URGENT – CALL TO ACTION Contact Congress Today About COVID-19 Ambulance Relief!

URGENT – CALL TO ACTION

Contact Congress Today About COVID-19 Ambulance Relief!

The Congress and Administration are currently in negotiations on a fourth economic stimulus package to address the impact of COVID-19. While the AAA and our members were successful in helping secure the recent direct payments to ambulance service providers and suppliers, we still have several issues yet to be addressed including additional financial relief. Specifically, we are advocating for coverage for “treatment in place”, the ability of private for-profit EMS organizations to apply directly for FEMA Public Assistance program grants, additional direct compensation for COVID-19 expenses and lost revenue, and priority access to PPE and COVID-19 testing for paramedics and EMTs.

Please e-mail today the health aides for your members of Congress!

 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, if you are sending to the office of a Senator or Representative and any additional details as to services you are providing during the COVID-19 outbreak and the financial impact on your operation.
  1. LOOK UP YOUR MEMBERS OF CONGRESS AND THEIR WEBFORM ADDRESS: CLICK HERE to access a list of the webform addresses of your Members of Congress.
  1. SEND LETTERS TO MEMBERS: Cut and paste 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 the Congress to address these issues in the next economic stimulus package, the AAA is also pressing federal agencies to use their authority to help make some of these changes regulatorily.

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/NAEMT Request PSOB Coverage for All Medics During 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. 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 Letter HERE.

AAA Sends Letter to Treasury Secretary Mnuchin on Paycheck Protection Program

Earlier today, the AAA sent a letter to Treasury Secretary Mnuchin asking that he use his discretionary authority to apply the same terms of the Paycheck Protection Program (PPP) to ambulance service organizations with 500 or more employees. The PPP, established by the CARES Act, is only available to businesses with 500 or fewer employees and provides more favorable loan terms based on the retention of employees. Read the letter HERE.

HHS Announces Release of Initial Tranche of CARES Act Provider Relief Funding

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.  These funds will be used to fund healthcare-related expenses or to offset lost revenue attributable to COVID-10.  These funds will also be used to ensure that uninsured Americans have access to testing a treatment for COVID-19.  Collectively, this funding is referred to as the “CARES Act Provider Relief Fund.”

On April 9, 2020, the Department of Health and Human Services (HHS) indicated that it would be disbursing the first $30 billion of relief funding to eligible providers and suppliers starting on April 10, 2020.  This money will be disbursed via direct deposit into eligible providers and supplier bank accounts.  Please note that these are outright payments, i.e., these are not loans that will need to be repaid. 

Who is Eligible to Receive Relief Fund Payments?

HHS indicated that any healthcare provider or supplier that received Medicare Fee-For-Service reimbursements in 2019 will be eligible for the initial allocation.  Payments to practices that are part of larger medical groups will be sent to the group’s central billing office (based on Medicare enrollment information).  HHS indicated that billing organizations will be identified by their Taxpayer Identification Numbers (TINs).

Are There Any Conditions to Receipt of this Funding?

Yes.  As a condition to receiving relief funding, a healthcare provider or supplier must agree not to seek to collection out-of-pocket payments from COVID-19 patients that are greater than what the patient would have otherwise been required to pay if the care had been provided by an in-network provider.

How is the Amount of Relief Funding an Entity will Receive Determined?

HHS indicated that the amounts healthcare providers and suppliers will receive will be based on their pro-rata share of total Medicare FFS expenditures in 2019.  HHS indicated that Medicare FFS payments totaled $484 billion in 2019.

Providers and suppliers can estimate their initial relief payment amount by dividing their 2019 Medicare FFS reimbursement by $484 billion, and then multiplying that “ratio” by $30 billion.  Note: payments from Medicare Advantage plans are not included in the calculation of a provider’s/supplier’s total 2019 Medicare payments.

As an example, HHS cited a community hospital that received $121 million in Medicare payments in 2019.  HHS indicated that this hospital’s ratio would be 0.00025.  That amount is then multiplied by $30 billion to come up with its initial relief fund payment of $7.5 million.

The AAA has created a CARES Act Provider Relief Calculator
that you can use to estimate your initial relief payment.  |
USE DOWNLOADABLE EXCEL CALCULATOR►

Do I Need to do Anything to Receive Relief Funds?

No.  You do not need to do anything to receive your relief funding.  HHS has partnered with UnitedHealth Group (UHG) to disburse these monies using the Automated Clearing House (ACH) system.  Payments will be made automatically to the ACH account information on file with UHG or CMS.

Providers and suppliers that are normally paid by CMS through paper checks will receive a check from CMS within the next few weeks.

How Will I Know if I Received My Relief Funds?

The ACH deposit will come to you via Optum Bank.  The payment description will read “HHSPayment.”

Do I Need to do Anything Once I Receive My Relief Funds?

