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HRSA | Federal Office of Rural Health Policy Update

HRSA | Federal Office of Rural Health Policy Update | May 13, 2021

What’s New

CDC and USDA Team Up for Vaccine Education Effort.  The Centers for Disease Control and Prevention (CDC) is providing $9.95 million in funding to the U.S. Department of Agriculture’s USDA) National Institute of Food and Agriculture (NIFA) to improve vaccine confidence in rural areas.  NIFA will work with local partners through the Land Grant University System and its Cooperative Extension System, a nationwide educational network that provides non-formal higher education and learning to farming communities.

HRSA COVID-19 Coverage Assistance Fund.  The Health Resources and Services Administration (HRSA) will provide claims reimbursement at the national Medicare rate for eligible health care providers administering vaccines to underinsured individuals. This may be particularly helpful in rural communities given higher rates of uninsured and underinsured.

HHS/DoD National Emergency Tele-Critical Care Network.  A joint program of the U.S. Department of Health & Human Services (HHS) and the U.S. Department of Defense (DoD) is available at no cost to hospitals caring for COVID-19 patients and struggling with access to enough critical care physicians, nurses, respiratory therapists and other specialized clinical experts. Teams of critical care clinicians are available to deliver virtual care through lightweight telemedicine platforms, such as an app on a mobile device. Hear from participating clinicians and email to learn more and sign up.

HHS Coordinates New Effort to Vaccinate Migratory/Seasonal Workers in Agriculture.  The U.S. Department of Health & Human Services (HHS) is working with several divisions, including the Food and Drug Administration and the Health Resources and Services Administration to boost vaccination rates in a workforce often at heightened risk of COVID-19 infection.

RAND/RWJF Report:  COVID-19 and the Experiences of Populations at Greater Risk.  The RAND Corporation joined with the Robert Wood Johnson Foundation (RWJF) to examine the way people view health issues. Researchers asked people in the United States about their experiences related to the pandemic, and their views on issues such as freedom, racism, and the role of government.


COVID-19 Resources

New: FCC Emergency Broadband Benefit ProgramThe Federal Communications Commission (FCC) created this temporary program to help eligible individuals and households afford internet service during the pandemic. Eligible households can enroll through an approved broadband service provider or by visiting GetEmergencyBroadband.org.  The program will end when the fund runs out of money, or six months after the U.S. Department of Health and Human Services declares an end to the COVID-19 health emergency, whichever is sooner.

We Can Do This: COVID-19 Public Education Campaign.  The U.S. Department of Health & Human Services announced a national effort to help community partners promote COVID-19 vaccine confidence.  The campaign includes educational materials targeted to specific audiences and seeks volunteers for the COVID-19 Community CorpsNew: The Rural Communities Toolkit provides resources for building vaccine confidence.  

Volunteer to Administer COVID-19 Vaccines.  The U.S. Department of Health & Human Services has expanded its definition of persons authorized to give the vaccine.  These include, among others, current and retired traditional and non-traditional health care professionals, and students in health care programs.

HHS Facts About COVID Care for the Uninsured. The U.S. Department of Health & Human Services (HHS) helps uninsured individuals find no-cost COVID-19 testing, treatment and vaccines.  The HRSA Uninsured Program provides claims reimbursement to health care providers generally at Medicare rates for testing, treating, and administering vaccines to uninsured individuals, including undocumented immigrants.  There are at-a-glance fact sheets for providers and for patients in English and Spanish.

Federal Office of Rural Health Policy FAQs for COVID-19.  A set of Frequently Asked Questions (FAQs) from our grantees and stakeholders.  NewResources for Rural Health Clinics.

COVID-19 FAQs and Funding for HRSA Programs. Find COVID-19-related funding and frequently asked questions for programs administered by the Health Resources and Services Administration (HRSA).

CARES Act Provider Relief Fund Frequently Asked Questions.  Includes information on terms and conditions, attestation, reporting and auditing requirements, general and targeted distributions, and how to report capital equipment purchases.

CDC COVID-19 Updates.  The Centers for Disease Control and Prevention (CDC) provides daily updates and guidance, including a section specific to rural health care, a vaccine locator by state, and COVID-19 Vaccination Trainings for new and experienced providers.  NewUpdated Frequently Asked Questions about COVID-19 vaccination, including new guidance for use in adolescents 12 and older.

CMS Coronavirus Partner Resources.  The Centers for Medicare & Medicaid Services (CMS) provides information for providers, health plans, state Medicaid programs, and Children’s Health Insurance Programs and holds regular stakeholder calls to provide updates.

HHS Coronavirus Data Hub.  The U.S. Department of Health & Human Services (HHS) website includes estimated and reported hospital capacity by state, with numbers updated daily.

NIH Community Engagement Alliance Against  COVID-19 Disparities.  The National Institutes of Health (NIH) created a collection of online resources with information for communities hit hardest by the pandemic, such as African Americans, Hispanics/Latinos, and American Indian/Alaska Natives.

COVID-19 Data from the U.S. Census Bureau. The site provides access to demographic and economic data, including state and local data on at-risk populations, poverty, health insurance coverage, and employment.

