Administration Includes Ambulance Add-Ons Extension on CR List

The Biden Administration has issued a list of expiring programs and items that they would like to see or have no objection to being, extended as part of the FY2023 Continuing Resolution.  The list includes “Medicare add-on payments for ground ambulance services”. The list also includes a “Suspension of Medicare Sequestration” on which the AAA has been advocating. Congress will need to pass a CR by September 30 to avoid a partial government shutdown.

No determination has been made by congressional decision-makers as to when Congress will address Medicare extenders that expire at the end of the year but most key congressional staff believe extenders will be addressed after the election. Even if extenders are not included in the CR, the list demonstrates the overall support and/or recognition of the Administration for the listed programs and items including the Medicare ambulance add-on payments and suspension of sequestration.

Authorization Issues

Note: The following list is provided for your information. In the event that authorizing
legislation is not enacted in a timely manner, these items will allow either for the
continuation of programs that will be funded in the continuing resolution (CR) or for other
legislative fixes.

Agriculture/Rural Development:

Necessary For Extension or Inclusion in the CR if Not Enacted First in Other Legislation
Agriculture, Livestock Mandatory Reporting

No Objection to Inclusion in a CR if Not Enacted First in Other Legislation
HHS, FDA User Fees
HHS, Exclusivity of Certain Drugs Containing Single Enantiomers
HHS, Medical device programs expiration: 1) Authority to accredit 3rd parties to review certain medical device applications; 2) Conformity Assessment Pilot Program for Devices; 3) Device Postmarket Pilot Projects; 4) Inspections by Accredited Persons; 5) Modification to Humanitarian Device Exemption

Commerce/Justice/Science:

Necessary For Extension or Inclusion in the CR if Not Enacted First in Other Legislation
Justice, Additional Special Assessment (Expires 9/11/22)
Justice, U.S. Parole Commission (NOTE: Extension for two years is recommended)
Justice, Protection of certain facilities and assets from unmanned aircraft (Also DHS)
Justice, Extending Temporary Emergency Scheduling of Fentanyl Analogues Act (Expires 12/31/22)

Defense:

Necessary For Extension or Inclusion in the CR if Not Enacted First in Other Legislation
Defense, North Atlantic Treaty Organization Security Investment Program (NSIP)
Defense, Authority to Provide Temporary Adjust in Rates of Basic Allowance for Housing (BAH) if the Actual Costs of Adequate Housing for Civilians in That Military Housing Area or Portion Thereof Differs from the Current BAH Rates by More than 20 Percent
Defense, Authority for reimbursement of certain coalition nations for support provided to United States military operations (Expires 12/31/22)
Defense, Authority to provide assistance to counter the Islamic State in Iraq and Syria (Expires 12/31/22)
Defense, Authority to provide assistance to the vetted Syrian groups and individuals. (Expires 12/31/22)
Defense, Authority to provide temporary increase in rates of Basic Allowance for Housing (BAH) under certain circumstances (Expires 12/31/22)
Defense, Authority to Support Operations and Activities of the Office of Security Cooperation In Iraq (Expires 12/31/22)
Defense, Authority to waive annual limitation on premium pay and aggregate limitation on pay for Federal civilian employees working overseas (Expires 12/31/22)
Defense, Extension of Certain Expiring Bonus and Special Pay Authorities (Expires 12/31/22)
Defense, Income Replacement Payments for Reserve Component Members Experiencing Extended and Frequent Mobilization for Active Duty Service (Expires 12/31/22)

No Objection to Inclusion in a CR if Not Enacted First in Other Legislation
Defense, Information Operations, and Engagement Technology Demonstrations
Defense, One-time Uniform Allowance for Officers Who Transfer to the Space Force
Defense, Increased Percentage of Sustainment Funds Authorized for Realignment to Restoration and Modernization at Each Installation
Defense, Pilot Program for the Temporary Exchange of Cyber and Information Technology Personnel
Defense, Reauthorization of Authority to Order Retired Members to Active Duty in Highdemand, Low-density Assignments

Financial Services/General Government:

Necessary For Extension or Inclusion in the CR if Not Enacted First in Other Legislation
FCC, FCC General, and Incentive Auction Authority Continuation (NOTE: Extension of auction authority through 9/30/2024 is recommended)
GSA, Pilot Programs for Authority to Acquire Innovative Commercial Items Using General Solicitation Competitive Procedure (NOTE: also covered by DHS)
SBA, Assistance for Administration, Oversight, and Contract Processing Costs
SBA, Commercialization Readiness Pilot Program for Civilian Agencies
SBA, Phase 0 Proof of Concept Partnership Pilot Program
SBA, Pilot Program to Accelerate DOD Awards
SBA, SBIR Commercialization Assistance Pilot Programs
SBA, SBIR Phase Flexibility
SBA, Small Business Innovation and Research (SBIR)
SBA, Small Business Technology Transfer (STTR)

Homeland Security:

Necessary For Extension or Inclusion in the CR if Not Enacted First in Other Legislation
Homeland Security, DHS Joint Task Forces
Homeland Security, E-Verify Program
Homeland Security, National Computer Forensics Institute
Homeland Security, National Flood Insurance Program
Homeland Security, Raising the H-2B Cap
Homeland Security, National Cybersecurity Protection System (NCPS) Authorization, including EINSTEIN
Homeland Security, Counter Threats Advisory Board
Homeland Security, Pilot Programs for Authority to Acquire Innovative Commercial Items Using General Solicitation Competitive Procedure (NOTE: also covered by GSA)
Homeland Security, Protection of certain facilities and assets from unmanned aircraft (Also DOJ)

