Ground Ambulance and Patient Billing Advisory Committee Update
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June 8 | FICEMS Virtual Meeting
2022 SESSION
Wednesday, June 8, 2022 1:00 p.m. – 3:45 p.m. Virtual Meeting Washington, DC
General Meeting1:00-1:05 Welcome, Introductions, Opening Remarks Jonathan Greene, Deputy Asst. Secretary for Preparedness & Response Director, Office of Emergency Management & Medical Operations FICEMS Chairperson Gam Wijetunge, Director, NHTSA OEMS Director of the Office of EMS, NHTSA Elizabeth Fudge Supervisory Program Analyst, Health Readiness Policy & Oversight Theresa “Tee” Morrison-Quinata EMS for Children Branch Chief, Maternal & Child Health Bureau Division of Child, Adolescent, & Family Health 1:20 Assistant Secretary for Preparedness & Response Jonathan Greene Deputy Assistant Secretary & Director, Office of Emergency Management & Medical Operations
1:25 Indian Health Services Darrell LaRoche Director, Office of Clinical & Preventive Services
1:30 Centers for Disease Control & Prevention Christine “Chris” Kosmos Director, Division of State & Local Readiness Center for Emergency Preparedness & Response
1:35 Centers for Medicare & Medicaid Services CAPT. Skip Payne Director, Emergency Preparedness & Response Operations 1:40 Countering Weapons of Mass Destruction Office Pritesh Gandhi, M.D. Chief Medical Officer, EMS Program
1:45 United States Fire Administration Richard Patrick Director, National Fire Programs Directorate 1:50 National Highway Traffic Safety Administration Nanda Srinivasan Associate Administrator, Research & Program Development 1:55 Public Safety & Homeland Security Bureau David Furth, J.D. Deputy Chief, Office of the Bureau Chief 2:00 State EMS Directors Update Steve McCoy EMS Bureau Florida Department of Public Health Kate Elkins EMS Specialist, NHTSA OEMS 2:10 COVID-19 First Responder Deaths Dave Bryson EMS Specialist, NHTSA OEMS 2:15 National 911 Program Update Brian Tegtmeyer National 911 Program Coordinator 2:20 NEMSIS Update Eric Chaney EMS Specialist, NHTSA OEMS 2:25 National Roadway Safety Strategy – Post Crash Care Gam Wijetunge Director, NHTSA OEMS
Diane Pilkey, DHHS HRSA | Max Sevareid, NHTSA OEMS
2:35 EMS Data Standards & Exchange Subgroup Rachel Abbey, DHHS ONC | David Millstein, DHS USFA 2:40 EMS Systems Integration & Preparedness Subgroup Tee Morrison-Quinata, DHHS HRSA | Gam Wijetunge, NHTSA OEMS 2:45 Workforce & Safety Subgroup Greg Williams, DHS USFA | Dave Bryson, NHTSA OEMS 2:50 Education & Training Subgroup Michael Stern, DHS USFA | Clary Mole, NHTSA OEMS
3:25-3:30 Public Comment |
NEMSAC | Webcast May 11-12
The National EMS Advisory Council (NEMSAC) will host a virtual meeting on Wednesday and Thursday, May 11-12, 2022. Members of the public can register for the webcast here.
The NEMSAC meets several times each year to discuss issues facing the EMS community. Members of NEMSAC provide counsel and recommendations regarding EMS to the National Highway Traffic Safety Administration (NHTSA) in the Department of Transportation (DOT) and the Federal Interagency Committee on EMS (FICEMS).
Daily agendas include time for NEMSAC subcommittee deliberations in the morning and the publicly webcasted portion of the meetings begin at 1:00 pm ET, Wednesday, May 11, 2022, and 12:00 pm ET on Thursday, May 12, 2022. Items on the agenda include:
- Updates from Federal Emergency Services Liaisons
- Discussion about FICEMS & NHTSA Initiatives
- Subcommittee Reports
- Public comment
Individuals registered for the meeting who wish to address the council during the public comment periods can review the current draft and interim advisories and submit comments in writing to NHTSA.NEMSAC@dot.gov by 5:00 pm ET on May 3, 2022.