ATTC Network COVID-19 Resources for Addictions Treatment. The Addiction Technology Transfer Center (ATTC) Network was established in 1993 by the Substance Abuse and Mental Health Services Administration.  The online catalog of COVID-related resources includes regularly-updated guidance and trainings for professionals in the field.

GHPC’s Collection of Rural Health Strategies for COVID-19.  The FORHP-supported Georgia Health Policy Center (GHPC) provides reports, guidance, and innovative strategies gleaned from their technical assistance and peer learning sessions with FORHP grantees.  New: The Impact of Rural Residence on COVID-19 Disparities.

Confirmed COVID-19 Cases, Metropolitan and Nonmetropolitan Counties.  The RUPRI Center for Rural Health Policy Analysis provides up-to-date data on rural and urban confirmed cases throughout the United States.  An animated map shows the progression of cases beginning March 26, 2020 to the present.

Rural Response to Coronavirus Disease 2019.  The Rural Health Information Hub has a compendium of rural-specific activities and guidelines, including Rural Healthcare Surge Readiness, a tool with resources for responding to a local surge in cases.

SAMHSA Training and Technical Assistance Related to COVID-19.  The Substance Abuse and Mental Health Services Administration (SAMHSA) created this list of resources, tools, and trainings for behavioral health and recovery providers.

Mobilizing Health Care Workforce via Telehealth.  ProviderBridge.org was created by the Federation of State Medical Boards through the CARES Act and the FORHP-supported Licensure Portability Program. The site provides up-to-date information on emergency regulation and licensing by state as well as a provider portal to connect volunteer health care professionals to state agencies and health care entities.

Online Resource for Licensure of Health Professionals.  Created by the Association of State and Provincial Psychology Boards, the site provides up-to-date information on emergency regulation and licensing in each state for psychologists, occupational therapists, physical therapists assistants, and social workers. 


Funding and Opportunities

Nurse Corps Scholarship Program – extended to May 26. The Nurse Corps Scholarship Program provides financial support to students enrolled in nursing degree programs in exchange for a commitment to serve in high-need areas across the country. This year, Nurse Corps has additional funding for qualified nursing students that includes tuition, fees, other reasonable educational costs, and a monthly living stipend.

DOJ National Tribal Clearinghouse on Sexual Assault – June 3. The U.S. Department of Justice (DOJ) will make one award for $980,000 to an organization that can provide nationwide training and technical assistance for response to sexual assault crimes and services for victims in American Indian/Alaska Native communities.

DOJ Comprehensive Opioid, Stimulant, and Substance Abuse Site-Based Program – June 7. The U.S. Department of Justice (DOJ) will make 110 awards with total funding of $163 million to support state, local, tribal, and territorial response to use of illicit substances.  A subcategory of the program will award up to $600,000 each for projects in rural areas, small counties, and tribal areas with a population of fewer than 100,000 for a federally recognized tribe.

HRSA Rural Northern Border Region Planning Program – June 14. The Health Resources and Services Administration’s (HRSA) will make approximately four awards of up to $190,000 each to support health care needs in underserved rural communities of the Northern Border Regional Commission (NBRC) service area.

DOJ Second Chance Act Youth Offender Reentry Program – June 15.  The U.S. Department of Justice (DOJ) will make 13 awards of up to $750,000 each to support youth returning to their communities from correctional facilities.  The program encourages collaboration between state agencies, local government, and community- and faith-based organizations.  Separately, the DOJ will make approximately 15 awards of up to $750,000 each for the Juvenile Drug Treatment Court Program – June 15.

USDA Local Food Promotion Program – June 21.  The U.S. Department of Agriculture (USDA) will make grants of up to $200,000 each for planning grants, and up to $750,000 for implementation grants.  Grant recipients will create or expand projects that increase the availability of locally produced food.

DOJ Strategies to Support Children Exposed to Violence – June 22.  The U.S. Department of Justice (DOJ) estimates eight awards with total investment of $7 million to support community-level strategies for children exposed to violence.  Priority consideration will be given to applications promoting civil rights, building trust between law enforcement and the community, and that are intended to benefit high poverty areas.

HUD Housing Opportunities for Persons with AIDS – July 6.  The U.S. Department of Housing and Urban Development (HUD) will make 18 awards of up to $2.25 million each for community projects that provide housing for people with HIV/AIDS in underserved areas. Rural populations are among those of interest for ensuring health equity. Also known as Housing as an Intervention to Fight AIDS, the program aims to create housing and service models that can be replicated in other similar localities.


Rural Health Research

Research in this section is provided by the HRSA/FORHP-supported Rural Health Research Gateway.  Sign up to receive alerts when new publications become available. 

Medicare-Paid Naloxone: Trends in Nonmetropolitan and Metropolitan Areas.  Previous research has found that Medicare paid for an increasing share of naloxone prescriptions from 2016 to 2018 and pays for 1/3 of all naloxone dispensed from retail pharmacies as of 2018.  This brief from the Rural and Underserved Health Research Center examines trends in Medicare-paid naloxone dispensing rates in nonmetropolitan versus metropolitan areas from 2014 to 2018.


Policy Updates

Visit the FORHP Policy page to see all recent updates and send questions to ruralpolicy@hrsa.gov.