No Objection to Inclusion in a CR if Not Enacted First in Other Legislation
Homeland Security, Authority to grant special immigrant status to religious workers other than ministers
Homeland Security, Waiver of Foreign Residence Requirements for Physicians Working in Underserved Areas (“Conrad State 30” Program)

Interior/Environment:

Necessary For Extension or Inclusion in the CR if Not Enacted First in Other Legislation
Interior, Omnibus Public Land Management Act of 2009

Labor/HHS/Education:

Necessary For Extension or Inclusion in the CR if Not Enacted First in Other Legislation
Labor, Trade Adjustment Assistance (TAA) for Workers Program (Expired 7/1/22)
HHS, TANF
HHS, Promoting Safe and Stable Families Program
HHS, Liability protections for health professional volunteers at community health centers (HRSA)
HHS, Medical Countermeasures Innovations Partner
HHS, Maternal, Infant, and Early Childhood Home Visiting Program
HHS, Interdepartmental Serious Mental Illness Coordinating Committee
HHS, Increase in Medicaid FMAP for territories
SSA, Demonstration Project Authority (Expires 12/31/22)

No Objection to Inclusion in a CR if Not Enacted First in Other Legislation
HHS, Additional support for Medicaid home and community-based services during the COVID-19 emergency (Expired 3/31/22)
HHS, Suspension of Medicare Sequestration (Expired 3/31/22)
HHS, Medicare IPPS adjustment for low-volume hospitals
HHS, Medicare-dependent hospital (MDH) program
HHS, Puerto Rico Medicaid Payment
HHS, Restriction on Alaska Native Regional Health Entities
HHS, Tick-Borne Diseases Working Group
HHS, Exception for eligible professionals based in ambulatory surgical centers with respect to incentives for meaningful use of certified EHR technology (Expires 12/31/22)
HHS, Incentives for Qualifying Alternative Payment Model Participants (Expires 12/31/22)
HHS, Medicare add-on payments for ground ambulance services (Expires 12/31/22)
HHS, Medicare add-on payments for rural home health services (Expires 12/31/22)
HHS, Temporary Increase in Medicare Physician and Non-physician Practitioners Payments (Expires 12/31/22)

Military Construction/VA:

Necessary For Extension or Inclusion in the CR if Not Enacted First in Other Legislation
VA, Adaptive Sports Assistance Program (formerly limited to Paralympics)
VA, Co-Pays for Hospital and Nursing Home Care
VA, Homeless and Seriously Mentally Ill Veterans- Additional Services at Certain Locations
VA, Homeless and Seriously Mentally Ill Veterans- Treatment/ Rehab
VA, Manila, Philippines Regional Office
VA, SAH – Assistive Technology Grants
VA, Transportation of Beneficiaries
VA, Advisory Committee on Minority Veterans
VA, Advisory Committee on Education (Expires 12/31/22)
VA, Advisory Committee on Homeless Veterans (Expires 12/31/22)
VA, SAH for Veterans Temporarily Residing with Family (Expires 12/31/22)

Transportation/HUD:

Necessary For Extension or Inclusion in the CR if Not Enacted First in Other Legislation
Transportation, Next Generation 9-1-1

CMS End of PHE Roadmap

CMS Prepares Providers and Suppliers for the End of the Public Health Emergency:

CMS Issues Updates on the End of Emergency Waivers and Flexibilities Issued during the PHE

By Kathy Lester, J.D., M.P.H.

 

Even though it appears that the Biden-Harris Administration will extend the COVID-19 Public Health Emergency (PHE) for at least another 90 days, CMS has begun the process of preparing for the termination of waivers and flexibilities that have been in effect during the pandemic.  During the PHE, the American Ambulance Association has worked closely with CMS and Congress to make sure that ground ambulance services were prioritized and provided with waivers and flexibilities to support their integral role as a front-line medical response during the pandemic.

 

CMS announced its roadmap for the end of the PHE on August 18.  The roadmap includes a summary of the policies that will terminate at the end of the PHE, but also notes that CMS intends to keep some policies in place even after the PHE ends. Examples of policies that will continue after the PHE is allowed to expire include certain morbidity and mortality reporting requirements on long-term care facilities and certain telehealth services expanded by Congress.

 

In its announcement, CMS indicated particular concern about patient safety.  “As mentioned by Lee A. Fleisher, M.D.; Michelle Schreiber, M.D.; Denise Cardo, M.D.; and Arjun Srinivasan, M.D., in February 17, 2022, New England Journal of Medicine Perspective, ‘Safety has also worsened for patients receiving post-acute care, according to data submitted to the Centers for Medicare and Medicaid Services (CMS) Quality Reporting Programs…’”

 

As part of this announcement, CMS released a fact sheet detailing the current status of the Medicare waivers and flexibilities for ambulance providers and suppliers.  Some of the policies highlighted in this fact sheet include:

 

  • Vaccine Reimbursement Rates: CMS will continue to pay approximately $40 per dose for administering COVID-19 vaccines in outpatient settings for Medicare beneficiaries through the end of the calendar year that the COVID-19 PHE ends.  Effective January 1 of the year following the year that the COVID-19 PHE ends, CMS will set the payment rate for administering COVID-19 vaccines to align with the payment rate for administering other Part B preventive vaccines.  CMS plans to continue to pay a total payment of approximately $75 per dose to administer COVID-19 vaccines in the home for certain Medicare patients through the end of the calendar year that the COVID-19 PHE ends.