Draft advisories:
- Cybersecurity – What to do when technology fails
- Strengthening EMS and Hospital Relationships
- The EMS Star of Rights
Interim advisory:
This meeting will be open to the public. NHTSA is committed to providing equal access to this meeting for all program participants. Persons with disabilities in need of accommodation should send their request to Clary Mole by phone at (202) 868-3275 or by email at Clary.Mole@dot.gov no later than May 3, 2022. A sign language interpreter will be provided and closed captioning services will be provided for this meeting through the WebEx virtual meeting platform.
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Notice of Public Meeting: This notice announces a meeting of the National Emergency Medical Services Advisory Council (NEMSAC).
CMS | Ambulance Ground Transport: Comparative Billing Report in April
In late April, CMS will issue a Comparative Billing Report (CBR) on Medicare Part B claims for ambulance ground transport. Use the data-driven report to compare your billing practices with those of peers in your state and across the nation.
CBRs aren’t publicly available. Look for an email from cbrpepper.noreply@religroupinc.com to access your report. Update your email address in the Provider Enrollment, Chain, and Ownership System to ensure delivery.
For More Information:
- View a webinar recording
- Visit the CBR website
- Register for a live webinar on May 11 from 3–4 pm ET
CAAS | GVS V3.0 Draft for Public Comment #2
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NACIDD & NACSD | Public Meetings 4/1 & 4/6
From ASPR on March 31, 2022
The National Advisory Committee on Seniors and Disasters (NACSD) and the National Advisory Committee on Individuals with Disabilities and Disasters (NACIDD) will soon host public meetings of these two advisory committees.
The next NACIDD meeting takes place on Friday, April 1 from 11:30 a.m. to 2:30 p.m. ET and the next NACSD meeting is on Wednesday, April 6 from 11:00 a.m. to 2:00 p.m. ET.
Join board members, distinguished guests, federal leaders, and other experts to discuss the challenges, opportunities, and priorities in meeting the unique health needs of older adult populations and people with disabilities during and after disasters and public health emergencies.
Advanced registration for these meetings is required and can be accessed, along with additional meeting agendas and public information, through the online event pages for the NACIDD and NACSD.
The agendas for each of the next meetings include time to hear from the public. The floor will be open to hear as many relevant comments as possible. To learn how to request a speaking time, please visit each committee’s event page. You can send questions about the NACSD to NACSD@hhs.gov and questions about the NACIDD to NACIDD@hhs.gov.
HHS PRF | EMS Funding Letter to Secretary Becerra
March 24, 2022
The Honorable Xavier Becerra
Secretary of Health and Human Services
Department of Health and Human Services
200 Independence Avenue, SW
Washington, DC 20201
Dear Secretary Becerra:
Ground ambulance service organizations and fire departments continue to struggle financially from the enduring economic effects of the COVID-19 public health emergency (PHE). Our respective members face sharp increases in the costs of fuel, equipment, medical supplies, and staffing as we deal with a severe shortage of paramedics and emergency medical technicians (EMTs) which has been an issue for years but exacerbated by the pandemic. We implore you to help ensure communities around the country have access to 9-1-1 emergency and non-emergency ground ambulance services through the remainder of the PHE and beyond with an infusion of $350 million from returned and/or unspent money in the Provider Relief Fund (PRF).
We greatly appreciate the funding that ground ambulance service organizations and fire departments have already received from the PRF. The funds have been a lifeline for many of our respective members and their ability to continue to serve their communities. However, as the Phase 4 distribution of funds demonstrated, more funding is needed for ground ambulance services. Our members indicate the funds they received in Phase 4 covered approximately 50% of their lost reimbursement and increased costs from July 1, 2020, to March 31, 2021, whereas previous distributions were closer to 88%. We therefore respectfully request an immediate distribution of $350 million or 10% of the annual Medicare expenditure on ground ambulance services.