Yes.  You will need to sign an attestation statement confirming relief of the funds within 30 days.  These attestations will be made through a webportal that HHS anticipates opening the week of April 13, 2020.  The portal will need to be accessed through the CARES Act Provider Relief Fund webpage, which can be accessed by clicking here.

You will also be required to accept the Terms and Conditions within 30 days.  Providers and suppliers that do not wish to accept these terms and conditions are required to notify HHS within 30 days, and then remit full repayment of the relief funds.  The Terms and Conditions can be reviewed by clicking here.

How will HHS Distribute the Remaining $70 Billion in Relief Funds?

HHS has indicated that it intends to use the remaining relief funds to make targeted distributions to providers in areas particularly impacted by the COVID-19 outbreak, rural providers, providers of services with lower shares of Medicare reimbursement or who predominantly serve Medicaid populations, and providers requesting reimbursement for the treatment of uninsured Americans.

HEROES Act – Tax Free Income for Paramedics and EMTs

On April 3, Congressman Bill Huizenga (R-MI) introduced the Helping Emergency Responders Overcome Emergency Situations Act of 2020 “HEROES Act of 2020” (H.R. 6433). H.R. 6433 would exclude from gross income, the wages (not to exceed $50,000) from February 15 to June 15 of qualified first responders. Those wages would therefore essentially be tax-free. A definition of a qualified first responder specifically includes paramedics and EMTs who provide services in a county with at least one confirmed case of COVID-19. The language would apply to all paramedics and EMTs regardless of their employer type. The AAA had reached out prior to the introduction of the bill to staff with Congressman Huizenga to ensure that would be the case.

AAA Sends Letter to HHS on COVID-19 Response

On April 6, the AAA sent a letter to Health and Human Services Secretary Azar requesting that the Department distribute direct payments to all ambulance service providers and suppliers who are on the front lines of the COVID-19 pandemic. The AAA requested funding under the $100 Billion Public Health and Social Service Emergency Fund, established by the CARES Act, in the amount of $48,000 per ambulance registered as of April 1. The AAA estimates the payments would represent approximately $2.6 billion in desperately-needed relief for our industry. Read the letter HERE.

On-Demand Webinar | Stimulus Package Assistance to Ambulance Services


Friday, March 27, 2020 | 1:00pm Eastern Time
AAA Member-Only Webinar | Free to Members
Presented by: Tristan North, SVP of Government Affairs, AAA; Kathy Lester, Esq., Principal, Lester Health Law; Scott Moore, Esq., Moore EMS Consulting; John Jonas, Esq., Partner, Akin Gump

On March 25, the U.S. Senate passed a third stimulus package to provide economic relief to individuals and businesses struggling from the impact of COVID-19 outbreak. The AAA and our members pushed several provisions to aide ambulance service organizations and our employees who are on the front lines of treating patients with the virus. The webinar presenters will provide an overview of the provisions of the package with impact ambulance service organizations and our employees.

Senate Passes Economic Stimulus Package Several Provisions Help Ambulance Services!

Moments ago, the U.S. Senate passed an economic stimulus package in response to the coronavirus (COVID-19) outbreak. The House is expected to consider the legislation in the next few days. As a result of the efforts of the AAA and our members who are also on the front line of the response to COVID-19, we were able to improve the final package.

The package includes several provisions that will provide urgent financial assistance and resources to ambulance service organizations and our employees. The provisions are consistent with requests made by the AAA, although they target a broader constituency consistent with much of the rest of the stimulus package.

The provisions in the package related to our requests are as follows:

Stimulus Package Provisions

Health Care Provider Provisions

  • $100 Billion Grant Program: Direct funding to public entities, Medicare or Medicaid enrolled suppliers and providers, and for-profit entities and not-for-profit entities as the Secretary may specify to reimburse for health care related expenses or lost revenues that are attributable to coronavirus. Ambulance service suppliers and providers will file applicants for funding with the Department of Health and Human Services.
  • Sequestration Delay: Suspension of the 2% sequestration cut in Medicare funding for ambulance service and other providers and suppliers. The suspension would begin May 1 and end December 31, 2020 with sequestration then extended from 2029 to 2030.
  • Telehealth: Authorizes the Secretary to waive any of the current requirements in statute for telehealth services during the emergency.

Business Provisions

  • Payroll Tax Deferral: Employers including ambulance service organizations starting upon enactment of the legislation will defer payment of their 6.2% share of the payroll tax through December 31, 2020. Half of the tax will be due by the end of 2021 and the second half by the end of 2022.
  • Small Business Loans: Provides $350 billion in loans under the Payment Protection Program for employers including ambulance service organizations with 500 or fewer employees. Loans available up to $10 million per employer.

Emergency Responder Provisions

  • $45 Billion Disaster Relief Fund: Grants made available under the FEMA Public Assistance Program to state and local governments to address the recovery from COVID-19 including reimbursement for medical response, PPE and backfilling positions. The funding highlights the critical need for access by emergency responders to PPE and other resources. For-profit ambulance service organizations would be eligible for funding through their state or local government. If your organization faces an issue with government officials as to eligibility, please provide them the FEMA Fact Sheet: Public Assistance for Ambulance Services which in 2009 the AAA had successfully encouraged FEMA to issue.
  • $3.5 Billion Child Care Grants: Provides funding for childcare programs for essential workers including emergency responders such as paramedics and EMTs.