Request for Information on Advancing Equity and Support for Underserved Communities – Comments due July 6.  The Office of Management and Budget (OMB) seeks input from a broad array of stakeholders in the public, private, advocacy, not-for-profit, and philanthropic sectors, including State, local, Tribal, and territorial areas, on available methods, approaches, and tools that the Government can use to promote equity and support underserved communities.

Increased Medicare payment for COVID-19 monoclonal antibody infusions.  The Centers and Medicare & Medicaid Service (CMS) announced last week an increase in the national average payment rate for administering monoclonal antibody treatments for COVID-19 from $310 to $450 for most health care settings.  Additionally, they have established a higher national payment rate of $750 for monoclonal antibody treatments administered in a beneficiary’s home, including the beneficiary’s permanent residence or temporary lodging.  CMS is updating its COVID-19 toolkits for providers, states, and insurers to reflect this change.

Medicare Guidance on Interoperability Rule Requirements for Hospitals.   This interpretive guidance from the Centers for Medicare & Medicaid Services (CMS) outlines the Conditions of Participation (CoPs) requiring hospitals, psychiatric hospitals, and Critical Access Hospitals (CAHs) to send electronic patient event notifications of a patient’s admission, discharge, and/or transfer to another healthcare facility or to another community provider or practitioner, which are effective as of May 1, 2021.  These CoPs were finalized in the May 2020 Interoperability and Patient Access Final Rule and are addressed in the recently released Interoperability Final Rule FAQs.

Medicare Waiver for Ambulance Treatment in Place.  This Fact Sheet describes the circumstances in which ground ambulance services may be reimbursed by Medicare for treatment provided in place because a patient was not able to be transported to a destination permitted under Medicare regulations due to community-wide emergency medical service (EMS) protocols due to the COVID-19 PHE.  This waiver is retroactively effective to March 1, 2020.


Learning Events and Technical Assistance

ONDCP Workshop for SUD: Rural Faith-Based Leaders – Thursday, May 13 at 1:00 pm ET.  The Office of National Drug Control Policy (ONDCP) will hold a second session (90 minutes) in its series for faith leaders in rural areas.  The workshops are meant to increase understanding of substance use disorder (SUD) and provide guidance on connecting faith to prevention, treatment, and recovery.  If you would like to attend, please RSVP to Betty-Ann Bryce, Special Advisor for Rural Affairs at MBX.ONDCP.RuralAffairs@ondcp.eop.gov with your name, title, organization, state/county, and contact information/email address. The Rural Health Information Hub has a recording of the first workshop for faith leaders in its Community Toolbox for SUD.

MATRC: Answering Questions About Telehealth and Telemental Health – Friday, May 14 at 12:00 pm ET.  The Mid-Atlantic Telehealth Resource Center (MATRC) holds a live, two-hour event to answer questions about the basics.  The MATRC is one of 14 FORHP-Supported Telehealth Resource Centers.  This is a recurring session taking place every other Friday from 12:00 to 2:00 pm ET.

HRSA Telehealth Series: Learn About Licensure Compacts – Monday, May 17 at 12:30 pm ET.  Experts from the National Center for Interstate Compacts will discuss agreements for doctors, nurses, psychologists and other clinicians to see patients across state lines via telehealth.

SBIRT for SUD Native American Communities – Tuesday, May 18 at 11:00 am ET.  Screening, Brief Intervention, and Referral to Treatment (SBIRT) is a process to quickly assess substance use disorder (SUD) in a person and move them toward more extensive treatment.  This hour-long session is hosted by the National American Indian & Alaska Native Prevention Technology Transfer Center.

AgriSafe: Zoonotic Disease and Pregnancy – Wednesday, May 19 at 1:00 pm ET.  The AgriSafe Network will hold a one-hour session to explain the risk that diseases transmitted between farm animals and humans pose to pregnant women.

Overcoming Mental Health Stigma in Rural Communities – Wednesday, May 19 at 2:00 pm ET.  The Mental Health Technology Transfer Center Network will host a one-hour workshop to discuss what influences negative attitudes toward mental health and techniques to overcome various forms of stigma.

Assessment of Opioid Misuse Risk Among Farmers in the Clinical Setting – Friday, May 21 at 1:00 pm ET. The AgriSafe Network will host an hour-long webinar to provide insight on misuse risk factors and warning signs among farmers.

SAMHSA Connecting Prevention Specialists to Native Communities – Friday, May 21 at 1:00 pm ET.  The Tribal Training and Technical Assistance Center at the Substance Abuse and Mental Health Services Administration (SAMHSA) holds virtual trainings to cover topics such as crisis response, youth engagement, and sexual assault awareness.  Trainings will take place on the third Friday of each month.


Resource of the Week

Successful COVID-19 Messaging in Rural CommunitiesIn this 30-minute video, the state leadership in West Virginia present insight from their research and vaccine outreach campaign.


