Earlier today, the Department of Health and Human Services (HHS) posted a revised set of frequently asked questions (FAQs) regarding the terms and details of payments distributed under the Public Health and Social Services Emergency Fund to Medicare providers including ground ambulance service providers and suppliers. The updated FAQs cover a range of topics regarding the acceptance of funds, revenue data submission and eligibility criteria.
CMS has issued a blanket waiver modifying the data collection period for the ground ambulance services that were selected to report in Year 1. Under the current law, these organizations would have been required to collect data beginning January 1, 2020, and through December 31, 2020. The waiver allows these organizations to select a new continuous 12-month data collection period that begins between January 1, 2021 and ends December 31, 2021. This modification means that such organizations will collect and report data during the same time period as the ground organizations that CMS will select for Year 2 of the cost collection program.
From the summary of the waiver, it appears that organizations will have the choice of submitting data in Year 1 or Year 2. CMS has not moved the timeline for any other data collection year, so there is the potential for a substantial number of organizations to report in Year 2, which would increase the amount of data available.
The AAA has supported the data collection system to make sure that CMS and the Congress have valid and reliable data to support maintaining the geographic add-ons to the Medicare Ambulance Fee Schedule and to support efforts to address the chronic underfunding of the Medicare Ambulance Fee Schedule.
The complete FAQ is below and also available at: https://www.cms.gov/files/document/summary-covid-19-emergency-declaration-waivers.pdf (on page 29).
“CMS is modifying the data collection period and data reporting period, as defined at 42 CFR § 414.626(a), for ground ambulance organizations (as defined at 42 CFR § 414.605) that were selected by CMS under 42 CFR § 414.626(c) to collect data beginning between January 1, 2020 and December 31, 2020 (year 1) for purposes of complying with the data reporting requirements described at 42 CFR § 414.626. Under this modification, these ground ambulance organizations can select a new continuous 12-month data collection period that begins between January 1, 2021 and December 31, 2021, collect data necessary to complete the Medicare Ground Ambulance Data Collection Instrument during their selected data collection period, and submit a completed Medicare Ground Ambulance Data Collection Instrument during the data reporting period that corresponds to their selected data collection period. CMS is modifying this data collection and reporting period to increase flexibilities for ground ambulance organizations that would otherwise be required to collect data in 2020- 2021 so that they can focus on their operations and patient care.”
“As a result of this modification, ground ambulance organizations selected for year 1 data collection and reporting will collect and report data during the same period of time that will apply to ground ambulance organizations selected by CMS under 42 CFR § 414.626(c) to collect data beginning between January 1, 2021 and December 31, 2021 (year 2) for purposes of complying with the data reporting requirements described at 42 CFR § 414.626.”
The U.S. House of Representatives is scheduled to vote later today on the Health and Economic Recovery Omnibus Emergency Solutions Act “HEROES Act” (H.R. 6800). The HEROES Act is the House Democratic proposal for the latest legislative effort on economic relief related to COVID-19. The House is expected to pass the HEROES Act along party lines with the Senate developing its own legislative proposal with consideration in the coming weeks.
The HEROES Act contains numerous provisions of interest to ground ambulance service providers and suppliers. For a comprehensive summary of those provisions, please click HERE.
Here are a few of the highlights:
$100 Billion for Health Care Fund
Employee Retention Tax Credit Improvements
Payroll Protection Program
$500 Tax Credit for First Responders and Frontline Employees
The AAA has already turned its sights on the Senate as we continue to advocate for ground ambulance service providers and suppliers in our vital role as frontline medical responders in combating COVID-19.
Earlier today, the AAA sent a letter to the U.S. Public Health Service (USPHS) requesting that first responders with COVID-19 symptoms be given priority one status in the order of groups to be tested for COVID-19. The USPHS had issued guidance that assigned first responders a level two status. The AAA stated paramedics and EMTs should be included in the top level with other health care professionals who are on the front lines of caring for patients with COVID-19. Read the Letter HERE.
Congress Provides More PPP and Health Care Funds
Moments ago, the U.S. House of Representatives passed by a vote of 388 to 5 the Paycheck Protection Program and Health Care Enhancement Act. The United States Senate had passed the legislation by unanimous consent on Tuesday evening. The legislation is a bridge package between the CARES Act and Stimulus Package 4 which is still under development.
The Paycheck Protection Program and Health Care Enhancement Act provides an additional $310 billion for the Paycheck Protection Program (PPP) established under the CARES Act. The PPP had run out of its initial funding on April 9 and the program has been closed to new applications. The PPP provides businesses with fewer than 500 employees, including ambulance service organizations, with access to loans at favorable terms to cover employee payroll for eight weeks. A borrower can have all or a portion of the loan forgiven depending on the percentage of retained employees.
The legislation also allocates an additional $75 billion in funds for the Public Health and Social Services Emergency Fund (PHSSEF). Like the initial $100 billion funding from the CARES Act, these funds are intended to provide economic relief to health care providers during the COVID-19 public health emergency. AAA members received direct grant money a few weeks ago under the PHSSEF in the form of an additional Medicare payment. The Department of Health and Human Services (HHS) will have the discretion to determine how the additional $75 billion is made available to health care providers. The AAA continues to advocate directly with senior HHS officials for ground ambulance service suppliers and providers to receive a share of funds proportional to our role health care providers on the front line of the pandemic.
The final provision of the Paycheck Protection Program and Health Care Enhancement Act provides additional funding for testing and research related to COVID-19 through the remainder of 2020.
The AAA with the help of our members had pushed for additional funding under the PHSSEF and were successful. We now need to ensure that the actual funds make their way to our members.
The AAA leadership and staff will continue to tirelessly advocate for the much-needed relief to ensure that our members can keep their doors open, receive the equipment necessary to protect their staff, and the resources to provide excellence in mobile healthcare. We will keep you abreast of our advocacy efforts as well as how to access funding under the PHSSEF as soon as the details become available.
NAEMT President and AIMHI Education Chair Matt Zavadsky shared with Greta Van Susteren the grim economics of EMS during the COVID-19 pandemic. Don’t miss this informative video.
Download materials from Akin Gump including aid summaries and how-to guides on qualifying for tax credits and deferments and applying for financial assistance.
The Department of Treasury has announced that the $350 billion appropriated under the CARES Act for the Paycheck Protection Program has been exhausted. However, Congressional leaders are currently negotiating an economic stimulus package to act as a bridge between the CARES Act and the next comprehensive package stimulus package. A core provision of the bridge package is an allocation of an additional $250 billion for the Paycheck Protection Program. If your operation is in the process or plans to apply for a loan under the Paycheck Protection Program, you should move forward with your efforts. The AAA is advocating that the bridge package or next comprehensive package include more funding for ambulance services.
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.
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.
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.
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.
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.
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).
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.
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►
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.
The ACH deposit will come to you via Optum Bank. The payment description will read “HHSPayment.”
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.
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.
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.
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.
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.
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
Business Provisions
Emergency Responder Provisions
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
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.
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.
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.
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.