Not all of the provisions the AAA had advocated for inclusion in the package were addressed in some way. This is likely not the last legislative package that the Congress develops to combat COVID-19 and we will advocate for our provisions to be included in future packages. We will also continue to push these issues through regulatory and other legislative efforts as outlined below.

Regulatory and Additional Legislative Efforts

Coverage of Treatment in Place and Alternative Destination

On March 11, the AAA sent a letter to CMS Administrator Seema Verma asking the agency to wave regulatory restrictions for treatment in place and transport to alternative destinations and for Medicare to cover these services related to potential COVID-19 cases. CMS had initially indicated they do not think they have the authority to wave the restrictions under the 1135 Waiver, but the AAA is continuing to work with CMS to provide payment for these services when provided to Medicare beneficiaries.  A press release from the House Republican leadership suggests that this issue is being addressed.

Employee Tax Credit for EMS Training and Uniforms

While the stimulus package includes reimbursement for training and equipment for first responders, it did not include the specific request for an above-the-line tax credit for paramedics and EMTs for training and uniforms paid by the employee. Earlier this year, AAA representatives had met with staff of Congressman Suozzi (D-NY), who sponsored the tax credit language which passed the House late last year, on how we can press the Senate to consider the provision. The AAA will continue to work with Congressman Suozzi on other opportunities to pursue the tax credit.

Federal Benefits during COVID-19 for All Paramedics and EMTs

Several paramedics and EMTs who worked for private ambulance service organizations lost their lives on September 11, 2001, while responding to the aftermath of the attacks on the World Trade Center. Then-Attorney General John Ashcroft extended Public Safety Officers Benefits (PSOB) to the surviving family members of those paramedics and EMTs. The AAA is sending a letter to Attorney General William Barr asking him to provide the same consideration for paramedics and EMTs responding to the COVID-19 outbreak.

The AAA Will Keep Fighting

We 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.

We greatly appreciate the efforts of all of our members who contacted their members of Congress in support of relief and resources for ambulance services

AAA members can register for our free members-only webinar here

URGENT – CALL TO ACTION Congress Still Negotiating Stimulus Package Ambulance Specific Relief Not Yet Included: Act Now!

None of the proposals offered so far on an economic stimulus package to address the impact of COVID-19 include our specific provisions to provide ambulance relief! Negotiators on a final package failed to reach an agreement over the weekend. There is still time to influence the final outcome! Please write to your members of Congress!

There are provisions in the packages that would help businesses, first responders and Medicare providers and suppliers. However, the AAA is advocating for specific help for ambulance services with the prioritization of COVID-19 resources, coverage of services, as well as direct financial assistance. The Congress has heard directly from the AAA about our requests and they need to hear from their constituents about assistance to your operations. If you have not yet contacted your members of Congress, please do so today!

Please e-mail today the health aides for your members of Congress!

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, if you are sending to the office of a Senator or Representative 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 HEALTH STAFFER AND EMAIL ADDRESS: CLICK HERE to access a list of the name of the health staffer and email address for all congressional offices.

3. SEND E-MAILS TO STAFFERS: Copy and paste the email address of the health staffer and copy and paste the letter as the body of the e-mail and send.

While the Congress may not include all of our requests in this stimulus package, there are likely to be future legislative vehicles in which the AAA will continue to press for passage of additional relief for ambulance service organizations and personnel.

URGENT – CALL TO ACTION Contact Congress Today About COVID-19 Ambulance Relief!

The Congress and Administration are currently in negotiations to finalize an economic stimulus package to address the impact of COVID-19. As reported previously, the AAA has been pressing for the prioritization of COVID-19 resources and coverage of services, as well as financial assistance, for ambulance services organizations. Negotiations are expected to wrap up this weekend.

Please e-mail today the health aides for your members of Congress!

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, if you are sending to the office of a Senator or Representative 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 HEALTH STAFFER AND EMAIL ADDRESS: CLICK HERE to access a list of the name of the health staffer and email address for all congressional offices.

3. SEND E-MAILS TO STAFFERS: Copy and paste the email address of the health staffer and copy and paste the letter as the body of the e-mail and send.

While the Congress may not include all of our requests in this stimulus package, there are likely to be future legislative vehicles in which the AAA will continue to press for passage of additional relief for ambulance service organizations and personnel.

AAA Pushing Ambulance COVID-19 Relief

Over the past several days, the AAA has been pushing the Congress and the Administration to provide immediate financial and other relief to ambulance service organizations and their employees. EMS personnel are often the first medical professionals to come into contact with patients with COVID-19. But our members are running low on personal protection equipment and other supplies necessary to respond to the pandemic.

