From CNN on May 22, 2021
America’s rural ambulance services, often sustained by volunteers, are fighting for their survival — a crisis hastened by the impact of Covid-19.
More than one-third of all rural EMS are in danger of closing, according to Alan Morgan, CEO of the National Rural Health Association. “The pandemic has further stretched the resources of our nation’s rural EMS.”
From Whitehouse.gov’s Briefing Room on Presidential Actions
Every day, in communities across the country, Emergency Medical Service (EMS) providers put themselves on the line to save lives, safeguard dangerous situations, and deliver hope to families and communities in crisis. With selflessness, professionalism, and grace under fire, they provide essential care — never more so than during our battle with COVID-19 over the past year. This year’s Emergency Medical Services Week theme, “THIS IS EMS: Caring for Our Communities,” honors our heroic frontline workers who provide vital emergency medical care and ease the burden of crisis for Americans in need of help.
Through service, compassion, and dedication, EMS providers represent the very best of the American spirit. In the face of unprecedented challenges, their expertise, endurance, and hard work have been a literal lifeline for families in every community. Whether responding to the enormous suffering caused by COVID-19, the devastation of extreme climate events, or daily medical emergencies, EMS providers — many of whom are volunteers — prepare, sacrifice, and put others ahead of themselves. Not only do they assume the heightened risks associated with emergency care during a pandemic, but they also spend countless hours away from families and friends in order to serve their communities.
In the face of these challenges, EMS providers have not hesitated to take on new roles, including supporting COVID-19 testing, therapeutics, and vaccination sites. To help support the women and men who do this vital work, my American Rescue Plan included $100 million to support the mental well-being — including the mental health — of our health care professionals, paraprofessionals, public safety officers, and EMS providers. My Administration has also made it a priority to ensure that our State, local, Tribal, and territorial partners have the resources they need so that EMS providers are trained and equipped to respond to public health emergencies safely and effectively, now and in the future.
During Emergency Medical Services Week, we extend our deepest gratitude to all EMS providers. Their courage, selflessness, and commitment are extraordinary examples of what it means to serve this great country. We also extend our sincere condolences to the loved ones of EMS providers who have given their lives in the line of duty. This week and every week, I urge all Americans to express their appreciation for our Nation’s EMS providers — and to bring greater safety to their lives, and to all of our lives, by getting vaccinated to help bring an end to the COVID-19 pandemic.
NOW, THEREFORE, I, JOSEPH R. BIDEN JR., 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 16 through May 22, 2021, as Emergency Medical Services Week. I call upon public officials, doctors, nurses, paramedics, Emergency Medical Service providers, and all the people of the United States to observe this week with appropriate programs, ceremonies, and activities.
IN WITNESS WHEREOF, I have hereunto set my hand this fourteenth day of May, in the year of our Lord two thousand twenty-one, and of the Independence of the United States of America the two hundred and forty-fifth.
JOSEPH R. BIDEN JR.
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.
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.