response to the COVID-19 pandemic we will continue to update this post with any documents that may be of interest to our membership and industry.
January 28, 2021 | Week 2
U.S. House and Senate Notification
Centers for Medicare & Medicaid Services
Re: HHS Announces Marketplace Special Enrollment Period for COVID-19 Public Health Emergency
In accordance with the Executive Order issued today by President Biden, the U.S. Department of Health and Human Services (HHS), through the Centers for Medicare & Medicaid Services (CMS), announced a Special Enrollment Period (SEP) for individuals and families for Marketplace coverage in response to the COVID-19 Public Health Emergency. This SEP will allow individuals and families in states with Marketplaces served by the HealthCare.gov platform to enroll in 2021 health insurance coverage.
Beginning February 15, 2021 and through May 15, 2021, these Marketplaces will operationalize functionality to make this SEP available to all Marketplace-eligible consumers who are submitting a new application or updating an existing application. State-based Marketplaces (SBMs) operating their own platform have the opportunity to take similar action within their states. Starting February 15, consumers seeking to take advantage of the new SEP can find out if they are eligible by visiting HealthCare.gov. Consumers can find local help at Localhelp.healthcare.gov or by calling the Marketplace Call Center at 1-800-318-2596. TTY users should call 1-855-889-4325.
To view a press release about this announcement, visit: https://www.hhs.gov/about/
To view a fact sheet about this announcement, visit: https://www.cms.gov/newsroom/
January 20-27, 2021 | Week 1
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.
From the HRSA Federal Office of Rural Health Policy
The Health Resources and Services Administration’s Federal Office of Rural Health Policy has released the Notice of Funding Opportunity (NOFO) for the Rural Health Care Services Outreach Program (Outreach) (HRSA-21-027). HRSA plans to award 60 grants to rural communities as part of this funding opportunity.
The Outreach Program administered by HRSA’s FORHP focuses on expanding the delivery of health care services to include new and enhanced services exclusively in rural communities. Applicants are required to deliver health care services through a consortium of at least three health care provider organizations, use an evidence-based or promising practice model to inform their approach, and demonstrate health outcomes and sustainability by the end of the four-year performance period.
In addition to funding Outreach programs through the regular Outreach track, in FY 21, FORHP will also afford applicants a unique opportunity to take part in a national effort that targets rural health disparities through a second track called the “Healthy Rural Hometown Initiative.” This initiative was created through the HHS Rural Task Force and driven by findings from a report published by the Centers of Disease Control and Prevention (CDC) that noted that the number of preventable death from the five leading cause of death in rural areas was higher than those in urban areas. Unfortunately, these findings echo earlier CDC research on the rural disparities in avoidable or excess death in 2017.
The Healthy Rural Hometown Initiative (HRHI) is an effort that seeks to address the underlying factors that are driving growing rural health disparities related to the five leading causes of avoidable death (heart disease, cancer, unintentional injury/substance use, chronic lower respiratory disease, and stroke). The goal of the HRHI track is to demonstrate the collective impact of projects that better manage conditions, address risk factors and focus on prevention that relate to the leading causes of death in rural communities. This track should be a good fit for applicants who want to identify and bridge the gap between the social determinants of health and other systemic issues that contribute to achieving health equity with regards to excess death in rural communities. Furthermore, this is a rural-specific and community-based approach to addressing these disparities and represents a new and more targeted strategy given the enduring health gaps between rural and urban populations.
Of the successful 60 award recipients, HRSA aims to award approximately 45 to regular Outreach track applicants and at least 15 to HRHI applicants for a ceiling amount of up to $200,000 (Regular Outreach) or $250,000 (HRHI) total cost (includes both direct and indirect, facilities and administrative costs) per year (and final numbers will be subject to how applicants score).
The HRHI is part of an ongoing multi-year effort by FORHP to highlight how rural community health efforts can improve health at the local level. We are encouraging rural health stakeholders to join us in this broader effort while also taking on the challenge of addressing these long-standing rural health disparities related to the five leading causes of death.
NOTE: The eligibility criteria for this program has changed and now includes all domestic public and private, nonprofit and for-profit entities with demonstrated experience serving, or the capacity to serve, rural underserved populations. Urban-based organizations applying as the lead applicant should ensure there is a high degree of rural control in the project. The applicant organization must represent a network that includes at least three or more health care provider organizations and, at least 66% (or two-thirds) of consortium members must be located in a HRSA-designated rural area.
Please review the guidance in its entirety for more information about eligibility criteria and specific program requirements. Visit www.grants.gov to review the Outreach NOFO and apply. Learn about the Outreach Program.
A webinar for applicants is scheduled on Tuesday October 13, from 3-4:30 p.m., EST. A recording will be made available for those who cannot attend.
