Tag: COVID-19 coronavirus

CMS End of PHE Roadmap

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

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

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

New EEOC Guidance on COVID-19 Testing

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

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

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

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

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

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

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

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

June 8 | FICEMS Virtual Meeting

 

 

2022 SESSION

 

Wednesday, June 8, 2022

1:00 p.m. – 3:45 p.m.

Virtual Meeting

Washington, DC

 

General Meeting

1:00-1:05    Welcome, Introductions, Opening Remarks      
 

Jonathan Greene, Deputy Asst. Secretary for Preparedness & Response

Director, Office of Emergency Management & Medical Operations

FICEMS Chairperson
1:05-1:10    Approve:  Meeting Summary [December 8, 2021]
 

Gam Wijetunge, Director, NHTSA OEMS

Director of the Office of EMS, NHTSA
1:10-1:15    Department of Defense Update
1:10     Office of the Assistant Secretary of Defense for Health Affairs

Elizabeth Fudge

Supervisory Program Analyst, Health Readiness Policy & Oversight
1:15-1:35    Department of Health & Human Services Update
1:15     Health Resources & Services Administration

Theresa “Tee” Morrison-Quinata

EMS for Children Branch Chief, Maternal & Child Health Bureau

Division of Child, Adolescent, & Family Health

1:20     Assistant Secretary for Preparedness & Response

Jonathan Greene

Deputy Assistant Secretary & Director,

Office of Emergency Management & Medical Operations

 

1:25     Indian Health Services

Darrell LaRoche

Director, Office of Clinical & Preventive Services

 

1:30     Centers for Disease Control & Prevention

Christine “Chris” Kosmos

Director, Division of State & Local Readiness

Center for Emergency Preparedness & Response

 

1:35     Centers for Medicare & Medicaid Services

CAPT. Skip Payne

Director, Emergency Preparedness & Response Operations
1:40-1:50    Department of Homeland Security Update 
 

1:40     Countering Weapons of Mass Destruction Office

Pritesh Gandhi, M.D.

Chief Medical Officer, EMS Program

 

1:45     United States Fire Administration

Richard Patrick

Director, National Fire Programs Directorate
>1:50-1:55    Department of Transportation Update
 

1:50     National Highway Traffic Safety Administration

Nanda Srinivasan

Associate Administrator, Research & Program Development
1:55-2:00    Federal Communications Commission Update 
 

1:55     Public Safety & Homeland Security Bureau

David Furth, J.D.

Deputy Chief, Office of the Bureau Chief
2:00-2:05    State EMS Directors Update
 

                        2:00     State EMS Directors Update

Steve McCoy

EMS Bureau

Florida Department of Public Health
2:05-2:45    NHTSA Office of EMS Projects Updates
2:05     COVID-19 Healthcare Resilience Working Group Update; 988 Update;                                         Mental Health & Suicide Prevention for EMS

Kate Elkins

EMS Specialist, NHTSA OEMS

2:10     COVID-19 First Responder Deaths

Dave Bryson

EMS Specialist, NHTSA OEMS

2:15     National 911 Program Update

Brian Tegtmeyer

National 911 Program Coordinator

2:20     NEMSIS Update

Eric Chaney

EMS Specialist, NHTSA OEMS

2:25     National Roadway Safety Strategy – Post Crash Care

Gam Wijetunge

Director, NHTSA OEMS

 

 

 
2:30-2:55    Technical Working Group Subgroup Updates
2:30     Evidence-based Practice & Quality Subgroup

Diane Pilkey, DHHS HRSA | Max Sevareid, NHTSA OEMS

 

2:35     EMS Data Standards & Exchange Subgroup

Rachel Abbey, DHHS ONC | David Millstein, DHS USFA

2:40     EMS Systems Integration & Preparedness Subgroup

Tee Morrison-Quinata, DHHS HRSA | Gam Wijetunge, NHTSA OEMS

2:45     Workforce & Safety Subgroup

Greg Williams, DHS USFA | Dave Bryson, NHTSA OEMS

2:50     Education & Training Subgroup

                                    Michael Stern, DHS USFA | Clary Mole, NHTSA OEMS
3:05-3:15    Break – 10 minutes
3:15-3:20    National EMS Advisory Council Update
                                    Jonathan Washko, Vice Chair, NEMSAC
3:20-3:25    FICEMS COVID-19 Response White Paper Project Update
                                    Mark Sigrist, Energetics (NHTSA OEMS)               

 

3:25-3:30    Public Comment
3:30-3:45    Committee Round Table Discussions
 
3:45             Adjournment

Infection Prevention and Control for the EMS/911 Workforce: Public Comment Requested

Draft Report on Infection Prevention and Control for the EMS/911 Workforce Released: Public Comment Requested
From EMS.gov on April 12, 2022

The draft report for the technical brief on Infection Prevention and Control for the Emergency Medical Services (EMS)/911 workforce has been released by the Evidence-based Practice Center (EPC) Program at the Agency for Healthcare Research and Quality (AHRQ). The draft report is available for review and feedback through April 22, 2022 on Effective Healthcare’s website.

The technical brief summarizes the latest evidence on infectious pathogen exposure among the EMS/911 workforce and offers recommendations for the prevention, recognition, and control of infectious diseases and other related exposures that may be acquired in occupational settings.

The AHRQ is requesting feedback from the community to improve the final technical brief. The agency values feedback and will consider all comments received.