AAA members are providing vital medical services beyond the traditional stabilizing and transporting of patients for which they need to be reimbursed. Our members are also seeing a decrease in both emergency and non-emergency transport call volume as Americans are opting to forgo medically necessary trips to the emergency department and as elective procedures are postponed. It is important that Congress understands the short and long-term implications of our response to COVID-19 and provides critical financial relief.

To help our members in their time of need as they respond to the COVID-19 pandemic, the AAA has been advocating that Congress needs to include in the stimulus package they are developing several provisions to help ambulance service organizations. The provisions include providing ambulance service organizations priority access to PPE, authorizing CMS to waive Medicare policy and reimburse for treatment in place, reimbursing ambulance services for additional costs incurred in responding to COVID-19, suspending the payroll tax and providing all paramedics with coverage under the Public Safety Officers’ Benefit (PSOB) and a tax credit for training and uniforms.

For the details of our requests of the Congress, please access our position paper.

While the Congress is working on its third stimulus package which it is expected to complete in the next few days, it is likely not to be the last. With this package moving so quickly, the AAA has been working with a targeted list of AAA members in the states and districts of key policymakers to the negotiations. We will be issuing in the near term a Call To Action to the entire AAA membership with the request for everyone to contact their members of Congress with our list of requests. We hope you will answer the call.

The AAA will continue over the next weeks and months to push the Congress and Administration on our requests to help ambulance service organizations. Thank you for your support.

President Signs Stimulus Bill on COVID-19 Sick and Medical Leave

On March 18, President Trump signed into law an economic stimulus package in response to the Coronavirus (COVID-19) that will provide Emergency Paid Family Medical Leave and Sick Leave to many U.S. workers. H.R.6201 is one of many measures that the federal government has been working on to provide relief to individuals and businesses that are impacted by COVID-19.  While the regulations as to exactly how these emergency paid leaves will work have not been drafted, the following is an overview of what the Bill provides and how it is likely to impact health care and EMS employers.

Emergency Family & Medical Leave Expansion Act (Division C)

