NEMSAC | Meeting August 9-10
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AAA Encourages CMS to Consider Revised Innovation Model for Treatment in Place
Washington, DC— While the Centers for Medicare & Medicaid Services (CMS) has decided to end the Emergency Triage, Treat, and Transport (ET3) Model two years early on December 31, 2023, the American Ambulance Association (AAA) remains committed to working with CMS on all future efforts to design programs that fully utilize the ground ambulance services in the delivery of mobile healthcare services. CMS made the decision to end the model “due to lower than expected participation and lower than projected interventions.”
The AAA is encouraged that CMS has stated that, “the lessons learned from the ET3 Model can aid in the development of potential future initiatives.” Our members are committed to supporting such future efforts to make sure that the requirements support true treatment in place and recognize the unique needs of rural ground ambulance services and the communities they serve. Moreover, we encourage CMS to work with the AAA to move forward with alternative destination as a permanent policy based not only on the lessons learned from the ET3 model, but also those garnered as a result of the Public Health Emergency (PHE) waiver. The AAA continues to support efforts to refine the Medicare ground ambulance emergency benefit to support delivering pre-hospital services to the patients who need them at the time they need them and where they need them.
CMS Releases Advance Copy of CY 2024 Physician Fee Schedule Proposed Rule
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7/27 CMS Ambulance Open Door Forum
From CMS on July 19, 2023
The next CMS Ambulance Open Door Forum scheduled for:
Date: Thursday, July 27, 2023
Start Time: 2:00pm-3:00pm PM Eastern Time (ET);
Please dial-in at least 15 minutes before call start time.
Conference Leaders: Jill Darling, Maria Durham
**This Agenda is Subject to Change**
- Opening Remarks
Chair- Maria Durham, Director, Division of Data Analysis and Market Based Pricing
Moderator – Jill Darling (Office of Communications)
Announcements & Updates
- Ground Ambulance & Patient Billing Advisory Committee Meeting Announcement
- Update on Emergency Triage, Treat, and Transport (ET3) Model
- Medicare Ground Ambulance Data Collection System (GADCS): Proposed Changes in the CY 2024 Physician Fee Schedule Proposed Rule
- Slide presentation will be available at: https://www.cms.gov/
medicare/ambulance-fee- schedule-zip-code-files/ ambulance-events
- Slide presentation will be available at: https://www.cms.gov/
- Consolidated Appropriations Act, 2023: Division FF, section 4103: Extension of Add-On Payments for Ambulance Services
III. Open Q&A
**DATE IS SUBJECT TO CHANGE**
Next Ambulance Open Door Forum: TBA
ODF email: AMBULANCEODF@cms.hhs.gov
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This Open Door Forum is open to everyone, but if you are a member of the Press, you may listen in but please refrain from asking questions during the Q & A portion of the call. If you have inquiries, please contact CMS at Press@cms.hhs.gov. Thank you.
NEW and UPDATED Open Door Forum Participation Instructions:
This call will be a Zoom webinar with registration and login instructions below.
Register in advance for this webinar:
https://cms.zoomgov.com/
Webinar ID: 161 099 7532
Passcode: 131371
After registering, you will receive a confirmation email containing information about joining the webinar. You may also add the webinar to your calendar using the drop-down arrow on the “Webinar Registration Approved” webpage after registering. Although the ODFs are now a Zoom webinar, we will only use the audio function, no need for cameras to be on.
For ODF schedule updates and E-Mailing List registration, visit our website at http://www.cms.gov/
Were you unable to attend the recent Ambulance ODF call? We encourage you to visit our CMS Podcasts and Transcript webpage where you can listen and view the most recent Ambulance ODF call. The webinar recording and transcript will be posted to: https://www.cms.gov/Outreach-
CMS provides free auxiliary aids and services including information in accessible formats. Click here for more information. This will point partners to our CMS.gov version of the “Accessibility & Nondiscrimination notice” page. Thank you.
CMS | Updates to Coverage for COVID-19 Tests
The COVID-19 Public Health Emergency is to end on May 11, 2023. The ending of the Public Health Emergency may impact an individual’s coverage of COVID-19 tests. We encourage you to know these changes and share the New Consumer Fact Sheet on COVID-19 tests.
Consumer Fact Sheets:
- English – https://www.cms.gov/files/
document/covid-over-counter- test-coverage.pdf - Spanish – https://www.cms.gov/files/
document/covid-over-counter- test-coverage-spanish.pdf
Before May 11, 2023
If you have any type of health insurance, you can get up to eight over-the-counter tests per month with no out-of-pocket costs. Over-the-counter tests are available in most pharmacies and may also be available online for delivery.
After May 11, 2023
Laboratory tests for COVID-19 that are ordered by your provider will still be covered with no out-of-pocket costs for people with Medicare. Over-the-counter tests will still be available, but there may be out-of-pocket costs. Coverage of over-the-counter tests may vary by your insurance type, as described below.
What does this mean for Medicare Beneficiaries?
