Senate Passes Ambulance Treatment in Place Language

On Saturday, the U.S. Senate passed language for Medicare coverage of emergency treatment in place of lower acuity patients by ground ambulance services providers and suppliers during the COVID-19 public health emergency (PHE). The language is from S. 149 by Senators Cortez Masto (D-NV) and Cassidy (R-LA) and passed as part of the $1.9 Trillion American Rescue Plan (H.R. 1319). The House is scheduled to vote and expected to pass the package tomorrow.

The American Ambulance Association along with the International Association of Fire Chiefs, International Association of Firefighters, National Association of EMTs and National Volunteer Fire Council pushed for passage of the bill language.

S. 149 would authorize the Centers for Medicare and Medicaid Services (CMS) to waive the transport requirement under Medicare for treatment in place for 9-1-1 or equivalent ambulance responses in which community EMS protocols dictate that the patient not be transported to a facility. The waiver would apply during the public health emergency.

Similar to other waivers provided by Congress for Medicare coverage during the pandemic, CMS would not be required to implement the policy. However, CMS has done so in all other situations and has also made the coverage retroactive to the beginning of the PHE. Upon passage of the language, the AAA will strongly advocate for CMS to implement the waiver and make it retroactive.

The AAA will be offering educational services to our members on the requirements of the proposed new policy and how to bill for covered services.

Treatment In Place in Senate Draft

Ambulance Treatment in Place Bill Included in Senate Draft Budget Reconciliation Package

The draft bill by Senate Democrats on a Budget Reconciliation package includes the language of S. 149 which would waive the transport requirement under Medicare for certain 9-1-1 ground ambulance services during the public health emergency. The Senate is expected to consider the package as soon as tomorrow.

Senators Catherine Cortez Masto (D-NV) and Bill Cassidy, M.D. (R-LA) introduced S. 149 on February 3 which is supported by the AAA, International Association of Fire Chiefs, International Association of Firefighters, National Volunteer Fire Council and National Association of EMTs.

Under S. 149, the Centers for Medicare and Medicaid Services (CMS) would have the authority to waive the requirement that a patient must be transported to a medical facility in order for a ground ambulance service organization responding to a 9-1-1 emergency call to be reimbursed by Medicare when there is a community-wide EMS protocol restricting the transport of the patient.  Ground ambulance service organizations whose paramedics and EMTs are on the frontlines of this pandemic are struggling financially due to the reduction in ambulance transports and higher costs such associated with responding to medical emergencies that cannot be reimbursed because of the transportation requirement. S. 149would greatly help address part of that problem and recognizes the critical role that ground ambulance service organizations are playing in controlling hospital surges and reducing the spread of COVID-19 .”

The House has already passed their version of Budget Reconciliation and would still need to pass a Senate version before sending to the President. S. 149 would provide CMS with the authority and, if passed, the AAA would advocate for the agency to exercise that authority and follow through with the waiver starting at the beginning of the public health emergency.

Senators Wyden & Cortez Masto Propose Mobile Crisis Response Teams

From Chairman Ron Wyden on February 18

FOR IMMEDIATE RELEASE

Contact: Taylor Harvey   

February 18, 2021

 

WYDEN, CORTEZ MASTO, SENATORS PROPOSE FUNDING TO IMPROVE PUBLIC SAFETY WITH MOBILE CRISIS RESPONSE TEAMS

After Down Payment on the Policy Included in Reconciliation Relief Legislation, CAHOOTS Act Builds on Proven Models to Help Americans with Mental Illness and Enhances Medicaid Funding to States

Washington, D.C. – Senate Finance Committee Chair Ron Wyden, D-Ore., Senator Catherine Cortez Masto, D-Nev., and six senators today proposed a bill to help states adopt mobile crisis response teams that can be dispatched when a person is experiencing a mental health or substance use disorder (SUD) crisis instead of immediately involving law enforcement. The funding is provided through an enhanced federal match rate for state Medicaid programs.

