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

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…

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Final Rule for ACA Section 1557

On June 12, 2020, the Office of Civil Rights (OCR) of the Department of Health and Human Services (HHS) published the long-awaited final rule which significantly changes several of the anti-discrimination provisions of Section 1557 of the Affordable Care Act.  The final rule, which is a departure from the agency’s previous interpretation of the rules…

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EEOC Guidance on COVID-19 Antibody Testing

The Equal Employment Opportunity Commission (EEOC) issued updated guidance yesterday titled, What You Should Know About COVID-19 and the ADA, the Rehabilitation Act, and Other EEO Laws yesterday.  The updated guidance addresses employers who wish to require employees to have a COVID-19 antibody tests prior to re-entering the workplace.  The guidance consists of seventeen pages…

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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…

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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…

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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.

AAA Sends Letter to Treasury Secretary Mnuchin on Paycheck Protection Program

Earlier today, the AAA sent a letter to Treasury Secretary Mnuchin asking that he use his discretionary authority to apply the same terms of the Paycheck Protection Program (PPP) to ambulance service organizations with 500 or more employees. The PPP, established by the CARES Act, is only available to businesses with 500 or fewer employees…

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CMMI Delays ET3 Pilot Program Until Fall

The Centers for Medicare and Medicaid Innovation (CMMI) has announced the delay of the start of the ET3 Model Pilot Program. CMMI has delayed the program until the fall of this year. The program was set to begin on May 1. In its notice, CMMI also referenced the interim final rule providing waivers for transport…

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HEROES Act – Tax Free Income for Paramedics and EMTs

On April 3, Congressman Bill Huizenga (R-MI) introduced the Helping Emergency Responders Overcome Emergency Situations Act of 2020 “HEROES Act of 2020” (H.R. 6433). H.R. 6433 would exclude from gross income, the wages (not to exceed $50,000) from February 15 to June 15 of qualified first responders. Those wages would therefore essentially be tax-free. A…

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AAA Sends Letter to HHS on COVID-19 Response

On April 6, the AAA sent a letter to Health and Human Services Secretary Azar requesting that the Department distribute direct payments to all ambulance service providers and suppliers who are on the front lines of the COVID-19 pandemic. The AAA requested funding under the $100 Billion Public Health and Social Service Emergency Fund, established…

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AAA Sends Letter to CMS on COVID-19 Response

The AAA has sent a letter to CMS on how the agency can most help ground ambulance service providers and suppliers be better prepared to respond to potential cases of COVID-19. The AAA has requested priority access to personal protection equipment for EMS personnel and COVID-19 test kits and results, as well as easing Medicare…

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President signs law providing funds to combat Corona Virus

President Donald Trump today signed H.R. H.R. 6074 into law, approving $8.3 billion in supplemental appropriations to fund programs in response to the COVID-19 illness. The bill would bolster vaccine development, research, equipment stockpiles, and state and local health budgets as government officials and health workers fight to contain the outbreak, which has claimed 11…

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AAA Releases 2020 Medicare Rate Calculator

AAA 2020 Medicare Rate Calculator Now Available! The American Ambulance Association is pleased to announce the release of its 2020 Medicare Rate Calculator tool. The AAA believes this is a valuable tool that can assist members in budgeting for the coming year. This calculator has been updated to account for recent changes in Medicare policies,…

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Member Advisory: CMMI Releases Initial List of ET3 Participants

The Centers for Medicare and Medicaid Services (CMMI) has released its initial list of applicants selected to participate in the ET3 pilot program. CMMI notes that the list is not final as it still needs to execute participation agreements with the applicants. CMMI will issue a final list once it completes the process.

Applicants from 36 states and the District of Columbia were selected to participate in the program. Approximately 200 applicants were approved with instances in which the same ambulance service organization submitted applications for multiple counties as well as more than one organization submitting an application for the same county. CMMI has sent notifications to each of the applicants letting them know to expect a follow up email with the partnership agreement, program guidance and additional details.

The ET3 program is a five-year voluntary pilot program designed to test the potential benefit to the Medicare program and patients of ambulance service providers and suppliers furnishing treatment in place as well as transport to alternative destinations. For more information about the ET3 program, please go the ET3 website.

House Committees Consider Balance Billing Proposals

This past Tuesday and Wednesday, respectively, the House Ways & Means and Education & Labor Committees marked up their proposals on balance or “surprise” billing. As we reported on Monday of this week, the Ways & Means Committee proposal, the Consumer Protections Against Surprise Medical Bills Act (H.R. 5826), did not include a provision on ground ambulance services. The House Education & Labor proposal, The Ban Surprise Billing Act (H.R. 5800), however, included a provision to create a federal advisory committee to recommend restrictions on the ability of ground ambulance service providers and suppliers to balance bill.

The Ways & Means Committee reported out H.R 5826 favorably by voice vote. While the Education & Labor Committee also reported out H.R. 5800 favorably, the vote was 30 to 13 as a block of its Committee members preferred the approach of the Ways & Means proposal on how to address balance billing for other providers. It is now up to House leadership to determine next steps on how the chamber will approach a final package on balance billing.

While H.R. 5800 as reported out by the Education & Labor Committee still includes the provision on ground ambulance services, Chairman Scott (D-VA) and Ranking Member Foxx (R-NC) prior to mark up had removed the most problematic language in the bill. As introduced, H.R. 5800 would have given the Department of Health and Human Services the authority to issue regulations to restrict balance billing based on the findings of the advisory committee. This would have eliminated federal lawmakers from being able to evaluate the recommendations prior to the changes being implemented. The language was removed in the chairman’s mark of the bill, and thus the Congress would now have an opportunity to debate and craft legislation on the recommendations.

The AAA along with the International Association of Fire Chiefs (IAFC), International Association of Firefighters (IAFF) and National Association of EMTs (NAEMT) had advocated against the ground ambulance provision. We thank Chairman Scott, Ranking Member Foxx and members of the Committee for listening to our concerns and removing the regulation authority language.

Only one of the four pieces of legislation on balance billing reported out by congressional committees includes a provision on ground ambulance services. We will continue to advocate to preserve the ability of local governments to determine the rates and standards for their EMS systems and against the inclusion of a ground ambulance provision in a final package on balance billing.

We will keep you apprised of new developments on the issue.