    • Amends Family & Medical Leave Act of 1993
      • Employers with under 500 employees
      • Provide employees who have been employed for at least 30 days:
        • Up to 12 weeks of job-protected leave for following reasons
          • Care for child due to school closure, childcare unavailable due to coronavirus
        • After first 10 days, receive no less than 2/3 employee regular rate of pay.
        • Not to exceed $200 per day, $10,000 in the aggregate
        • Cannot require employee to use other paid leave first.
        • Expands current FMLA definition of parent
      • Includes Multi-Employer Bargaining Agreements
    • Exempts small businesses with fewer than 25 employees from the obligation to reinstatement employee following Emergency Paid Family Medical Leave if several conditions are met.
    • Employer with employees who are healthcare worker or emergency responder may elect to exclude employee from the provisions of Emergency Paid FMLA.
  • Emergency Paid Sick Leave Act (Division E)
  • Employers with under 500 employees
  • Public agency or other entity that is not private, employ one or more employees
  • Employer with employees who are healthcare worker or emergency responder may elect to exclude from the provisions of Emergency Paid Sick Leave.
  • Paid sick leave for an employee unable to work or telework at employee’s regular rate due to:
    • Quarantine, advised to self-quarantine, seek diagnosis, preventative care or diagnosis for coronavirus
    • Caring for an individual who subject to quarantine or isolation order or advised to self-quarantine
    • Caring for son or daughter due to closed school or childcare
    • Cannot require employee to use other paid leave first.
  • Full-time employees entitled to 80 hours (14 days)
  • Part-Time entitled to average number of hours employee is scheduled per day over six-month period.
    • Full pay, not to exceed $511 per day, $5,110 in the aggregate for employee Quarantine, self-quarantine, or preventative care or diagnosis
  • 2/3 pay, not to exceed $200 per day, $2,000 in the aggregate for caring for individual who is subject to quarantine, child school or childcare closure, or employee experiencing any other substantially similar condition specified by the Secretary of HHS.
  • Employers with existing paid leave shall make Emergency Paid Sick Leave available in addition to existing leave benefits and cannot amend those existing policies.
  • Employees in multi-employer collective agreement whose employers pay in plan.
  • The Secretary of Labor can draft regulations to exempt small employers (less than 50 employees) from these provisions if it would jeopardize the entity.
  • Health Provisions (Division F)
  • Private health plans must cover COVID-19 diagnostic testing, including urgent care and emergency room visits to receive testing. (Division F, Sec. 6001).
  • Requires Medicare Part B to cover cost-sharing for provider benefits if a COVID-19 diagnostic test is administered. (Sec. 6002).
  • Requires waiver of Medicare Advantage Program cost sharing and covers the cost of COVID-19 diagnostic test is administered at no cost to beneficiary. (Sec. 6003)
  • Requires Medicaid CHIP to cover cost for COVID-19 visit and diagnostic testing. Extends Medicaid eligibility to uninsured population for purposes of testing (Sec. 6004).
  • Requires certain personal respiratory protective devices, such as industrial masks that gained emergency authorization, to be considered a countermeasure under the PREP Act Declaration during the COVID-19 outbreak. (Sec. 6005).
  • Requires coverage for testing, covered veterans and federal workers and individuals enrolled in TRICARE for COVID-19 diagnostic testing without cost-sharing. (Sec. 6006).
  • Requires coverage for American Indians and Alaskan Natives for COVID-19 diagnostic testing, including away from Indian Health Service or tribal health facility. (Sec. 6007).
  • Provides temporary increase to states’ federal medical assistance percentage (FMAP) for the duration of public health emergency for COVID-19 diagnostic testing. (Sec. 6008).
  • Provides increase to territories’ Medicaid allotments for 2020 and 2021. It will ensure that territories that receive FMAP increase under the previous section will have necessary federal funds for their Medicaid programs. (Sec. 6009).
  • Makes technical change to Medicare telehealth provision of the Coronavirus Preparedness and Response Supplemental Appropriations Act, 2020 (P.L. 116-123 to ensure new Medicare beneficiaries are able to access telehealth services under the emergency authority granted the Secretary (Sec. 6010).
  • Tax Credits for Paid Sick and Paid Family & Medical Leave (Division G)
  • Payroll Credit for Required Paid Sick Leave (Sec. 7001)
    • Refundable tax credit equal to 100% of qualified sick leave wages paid by employers for each quarter.
    • Tax credit allowed against the excise tax imposed by 3111(a) or 3221(a)..
    • Qualified leave wages capped $200 ($511 for employee’s quarantine or illness) per day, not to exceed 10 days.
    • If credit exceeds employer total liability under 3111(a), excess credit is refundable to employer.
    • Credit may be increased in amount of employer’s qualified health plan expense related to paying sick time, including amount employer paid to maintain health benefits, only to the amounts that are excluded from gross income.
    • No credit allowed with respect to wage for which a credit is allowed under 45S (existing paid FMLA tax credit) .
    • No credit allowed for Federal or state government, including political subdivisions. 
  • Payroll Credit for Required Paid Family Leave (Sec. 7003)
    • Refundable tax credit equal to 100% of qualified family leave wages paid by employers for each quarter
    • Tax credit allowed against the excise tax imposed by Sect. 3111(a) or 3221(a).
    • Qualified leave wages capped $200 per day, and $10,000 for all calendar quarters. If credit exceeds employer total liability under 3111(a) or 3221(a)., excess credit is refundable to employer.
    • Credit may be increased in amount of employer’s qualified health plan expense related to paying sick time, including amount employer paid to maintain health benefits, only to the amounts that are excluded from gross income.
    • No credit allowed with respect to wage for which a credit is allowed under 45S (current paid FMLA benefit tax credit for employers with paid FMLA).
    • No credit allowed for Federal or state government, including political subdivisions. 
  • Special Rule Related to Tax on Employers (Sec. 7005)
    • Ensures any wages paid by reason of Emergency Paid Sick Leave Act and Emergency Family and Medical Leave Expansion Act will not be considered wages for purposes of Sec. 3111(a) or 3221(a). (Taxable wages or benefits amounts paid by employers under IRC) 

Analysis of Impact for AAA Members 

  • Emergency Family & Medical Leave Expansion Act (Division C)
    • Updated version maintains the provisions that permit EMS employers to exclude health care providers and emergency responders from the definition of an eligible employee.
    • There may be an overlap which provides for paid emergency family and medical leave on the eleventh day which overlaps with the provision under the Paid Sick Leave provisions.
    • Unclear if employer opts to not exclude employee or has 500 or more employees and opts to provide Emergency Paid FMLA or Sick Leave is eligible for tax credit.
    • Funding is from employer with offsetting excise tax credit under 3111(a) or 3221(a) and adds provisions for additional tax credit for any health insurance related expenses the employer incurs related to maintaining health insurance benefits for employees using Emergency Paid FML.
      • Primary concern is for immediate cash-flow for member companies.
      • Most employers pay excise tax owed under 3111(a) or 3221(a) are submitted based upon IRS Code Deposit Rules on a bi-weekly or monthly payment arrangement.
      • EMS agencies will have to fund Emergency Family & Medical Leave wages and other associated costs for a period of two to four weeks before offsetting excises tax relief.
      • Also, EMS agencies will likely have the financial burden of paying replacement workers at a premium of an additional .5 per hour.
  • Emergency Paid Sick Leave Act (Division E)
    • Includes provision permit EMS employers to exclude health care providers and emergency responders from the definition of an eligible employee.
    • No provisions for Emergency Paid Sick Leave for large employers (500 or more employees)
      • AAA should work to get a permissible tax credit for large employers who opt to provide Emergency Paid Leave to employees.
    • Funding is from employer with offsetting excise tax credit under 3111(a) or 3221(a) and adds provisions for additional tax credit for any health insurance related expenses the employer incurs related to maintaining health insurance benefits for employees using Emergency Paid Primary concern is for immediate cash-flow for member companies, similar to concerned outline with Emergency Paid Family and Medical Leave.
  • Payroll Credit for Required Paid Sick Leave (Sec. 7001)
    • It is unclear if the proposed tax credits are permitted for large employers (500>) who opt to voluntarily provide Emergency Paid Family & Medical Leave.
      • AAA should advocate for this if not provided. 
  • Payroll Credit for Required Paid Family Leave (Sec. 7003)
    • It is unclear if the proposed tax credits are permitted large employers (500>) who opt to provide Emergency Paid Family & Medical Leave.
  • Other Considerations
    • Track all COVID-19 related activities from a cost perspective in case future monies are allocated to reimburse ambulance providers
    • Track all COVID-19 related activities for the purpose of CMS Cost Data Collection to ensure ambulance service providers can understand the true cost of this pandemic for potential future pandemics.