 

  • Alternative Destination: CMS indicates that it will include this issue in future rulemaking.

 

  • Treat in Place: CMS indicates that the waiver will end with the end of the PHE.

 

  • Repetitive, Scheduled Non-Emergent Ambulance Transport (RSNAT) Prior Authorization: CMS notes that it has already returned to the full model operations including post-payment reviews of claims submitted during the PHE.

 

  • Signature Requirements: Absent indications of potential fraud and abuse, CMS will not review claims for dates of service during the COVID-19 PHE for compliance with the signature requirements.

 

  • Appeal Flexibilities: CMS will allow some of the flexibilities related to the timing of appears to continue consistent with existing authority for appeals once the PHE ends.

 

The AAA will continue to monitor the PHE and any changes in the waivers and flexibilities specific to ground ambulance services.  We encourage members to reach out to our team if concerns or questions arise as CMS winds down the PHE.

CMS Ambulance Open Door Forum Summary

On August 18, 2022, the Centers for Medicare and Medicaid Services (CMS) held its most recent Ambulance Open Door Forum (ODF). As is typically the case, CMS started the ODF with a series of announcements, before opening the call to questions from the ambulance industry.

 

The first announcement related to proposed changes to the regulations governing the medical necessity requirements for non-emergency, scheduled, repetitive ground ambulance services. Specifically, CMS is proposing to modify the so-called “special rule” for repetitive, scheduled non-emergency services (set forth in the regulations at 42 C.F.R. §410.40(e)(2)(ii)). CMS indicated that these proposed changes would provide necessary and ensure the consistent application of the documentation requirements by its contractors. The proposed change would add language indicating that both the Physician Certification Statement and “additional documentation from the beneficiary’s medical record” could be used to support medical necessity for the ambulance transport. The new language would further indicate that these documents must provide detailed explanations that are consistent with the beneficiary’s current medical condition. On the ODF, CMS encouraged the industry to submit comments on these proposed changes. However, CMS indicated that, because these changes were the subject of ongoing rulemaking, it would not be able to answer any questions on the ODF.

 

The second announcement related to the proposed changes to the Medicare Ground Ambulance Data Collection System (GADCS) included in the July 2022 Proposed Rule. CMS and its contractor, the Rand Corporation, went through a detailed PowerPoint presentation that summarized these proposed changes. That PowerPoint presentation can be accessed by clicking here.

 

As part of its discussion of the GADCS, CMS also announced the implementation of an automated process for requesting hardship exemptions and informal review of determinations that an ambulance provider is subject to a financial penalty for failing to properly submit its cost data.

 

The final announcement related to ambulance services furnished by Rural Emergency Hospitals (REHS). In the FY 2023 Outpatient Hospital Proposed Rule, CMS is proposing to codify in its regulations the statutory requirement that ambulance services furnished by entities that are owned and operated by REHS will be paid under the Medicare Ambulance Fee Schedule. CMS is also proposing to revise the origin and destination requirements to include REHS as both a covered origin and covered destination for ambulance services.

 

The ODF concluded with a brief Q&A period. All of the questions posed to CMS related to the GADCS.  One of the questions placed to CMS was whether it would permit ambulance suppliers to prospectively seek a hardship exemption, i.e., to permit an ambulance supplier to ask now that it be relieved of the financial penalties for failing to report its cost data. The person posing the question specifically referenced ambulance suppliers impacted by the severe flooding in the State of Kentucky. CMS confirmed that an ambulance supplier had to be notified that it was subject to a financial penalty before it was eligible to seek a hardship exemption.

New EEOC Guidance on COVID-19 Testing

EEOC Issued New Guidance on Employer Mandatory COVID-19 Testing Policies

On July 12, 2022, the Equal Employment Opportunity Commission (EEOC) updated its guidance, What
You Should Know About COVID-19 and the ADA, the Rehabilitation Act, and Other EEO Laws, which
impacted several long-standing COVID-19-related policies. The most significant policy change in the
latest guidance was related to employer mandatory COVID-19 testing. The updated guidance is not likely
to significantly impact EMS employer testing practices for field personnel, but could for those who work
in administrative or non-patient facing roles.

In the latest guidance, the EEOC changed its previous position that employers could generally require
COVID-19 testing for most employees. The EEOC had previously taken the position that it believed that
COVID-19 viral testing was per se, job-related and consistent with business necessity, regardless of the
employer type. Under the latest guidance, the EEOC is now stating that employers will need to more
closely analyze whether viral testing is job-related and consistent with business necessities. In doing so,
employers should utilize any of these factors:

 The Center for Disease Control (CDC) level of community transmission.
 The vaccination status of employees.
 The degree of breakthrough infections are possible for vaccinated workers.
 The transmissibility of current variants.
 The possible severity of illness from a current variant.

In most instances, EMS employers who require COVID-19 viral testing for field employees for ongoing,
symptomatic, or return to work reasons, are likely to meet the job related and consistent with business
necessity requirement. However, for those employees who are in non-patient-facing roles, it will be far
more difficult to justify mandatory COVID-19 testing and employers should reconsider their position on
mandatory testing.

The guidance also included updates to clarify the timeline factors to consider when handling reasonable
accommodation exceptions for vaccinations and how there could be a reasonable pandemic-related
delay. However, they acknowledged that this is likely less impactful at this point in the pandemic.
Additionally, the guidance highlighted that employers are not under an obligation to engage an
employee who has a serious health condition if the employee has not requested an accommodation
from vaccination.