Generally, Medicare doesn’t cover or pay for over-the counter products. The demonstration that has allowed us to offer coverage for COVID-19 over-the-counter tests at no cost ends on May 11, 2023.
However, if you are enrolled in Medicare Part B, you will continue to have coverage with no out-of-pocket costs for appropriate laboratory-based COVID-19 PCR and antigen tests, when a provider orders them (such as drive-through PCR and antigen testing or testing in a provider’s office).
If you are enrolled in a Medicare Advantage plan, you may have more access to tests depending on your benefits. Check with your plan.
What does this mean for people with Medicaid or Children’s Health Insurance Program?
If you have coverage through Medicaid or the Children’s Health Insurance Program, you will have access to COVID-19 over-the-counter and laboratory testing through September 30, 2024. After that date, coverage of testing may vary by state.
What does this mean for people with Private Insurance?
If you have private insurance, coverage will vary depending on your health plan. However, private plans won’t be required by federal law to cover over-the counter and laboratory-based COVID-19 tests after
May 11, 2023. If your insurance chooses to cover COVID-19 testing, they may require cost sharing, prior authorization, or other forms of medical management.
CMS Releases New Guidance on Implementation of the NSA and Payment Delays
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NEMSAC | Private and Fire-based EMS: Join the National EMS Advisory Council
Interested in Applying for NEMSAC?
Please contact the American Ambulance Association at info@ambulance.org.
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Summary: CMS Ambulance Open Door Forum
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EMS.Gov | NOFO 2023 Rural EMS Training Grant Program
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HHS OCR Settlement in FL to Improve Access to Care for Communities of Color
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3/16 | CMS Ambulance Open Door Forum
The next CMS Ambulance Open Door Forum scheduled for:
Thursday, March 16, 2023
2:00pm-3:00pm PM Eastern Time (ET);
This call will be Conference Call Only.
To participate by phone:
Dial: 1-888-455-1397 & Reference Conference Passcode: 4325849
Conference Leaders: Jill Darling, Maria Durham
**This Agenda is Subject to Change**
I. Opening Remarks
Chair- Maria Durham, Director, Division of Data Analysis and Market Based Pricing
Moderator – Jill Darling (Office of Communications)
II. Announcements & Updates
• Medicare Ground Ambulance Data Collection System
(GADCS): Top 5 Tips for Selected Organizations in Year 1, 2, 3, and 4
Slide presentation will be available on CMS’ Ambulances
Services Center website: https://www.cms.gov/medicare/ambulance-fee-schedule-zipcode-files/ambulance-events
Please see the following information regarding COVID-19
PHE Updated Guidance for Ambulance Organizations:
Public Health Emergency (PHE) 1135 Waivers: Updated
Guidance for Providers
III. Open Q&A
**DATE IS SUBJECT TO CHANGE**
Next Ambulance Open Door Forum: TBA
ODF email: AMBULANCEODF@cms.hhs.gov
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This Open Door Forum is open to everyone, but if you are a member of the Press,
you may listen in but please refrain from asking questions during the Q & A portion of
the call. If you have inquiries, please contact CMS at Press@cms.hhs.gov. Thank
you.
Open Door Participation Instructions:
This call will be Conference Call Only.
To participate by phone:
Dial: 1-888-455-1397 & Reference Conference Passcode: 4325849
Persons participating by phone do not need to RSVP. TTY Communications Relay
Services are available for the Hearing Impaired. For TTY services dial 7-1-1 or 1-
800-855-2880. A Relay Communications Assistant will help.
Instant Replay: 1-800-814-6745; Conference Passcode: No Passcode needed
Instant Replay is an audio recording of this call that can be accessed by dialing 1-
800-814-6745 and entering the Conference Passcode beginning 1 hours after the call
has ended. The recording is available until March 18, 2023, 11:59PM ET.
For ODF schedule updates and E-Mailing List registration, visit our website at
http://www.cms.gov/OpenDoorForums/.
Were you unable to attend the recent Ambulance ODF call? We encourage you to
visit our CMS Podcasts and Transcript webpage where you can listen and view the
most recent Ambulance ODF call. The audio and transcript will be posted to:
https://www.cms.gov/Outreach-andEducation/Outreach/OpenDoorForums/PodcastAndTranscripts.html.
CMS provides free auxiliary aids and services including information in accessible
formats. Click here for more information. This will point partners to our CMS.gov
version of the “Accessibility & Nondiscrimination notice” page. Thank you.
CMS Releases New Guidance on Ending of the COVID-19 PHE
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CMS Innovation Center Releases Additional Model Data
CMS is pleased to announce the availability of Research Identifiable Files (RIFs) and Public Use Files (PUFs) for two CMS Innovation Center models.