 

 

AAA Sends Letter to CMS on COVID-19 Response

The AAA has sent a letter to CMS on how the agency can most help ground ambulance service providers and suppliers be better prepared to respond to potential cases of COVID-19. The AAA has requested priority access to personal protection equipment for EMS personnel and COVID-19 test kits and results, as well as easing Medicare and Medicaid policies on alternative destinations and treatment in place. The letter was also sent to the National Highway Traffic Safety Administration (NHTSA) and the Assistant Secretary for Preparedness and Response (ASPR). Read the letter HERE.

Read the Letter

President signs law providing funds to combat Corona Virus

President Donald Trump today signed H.R. H.R. 6074 into law, approving $8.3 billion in supplemental appropriations to fund programs in response to the COVID-19 illness. The bill would bolster vaccine development, research, equipment stockpiles, and state and local health budgets as government officials and health workers fight to contain the outbreak, which has claimed 11 lives in the U.S. and sickened more than 160 people across more than a dozen states.

The AAA advocated to negotiators of the bill that first responders needed to be included in the funding package and that all communities be eligible for the funding. Due in part to our outreach, the emergency funding provides a transfer of no less than $10 million to the National Institute of Environmental Health Sciences for worker-based training aimed at preventing exposure of the virus to emergency first responders, and others at risk of exposure (i.e., hospital employees).

The supplemental also appropriates $1 billion for state and local preparedness, which will allow state and local governments to carry out preparedness and response activities, with each State receiving a minimum of $4 million. Of the $1 billion, $300 million is allocated for global disease detection and emergency response, and FY 2019 Public Health Emergency Preparedness grantees.

Permanent Medicare Ambulance Relief Bill Introduced in House

Moments ago, Congresswoman Terri Sewell (D-AL) and Congressman Devin Nunes (R-CA) introduced the Medicare Ambulance Access, Fraud Prevention, and Reform Act of 2019 (H.R. 4938). Congressmen Peter Welch, (D-VT), Markwayne Mullin (R-OK), and Earl Blumenauer (D-OR) are original cosponsors of the legislation. Thank you to the bill sponsors for their continued support!

H.R. 4938 would help stabilize current and future Medicare reimbursement of ambulance services and set the stage for future reform of the Medicare ambulance fee schedule. If passed, this bill would:

  • Make Medicare Add-ons Permanent – Current temporary 2 percent urban, 3 percent rural, and super rural bonus payments would be made permanent.
  • Expand Prior Authorization Pilot Program Nationwide – To address fraud and abuse with the transportation of dialysis patients by ambulance, the bill expands the Centers for Medicare & Medicaid Services (CMS) national prior authorization program for repetitive non-emergency basic life support (BLS) dialysis transports. CMS has not yet exercised its authority to expand this successful pilot program nationwide. While CMS is considering exercising its authority to extend the program nationwide in a recent proposed rule, it has not made a final determination yet.
  • Provide Regulatory Relief – Amend requirements under the 855 form to make change notifications less burdensome.
  • Protect Access to Ambulance Services in Rural and Low Population Density Areas – Protect access to ambulance services in rural and super-rural areas, by establishing a policy to protect low volume areas and a process for CMS to review changes in the rural or super-rural status of an area after the next census occurs.

The AAA has worked diligently to get this legislation introduced and we are excited to share this news with the membership. We would like to thank all the AAA members who have worked closely with their elected representatives to get this legislation introduced. In the coming weeks, the AAA will be asking members to contact their Members of Congress to voice their support of this legislation.

If you have any questions, please contact Tristan North (tnorth@ambulance.org) or Aidan Camas (acamas@ambulance.org).

CMS Releases Proposed Cost Collection Rule

Today, CMS has released the proposed rule that would establish the ambulance fee schedule cost collection system as required by statute. The AAA is currently reviewing the rule and will provide a more detailed summary in the coming days.

