Government Affairs Update

Government Affairs Update: What We’re Working On The AAA continues to press policy initiatives with Congress and the Administration that are important to our members. While not as high-profile as our successful efforts earlier this year on the five-year extension of the Medicare ambulance add-ons, the AAA is working hard on ambulance legislation and regulations that impact the EMS industry and ambulance services across the country. Here is a snapshot of those current efforts. Over the next month, we will be providing weekly in-depth updates highlighting these issues. Ambulance Cost Data Collection System The AAA was successful in getting our preferred language of an ambulance cost data collection system using a survey and random sample methodology included with the extension of the add-ons in the Bipartisan Budget Act of 2018. However, that was just the first key step in the process. We now need to ensure that CMS gets the details right as the agency develops the structural specifics and data elements for the system. It is critical that the system is designed in a way that ambulance service suppliers and providers will submit the most accurate data possible. The data will ultimately provide the information necessary for Congress, the...

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Notice of Proposed Change to OSHA Injury Reporting

Notice of Proposed Change to OSHA Electronic Injury Reporting Regulations The Occupational Safety and Health Administration (OSHA) announced on July 27, 2018 that it has published a Notice of Proposed Rulemaking (NPRM) that would change the Electronic Injury Reporting Regulations (29 CFR Part 1904) for employers with 250 or more employees. OSHA is proposing this change due to a heightened concern that employee Personally Identifiable Information may be at risk of disclosure through the Freedom of Information Act (FOIA). Currently, all EMS employers must submit their annual injury and illness data to OSHA through the Injury Tracking Application (ITA). Historically, employers were required to track all workplace injuries and illnesses and maintain records of those incidents in the workplace on the OSHA Form 300, 301, and 300A. Each year, employers are required to post a Summary of Workplace Injuries and Illnesses on the Form 300A from February 1st through April 30th. In May 2016, OSHA amended the regulations requiring all employers to submit their Form 300A Summary electronically through the Injury Tracking Application (ITA). Employers with 250 or more employees were required to electronically report all injury and illness data from Forms 300, 301, and 300A each year. Initially OSHA...

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CMS Non-Emergency Ambulance Transport Open Door Forum 7/26

CMS Issues Data Elements and Templates for Non-Emergency Ambulance Transports (NEAT): Open Door Forum for Thursday, July 26, 2018 Just Announced As part of its Patients Over Paperwork Project, the Centers for Medicare & Medicaid Services (CMS) Provider Compliance Group (PCG) has been hosting quarterly listening sessions and reviewing the Request for Information submissions. The American Ambulance Association has been actively engaged in these efforts, highlighting the recommendations we submitted to CMS and the House Ways & Means Committee last year. These recommendations included suggestions as to how CMS could streamline regulatory requirements to eliminate duplicative requirements and reduce regulatory burdens.  In addition to these efforts, CMS has been working to standardize documentation data elements and establish templates that providers and suppliers can use to help make the current documentation processes less burdensome as well. On July 24, CMS released draft documentation-related clinical data elements and clinical templates that could be used for the Physician Certification Statement, Progress Notes, and Prior Authorization requests. View the Documents. These documents are not intended to change current law. CMS also announced yesterday that it will discuss the templates on a Special Open Door Forum which is scheduled for July 26 at 2-3 pm ET. ...

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Robert Wilkie Confirmed as VA Secretary

The Senate voted today to confirm Robert Wilkie as Department of Veterans Affairs secretary. Wilkie, previously an undersecretary at the Pentagon, was approved by the Senate 86-9. Of note, Wilkie becomes the fourth VA Secretary in the past five years. New VA Secretary, Robert Wilkie Senate confirms Robert Wilkie to be the next VA Secretary What To Know About Trump’s VA Secretary Nominee Robert Wilkie Wilkie takes over after Secretary David Shulkin was fired earlier this year. Wilkie is the second nominee put forward to replace Shulkin after White House physician, Ronny Jackson, withdrew his nomination in April.