Approaching Deadlines

CDC Childhood Lead Poisoning Prevention and Surveillance – extended to May 14 (from April 25)

Park and Recreation Mentorship Grants for Rural Youth Impacted by Opioids – May 15

ARC Investments Supporting Partnerships/Recovery Ecosystems – Letters of Intent May 17

CDC Drug Free Communities – extended to May 17 (from May 10)

Cross-Jurisdictional Sharing in Public Health: Small Grants Program – May 17

EPA Technical Assistance for Wastewater Treatment – May 17

SAMHSA Overdose Treatment for Use by First Responders – May 17

HRSA Expanding Community-Based Workforce for COVID-19 Vaccine Outreach – May 18

Comments Requested:  Proposed Changes to the Census Bureau Definition of Urban – May 20

CMS Primary Care First Model Cohort 2 – extended to May 21 (from April 30)

CDC Community Health Workers for COVID Response – May 24

New Sites for National Health Service Corps (NHSC) – May 25

Native American Agriculture Fund Grants for Youth – May 25

Nurse Corps Scholarship Program – extended to May 26

EMS Week Featured Service Application

EMS Week will take place from May 16–22, 2021.  To celebrate the extraordinary contributions of ambulance services to the communities they serve, we will be featuring specific services throughout EMS week on AAA’s website and social media.

If you would like to apply to have your service featured, please complete and submit all fields below by May 12. Thank you for your service to your community!

 

 

 

EMS1 | EMS advocacy and adaptability with Shawn Baird

EMS1 Interview of AAA President Shawn Baird by AAA Communications Chair Rob Lawrence

As we enter, hopefully, a happier new year, several of our national associations that have been at the forefront of collaborative advocacy efforts and the voices of the EMS profession have undergone planned changes in their leadership.

To welcome in 2021, I sat down, via Zoom, with Shawn Baird, incoming president of the American Ambulance Association and asked him about 2020 and his thoughts on the future of our industry. Shawn is the vice president for rural services with MetroWest Ambulance Family of Companies in Oregon. Shawn spent the last two years serving the AAA as president elect and has been at the center of AAA activity and advocacy.

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EMS1 | Inside EMS Podcast: Elephants In the Room

From EMS1 featuring AAA Communications Chair Rob Lawrence

What to do about the EMS elephants in the roomOur hosts discuss industry hot topics that will need to be addressed in the future, including the debate about responding with lights and sirensNov 6, 2020
This episode of Inside EMS is sponsored by ImageTrend, the creators of the free mobile app for first responders, CrewCare. It’s time to thrive.

In this episode, host Chris Cebollero speaks with guest host Rob Lawrence about his recent keynote address at the American Ambulance Association’s Annual Conference. Lawrence shares his thoughts on his EMS “elephants in the room.” Where should EMS stand on the issue of responding with lights and sirens? Do EMS practitioners need college degrees? Listen to the discussion and join the debate in the comments below.

Expanded Support for EMS Responding to Natural Disasters, COVID-19

Frontline Impact Project Expands Support for Frontline Heroes, Offers Companies a New Way to Give Amidst Historic Natural Disasters

COVID-19 response platform will now direct resources to first responders facing wildfires, hurricanes and other catastrophes   

September 15, 2020 – Frontline Impact Project is expanding its mission and will now also support heroes on the frontlines of major natural disasters including the Western wildfires and Hurricane Laura. The platform, which The KIND Foundation launched in partnership with dozens of companies in response to COVID-19, will activate its existing infrastructure to shepherd resources like meals, snacks, beverages and personal care items to first responders in need. The announcement comes after extraordinary displays of courage and sacrifice from the nation’s firefighters, paramedics and emergency volunteers.

“We started Frontline Impact Project to meet the needs of those on the frontlines of the COVID-19 pandemic. While this work will continue, we are cognizant of the many others risking their lives to keep us safe, particularly as peak wildfire and hurricane seasons approach,” says Michael Johnston, President of The KIND Foundation. “Thanks to the generosity of more than 60 companies, we’re set up to respond in real time and help take care of America’s heroes as they take care of us.”

As part of this expansion, Frontline Impact Project has initiated partnerships with two leading disaster response nonprofits, National Voluntary Organizations Active in Disaster (NVOAD) and Good360, to get donated items to workers across the Gulf Coast and Western United States.

“Non-profit staff and volunteers work tirelessly to serve survivors impacted by disaster. Frontline Impact Project’s commitment and efforts to supporting those serving on the frontlines of disasters across the country is a welcome addition to the disaster response community,” says Katherine Boatwright, Director of Operations, NVOAD.

Since April, Frontline Impact Project has matched more than 650 frontline institutions with companies that have products or services to donate. Available resources include food, beverages, personal care items, mental health services and virtual fitness classes. Together with its inaugural partner KIND, the project has donated nearly four million products to date.

“We were looking for a flexible and streamlined way to donate our products. Frontline Impact Project gives us the opportunity to scale our giving as the situation demands and reach a deserving audience whose needs are paramount but not always top of mind,” says Aaron Croutch, Executive Vice President, Lenny & Larry’s.

Kara Goldin, Founder and CEO of Hint, adds, “Now, more than ever, it’s critical that we support first responders and help keep them healthy and hydrated. Hint has donated water to hundreds of healthcare organizations and first responders across the country, and the Frontline Impact Project has made coordination with a number of those groups much easier.”