We request that the funds be distributed in a similar manner as the Tranche 1 distribution from the PRF. The automatic, across-the-board deposit of funding was especially helpful for small and rural ground ambulance service organizations. These rural organizations provide care in underserved areas and are often daunted even by an abbreviated application process. To ensure equity for all communities, we support universal direct deposit.
Additionally, we encourage HHS to make these payments based on the National Provider Identification (NPI) number of the ground ambulance service organization or fire department rather than Tax ID Number (TIN). In the case of moderate and large cities, many municipal departments may share a TIN while maintaining distinct NPIs. Providing these payments according to TIN may unintentionally comingle funds intended for different departments such as fire departments, public health departments, and local government-run hospitals or clinics.
The American Ambulance Association (AAA), International Association of Fire Chiefs (IAFC), International Association of Fire Fighters (IAFF), National Association of Emergency Medical Technicians (NAEMT), and National Volunteer Fire Council (NVFC) represent the providers of vital emergency and non-emergency ground ambulance services and the paramedics, EMTs and firefighters who deliver the direct medical care and transport for every community across the United States.
Our members take on substantial risk every day to treat, transport, and test potential COVID-19 patients, and play a vital role in providing vaccinations to individuals in their homes. Ground ambulance service organizations and fire departments, however, urgently need the additional
$350 million to help offset the increased costs and lower reimbursement resulting from our vital response to the pandemic.
Thank you in advance for your consideration of this request.
Sincerely,
American Ambulance Association
International Association of Fire Chiefs
International Association of Fire Fighters
National Association of Emergency Medical Technicians
National Volunteer Fire Council
Student Loan Forgiveness for Frontline Health Workers Act (S. 3828) Introduced
This week, Senator Sheldon Whitehouse (D-RI) along with Senator Alex Padilla (D-CA), introduced the Student Loan Forgiveness for Frontline Health Workers Act (S. 3828), which provides loan forgiveness to individuals working in frontline healthcare responding to the Covid-19 pandemic. The legislation broadly defines healthcare workers and includes those who work in both public and private EMS. It provides relief to those who participate in both Federal student loans and private loans. We are very pleased to see the introduction of this legislation as it represents the kind of broad-based coverage for both governmental and non-governmental EMS that we have been advocating for. The legislation specifically covers paramedic certification programs that are accredited as part of CoAEMSP which requires college affiliation and makes them eligible for relief as federal student loans. The bill has broader standards than the current Public Safety Loan Forgiveness program. S. 3828 covers front-line healthcare workers regardless of their length of service as long as they are providing Covid healthcare-related services and specifically covers “an emergency medical services worker who responds to health emergencies or transports patients to hospitals or other medical facilities”. In addition, the student loan forgiveness for those working in EMS, would be exempt from inclusion in that individual’s taxable income.
The AAA supports this legislation and applauds Senator Whitehouse and Senator Padilla for their efforts to assist our frontline healthcare workers.
NASEMSO | Model EMS Clinical Guidelines v3
From NASEMSO on March 23, 2022
Overview
The National Model EMS Clinical Guidelines Project was first initiated by NASEMSO in 2012 and has produced three versions of model clinical guidelines for EMS: the first in 2014, a revision 2017, and now this third version in 2022. The guidelines were created as a resource to be used or adapted for use on a state, regional or local level to enhance prehospital patient care and can be viewed here. These model protocols are offered to any EMS entity that wishes to use them, in full or in part. The model guidelines project has been led by the NASEMSO Medical Directors Council in collaboration with six national EMS physician organizations, including: American College of Emergency Physicians (ACEP), National Association of EMS Physicians (NAEMSP), American Academy of Emergency Medicine (AAEM), American Academy of Pediatrics, Committee on Pediatric Emergency Medicine (AAP-COPEM), American College of Surgeons, Committee on Trauma (ACS-COT) and Air Medical Physician Association (AMPA). Co-Principal Investigators, Dr. Carol Cunningham and Dr. Richard Kamin, led the development of all three versions. Countless hours of review and edits are contributed by subject matter experts and EMS stakeholders who responded with comments and recommendations during the public comment period.