For more information about this funding opportunity, contact the Program Coordinator, Alexa Ofori, at RuralOutreachProgram@hrsa.gov.
The online portal for ambulance service providers and suppliers to submit applications for additional funding under the HHS Provider Relief Fund is now open.
Apply Soon for Funds!
While providers and suppliers have until November 6 to apply for funding, we strongly recommend that AAA members submit applications as soon as you are prepared as funding is on a first-come, first-served basis. HHS allocated a total of $20 billion for this round of funding.
Attend Today’s AAA Funding Webinar
The AAA will be hosting a webinar today, Monday, October 5, at 11:00 am (eastern), on how to apply for the funds and what information you will need in applying.
Thank You AAA Members!
As reported by the AAA on October 1, the additional funds are a direct result of the efforts of the AAA and our members and we thank all of you who reached out to the White House or your members of Congress advocating for the funds.
by Kathy Lester, J.D., M.P.H.
As the American Ambulance Association (AAA) reported yesterday, President Trump issued an Executive Order (EO) “An America-First Healthcare Plan.” The EO includes several provisions, including related to drug importation generally and for insulin specifically. It also includes statements that indicate if the Congress does not act before the end of the year, the President will have the Department of Health and Human Services (HHS) “take administrative action to prevent a patient from receiving a bill for out-of-pocket expenses that the patient could not have reasonably foreseen.” It does not mention ground ambulances.
In addition to suggesting action if the Congress does not pass legislation, the EO also states that within 180 days, the Secretary will update the Medicare.gov Hospital Compare website to inform beneficiaries of hospital billing quality, including:
The narrative related to balance billing (surprise coverage) reads as follows:
My Administration is transforming the black-box hospital and insurance pricing systems to be transparent about price and quality. Regardless of health-insurance coverage, two‑thirds of adults in America still worry about the threat of unexpected medical bills. This fear is the result of a system under which individuals and employers are unable to see how insurance companies, pharmacy benefit managers, insurance brokers, and providers are or will be paid. One major culprit is the practice of “surprise billing,” in which a patient receives unexpected bills at highly inflated prices from providers who are not part of the patient’s insurance network, even if the patient was treated at a hospital that was part of the patient’s network. Patients can receive these bills despite having no opportunity to select around an out-of-network provider in advance.
On May 9, 2019, I announced four principles to guide congressional efforts to prohibit exorbitant bills resulting from patients’ accidentally or unknowingly receiving services from out-of-network physicians. Unfortunately, the Congress has failed to act, and patients remain vulnerable to surprise billing.
In the absence of congressional action, my Administration has already taken strong and decisive action to make healthcare prices more transparent. On June 24, 2019, I signed Executive Order 13877 (Improving Price and Quality Transparency in American Healthcare to Put Patients First), directing certain agencies — for the first time ever — to make sure patients have access to meaningful price and quality information prior to the delivery of care. Beginning January 1, 2021, hospitals will be required to publish their real price for every service, and publicly display in a consumer-friendly, easy-to-understand format the prices of at least 300 different common services that are able to be shopped for in advance.
We have also taken some concrete steps to eliminate surprise out‑of-network bills. For example, on April 10, 2020, my Administration required providers to certify, as a condition of receiving supplemental COVID-19 funding, that they would not seek to collect out-of-pocket expenses from a patient for treatment related to COVID-19 in an amount greater than what the patient would have otherwise been required to pay for care by an in-network provider. These initiatives have made important progress, although additional efforts are necessary.
Not all hospitals allow for surprise bills. But many do. Unfortunately, surprise billing has become sufficiently pervasive that the fear of receiving a surprise bill may dissuade patients from seeking appropriate care. And research suggests a correlation between hospitals that frequently allow surprise billing and increases in hospital admissions and imaging procedures, putting patients at risk of receiving unnecessary services, which can lead to physical harm and threatens the long-term financial sustainability of Medicare.
Efforts to limit surprise billing and increase the number of providers participating in the same insurance network as the hospital in which they work would correspondingly streamline the ability of patients to receive care and reduce time spent on billing disputes.
The AAA will continue to advocate for the resources necessary to sustain life-saving mobile healthcare.
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.
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.
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.
Although President Donald Trump promised Newsmax earlier this month that he would “certainly look into it,” several ambulance professionals and their representatives have since told us they have seen none of the operating funds in question from the Department of Health and Human Services.
On August 11, AAA President Aarron Reinert sent a letter to President Trump in follow up to the White House Press Conference last week in which President Trump engaged in dialogue with a reporter about the need for additional ambulance relief.
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.
American Ambulance Association
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.