In addition to Lenny and Larry’s and Hint, a number of companies have signed on to support this effort, including Adrenaline Shoc Smart Energy; Belgian Boys; CLEAN Cause; Just the Cheese; Kabaki Tea; Kodiak Cakes; KIND; La Colombe; Neuro; Paunchy Elephant; RISE Brewing Co; ROWDY; Purely Elizabeth; and ZICO Coconut Water.

To submit a donation or make a request, visit www.frontlineimpact.org.

California’s 50 years of prehospital medicine

From EMS1 on July 14 by AAA Communications Chair Rob Lawrence

The history of our history: 50 years of prehospital medicine: A transatlantic tale of former army doctors, paramedic development, cardiac arrest survival, and Johnny and Roy

Fifty years ago, on July 15, 1970, then California Governor Ronald Reagan signed into law the Wedworth-Townsend Paramedic Act. The law created the conditions for the establishment of the first accredited paramedic training program in the United States.

The story of American paramedicine did not begin in California or even in the U.S., but in Belfast, Northern Ireland. The inspiration for this program came from World War II era British Royal Army Medical Corps (RAMC) Medical Officer, Professor Frank Pantridge, MD.

Continue reading►

Legislative hurdles check hazard pay, PSOB benefits

Frustration mounts as small print delays the HEROES Act, and presents a dual standard for provider benefits for the fallen

May 22 at 2:20 PM | EMS1 | By AAA Communications Chair Rob Lawrence

In  my last EMS One-stop column, I commented on the legislative to-do list to ensure that EMS receives the federal support it deserves right now as we staff the front lines and perhaps brace ourselves for COVID-19 round two as the nation craves a return to the normality and liberty enjoyed before the lockdown.

On May 15, 2020, the much talked about HEROES Act narrowly passed from the U.S. House of Representatives by a 208 to 199 vote to the Republican-controlled Senate.  The HEROES Act proposed $3 trillion in tax cuts and spending to address the negative health and financial impacts of the COVID-19 pandemic. This included benefits for the public safety community, extensions to enhanced unemployment benefits, debt collection relief, direct cash payments to households and possibly even hazard pay.

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Massachusetts | Convoy of Champions

A parade of more than 50 ambulances, representing more than 20,000 paramedics, EMTs, and 911 dispatchers, traveled from UMass Medical Center in Worcester, Massachusetts to the warning track inside Fenway Park on Wednesday, May 20. The Boston Red Sox, Mayor Marty Walsh, state officials, and healthcare professionals joined the Massachusetts Ambulance Association, the Professional Fire Fighters of Massachusetts, and municipal ambulance providers in celebrating these front line heroes during National EMS Week.

Once inside the park, the EMS professionals were greeted by video tributes from dignitaries and celebrities and a select number of live speakers following safe social distancing guidelines.

The event takes on even greater significance this year because of the unprecedented response to the COVID-19 crisis from EMS professionals and their colleagues across the state’s medical community.

The Commonwealth’s EMS professionals have been crucial in responding to the current COVID-19 pandemic. Massachusetts has been among the nation’s hardest-hit states, experiencing the third most deaths and fourth-most cases of the novel coronavirus.

During the current public health crisis, EMS professionals have helped manage testing and treatment for homebound patients and provided supplemental support for hospitals and neighborhood health centers, in addition to its duties in responding to daily emergencies.

Watch the Facebook Live Video

Thank you to everyone who participated in yesterday’s #ConvoyofChampions parade in celebration of #EMS! The event was a…

Posted by Massachusetts Ambulance Association on Thursday, May 21, 2020

EMS1: National associations join forces to tell the story of the front line

AAA Communications Chair Rob Lawrence shared his insights about recent  EMS and fire association joint advocacy efforts in EMS1. Don’t miss the full article!

Last week, the AAA were approached, via EMS1, by U.S. News, a national publication represented by journalist Gaby Galvin, asking about COVID-19 as it affects the front lines, rates of infection and quarantine, and generally life on the street. This opportunity provided the chance to bring together three national organizations who are all working hard to represent their members, lobby Congress and highlight the challenges at the tip of the spear.

Keep reading on EMS1►

AAA Social Media Campaign During COVID-19

Demonstrate the value of EMS in the COVID-19 crisis!
#EMS is on the very front lines of the #COVID19 epidemic. We provide on-demand #mobilehealthcare for the most vulnerable patient populations, 24/7. Help AAA showcase the incredible importance of #Paramedics#EMTs, and #Dispatchers in the response to this pandemic. Would you please capture a photo of yourselves in action, holding a simple sign? It is essential that we communicate visually with legislators, regulators, and the general public to help them understand the critically important role we play in saving and sustaining lives. #AlwaysOpen #StayHomeForUs

If practical, please consider showing your medics standing apart from one another (social distancing) if they are not in PPE.

Instructions on Facebook►

2019 Ambulance Ride-Along Toolkit

AAA ambulance emt member legislation

2019 Ride-Along Toolkit Now Available!

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

Congress is scheduled to adjourn on July 27 for their August congressional recess 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 those issues, in particular the Public Safety Officers Benefit (PSOB), permanent ambulance relief and ambulance cost data collection which are important to your operation. 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. The AAA has made the process of arranging a ride-long or scheduling a meeting easy for you with our 2019 Congressional Ride-Along Toolkit.