NASEMSO gratefully acknowledges the Technical Expert Panel, the Technical Reviewers, and many others who volunteered their time and talents to ensure the success of this project.
The comprehensive review and revision of these guidelines was made possible by funding support from the National Highway Traffic Safety Administration Office of EMS and the Health Resources and Services Administration Maternal and Child Health Bureau EMS for Children Program.
For More Information
Andy Gienapp, MS, NRP
Deputy Executive Director
andy@nasemso.org
HHS IEA | COVID-19 Update for March 21, 2022
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HHS Office of Intergovernmental and External Affairs COVID-19 Update for
March 21, 2022 |
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Marvin B. Figueroa, Director
U.S. Department of Health and Human Services
Intergovernmental and External Affairs 200 Independence Ave., S.W. Washington, D.C. 20201 |
Connect With Us     |
HHS OIG Report on Telehealth for Medicare Beneficiaries in COVID-19
From HHS Office of Inspector General on March 15, 2022
Telehealth Was Critical for Providing Services to Medicare Beneficiaries During the First Year of the COVID-19 Pandemic
WHY WE DID THIS STUDY
The COVID-19 pandemic created unprecedented challenges for how Medicare beneficiaries accessed health care. In response, the Department of Health and Human Services (HHS) and the Centers for Medicare & Medicaid Services (CMS) took a number of actions to temporarily expand access to telehealth for Medicare beneficiaries. CMS allowed beneficiaries to use telehealth for a wide range of services; it also allowed beneficiaries to use telehealth in different locations, including in urban areas and from the beneficiary’s home.
This data brief provides insight into the use of telehealth in both Medicare fee-for-service and Medicare Advantage during the first year of the COVID-19 pandemic, from March 2020 through February 2021. It is a companion to a report that examines the characteristics of beneficiaries who used telehealth during the pandemic. Another report in this series identifies program integrity concerns related to telehealth during the pandemic. Understanding the use of telehealth during the first year of the pandemic can shed light on how the temporary expansion of telehealth affected where and how beneficiaries accessed their health care. This information can help CMS, Congress, and other stakeholders make decisions about how telehealth can be best used to meet the needs of beneficiaries in the future.
HOW WE DID THIS STUDY
We based this analysis on Medicare fee-for-service claims data and Medicare Advantage encounter data from March 1, 2020, to February 28, 2021, and from the prior year, March 1, 2019, to February 29, 2020. We used these data to determine the total number of services used via telehealth and in-person, as well as the types of services used. We also compared the number of services used via telehealth and in-person during the first year of the pandemic to those used in the prior year.
WHAT WE FOUND
Over 28 million Medicare beneficiaries used telehealth during the first year of the pandemic. This was more than 2 in 5 Medicare beneficiaries. In total, beneficiaries used 88 times more telehealth services during the first year of the pandemic than they used in the prior year. Beneficiaries’ use of telehealth peaked in April 2020 and remained high through early 2021. Overall, beneficiaries used telehealth to receive 12 percent of their services during the first year of the pandemic. Beneficiaries most commonly used telehealth for office visits, which accounted for just under half of all telehealth services used during the first year of the pandemic. However, beneficiaries’ use of telehealth for behavioral health services stands out. Beneficiaries used telehealth for a larger share of their behavioral health services compared to their use of telehealth for other services. Specifically, beneficiaries used telehealth for 43 percent of behavioral health services, whereas they used telehealth for 13 percent of office visits.
WHAT WE CONCLUDE
Telehealth was critical for providing services to Medicare beneficiaries during the first year of the pandemic. Beneficiaries’ use of telehealth during the pandemic also demonstrates the long-term potential of telehealth to increase access to health care for beneficiaries. Further, it shows that beneficiaries particularly benefited from the ability to use telehealth for certain services, such as behavioral health services. These findings are important for CMS, Congress, and other stakeholders to take into account as they consider making changes to telehealth in Medicare. For example, CMS could use these findings to inform changes to the services that are allowed via telehealth on a permanent basis.