Many EMS employers are currently required to mandate COVID-19 vaccinations for employees who may
enter or interact with the patients or staff of a covered healthcare facility unless they have a covered
religious or disability-related exemption. After nearly two years of the pandemic and the availability of
COVID-19 vaccinations, those employees who wish to be vaccinated would have done so by now. Those
who remain unvaccinated are doing so by choice.

If you have any questions or concerns regarding the updated guidance or any COVID-19 related
workplace practice, be sure to contact the American Ambulance Association for assistance at
hello@ambulance.org.

Organized Labor is Making a Comeback

In my early EMS leadership career, I worked for an organization that was swallowed up by a large national EMS consolidator. The unsettled times that occurred during, and immediately following the acquisition,  led a small group of paramedics to petition for union representation. At the time, I had not yet finished my undergraduate or law degree.  My experience with leading a management team through a union campaign was non-existent.  The organization hired a labor attorney to work with our team to ensure that we stayed compliant in the weeks leading up to the National Labor Relations Board (NLRB) election.

 

It was an incredibly difficult time for both the leadership and the employees.  Anyone who has lived through a union campaign can tell you, it can make you question the type of leader and manager you think you are.  It puts an unbelievable strain upon everyone in the organization.  Ultimately, the employees elected not to be represented by a union. As a team, we learned a great deal during this process. We realized that we were not the employee-centric organization that we believed we were.  There is an old saying in labor relations, “every company gets the union it deserves.”

 

Union representation had been on the decline for several decades as numerous laws and regulations have been enacted to address many of the concerns that drove union membership. As we know, the last few years have presented incredible challenges for EMS organizations and their employees. The Biden Administration brings with it a President who has adopted a pro-union agenda and a Secretary of Labor, who is a former union leader.

 

A recent article published by the National Law Review states that union petitions are up 57%. Nearly every day there is a story of unionization at organizations that were previously not union strongholds.  Additionally, polling seems to suggest that Americans view unions far more favorably than they did just over a decade ago. Traditionally, unions used to focus on larger employers, but have recently added all employers, including those with smaller collective bargaining units.

 

EMS agencies are no exception to this trend in union representation. It should be no surprise to EMS leaders that several unions believe that EMS is ripe for labor organizing. I will not go into all of the reasons that EMS is the focus of labor organizations but suffice it to say, the recent workforce challenges have made their message far more enticing to employees. Recently, an organization that I once was a part of and would not have believed was ripe for organizing, just overwhelmingly voted to be represented by a union.

 

The Best Strategy

If your organization is committed to remaining in a non-union environment, it is critical that you make this an intentional part of your strategic plan. Generally, employees join unions because they are unhappy or dissatisfied with the relationship they have with the management team or company they work for.  This is often articulated by dissatisfaction with pay and benefits, consistency in policy and procedure practices, and the day-to-day interactions with management. More specifically, the relationship or treatment by their immediate supervisor.

 

The best strategy is to be proactive. This is not something that employers can or should ignore. This must be a stated and intentional part of your organizational strategic plan. Due to the workforce shortage, most organizations have been evaluating their pay and benefits programs. However, we are not always so good at communicating these benefits to our employees. Often, we treat pay and benefits like trade secrets, even with our own folks. EMS is notorious for its rumor mill and it is far better to control or influence the narrative regarding the benefits that your employees enjoy by working for your organization. You will be surprised how many on your team have no idea that some of your benefits exist or are available to them.

 

Education and communication are key elements in any union-free workplace strategy. Employers should utilize the AAA Total Compensation Statement that highlights all costs associated with pay and benefits.

The leadership team should evaluate the frequency of supervisor-employee interactions and the tools used to track these engagements. The stronger the relationship between the frontline employees and the leadership team, the less likely your employees are to invite an outside third party to represent them. If this is not one of your organization’s leading Key Performance Indicators (KPIs) or Vital Signs, it will disappear into the whirlwind of activity that consumes your team’s day.

 

Rules of the Road

It is important for your team to know the rules of the road as it relates to a fostering union-free strategy. The playing field is not exactly even.  Unions have the right to solicit employees and make promises of increased wages, benefits, and working conditions, regardless of their ability to deliver.  However, employers are far more limited in what actions they can take regarding union representation.  Employers can find themselves in trouble if they fail to follow some simple rules. Here are a few TIPS to help employers stay compliant.

T –          Employers cannot Threaten to discipline or reduce wages and/or benefits if their employees unionize or engage in union activity;

I –           Employers cannot Interrogate employees about their activities or feelings on union representation;

P –          Employers may not make Promises to employees to improve wages, benefits, or working conditions if they remain union-free;

S –          Employers cannot Spy on employees’ union-related activities.

Employers are free to discuss what joining a union might mean for the employee. For example, an employer can say “if the workforce is represented by a union, the terms and conditions of employment will be subject to collective bargaining.  The collective bargaining process may result in employees getting more, getting less, or the same wages and benefits that they have now.” The key is, to be honest in all communications with your employees.

A Path Forward

EMS leaders should deliver a clear message to their frontline leadership team. Focus on developing strong relationships with their employees. Encourage open and frequent lines of communication, listen to employee concerns, and address them quickly. Ensure that frontline leaders have been provided training and the TIPS for maintaining a union-free work environment. Lastly, be sure to contact the AAA at hello@ambulance.org if you have questions or need assistance.