“I’m proud there is a down payment on CAHOOTS in the emergency relief package moving through Congress now,” Wyden said. “Every day there are stories across the country of Americans in mental distress getting killed or mistreated because they did not receive the emergency mental health services they needed. White Bird Clinic in Eugene, Oregon has been a pioneer for years in this area, and it’s high time the CAHOOTS model is made available to states and local governments across the country. I am eager to get the down payment signed into law and continue working to get further investments in mobile crisis services made under the bill across the finish line.”  

“Individuals experiencing a behavioral health crisis deserve to be treated with compassion and care by health care and social workers,” Cortez Masto said. “These professionals are extensively trained in deescalating situations and addressing mental health crises, and this legislation would help more states across the country fund mobile crisis teams. I’m hopeful that these investments in community-based crisis intervention services will be included in the final version of the current coronavirus relief package, and I’ll continue to advocate for effective, trauma-informed care for those in need.” 

Earlier this month, the House Energy and Commerce Committee included provision in its budget reconciliation language for COVID-19 relief that makes an investment in these services by funding state Medicaid programs at an enhanced 85 percent federal match if they choose to provide qualifying community-based crisis intervention services and funding state planning grants to apply for the option. The pandemic has taken a serious toll on the mental health and wellbeing of Americans with studies showing a four-fold increase in the rates of anxiety and depressive disorders since the beginning of the pandemic.

The bill, the Crisis Assistance Helping Out On The Streets (CAHOOTS) Act, grants states further enhanced federal Medicaid funding for three years to provide community-based mobile crisis services to individuals experiencing a mental health or SUD crisis. It also provides $25 million for planning grants to states and evaluations to help establish or build out mobile crisis programs and evaluate them.

Senators Jeff Merkley, D-Ore., Bob Casey, D-Pa., Tina Smith, D-Minn., Dianne Feinstein, D-Calif., Sheldon Whitehouse, D-R.I., and Bernie Sanders, D-Vt., are co-sponsors of the CAHOOTS Act.

A one page summary of the bill can be found here. Legislative text can be found here.

Senators Cortez Masto and Cassidy Introduce Bill on Ambulance Treatment in Place

Yesterday, Senators Catherine Cortez Masto (D- NV) and Bill Cassidy, MD (R-LA) introduced legislation (S. 149) to allow for Medicare reimbursement under certain circumstances of treatment in place by ground ambulance service organizations during the COVID-19 public health emergency. The AAA applauds the efforts of Senators Cortez Masto and Bill Cassidy as well as the Senate Finance Committee and Leadership.

S. 149 would provide the Centers for Medicare and Medicaid Services (CMS) with the authority to waive the requirement that a patient be transported to a medical facility in order for the ground ambulance service provider or supplier to receive Medicare reimbursement. The waiver would apply to 9-1-1 emergency ambulance services in which the transport did not occur as a result of “community-wide EMS protocols” due to the public health emergency. While the bill would not apply to situations in which a patient declines transport due to COVID-19 exposure concerns as advocated by the AAA, S. 149 is a significant step in the right direction to recognize ground ambulance services not being reimbursed during the pandemic.

The American Ambulance Association (AAA) along with the International Association of Fire Chiefs (IAFC), International Association of Firefighters (IAFF) and National Association of Emergency Medical Technicians (NAEMT) have spearheaded efforts for the Congress to provide CMS with waiver authority for treatment in place. We will be pushing to include the language of S. 149 in the COVID-19 stimulus package currently being negotiated between the White House and the Congress.

For the official statement of the AAA on the introduction of S. 149, please click here.

S.149 Treatment In Place

The American Ambulance Association Urges Immediate Passage of  S. 149 to Allow CMS to Support Local Ground Ambulance Service Responses to the Public Health Emergency

Treatment in Place Supports Patients and Sustains 9-1-1 EMS Providers During the COVID-19 Pandemic

Washington, DC, February 2, 2021 – The American Ambulance Association (AAA), our nation’s voice for ground ambulance service organizations commends Senators Catherine Cortez Masto (D-NV) and Bill Cassidy, M.D. (R-LA) for the introduction of S. 149 and urges its immediate passage. This legislation would remove a statutory barrier that has stopped ground ambulance service organizations from being reimbursed for health care services they provide consistent with local emergency medical service (EMS) protocols.