CMMI Model Data Sharing (CMDS) Model Participation Files
CMS is releasing new participation data for the following models:
These models join the 10 models that released data in 2022, bringing the total to 12 models represented in the CMMI Model Data Sharing (CMDS) model participation files. Each model in the release will include a set of three files, one per participant type (entity, provider, beneficiary). Each set of files will be updated on a quarterly basis, reflecting changes captured for the prior quarter. Quarterly updates will include “full replacement files” and will contain data from the launch of each model to the current quarter. The group of models for which files are available will expand over time to include additional models.
To get information about the participating models and data files, please visit the CMMI Model Data Sharing Model Participation Data Initiative page.
Comprehensive ESRD Care (CEC) Model Data
Additionally, CMS is announcing the availability of new Research Identifiable Files (RIFs) for the 2018-2020 performance years for the Comprehensive ESRD Care (CEC) Model. Two RIFs are available for each model year:
- The CEC Beneficiary RIF contains enrollment data for beneficiaries in the CEC Model for a given model year
- The CEC Provider RIF contains identifying information about the providers participating in the CEC Model for that year.
CMS will also be releasing the Public Use Files (PUFs) for performance years 4 and 5 on the CEC website. These files contain public information about the model participants and their performance. For more information on the model visit https://innovation.cms.gov/innovation-models/comprehensive-esrd-care.
Follow us on Twitter | Visit the CMS Innovation Center website
OMB PHE Update | May 11
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CMS Webinar on Addressing Healthcare Inequities
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GAPBAC Meeting Postponed
The first meeting (virtual) of the Ground Ambulance and Patient Billing Advisory Committee scheduled for January 17 and 18 has been postponed. According to CMS, the meeting is being postponed due to “operational impediments”. We will let you know the new dates for the meeting when announced by CMS.
Revised CY 2023 Ambulance Fee Schedule Public Use Files
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AAA President Baird Named to Balance Billing Advisory Committee
The Centers for Medicare & Medicaid Services (CMS) today appointed American Ambulance Association President Shawn Baird to the Ground Ambulance and Patient Billing Advisory Committee (GAPBAC), established by the Congress under “The No Surprises Act.” Shawn will represent the ground ambulance service provider and field personnel community.
“I am honored to have the opportunity to serve,” stated Baird. “I look forward to representing the interests of EMS providers and professionals as they care for our communities.
The Congress recognizes that the one-size-fits all approach to addressing surprise medical bills would not work for EMS. State and local governments regulate EMS agencies services and rates, as both first responders and medical care providers, which adds another level of complexity. As a result, the Congress established GAPBAC so the unique characteristics of ground ambulance services could be taken into consideration when evaluating private insurer billing policies to protect access to EMS, respect state and local government regulation, and protect patients.
Patients with private insurance should not be caught in the middle when their insurers do not adequately reimburse for vital ground ambulance services,” said Baird. “EMS must receive fair reimbursement by insurance companies for providing critical medical services to patients.”
Baird will bring to the Committee his years of firsthand experience and expertise as a paramedic and operator of an ambulance service in both urban and rural areas. He will also share knowledge gained from his years of volunteer leadership at the American Ambulance Association and the Oregon State Ambulance Association, as well as his term as an appointee to the National EMS Advisory Committee.
The GAPBAC is charged with “reviewing options to improve the disclosure of charges and fees for ground ambulance services, better inform consumers of insurance options for such services, and protect consumers from balance billing.” The Committee will submit a report that includes recommendations with respect to disclosure of charges and fees for ground ambulance services and insurance coverage, consumer protection and enforcement authorities of the Departments of Labor, Health and Human Services, and the Treasury and State authorities, and the prevention of balance billing to consumers. The report must be received no later than 180 days after the date of its first meeting.
About the American Ambulance Association
The American Ambulance Association safeguards the future of mobile healthcare through advocacy, thought leadership, and education. AAA advances sustainable EMS policy, empowering our members to serve their communities with high-quality on-demand healthcare. For more than 40 years, we have proudly represented those who care for people first.
CMS Publishes New EMTALA Training Materials
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CMS Announces Providers Selected for Year 3 & 4 Cost Data Collection
Centers for Medicare & Medicaid Services Announces Year 3 and Year 4 Medicare Ground Ambulance Data Collection System Selected Providers and Suppliers
The Centers for Medicare & Medicaid Services (CMS) has released the ground ambulance suppliers and providers selected for Years 3 and 4 of the Medicare ground ambulance data collection system. The list of the selected providers and suppliers is available on the CMS website. These providers and suppliers will be asked to collect data during their budget year starting in 2023 and to report the data within five months of the close of that year.
Providers and suppliers who are selected should respond to the notification letter sent by Medicare Administrative Contractors (MAC). Organizations may select a calendar year or fiscal year start date for the data collection period. Data will be submitted for a continuous 12-month period using the Medicare Ground Ambulance Data Collection Instrument: English (PDF).
The AAA continues to provide educational support for ground ambulance services to help them collect and report these data. In addition to in-person sessions, the AAA offers webinars on demand.
It is important that all ground ambulance providers and suppliers collect and report data through this program. The Congress intends to use the information to help reform Medicare ambulance fee schedule.