National EMS Memorial Bike Ride Registration is OPEN!

The National EMS Memorial Bike Ride is currently accepting registrations for the East Coast, Southern, Midwest, and Weekend of Honor Events.

To learn more about each one of these events, check out the details below.  Looking to register?  Click on the registration buttons located under each of the route headings.

 

Weekend of Honor – July 22nd Crystal City, VA

This single-day event kicks off the Weekend of Honor in coordination with the National EMS Memorial Service. Registration is only $20.

Click Here to Learn More and Register »

MidWest Route – June 20th – June 25th

Experience the beauty of the Midwest from St. Paul, MN. to Chicago, IL over the course of this six-day event.

Click Here to Learn More and Register »

Southern Route – May 22nd – May 28th

This seven-day route begins in Fayetteville, NC, with a final destination of Williamsburg, VA.

Click Here to Learn More and Register »

East Coast – May 21st – May 27th

The original route of The National EMS Memorial Bike Ride will travel from Boston, MA to Baltimore, MD.

Click Here to Learn More and Register »

Colorado Route – September 11th – September 16th

Are you up for a climb?  Don’t worry, half of the route is all downhill.  With a start in Snowmass, CO to Littleton, CO you can take in the best sights of the Rocky Mountains.

Registration Coming Soon…..

West Coast – September 19th – September 24th

From Reno, NV to San Francisco, CA this route has it all, The views, the weather, and the wine of the Napa Valley, don’t miss this season-ending route.

Registration Coming Soon…..

Covid-19 Mitigation
The National EMS Memorial Bike Ride remains committed to providing a safe cycling and support environment for all participants, spectators, and hosts.  During all 2022 events, the CDC Covid-19 guidelines in effect at the time and location of the individual event will be followed by all participants.  You can view these requirements at the CDC Covid-19 Community Levels website by clicking here.
 

The National EMS Memorial Bike Ride, Inc. honors Emergency Medical Services personnel by organizing and implementing long-distance cycling events that memorialize and celebrate the lives of those who serve every day, those who have become sick or injured while performing their duties, and those who have died in the line of duty.

You can learn more about the 2022 National EMS Memorial Service and obtain the hotel reservation list by clicking here

PRF Late Reporting Extended

HRSA announces potential relief for health care providers that missed the deadline to report on their use of Provider Relief Funds

On April 7, 2022, the Health Resources and Services Administration (HRSA) posted a notice that offers providers that missed the deadline to report on their use of HHS Provider Relief Funds the opportunity to potentially be able to file that report and therefore avoid the potential recoupment of PRF funds.  The “Request to Report Late” is limited to situations where the failure to timely submit the required report was due to one or more extenuating circumstances.

 

If you were notified that you failed to submit your required PRF Report on a timely basis and are being asked to return PRF funds, you should read this member advisory carefully. 

 

Relevant Background

 

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 (increased to $178 billion by subsequent legislation) to the creation of the CARES Act Provider Relief Fund (PRF) which was used to support hospitals and other healthcare providers on the front lines of the nation’s coronavirus response.

 

Under the terms of the PRF program, health care providers that received more than $10,000 in any reporting period were required to submit a report that provides details on how those funds were expended.  The first report covered PRF payments received between April 10, 2020, and June 30, 2020, and was due on or before September 30, 2021.  HHS subsequently enacted a 60-day grace period, which ran from October 1, 2021, through November 30, 2021.  The second report covered PRF payments received July 1, 2020, and December 31, 2020, and was due on or before March 31, 2022.

 

Providers that failed to submit any required report by these deadlines are subject to the potential recoupment of those funds.

 

What HRSA Considers to be “Extenuating Circumstances”

 

According to the notice, health care providers will be permitted to request the opportunity to complete their report after the deadline to the extent the filing of their report was delayed due to one or more of the following:

 

  • Severe illness or death – a severe medical condition or death of a provider or key staff member responsible for the reporting hindered the organization’s ability to complete the report during the relevant reporting period.
  • Nature Disaster – a natural disaster occurred during or in close proximity to the end of the reporting period that damaged the organization’s records or information technology.
  • Lack of receipt of reporting communications – an incorrect email or mailing address on file with HRSA prevented the organization from receiving instructions prior to the relevant reporting period deadline.
  • Failure to click “Submit” – the organization registered and prepared a report in the PRF Reporting Portal but failed to take the final step to click “Submit” prior to the reporting deadline.
  • Internal Miscommunication or error – internal miscommunication or error regarding the individual who was authorized and expected to submit the report on behalf of the organization and/or the registered point of contact in the PRF Reporting Portal.
  • Incomplete Targeted Distribution payments – the organization’s parent entity completed all General Distribution payments, but a Targeted Distribution(s) was not reported on by the subsidiary.

 

Process for Applying for Permission to Submit a “Late Report”

 

To the extent one or more of the extenuating circumstances described above applies, the provider will be given the opportunity to submit a Request to Report Late Due to Extenuating Circumstances.  The timeframe to submit these requests will run from April 11, 2022, to April 22, 2022. 

 

HRSA is indicating that any provider that plans to submit such a request but has yet to register in the PRF Reporting Portal, should register prior to submitting their request.

 

To submit a request to file late, the provider will need to submit a form indicating the extenuating circumstance(s) that prevented the required report from being submitted in a timely fashion.  That form will require the provider to provide a “clear and concise explanation” of the applicable extenuating circumstance.  However, providers will not be required to submit any supporting documentation.  The provider will be required to attest to the truthfulness and accuracy of their extenuating circumstance.