Are you willing to host a Member of Congress at your service but unsure of how to set it up? Email or call Aidan Camas at acamas@ambulance.org – (202) 802-9026 and Aidan can help you set up a meeting.

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

2018 AMBY Award Winners Announced

The American Ambulance Association is proud to announce the recipients of the 2018 AMBY Awards. The AMBYs highlight excellence in EMS and the ingenuity and entrepreneurial spirit that epitomize AAA members. The mission of the awards is to showcase creativity and innovation in the ambulance industry by fostering a culture of collaboration, cooperation and a passion for excellence in patient care. This year’s awards will be presented at the Annual Conference & Trade Show Awards Reception on September 7, 2018. Please join us in congratulating our 2018 winners!

Clinical Outcome Program

Medic Ambulance Service, Inc. | Vallejo, CA

Community Impact Program

NorthStar EMS, Inc. | Tuscaloosa, AL

Employee Programs

Hall Ambulance Service, Inc. | Bakersfield, CA

Innovation in EMS

Priority Ambulance | Knoxville, TN

Mercy Ambulance Service, Inc. | Savannah, GA

Public Relations Campaign

MEDIC EMS Agency | Charlotte, NC

Hall Ambulance Service, Inc. | Bakersfield, CA

Quality Improvement Program

Sunstar Paramedics | Largo, FL

Patient and Employee Safety Program

Priority Ambulance | Knoxville, TN

Once again, join us in celebrating the 2018 winners! Learn more about the AMBYs.

 

Ambulance Cost Data Collection is Coming

Although the most prominent ambulance provision passed in the Bipartisan Budget Act of 2018 (H.R. 1892) was the five-year extension of the Medicare add-ons, the Act also included important language directing the Centers for Medicare and Medicaid Services (CMS) to collect cost and other financial data from ambulance service suppliers and providers.

This week, an editorial from AAA Senior Vice President of Government Affairs Tristan North was featured in the June issue of JEMS‘s “EMS Insider”. Read the full article►

Build Your Future with a Career in EMS

The U.S. Bureau of Labor Statistics expects career opportunities for EMTs and Paramedics to grow another 15 percent by 2026, far outpacing most other professions… With EMS agencies hungry for skilled providers, there has never been a better time to chart your career path in mobile healthcare.

This week, an editorial from AAA President Mark Postma was featured in a special Media Planet section on healthcare careers. Read the full article►

AETNA/CVS Deal Along with Uber Concepts May Finally Change Ambulance Industry

Mark Postma, AAA President & Asbel Montes, AAA Payment Reform Chair

The recent merger of Aetna/CVS may be the catalyst that finally brings the change that the ambulance industry has been advocating for over the past several years. This new healthcare strategy supports the ambulance industry’s ideas that alternative patient destinations are needed in EMS.

To explain this better, one must understand the current state of ambulance reimbursement via the 911 system or equivalent. At this point in time most commercial payers of healthcare (Insurance) as well as Medicare will not pay for 911 ambulance transportation to any destination other than the “nearest appropriate” hospital based emergency room; arguably, the most expensive and least efficient form of healthcare. The continuation of this policy discounts the advanced capabilities of both EMS and new clinical settings and the savings that can be achieved through innovative change. In addition, at the same time that the cost of healthcare in general is increasing, reimbursement from all payers is decreasing, creating a significant challenge for providers. Medicare consistently pays providers below cost for providing life-saving services and state Medicaid agencies are consistently underfunding the critical services to the un- and under-insured populations that have allowed intermediaries to delay or not pay ambulance services.

Much of the U.S. population believes that vital 911 EMS services or the equivalent are provided free or included in their local property taxes. This is generally not the case. While EMS services must be at the ready on a 24/7/365 basis, they are not paid for being on call, but only when the service is used.

Many communities have governing rules that require 911, or the equivalent, paramedic services to arrive on-scene within 8-12 minutes of receiving the call. This cost of readiness is VERY expensive. Skyrocketing personnel costs, ambulances, equipment, and other high cost drugs only exacerbate an already fragile reimbursement structure. Although recent articles about calling Uber or Lyft sound intriguing, these drivers and cars are not prepared for any type of injury. Nor can they alert the hospital in critical situations to have the heart cath lab ready or a trauma surgeon on standby, shortening the time to definitive care when time matters most. Emergency paramedics are highly trained, are nationally and/or state certified, and provide services on state regulated ambulances equipped to manage all types of emergencies. Ambulances are also often strategically placed to arrive in that 8-12 minute response time requirement. However, there is one piece missing from the ambulance scenario that allows for Uber/Lyft to succeed; your personal credit card is on file with them. NO GUARANTEED PAYMENT, NO TRANSPORT. The cost of providing ambulance services “on call” with life-saving equipment, medications, and personnel at the ready is steep. When you consider the many regulations providers must adhere to outside of patient care, the cost increases even more. This misunderstanding of the cost often results in patients being stunned when they receive a bill for services provided and feel that it is excessive. However, comparing the cost of a life-saving ambulance transport to an Uber/Lyft ride is like comparing the cost of building a house to putting up a tent.