House Passes MedPAC Ambulance Report Delay
Last night, the United States Senate passed language as part of the FY 2022 Omnibus Appropriations Package that would delay the due date of the Medicare Payment Advisory Committee (MedPAC) report analyzing ambulance cost data. The U.S. House of Representatives had passed the package on Wednesday. The delay in the MedPAC report is a victory for the AAA and our members as we spearheaded efforts for the delay.
We thank Senators Chuck Schumer, Catherine Cortez Masto, Ron Wyden, Mike Crapo and Debbie Stabenow and Representatives Richard Neal, Kevin Brady, Frank Pallone and Catherine McMorris Rogers for championing and assisting with passage of the provision.
The delay in the timing of the MedPAC report was necessary due to CMS postponing the beginning of ambulance cost data collection by two years to account for the COVID-19 pandemic. Even though data collection had been delayed, MedPAC indicated that they were compelled to stick to the statutory deadline of issuing a report – with very little or no new ambulance data – to Congress by March 15, 2023.
With little to no new data, MedPAC would have likely reinstated their recommendations from their 2002 ambulance report which did support most of the temporary ambulance increases but at the cost of cutting BLS non-emergency services by 5.75%. MedPAC had also recommended doing away with rural and super rural increases in favor of a low volume adjuster which would disrupt reimbursement levels for rural providers without having more detailed data if indeed the proper approach.
The language from the FY2022 Omnibus Appropriations Package is as follows:
SEC. 311. REVISION OF THE TIMING OF MEDPAC REPORT ON AMBULANCE COST DATA.
Section 1834(l)(17)(F)(i) of the Social Security Act (42 U.S.C. 1395m(l)(17)(F)(i)) is amended by striking ‘‘Not later than March 15, 2023, and as determined necessary by the Medicare Payment Advisory Commission thereafter’’ and inserting ‘‘Not later than the second June 15th following the date on which the Secretary transmits data for the first representative sample of providers and suppliers of ground ambulance services to the Medicare Payment Advisory Commission, and as determined necessary by such Commission thereafter,’’.
Next week, we will be launching a Call to Action asking AAA members to reach out to their members of Congress to cosponsor the Protecting Access to Ground Ambulance Medical Services Act (H.R. 2454, S. 2037) Medicare Ambulance which would extend the temporary Medicare ambulance increases for five years. The increases expire at the end of this year and the five-year extension is necessary to provide time for the MedPAC report and the Congress to act.
HRSA eNews | Expanding Health Care Access and Resources in Underserved Populations,
| HRSA eNews March 3, 2022 |
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In his State of the Union address, President Biden announced an ambitious strategy to address our national mental health crisis. At the Health Resources and Services Administration, we stand with the President in his call for unity in our national response and know that for the millions of Americans living with a mental health condition or caring for a loved one with a mental health condition, the time for action is now.
In February, HRSA announced the winners of the Promoting Pediatric Primary Prevention Challenge, $66.5 million to support community-based vaccine outreach efforts, more than $560 million in pandemic relief payments to health care providers, funding to increase virtual care quality and access, and new funding to support primary care residency programs.
With this funding, nearly $19 billion will have been distributed from the Provider Relief Fund and the American Rescue Plan Rural provider funding since November 2021
Our 
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Climate change influences human health and diseases in numerous ways. Underserved communities stand to bear the brunt of these climate-induced risks (e.g., extreme heat, poor air quality, flooding, extreme weather events). HRSA and CDC’s Climate and Health Program invite you to consider the impacts of climate change on the U.S. health care system. CDC will share its work to build resilience to these public health effects.
Patient Safety Awareness Week is March 13-19. We are hosting an event in partnership with the Agency for Healthcare Research and Quality (AHRQ), the Centers for Disease Control and Prevention (CDC), the Centers for Medicare & Medicaid Services (CMS), the Food and Drug Administration (FDA), the Indian Health Service (IHS), and the National Institutes of Health (NIH).
Children’s mental health continues to be a top priority for state leaders across both legislative and executive branches of state government. With COVID-19 exacerbating the challenges children are facing, there is much more work to be done.