 

After submitting their request, the provider will be notified by HRSA whether their request is approved or denied.  If the request is approved, the provider will have 10 days from the date of the notification to submit the required report through the PRF Reporting Portal.

 

If the request is denied, HRSA will proceed with the recoupment of the PRF funds subject to the missed report.

 

National EMS Memorial Bike Ride Registration is OPEN!

The National EMS Memorial Bike Ride is currently accepting registrations for the East Coast, Southern, Midwest, and Weekend of Honor Events.

To learn more about each one of these events, check out the details below.  Looking to register?  Click on the registration buttons located under each of the route headings.

 

Weekend of Honor – July 22nd Crystal City, VA

This single-day event kicks off the Weekend of Honor in coordination with the National EMS Memorial Service. Registration is only $20.

Click Here to Learn More and Register »

MidWest Route – June 20th – June 25th

Experience the beauty of the Midwest from St. Paul, MN. to Chicago, IL over the course of this six-day event.

Click Here to Learn More and Register »

Southern Route – May 22nd – May 28th

This seven-day route begins in Fayetteville, NC, with a final destination of Williamsburg, VA.

Click Here to Learn More and Register »

East Coast – May 21st – May 27th

The original route of The National EMS Memorial Bike Ride will travel from Boston, MA to Baltimore, MD.

Click Here to Learn More and Register »

Colorado Route – September 11th – September 16th

Are you up for a climb?  Don’t worry, half of the route is all downhill.  With a start in Snowmass, CO to Littleton, CO you can take in the best sights of the Rocky Mountains.

Registration Coming Soon…..

West Coast – September 19th – September 24th

From Reno, NV to San Francisco, CA this route has it all, The views, the weather, and the wine of the Napa Valley, don’t miss this season-ending route.

Registration Coming Soon…..

Covid-19 Mitigation
The National EMS Memorial Bike Ride remains committed to providing a safe cycling and support environment for all participants, spectators, and hosts.  During all 2022 events, the CDC Covid-19 guidelines in effect at the time and location of the individual event will be followed by all participants.  You can view these requirements at the CDC Covid-19 Community Levels website by clicking here.
 

The National EMS Memorial Bike Ride, Inc. honors Emergency Medical Services personnel by organizing and implementing long-distance cycling events that memorialize and celebrate the lives of those who serve every day, those who have become sick or injured while performing their duties, and those who have died in the line of duty.

You can learn more about the 2022 National EMS Memorial Service and obtain the hotel reservation list by clicking here

DOL Electronic Injury & Illness Reporting

Proposed Changes to the OSHA Electronic Injury & Illness Reporting Requirements

The U.S. Department of Labor’s Occupational Safety and Health Administration (OSHA) is proposing amendments to its occupational injury and illness recordkeeping regulation, 29 CFR 1904.41. The current regulation requires certain employers to electronically submit their summary injury and illness data (Form 300A) to OSHA annually. OSHA uses these reports to identify and respond to emerging hazards and makes aspects of the information publicly available.

In addition to reporting their Annual Summary of Work-Related Injuries and Illnesses, the proposed rule would require certain establishments in certain high-hazard industries to electronically submit additional information from their Log of Work-Related Injuries and Illnesses, as well as their Injury and Illness Incident Report (Form 300, 300A, & 301). The latest proposed rule will require certain employers to submit more detailed information and is a return to the original electronic data submission rule that was proposed in 2016 and rolled back in 2017, prior to the rule taking effect. EMS organizations will be included in those industries that are considered high-hazard and thus, required to submit this information.

As we reported last month, OSHA reported that there was a 249% increase in illnesses and injuries reported by healthcare employers in 2020. This is no surprise given that this was at the heart of the pandemic. OSHA believes this rule will improve the agency’s ability to use the information in its enforcement and compliance assistance efforts to identify workplaces where workers are at high risk.

The proposed rule would:

  • Require establishments with one hundred (100) or more employees in certain high-hazard industries to electronically submit information from their OSHA Forms 300, 301, and 300A to OSHA once a year. Currently, only the Form 300A summary data is submitted electronically.
  • Update the classification system used to determine the list of industries covered by the electronic submission requirement.
  • Remove the current requirement for establishments with 250 or more employees not in a designated industry to electronically submit information from their Form 300A to OSHA annually.
  • Require establishments to include their company name when making electronic submissions to OSHA.

Under the proposed rule, establishments with 20-99 employees in certain high-hazard industries would continue to be required to electronically submit information from their OSHA Form 300A annual summary to OSHA annually.

Those interested can submit comments must do so by May 30, 2022. If you have questions about your organization’s reporting requirements under the OSHA Regulations, be sure to contact the AAA at hello@ambulance.org for assistance.

2021 Ambulance Ride-Along Toolkit

AAA ambulance emt member legislation

2021 Ride-Along Toolkit Now Available!

Educating your members of Congress about ambulance industry issues makes them more likely to support our policy efforts. An easy and effective way to educate them is to invite them to participate in a local Ambulance Ride-Along!

Congress has adjourned for summer recess and members have returned home to their districts and states. This is the perfect opportunity for you to educate your members of Congress about our issues, in particular our Medicare Ambulance Bill, Balance Billing, and access to the Provider Relief Fund, which are all essential to your service.