On the other hand, these highly trained paramedics, with vehicles that are comprehensively (medically) equipped to meet the highest safety standards, have no credit card on file. They do not treat you based on your ability to pay. In fact, approximately less than half of ambulance patients have insurance, and when commercial insurance does pay, they are increasingly paying only a percentage of the total bill, leaving their insured left to pay the balance. In a time of an emergency, insurers should not place an additional burden on their insured through underpayment or claiming out of network status. In addition, although many emergency 911 calls begin as a “frantic call for help,” not all are life threatening and require the highest level of care; however, they do need some type of a health care intervention.

It is this high volume of low acuity patients who do not have primary care physicians and who currently by law must be transported to hospitals that continue to bottleneck emergency rooms. This bottleneck then requires ambulances to be “on the wall” at local hospital emergency rooms. The cost to the 911 EMS system rapidly begins a domino effect where all the patients begin to be diverted/directed to other hospitals causing an overflow to the next hospital. In large EMS systems, this domino effect can bring emergency rooms at all available hospitals to capacity quickly. EMS units are unable to go on additional emergency calls because they are caring for a patient while waiting on hospital staff to become available to take over. They also cannot leave that hospital with the patient to go to another hospital due to federal laws that prohibit this movement.

So why does the AETNA/CVS excite the leaders of EMS organizations? Most people assume that since this acquisition just occurred, Walgreens will probably follow suit with another insurer. Other local pharmacy “CVS types” may partner with local hospitals or medical insurance cooperatives as well. This leads the ambulance industry to believe that the capacity to transport patients to alternative locations could greatly change the landscape of EMS. The idea that local CVS/Walgreens/clinics could receive low acuity patients breaks open the bottleneck and can provide several benefits for the ambulance service and patient. One benefit is that adding these stores/clinics greatly increases the resources for caring for low acuity patients and could potentially double the locations an ambulance can transport to, which will allow for quicker transport times and increase efficiencies. Lastly, and most importantly, diverting the low acuity patients to these additional community resources would reduce overflow in the emergency departments and allow true emergency patients to be transferred over more quickly to receive the higher level of care they require. This scenario is also a win for the patient. They could be transported to the most appropriate location to care for their needs and therefore can be billed more accurately for services they require rather than the emergency department fees which are usually costlier.

To make this happen, obviously the CVS system needs to evolve to receive these patients. More importantly, ambulance reimbursement by federal, state, and private payers must evolve to meet the demands of the market. Due to the complexities of how EMS services are provided because of state and local regulations, mandatory response times, service area parameters, and others, reimbursement for these services must be adequately paid for by Medicare, Medicaid, and private insurers. Today EMS agencies can only “hope” that their patients have a source of payment!

Although one would think that this state of concern for EMS services is being monitored, it currently has only a very small voice in the healthcare continuum. Federal agencies seem to want to look at what EMS will look like in 10 to 25 years rather than where EMS is today and where it can develop over the next few years. EMS reform needs to happen soon to save these systems from bankruptcy and/or the public from higher taxation.

We hope that this merger will be the beginning of alternative EMS/ambulance destinations with allocated reimbursements that meet the costs of providing high quality, efficient, and necessary 911 ambulance services.

Mark Postma, COO, Sunstar Paramedics
American Ambulance Association, President
Works for Sunstar Paramedics, Florida’s largest EMS provider
MPostma@sunstarems.com, 727-224-0295

Asbel Montes, Vice President, Acadian Ambulance Service, Inc.
American Ambulance Association, Chair-Payment Reform Committee
Works for Acadian Ambulance Service, Inc., Louisiana’s largest EMS provider
Asbel.Montes@acadian.com, 337-291-3310

Response to Kaiser Health News Ambulance Billing Article

Below is the American Ambulance Association’s Response to a recent Kaiser Health News article on ambulance billing. It was reprinted in several metropolitan areas on November 20, 2017.

To the Editor:

I write today in response to Melissa Bailey’s November 20 piece about ambulance balance (“surprise”) billing. While we disagree with the characterization of ambulance services in the article, we welcome the ongoing public dialogue about how unsustainable reimbursement for emergency medical services results in cost-shifting to patients.

Missing from the article is a true understanding of the sky-high cost of readiness for emergency medical services. Ambulance service providers offer their communities 24/7/365 on-demand mobile healthcare. Skilled staff and ambulances—high-tech emergency rooms on wheels—are ready to respond to a 9-1-1 call at a moment’s notice to help patients with issues ranging from stroke to heart attack to trauma to childbirth. EMS is also on the very front lines of the surge in opioid overdoses, providing naloxone (Narcan) to hundreds of patients each day. Keeping supplies, medications, equipment, and personnel at-the-ready requires a significant ongoing investment, regardless of whether or not an ambulance is out responding to a call. Cost comparisons between EMS and the rideshare app Uber may make for catchy sound bites, but they are misleading and misguided.

The piece states that our nation’s 14,000 ambulance service providers received 1,200 Better Business Bureau complaints spread over three years. While certainly not optimal, this is a tiny, unrepresentative fraction of the tens of millions of responses ambulance service providers conduct annually. In fact, BBB 2016 statistics show that ambulance services receive far fewer complaints than hospitals, physicians, dentists, and many other trusted healthcare providers.