On May 26, the AAA sent a letter to HHS Secretary Alex Azar and CMS Administrator Seema Verma, requesting improvements to the Medicare Accelerated and Advance Payment (MAAP) Programs. The nation’s response to the COVID-19 pandemic is putting an increased financial strain on emergency medical services, and ground ambulance service providers and suppliers already faced significant funding challenges. The suggested improvements include:
The AAA believes the improvements to the MAAP discussed above would provide short-term financial relief to ambulance service providers and suppliers nationwide and allow us to continue our critical work during this difficult time for our country. Read our letter HERE.
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. While paramedics and EMTs employed by governmental and non-profit EMS agencies are currently eligible for the program, those employed by private for-profit organizations and on the front lines of responding to COVID-19 pandemic are not covered. Read our letter HERE.
On May 22, the AAA received a written response from the DOJ denying any expansion of the PSOB program. They state 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 as defined under the 1976 PSOB Act despite the waiver of said eligibility requirements by former Attorney General Ashcroft in the aftermath of September 11, 2001. Read their Response HERE.
The AAA continues to pursue an expansion of the PSOB program to include all paramedics and EMTs and will push for a legislative solution on Capitol Hill.
During Emergency Medical Services Week, we honor all of the Emergency Medical Services (EMS) providers who play such a critical role in our Nation’s health and safety. These incredible professionals respond to daily calls for urgent assistance and work tirelessly to serve their communities. Most recently, they have made significant contributions and immeasurable sacrifices during our Nation’s response to the coronavirus pandemic, one of the most daunting and demanding challenges the country has ever faced. This week, we recognize these heroic men and women for their efforts to deliver life‑saving care and compassion to their fellow Americans, and we acknowledge that our country is a safer and healthier place because of their work.
EMS providers — many of whom are volunteers — make up a coordinated and comprehensive network of highly trained workers. They are prepared to respond immediately to any crisis with pre‑hospital assessment, trauma care, and medical transport, and they also share valuable data with their public health partners. They do all of this under incredible pressure that can take an emotional and physical toll on even the most seasoned professionals. At a moment’s notice, these dedicated men and women rush to employ their specialized knowledge, experience, and leadership to reduce the severity of injuries and save lives, often in very high-risk situations. Every day, EMS personnel stand ready to help those in peril, responding faithfully to the needs of their fellow citizens when lives are on the line and every second matters.
The far-reaching and devastating scope of the coronavirus pandemic has increased the demands on our Nation’s EMS professionals, including those from our military service branches. These heroes have courageously risen to the challenge. They remain undeterred in their efforts to deliver critical assistance to their fellow Americans. EMS personnel are often the first point of contact with patients who are experiencing coronavirus symptoms. Acting quickly and decisively, they evaluate and triage patients, transport them to hospitals or treatment facilities, and clearly and compassionately communicate with family members who are anxious about their loved ones. During this unprecedented time in our Nation’s history, we are ceaselessly inspired by the sense of duty, selfless service, and sacrifice that epitomize EMS personnel.
This week, we honor all who provide emergency medical services across our country for their tenacity and life‑saving skills. Thanks to their incredible efforts, our communities and our Nation are stronger, safer, and more resilient. Especially in these trying times, we are immensely proud of these brave Americans.
NOW, THEREFORE, I, DONALD J. TRUMP, President of the United States of America, by virtue of the authority vested in me by the Constitution and the laws of the United States, do hereby proclaim May 17 through May 23, 2020, as Emergency Medical Services Week. I encourage all Americans to observe this occasion by showing their support for local EMS professionals through appropriate programs, ceremonies, and activities.
IN WITNESS WHEREOF, I have hereunto set my hand this fifteenth day of May, in the year of our Lord two thousand twenty, and of the Independence of the United States of America the two hundred and forty-fourth.
DONALD J. TRUMP
On April 28, the American Ambulance Association sent a letter to President Donald Trump with four requests as to how his Administration can best help ground ambulance service providers mitigate the COVID-19 pandemic. The AAA requested the following:
Increase Financial Assistance Related to COVID-19 for Ground Ambulance Services
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 PHE.
Priority Access for Paramedics and EMTs to PPE, COVID-19 Testing and Tax Relief
Protect paramedics and EMTs by directing federal agencies to provide them with higher priority access to PPE and COVID-19 testing. Paramedics and EMTs are too often not given primary access to PPE and testing even though they are frequently the first health care professionals to come into contact with COVID-19 patients. We also requested tax relief for frontline healthcare responders and to ensure that all governmental and nongovernmental responders are eligible for any additional essential worker compensation specific to the Public Health Emergency (PHE).
Coverage for Treatment in Place During COVID-19 Pandemic
Direct 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.
Direct Access to FEMA COVID-19 Grants for All Ground Ambulance Services
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. 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.
The AAA continues to advocate through multiple channels within the Administration and the Congress for relief related to COVID-19 for ground ambulance service providers and suppliers.