On Tueusday, July 30 at 12:00pm Eastern, the AAA will be hosting a free webinar during which AAA counsel will provide an overview of the proposals in the rule. Do not miss out on this chance for the most up to date information.

Read the Proposed Rule

Sign Up for the Webinar

Questions?: Contact Us:

If you have questions about the legislation or regulatory initiatives being undertaken by the AAA, please do not hesitate to contact a member of the AAA Government Affairs Team.

Tristan North – Senior Vice President of Government Affairs
tnorth@ambulance.org | (202) 802-9025

Ruth Hazdovac – AAA Senior Manager of Federal Government Affairs
rhazdovac@ambulance.org | (202) 802-9027

Aidan Camas – Manager of State & Federal Government Affairs
acamas@ambulance.org | (202) 802-9026

Thank you for your continued membership and support.

2019 AAA Legislative Awards

The American Ambulance Association is proud to announce the winners of the 2019 AAA Legislative Awards, in recognition of their strong advocacy for emergency medical services. Each legislator was chosen for their ongoing dedication to the ambulance services across the United States.

2019 AAA Legislator of the Year

Representative Terri Sewell (D-AL)

2019 AAA Legislative Recognition Award Recipients

Senators

  • Senator Bill Cassidy, M.D.
  • Senator Susan M. Collins
  • Senator Chuck Grassley
  • Senator Doug Jones
  • Senator Patrick J. Leahy
  • Senator Pat Roberts
  • Senator Charles E. Schumer
  • Senator Debbie Stabenow
  • Senator Jon Tester
  • Senator John Thune
  • Senator Ron Wyden

Representatives

  • Representative Earl Blumenauer
  • Representative Rosa DeLauro
  • Representative Debbie Dingell
  • Representative Richard Hudson
  • Representative Darin LaHood
  • Representative Markwayne Mullin
  • Representative Richard E. Neal
  • Representative Devin Nunes
  • Representative Steve Scalise
  • Representative Scott Tipton
  • Representative Fred Upton
  • Representative Greg Walden
  • Representative Peter Welch
  • Representative Lee Zeldin

House Introduces PSOB Bill (H.R. 2887)

The American Ambulance Association (AAA) is pleased to announce that Congressman Lee Zeldin (R-NY-01) and Congressman Thomas Suozzi (D-NY-03) have introduced H.R. 2887, the “Emergency Medical Services Providers Protection Act.” This piece of legislation would extend the Public Safety Officers’ Benefit (PSOB) to cover first responders who work for private providers. The PSOB Program provides death and education benefits to survivors of fallen law enforcement officers, firefighters, and other first responders, and disability benefits to officers catastrophically injured in the line of duty.

The AAA has advocated tirelessly for years that all first responders killed in the line of duty, should be eligible for this benefit regardless of who their employer is. Many of the nation’s first responders work for more than one EMS Agency. Local communities throughout the country decide which organization is best fit to provide high quality mobile healthcare to their community. For large parts of the country, privately run ambulance services have been providing high quality health care, and responding to the same natural disasters, incidents, etc. as their peers for decades.

It is common for Paramedics and EMTs to also work/volunteer as firefighters and vice versa. Currently, if a line of duty death occurs, whether first responders receive this benefit depends on which uniform they were wearing that day. A firefighter picking up an extra shift with a local ambulance service could end up being ineligible for this benefit if that company happens to be privately run. The AAA believes this legislation acknowledges the vital role that all first responders play in keeping our communities safe and healthy. If passed, this change would apply to injuries sustained on or after March 1, 2007.

The AAA thanks Congressman Zeldin and Suozzi for taking the lead on this critical issue. AAA members are encouraged to contact their representatives about co-sponsoring H.R. 2887. Full text of the Bill is not yet available online but can be read here. Please contact the AAA’s Government Affairs team if you have any questions.

Questions? Contact Us

If you have questions about the discussion draft or balance billing initiatives being undertaken by the AAA, please do not hesitate to contact a member of the AAA Government Affairs Team.

Tristan North – Senior Vice President of Government Affairs
tnorth@ambulance.org | (202) 802-9025

Ruth Hazdovac – AAA Senior Manager of Federal Government Affairs
rhazdovac@ambulance.org | (202) 802-9027

Aidan Camas – Manager of State & Federal Government Affairs
acamas@ambulance.org | (202) 802-9026

Thank you for your continued membership and support.

Member Update on Balance Billing

This morning Ruth Hazdovac and Aidan Camas of AAA staff and Kathy Lester, Esq, Healthcare Consultant to the AAA attended a briefing held by the House Energy & Commerce Committee on the issue of surprise/balance billing. At the briefing, staff for Chairman Frank Pallone (D-NJ) and Ranking Member Greg Walden (R-OR) announced that they would be releasing a bipartisan discussion draft, the No Surprises Act, which would “protect consumers from surprise medical bills and increase transparency in our health care system.”