The article also offhandedly mentions that balance billing occurs when private insurers and ambulance service providers are unable to agree about fair reimbursement rates. This glosses over the dark reality that it would be hard to categorize the process that occurs between the insurer and ambulance services as a “negotiation.” Instead, insurers often present an all-or-nothing proposition to force ambulance service providers to accept contracts at unsustainably low reimbursement rates. Unlike the multi-billion dollar insurance behemoths, most ambulance services are small and operate on razor-thin margins. In fact, 73% of ambulance services provide fewer than 1,000 Medicare transports per year—just three per day. Ambulance services do not turn down insurance network contracts out of greed, but instead out of necessity. Facing reimbursement rates below the cost of the services they provide, they must decline these agreements in order to keep their doors open and continue to provide healthcare to their communities. Unfortunately, this sometimes creates a situation where out-of-network ambulance costs are shouldered by patients via balance billing, instead of insurers.

In addition to challenges receiving fair compensation from private insurance, EMS is stretched thin by ultra-low Medicare and Medicaid reimbursement rates. In fact, in 2007 and 2012 GAO studies showed that without temporary, Congress-authorized percentage increases in EMS payments, ambulance services would receive reimbursement from government payors below the cost of operations. These are often the very same unsustainable rates that private insurers are attempting to strong-arm EMS providers into accepting for network contracts.

Finally, when someone calls 9-1-1 in need of emergency medical care, it is key to recall that, unlike in other industries, an ambulance responds regardless of the patient’s ability to pay. In many cases, the patient does not have insurance and is financially unable to reimburse the ambulance service provider. Therefore, EMS provides a significant amount of uncompensated care, the cost of which must be spread across all payors in order for them to continue their life-saving operations.

Ambulance services provide an essential, on-demand healthcare benefit to their communities. Unfortunately our current healthcare payment structure means that much of this care is not compensated equitably, resulting in the necessity of balance billing patients. While there are no quick fixes for this issue, we encourage consumers to educate themselves about their own insurance coverage. We also ask for your support of legislation that provides sustainable reimbursement for ambulance providers, including the bipartisan US Senate Bill 967. Together, we can ensure the future of mobile healthcare in our great nation.

Mark Postma
President
American Ambulance Association
“Representing EMS In America”

 

Ambulance Ride-Along Toolkit

AAA ambulance emt member legislation

2018 Ride-Along Toolkit Now Available!

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

Congress is scheduled to adjourn on July 28 for their August congressional recess 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 those issues, in particular Medicare ambulance relief and reform, which are important to your operation. 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. If you cannot host a tour and ride-along, we strongly encourage you to arrange local meetings with your members of Congress during August. The AAA has made the process of arranging a ride-long or scheduling a meeting easy for you with our 2018 Congressional Ride-Along Toolkit.

Are you willing to host a Member of Congress at your service but unsure of how to set it up? Email Aidan Camas at acamas@ambulance.org and Aidan can help you set up a meeting.

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

REPLICA Compact Enacted

REPLICA Meets Goal, Interstate Compact Becomes Official

May 8, 2017
For Immediate Release
Contact:
Sue Prentiss
603-381-9195
prentiss@emsreplica.org

May 8, 2017 (Falls Church, VA). With the 10th member state enactment, the Recognition of
Emergency Medical Services Licensure Interstate Compact (REPLICA) has become official.
Governor Nathan Deal of Georgia signed Senate Bill 109 on today activating the nation’s first EMS
licensure compact. States that have passed REPLICA to date include: Colorado, Texas, Kansas,
Virginia, Tennessee, Idaho, Utah, Mississippi, Wyoming and Georgia.

Released in 2014, REPLICA’s model legislation creates a formal pathway for the licensed individual
to provide pre-hospital care across state lines under authorized circumstances. According to Keith
Wages, president of the National Association of State EMS Officials (NASEMSO), “REPLICA
represents a collective, nationwide effort to address the problems faced by responders when needing
to cross state borders in the line of their duties.” Wages highlighted the compact’s abilities to
“increase access to healthcare, reduce regulatory barriers for EMS responders, and place an
umbrella of quality over cross border practice not previously seen in the EMS profession.” Wages
also noted that the partnership with the National Registry of Emergency Medical Technicians
(NREMT) has been essential during the advocacy and implementation phases. “We are grateful for
their continued support and contributions.”

Through funding provided by the Department of Homeland Security (DHS), NASEMSO led 23 EMS,
fire, law enforcement organizations and associations as well as key federal partners in the design and
drafting of REPLICA. The National Registry of EMTs (NREMT) currently provides funding to finalize
the development of the Commission.

The compact calls for establishment of an Interstate Commission with each state that has passed
REPLICA holding a seat, as well as a national EMS personnel coordinated database. Member states
will be able to rapidly share personnel licensure information, develop policy focused only on cross
border EMS practice, and hold EMS personnel originating in other states accountable in an
unprecedented way. The National Registry of EMT’s (NREMT) has committed to the development
and hosting of the coordinated database.

Twelve national associations and organizations support REPLICA. Three states have REPLICA bills
under consideration in their legislative sessions. Learn more at www.emsreplica.org.

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