The most effective way to deliver these key messages is to host your member of Congress or their staff on a tour of your operation and an ambulance ride-along. While COVID-19 has made a traditional ride-along difficult, you can still host them for a virtual site visit to show your operation and how you are handling the public health emergency. The AAA has made the process of arranging a ride-long or scheduling a meeting easy for you with our 2021 Congressional Ride-Along Toolkit.

Everything you need to arrange the ride-along or schedule a meeting during this time of social distancing and virtual participation is included in the Toolkit. Act now and invite your elected officials to join you on an Ambulance Ride-Along!

Congress Passes $900 Billion Stimulus Package with Ambulance Relief

Last night, the U.S. House of Representatives followed soon after by the United States Senate passed an approximately $900 billion legislative package to provide additional economic relief to businesses and individuals struggling from the COVID-19 pandemic. The package also contained numerous unrelated policy changes with several provisions on interest to ground ambulance service organizations. The AAA is currently analyzing the legislative text of the massive 3,000 plus page package and will provide members with the final analysis. In the meantime, below are some highlights.

Sequestration Delay

Sequestration, which reduces Medicare reimbursement by 2% for Medicare providers and suppliers, is suspended through March 31, 2021.

Provider Relief Fund

An additional $3 billion is added to the Provider Relief Fund administered by the Department of Health and Human Services.

Balance Billing

Health care providers will no longer be able to balance bill patients with private insurance. Rates will be determined through an arbitration process. The restrictions do not apply to ground ambulance services. The AAA along with the International Association of Fire Chiefs, International Association of Firefighters and National Association of EMTs successfully educated lawmakers about the oversight role of local governments in 911 EMS systems. The legislation instead establishes an Advisory Committee on Ground Ambulance Billing which will issue a report to Congress on its findings. The AAA will be pushing for representatives of the AAA to be on the Committee.

Paycheck Protection Program (PPP)

Another round of $284 billion in PPP funding is made available to small businesses hit especially hard by the pandemic. Businesses must employ 300 or fewer employees and report losses of 25% or more in order to qualify. For ground ambulance service organizations which receive PPP funds under the past round or the current one, expenses covered by forgiven funds will now be deductible.

 

Today’s AAA webinar, “Wrapping Up a Year for the Record Books”, will include an overview of the stimulus package. This webinar is free for AAA members. Register Here!

Bipartisan, Bicameral Members of Congress Reach Agreement on “Surprise” Billing Legislation

It appears that members of Congress on the House Ways & Means, Energy & Commerce, and Education & Labor Committees along with the Senate Health, Education, Labor, & Pensions Committee have reached a compromise agreement that will allow “surprise” billing legislation to be considered for passage before the end of the year.  While the details of the legislation have yet to be unveiled, the American Ambulance Association has learned that it is likely to include provisions related to ground ambulance service and air ambulance service providers and suppliers.

Earlier legislation moved forward by the House Education & Labor Committee included a requirement for the Administration to create a Federal Advisory Committee to review ways to increase transparency around fees and charges for ground ambulance services and to better inform consumers about their treatment options.  We believe that this language will be included in the compromise, but that there may be an opportunity to suggest modifications to make it more balanced and fairer in terms of the charge of the Committee and the types of individuals and organizations who will be selected to participate on it.  The AAA is recommending that the Advisory Committee have at least a year to study and report on issues related to balance billing by ground ambulance service providers and suppliers, including the role of local and state governments in EMS systems amongst other considerations.  It is also important that the Committee members include representatives from all types, sizes, and geographical areas of ground ambulance service providers and suppliers, as well as state EMS officials, and paramedics and EMTs.

It is likely that if the congressional leadership agree to move this legislation forward, it would be attached to the end of the year packages that may also include COVID-19 relief, Medicare extenders, and the annual spending bills.

CDC Advisory Committee Recommends EMS for Phase 1 Vaccine Distribution

As reported in various media outlets, on December 1 the Center for Disease Control and Prevention’s (CDC) Advisory Committee on Immunization Practices (ACIP) voted 13-1 to recommend that health care providers, expressly including EMS personnel, be prioritized to receive the COVID-19 vaccines during Phase 1a of the vaccine distribution plan. The complicating factor is that State and local governments have the final say in whether these recommendations are incorporated into their own distribution plans. Thus, we encourage all AAA members to engage actively with their State and local governments to urge the adoption of the CDC recommendation. The AAA has developed a toolkit for members to use in reaching out to their state and local government officials.

View and Download Toolkit Here

The AAA has been engaging with ACIP and other federal policy makers to urge them to prioritize EMS in the vaccine distribution plan. On November 19, the AAA submitted a comment letter to the ACIP advocating that the advisory committee specifically include EMS personnel in their recommendation of groups in the first phase of receiving the vaccination. Even though States and local governments will create their own list, having EMS listed in Phase 1a CDC recommendations is a critically important step toward influencing the State and local process.

During its second emergency meeting in less than a month, ACIP met to develop recommendations on the prioritization of vaccines, given that it will be impossible to provide access to everyone in the United States immediately after the vaccines are approved. In both virtual meetings, Committee members noted the importance of EMS personnel having access to the vaccine in the very top tier for prioritization. Other health care personnel on this list are defined as hospitals, long-term care facilities, outpatient clinics, home health care, pharmacies, and public health. The Phase 1a tier also includes residents of nursing homes, assisted living facilities, and other residential care settings, given that approximately 40 percent of all COVID-19 deaths have occurred in these settings. The final recommendation approved states:

When a COVID-19 vaccine is authorized by FDA and recommended by ACIP, vaccination in the initial phase of the COVID-19 vaccination program (Phase 1a) should be offered to both 1) health care personnel§ and 2) residents of long-term care facilities.