Talking Medicare: A Good Thing Poorly Explained

On April 13, 2018, CMS released two Transmittals, Transmittal 243 and Transmittal 4021, and a related MedLearns Matter Article (MM10550). Collectively, these documents clarify Medicare’s coverage of ambulance transportation of SNF residents in a stay not covered by Part B, but who have Part B benefits, to the nearest supplier of medically necessary services that are not available at the SNF. This clarification relates to both the ambulance transport to the site of medical care, and the return trip. In order to properly understand the clarification, it is helpful to review Medicare’s coverage of ambulance transportation provided to SNF residents. At the onset, it is important to note that Medicare draws a distinction between the first 100 days of a beneficiary’s SNF stay, and any subsequent days of the same stay. The first 100 days are commonly referred to as the “Part A Period.” Under current Medicare rules, all ambulance transportation provided during the Part A Period is the financial responsibility of the SNF, unless a specific exemption applies. Outside the Part A Period, Medicare’s coverage rules generally mirror the rules applicable to ambulance transports that originate at the patient’s residence. However, there is an exception that relates to transportation...

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OSHA Updates & Reminders 2018

It is important that employers remember that they must post a copy of their OSHA Form 300A which is a summary of workplace injuries starting February 1, 2018 through April 30, 2018.  The OSHA Form 300A is a summary of all job-related injuries and illnesses that occurred in an employer’s workplace during 2017.  If a company recorded no injuries or illnesses in 2018, the employer must enter “zero” on the total line. The form must be signed and certified by a company executive. The OSHA Form 300A Injury Summary must be displayed in a common area where notices to employees are usually posted.  In addition to posting these reports in the workplace, covered employers will have to electronically report their injury data on the Injury Tracking Application (ITA) by July 1, 2018. Also, a reminder to employers who are subject to OSHA or to those who operate in a state with an OSHA approved state level plan, the penalty amounts for OSHA violations are increasing effective January 2, 2018.  In accordance with the Federal Civil Penalties Inflation Adjustment Act Improvements Act of 2015, the Department of Labor is required to adjust penalties for inflation each year. New penalties for willful...

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President’s Perspective: October 2017

Dear Fellow AAA Members, As I reflect on the past few months, I am awed by the dedication of ambulance services across the nation as they responded to emergencies ranging from hurricanes to wildfires to the Las Vegas MCI. As always, EMS aided their communities with humanity, efficiency, and deep-rooted professionalism. The outcomes of each of these incidents would assuredly have been far worse without the selfless service of our fellow healthcare providers. I was privileged to see this commitment to excellence firsthand as our staff at Sunstar responded to Hurricane Maria here in Florida, assisted by hundreds of EMTs, Paramedics, and strike team leaders who drove hours or days to help. Thanks to each of you for your service in our country’s time of need. Advocacy Update The AAA continues working hard to ensure the Medicare add-on payments don’t expire at the end of this year. In the Senate, S. 967 would make the add-on payments permanent. In the House, two versions of a bill (H.R. 3236, H.R. 3729) would extend the payments for five years. Extensions of Medicare provider provisions, including the ambulance add-on payments, will likely be addressed closer to the end of the year. We have...

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Is the TX Moratorium Ending?

Is CMS Ending the Temporary Moratorium on Enrollment of New Non-Emergency Ground Ambulance Providers in Texas? On September 2, 2017, the Centers for Medicare and Medicaid Services (CMS) posted a notice on its website that it was lifting the temporary moratorium on the enrollment of new Part B non-emergency ambulance suppliers in Texas, effective September 1, 2017.  CMS indicated that the lifting of this temporary moratorium was intended to aid in the disaster response to Hurricane Harvey. For reasons I will discuss in greater detail below, this explanation has struck a number of commentators as curious.  These commentators have speculated that this may notice may foretell a permanent elimination of the enrollment moratorium for non-emergency ground ambulance providers in Texas. Background on Temporary Moratorium on New Enrollments in Texas The Affordable Care Act granted CMS several new tools to combat fraud, waste, and abuse in the Medicare, Medicaid, and Children’s Health Insurance Programs.  This included Section 6401(a), which granted the CMS Secretary the authority to impose temporary moratoria on the enrollment of new Medicare, Medicaid, or CHIP providers to the extent the Secretary determined that doing was necessary to prevent fraud and abuse. The implementation of the first enrollment moratorium...

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