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.

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 and provides more favorable loan terms based on the retention of employees. Read the letter HERE.

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 to alternative destinations and other regulatory flexibility previously reported by the AAA.

ET3 Model Timeline Delay and Important Updates

ET3 Model Stakeholders,

Thank you for your engagement to date related to the ET3 Model. The Centers for Medicare & Medicaid Services (CMS) is seeking to support the community of organizations that are responding to the public health emergency stemming from the Novel Coronavirus Disease (COVID-19). As CMS and ET3 Model selected applicants work to respond to needs due to COVID-19, CMS has decided to delay the start of the ET3 Model from May 1, 2020 until Fall 2020.

CMS appreciates your continued support and enthusiasm for the innovations available under the ET3 Model, and as such, we will continue to communicate information and updates about the Model through this listserv.

Important Updates Regarding CMS Flexibilities to Fight COVID-19

In addition, we want to inform ET3 Model stakeholders that CMS recently announced in a press release an Interim Final Rule with Comment Period (IFC) that provides temporary regulatory waivers and new rules to equip the American healthcare system with maximum flexibility to respond to the 2019 COVID-19 pandemic. The IFC and all of CMS’s Coronavirus Waivers & Flexibilities can be found here.

The flexibilities offered specifically to ambulances during the Public Health Emergency (PHE) for the COVID-19 pandemic can be found at this link: Ambulances (PDF). This includes temporarily expanding the list of allowable destinations for ground ambulance transports during the COVID-19 PHE to include any destination that is equipped to treat the condition of the patient in a manner consistent with state and local Emergency Medical Services (EMS) protocols in use where the services are being furnished. These destinations may include, but are not limited to: any location that is an alternative site determined to be part of a hospital, CAH or SNF, community mental health centers, federally qualified health centers (FQHCs), rural health clinics (RHCs), physician’s offices, urgent care facilities, ambulatory surgical centers (ASCs), any location furnishing dialysis services outside of the ESRD facility when an ESRD facility is not available, and the beneficiary’s home. Home may be an appropriate destination for a COVID-19 patient who is discharged from the hospital to home to be under quarantine. There must be a medically necessary ground ambulance transport of a patient in order for an ambulance service to be covered.

These actions, and earlier CMS actions in response to COVID-19, are part of the ongoing White House Coronavirus Task Force efforts. To keep up with the important work the Task Force is doing in response to COVID-19, visit www.coronavirus.gov. For a complete and updated list of CMS actions, and other information specific to CMS, please visit the Current Emergencies website.

Thank you again for your interest in the Model and for your efforts to improve the quality of care in the EMS industry.

If you have any questions about this update, please contact the ET3 Model team at ET3Model@cms.hhs.gov.

Follow CMS and the CMS Innovation Center on Twitter at @CMSGov and @CMSinnovates.

Centers for Medicare & Medicaid Services (CMS) has sent this Emergency Triage, Treat, and Transport (ET3) Model Update. To contact Centers for Medicare & Medicaid Services (CMS) go to our contact us page.

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 definition of a qualified first responder specifically includes paramedics and EMTs who provide services in a county with at least one confirmed case of COVID-19. The language would apply to all paramedics and EMTs regardless of their employer type. The AAA had reached out prior to the introduction of the bill to staff with Congressman Huizenga to ensure that would be the case.

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 by the CARES Act, in the amount of $48,000 per ambulance registered as of April 1. The AAA estimates the payments would represent approximately $2.6 billion in desperately-needed relief for our industry. Read the letter HERE.

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 and Medicaid policies on alternative destinations and treatment in place. The letter was also sent to the National Highway Traffic Safety Administration (NHTSA) and the Assistant Secretary for Preparedness and Response (ASPR). Read the letter HERE.

Read the Letter