As of now, ground and air ambulances are NOT included in the discussion draft. However, the committee is asking for comments on ground and air ambulance and recommendations on how to provide relief to the consumer in this area. The AAA has a Balance Billing Work Group that is hard at work developing a policy recommendation that will work for our members.

The House Ways and Means Health Subcommittee Chairman Lloyd Doggett also announced today that the Health Subcommittee will hold a hearing next week entitled “Hearing on Protecting Patients from Surprise Medical Bills.” AAA Staff will be at the briefing and provide a timely update to membership on any developments.

The AAA team will be submitting comments and policy recommendations based off the work of the Balance Billing Work Group to both the Energy & Commerce and Ways & Means Committee to ensure that the views of our members are well represented. We will also be reaching out to AAA members in the states of key policymakers on the Committees to submit comments, as well. The AAA will also provide members with key talking points in the event they are contact by their Members of Congress or their staff.

Questions? Contact Us

If you have questions about the discussion draft or balance billing initiatives being undertaken by the AAA, please do not hesitate to contact a member of the AAA Government Affairs Team.

Tristan North – Senior Vice President of Government Affairs
tnorth@ambulance.org | (202) 802-9025

Ruth Hazdovac – AAA Senior Manager of Federal Government Affairs
rhazdovac@ambulance.org | (202) 802-9027

Aidan Camas – Manager of State & Federal Government Affairs
acamas@ambulance.org | (202) 802-9026

Thank you for your continued membership and support.

President’s Perspective April 2019

Aarron Reinert
President,  AAA

Dear Fellow AAA Members,

Spring is in full bloom in Washington, D.C., and the American Ambulance Association is hard at work in our nation’s capital advocating for mobile healthcare providers. I am pleased to share with you several updates from your association.

Advocacy Progress

The AAA continues to forge ahead advocating for the legislative and regulatory priorities of our membership. Earlier this month, more than forty AAA volunteer leaders and members came to Washington, D.C., meeting with more than 100 congressional offices to advocate for Medicare policies and improved claims processing by the Department of Veterans Affairs for emergency ambulance services. (View photos on Facebook.)

The AAA has also taken an active role in responding to potentially harmful “surprise billing” legislation. The AAA has been urging Members of Congress to recognize the unique and essential nature of emergency ambulance services and ambulance interfacility mobile healthcare transports. Ambulance service suppliers and providers are already heavily regulated at the local level and struggle with receiving adequate reimbursement. The Congress should protect patient access to ground ambulance services and continue to allow us to balance bill.

The AAA is working closely with CMS and the RAND corporation on the development of the ambulance cost data collection system in order to ensure that the end survey and methodology is feasible for our industry. The AAA has established itself and our membership as an important stakeholder throughout the cost data collection development process, and we look forward to remaining involved this year.

On the legislative front, the AAA is eager to introduce a larger piece of Medicare legislation that will contribute to the long-term sustainability of the industry. This legislation will address issues such as inadequate reimbursement, the need for innovative payment models, the lack of equitable polices, rural zip code classifications, and more. Buy Diamox 250 mg https://www.rpspharmacy.com/product/diamox/

Legislation to restructure the offset included in the Bipartisan Budget Act of 2018 to pay for the 5-year extension of Medicare add-on payments has been reintroduced in the Senate (S. 228) and should be re-introduced in the House soon. The AAA is also working on updating the Veterans Reimbursement for Emergency Ambulance Services Act (VREASA) to adequately address issues regarding reimbursement from the VA.

With many important legislative priorities, we will continue to lean on our members for their support and encourage you all to continue to build relationships with your Members of Congress.

Ambulance Cost Education (ACE)

Time is running out to prepare for the new federal cost data collection requirements for ambulance services which go into effect January 1, 2020. To help ambulance services ready themselves, our expert faculty has developed comprehensive Ambulance Cost Education (ACE) webinars, regional workshops, and online resources. With AAA ACE, your service will have all the tools needed to comply with federally mandated cost collection. An ACE subscription is the turn-key solution to prepare for ambulance cost collection. Learn more about our affordable packages today.

Stars of Life

Every year, the American Ambulance Association’s Stars of Life program showcases the value of mobile healthcare to legislators and the general public. I look forward to seeing many of you this June in Washington D.C., for the 2019 celebration. Follow the 2019 AAA Stars of Life on Facebook and Twitter in the coming months! Levitra generic http://www.gastonpharmacy.com/levitra.php

Annual Conference & Trade Show

Preparations are in full swing for the 2019 AAA Annual Conference & Trade Show in exciting Nashville, Tennessee. AAA Annual is the can’t-miss educational experience for ambulance leaders interested in bringing excellence in reimbursement, operations, and human resources to their services! I hope that you will join me and hundreds of our colleagues for networking, learning, and fun November 4-6Early bird registration is open now!

Thank You, Members!

It continues to be my pleasure to serve so many talented, dedicated health care professionals. Thank you for your service to your communities, and I wish you continued success in 2019!

Aarron Reinert
President
American Ambulance Association