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House Energy & Commerce Hearing on COVID-19 Frontlines
On March 2, the House Energy and Commerce Subcommittee on Oversight and Investigations held a hearing on “Lessons from the Frontline: COVID-19’s Impact on American Health Care.” Subcommittee Chair Diane DeGette (D-CO) and members Lorie Trahan (D-MA) and Tom O’Halleran (D-AZ) referenced the important role of EMS during their comments. The AAA submitted written comments for the hearing record requesting that the Subcommittee help address the EMS workforce shortage, access to grant funding for all EMS provider types and stability with funding for ground ambulance services. Here is a link should you want to watch a recording of the hearing.
Balance Billing | TX Judge Vacates Portions of NSA IFR
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Reminder for EMS Employers to Electronically Report 2021 Injury & Illness Data
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FAIR Health | Ground Ambulance Services in the United States
From FAIR Health in February 2022
“Currently, no federal law protects consumers against “surprise” bills from out-of-network ground ambulance providers. Some state and local governments regulate ground ambulance surprise billing practices; however, such laws may not apply to all health plans or ambulance providers in an area. Because of the substantial policy interest in ground ambulance services, FAIR Health drew on its vast database of private healthcare claims to illuminate multiple aspects of such services across the nation, including utilization, costs, age, gender, diagnoses and differences across states.”
NEMSAC | National EMS Advisory Council Meeting Webcast March 2–3
The National EMS Advisory Council will be holding a virtual meeting on Wednesday and Thursday, March 2-3. Members of the public can register for the webcast here.
NEMSAC meets several times each year to discuss issues facing the EMS community and provide advice and recommendations regarding EMS to the National Highway Traffic Safety Administration in the Department of Transportation and to the Federal Interagency Committee on EMS.
The agenda for each day includes time for NEMSAC subcommittee deliberations in the morning, with the webcast council meeting convening at 12:00 pm ET on Wednesday, March 2, 2022, and 1 pm ET on Thursday, March 3, 2022. Items on the council’s agenda include:
– FICEMS COVID-19 Response
– National Suicide Hotline Update
– Reviewing the Need for EMS and Obstetric Collaboration
– Rural, Tribal and Frontier EMS Challenges
– Improving Stroke Triage and Transport Protocols for EMS
– Public Comment
Individuals registered for the meeting interested in addressing the council during the public comment periods must submit their comments in writing to Clary Mole at clary.mole@dot.gov by 5pm ET on February 24, 2022.
This meeting will be open to the public. NHTSA is committed to provide equal access to this meeting for all program participants. Persons with disabilities in need of an accommodation should send your request to Clary Mole by phone at (202) 868-3275 or by email at Clary.Mole@DOT.gov no later than February 24, 2022. A sign language interpreter will be provided, and closed captioning services will be provided for this meeting through the WebEx virtual meeting platform.
National Emergency Medical Services Advisory Council Notice of Public Meeting This notice announces a meeting of the National Emergency Medical Services Advisory Council (NEMSAC).
2/17 | ASPR National Advisory Committee on Children and Disasters
From ASPR on February 14, 2022
The NACCD will conduct an inaugural public meeting (virtual) on February 17, 2022. The new advisory committee will be sworn in along with the presentation and discussion of challenges, opportunities, and priorities for national public health and medical preparedness, response and recovery, specific to the needs of children and their families in disasters.
Members of the public may attend the meeting via Zoom teleconference, which requires pre-registration, and may provide written comments, submit questions to the NACCD, and provide comments after the meeting by email to NACCD@hhs.gov.
Bloomberg Radio | President Baird on the Workforce Shortage
Fantastic Bloomberg Radio interview with President Shawn Baird covering key causes and impacts of the EMS workforce shortage.
Balance of Power Podcast • Browse all episodes
https://www.bloomberg.com/news/audio/2022-02-11/balance-of-power-ems-worker…
Balance of Power: EMS Worker Shortage Crisis (Radio)
Shawn Baird, President of the American Ambulance Association, discusses the shortage of emergency medical workers and paramedics. He spoke with Bloomberg’s David Westin.