“S. 149 will empower ground ambulance service organizations to better meet the emergency medical needs of their communities, which are struggling during the pandemic,” stated AAA President Shawn Baird. “I applaud Senators Cortez Masto and Cassidy for their leadership on introducing this vital piece of legislation, as well as the Senate Finance Committee and Leadership for their support of these efforts.”

Under S. 149, the Centers for Medicare and Medicaid Services (CMS) would have the authority to waive the requirement that a patient must be transported to a medical facility in order for a ground ambulance service organization responding to a 9-1-1 emergency call to be reimbursed by Medicare when there is a community-wide EMS protocol restricting the transport of the patient.  “Ground ambulance service organizations whose paramedics and EMTs are on the frontlines of this pandemic are struggling financially due to the reduction in ambulance transports and higher costs such associated with responding to medical emergencies that cannot be reimbursed because of this transportation requirement,” said Baird. “This bill would greatly help address part of that problem and recognizes the critical role that ground ambulance service organizations are playing in controlling hospital surges and reducing the spread of COVID-19 .”

The legislation would benefit patients by reducing their risk of exposure to the virus, which is often the focus of the local protocols requiring them to remain at home. It would also help hospitals experiencing surges during the pandemic by allowing hospital beds to be reserved for higher acuity patients.

The AAA will help push for swift passage of the bill. President Baird called on the Congress to address the legislation as part of negotiations on a new COVID-19 economic relief package. “The American Ambulance Association fully endorses S. 149 and we ask for all members of Congress to help their ground ambulance service organizations, their patients, and the communities they serve by supporting passage of this bill.”

About the American Ambulance Association

The American Ambulance Association safeguards the future of mobile healthcare through advocacy, thought leadership, and education. AAA advances sustainable EMS policy, empowering our members to serve their communities with high-quality on-demand healthcare. For more than 40 years, we have proudly represented those who care for people first. For more information about the AAA visit our website at www.ambulance.org.

E&C Health Subcommittee Announces Hearing on COVID-19

E&C Health Subcommittee Announces Hearing on COVID-19 Vaccines, Testing, and the Medical Supply Chain

Washington, D.C. – Energy and Commerce Chairman Frank Pallone, Jr. (D-NJ) and Health Subcommittee Chairwoman Anna G. Eshoo (D-CA) announced that the Health Subcommittee will hold a fully remote hearing on Wednesday, February 3, at 11 a.m. (EST) on federal COVID-19 response efforts related to vaccines, testing, and medical supply chain. The hearing is entitled, “Road to Recovery: Ramping Up COVID-19 Vaccines, Testing, and Medical Supply Chain.”

“Congress took bipartisan action last year to combat the coronavirus, but it was a down payment on the substantial aid and assistance necessary to crush the pandemic and rebuild our economy,” Pallone and Eshoo said. “The health and well-being of the American people depend on us coming together to execute a comprehensive federal strategy and expand access to vaccines, tests, and critical medical supplies. Next week, we will hear from public health experts about what led to ongoing supply, distribution, and access concerns, what actions are being taken to successfully address those issues, and what more needs to be done as we chart a unified path out of this public health crisis.”

This hearing will be conducted remotely via Cisco Webex video conferencing. Members of the public may view the hearing via live webcast accessible on the Energy and Commerce Committee’s website. Please note the webcast will not be available until the hearing begins.

Information for this hearing, including the Committee Memorandum, witness list, testimony and a live webcast will be posted here as they become available.

Congratulations, Senator Schumer!

Congratulations to Senator Chuck Schumer, who will now serve as Majority Leader.

Congratulations to Senator Chuck Schumer of New York, who will now serve as Majority Leader. Senator Chuck Schumer D-NY'…

Posted by American Ambulance Association on Tuesday, January 12, 2021

Medicare | 2% Sequestration Suspended Through March

From CMS on December 28

Medicare FFS Claims: 2% Payment Adjustment (Sequestration) Suspended Through March

The Coronavirus Aid, Relief, and Economic Security (CARES) Act suspended the payment adjustment percentage of 2% applied to all Medicare Fee-For-Service (FFS) claims from May 1 through December 31. The Consolidated Appropriations Act, 2021, signed into law on December 27, extends the suspension period to March 31, 2021.

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 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.

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.