Health care personnel are defined as paid and unpaid persons serving in health care settings who have the potential for direct or indirect exposure to patients or infectious materials.

Long-term care facility residents are defined as adults who reside in facilities that provide a variety of services, including medical and personal care, to persons who are unable to live independently.

The CDC plans to publish this recommendation in the Morbidity Mortality Weekly Report as well.

The only controversial issue related to whether long-term care facility residents should receive the vaccine given the limited information available about its effectiveness and safety in these populations.

Because President Trump has indicated that State and local governments do not have to follow the CDC recommendations, it is critically important that AAA members work closely with their State and local governments to ensure that the CDC recommendations with regard to EMS are adopted by them as well. The AAA has posted a tool kit on our website to help our members provide the necessary information to their State and local governments as they are making these decision.

ACIP will continue to evaluate the distribution prioritization for Phase 1b, which will likely be non-health care essential workers, and Phase 1c, which will include adults with high-risk medical conditions and adults 65 years or older.

2020 Ambulance Ride-Along Toolkit

AAA ambulance emt member legislation

2020 Ride-Along Toolkit Now Available!

Educating your members of Congress about ambulance industry issues makes them more likely to support our policy efforts. An easy and effective way to educate them is to invite them to participate in a local Ambulance Ride-Along!

Congress is adjourned this week and will then again starting on August 7 for an entire month with members of Congress returning home to their districts and states. This is the perfect opportunity for you to educate your members of Congress about our issues, in particular the need for additional COVID-19 financial relief, reimbursement for Treatment in Place during the pandemic, access to FEMA Public Assistance grants and coverage for all paramedics and EMTs under the Public Safety Officers Benefit (PSOB) program.

The most effective way to deliver these key messages is to host your member of Congress or their staff on a tour of your operation and an ambulance ride-along. While COVID-19 has made a traditional ride-along difficult, you can still host them for a virtual site visit to show your operation and how you are handling the public health emergency. The AAA has made the process of arranging a ride-long or scheduling a meeting easy for you with our 2020 Congressional Ride-Along Toolkit.

Everything you need to arrange the ride-along or schedule a meeting during this time of social distancing and virtual participation is included in the Toolkit. Act now and invite your elected officials to join you on an Ambulance Ride-Along!

CDC Elevates First Responders to Highest Priority for COVID-19 Testing

On April 27, the CDC issued an update to its Guidance on “Evaluating and Testing Persons for Coronavirus Disease 2019” in which “first responders with symptoms” are now in the category of “highest priority” as to the prioritization of groups who should be tested for COVID-19. The AAA has been advocating to federal agencies and the Congress to move first responders to the highest level of priority for COVID-19 testing. The update can be viewed at HERE.

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.

hippa

NASEMSO 2020 National EMS Assessment Released!

The National Association of State EMS Officials (NASEMSO) has released its 2020 EMS Assessment, updating the 2011 report. This report  provides unparalleled insights into the EMS systems that  provide mobile healthcare across our nation. We highly recommend that you download the full report at  www.nasemso.org/2020-assessment.

(Falls Church, Va.) In the midst of the COVID-19 pandemic and applause for first responders in the United States, the National Association of State Emergency Medical Services Officials (NASEMSO) has released the 2020 National EMS Assessment updating the 2011 assessment. The 2020 assessment provides a comprehensive accounting by state/territory of the numbers and types of all 911 ambulance services and emergency medical services (EMS) professionals.

The 2020 National EMS Assessment is the first set of documentation about these critical emergency medical response personnel and agencies to be published in nearly 20 years. Every year in times of disasters, disease outbreaks and daily medical emergencies, such as heart attacks and car crashes, out-of-hospital emergency medical care systems make life-and-death differences in the lives of millions of Americans. EMS systems are the safety net for hospital emergency departments and public health as the front lines of response to 911 calls. Additionally, responders place themselves in high risk situations on a daily basis, as well as during communicable disease outbreaks and pandemics.

Data collection for this assessment was completed in 2019 by NASEMSO members, who are the staff of the state agencies that license America’s critical EMS personnel and agencies. State EMS offices protect the public by regulating the human and organizational components of EMS systems across the United States, as well as executing their legislative mandates to implement and improve systems of care for time-sensitive emergencies in order to offer every patient an opportunity for survival and optimal outcomes. The assessment provides the following key findings:

  • More than 18,200 local EMS agencies respond to 911 calls for medical emergencies and injuries, utilizing nearly 73,500 ground vehicles such as ambulances and fire engines.

  • Local EMS agencies respond to nearly 28.5 million 911 dispatches every year in 41 states.

  • More than 750 services are licensed by state EMS offices to fly patients, using helicopters and fixed-wing aircraft to provide rapid transportation to critical care.

  • More than 1.03 million personnel are licensed as emergency medical technicians, paramedics, and other levels of EMS patient care capability within all 50 states, the District of Columbia, Puerto Rico and American Samoa.

  • More than 9,300 physicians serve as local EMS Medical Directors, assuring that contemporary and quality care is provided to patients.

  • Sixty percent of 53 state EMS offices participated or expect to participate in mass casualty exercises involving a biological threat during the 18-month evaluation period.

  • The report is available from NASEMSO at www.nasemso.org/2020-assessment.