Submit Input

AHRQ is a government agency that produces evidence-based guidance to improve the quality of healthcare delivery. It coordinates these efforts with partners in the field to ensure the evidence is understood and put into practice. For more information on the EPC Program, visit here. This project is supported by NHTSA’s Office of EMS, which strives to reduce death and disability by providing leadership and coordination to the EMS community in assessing, planning, developing, and promoting comprehensive, evidence-based emergency medical services and 911 systems.

DOL COVID-19 Exposure Rule-Making

The United States Department of Labor (US DOL) has published a notice of intent to partially reopen the rule-making process to permit additional comment and a public hearing on certain aspects of the OSHA Emergency Temporary Standard for Healthcare employers which was originally published in June 2021. OSHA is seeking further input from stakeholders as they develop a final standard. The public hearing will begin on April 27, 2022.

The agency is reopening the rulemaking record to allow for new data and comments on topics, including the following:

  • Alignment with the Centers for Disease Control and Prevention’s recommendations for healthcare infection control procedures.
  • Additional flexibility for employers to permit less prescriptive requirements
  • Removal of scope exemptions.
  • Tailoring controls to address interactions with people with suspected or confirmed COVID-19.
  • Employer support for employees who wish to be vaccinated.
  • Limited coverage of construction activities in healthcare settings.
  • COVID-19 recordkeeping and reporting provisions.
  • Triggering requirements based on community transmission levels.
  • The potential evolution of SARS-CoV-2 into a second novel strain.
  • The health effects and risk of COVID-19 since the ETS was issued.

OSHA made it clear that it is not proposing mandatory COVID-19 vaccination for healthcare workers. However, they are seeking comments regarding how it could help employers further support healthcare worker employees in their vaccination and boosting efforts. This could include paid leave, including travel time, for those seeking vaccinations or boosters.

The notice in the Federal Register had a slightly more relaxed tone as many areas in the country have seen a significant drop-off in cases.  If you are interested in submitting comments, you can do so electronically at www.regulations.gov.  If you wish to attend the video-based public hearing, you must file a notice of intention to appear with the US DOL within 14 days of the notice being officially published in the Federal Register.

If you have any questions about your current obligations under the OSHA rules, please email the AAA at hello@ambulance.org.

HHS PRF | EMS Funding Letter to Secretary Becerra

Download PDF Letter

March 24, 2022

The Honorable Xavier Becerra
Secretary of Health and Human Services
Department of Health and Human Services
200 Independence Avenue, SW
Washington, DC 20201

Dear Secretary Becerra:

Ground ambulance service organizations and fire departments continue to struggle financially from the enduring economic effects of the COVID-19 public health emergency (PHE). Our respective members face sharp increases in the costs of fuel, equipment, medical supplies, and staffing as we deal with a severe shortage of paramedics and emergency medical technicians (EMTs) which has been an issue for years but exacerbated by the pandemic. We implore you to help ensure communities around the country have access to 9-1-1 emergency and non-emergency ground ambulance services through the remainder of the PHE and beyond with an infusion of $350 million from returned and/or unspent money in the Provider Relief Fund (PRF).

We greatly appreciate the funding that ground ambulance service organizations and fire departments have already received from the PRF. The funds have been a lifeline for many of our respective members and their ability to continue to serve their communities. However, as the Phase 4 distribution of funds demonstrated, more funding is needed for ground ambulance services. Our members indicate the funds they received in Phase 4 covered approximately 50% of their lost reimbursement and increased costs from July 1, 2020, to March 31, 2021, whereas previous distributions were closer to 88%. We therefore respectfully request an immediate distribution of $350 million or 10% of the annual Medicare expenditure on ground ambulance services.

We request that the funds be distributed in a similar manner as the Tranche 1 distribution from the PRF. The automatic, across-the-board deposit of funding was especially helpful for small and rural ground ambulance service organizations. These rural organizations provide care in underserved areas and are often daunted even by an abbreviated application process. To ensure equity for all communities, we support universal direct deposit.

Additionally, we encourage HHS to make these payments based on the National Provider Identification (NPI) number of the ground ambulance service organization or fire department rather than Tax ID Number (TIN). In the case of moderate and large cities, many municipal departments may share a TIN while maintaining distinct NPIs. Providing these payments according to TIN may unintentionally comingle funds intended for different departments such as fire departments, public health departments, and local government-run hospitals or clinics.

The American Ambulance Association (AAA), International Association of Fire Chiefs (IAFC), International Association of Fire Fighters (IAFF), National Association of Emergency Medical Technicians (NAEMT), and National Volunteer Fire Council (NVFC) represent the providers of vital emergency and non-emergency ground ambulance services and the paramedics, EMTs and firefighters who deliver the direct medical care and transport for every community across the United States.

Our members take on substantial risk every day to treat, transport, and test potential COVID-19 patients, and play a vital role in providing vaccinations to individuals in their homes. Ground ambulance service organizations and fire departments, however, urgently need the additional

$350 million to help offset the increased costs and lower reimbursement resulting from our vital response to the pandemic.

Thank you in advance for your consideration of this request.

Sincerely,

American Ambulance Association

International Association of Fire Chiefs

International Association of Fire Fighters

National Association of Emergency Medical Technicians

National Volunteer Fire Council

Student Loan Forgiveness for Frontline Health Workers Act (S. 3828) Introduced

This week, Senator Sheldon Whitehouse (D-RI) along with Senator Alex Padilla (D-CA), introduced the Student Loan Forgiveness for Frontline Health Workers Act (S. 3828), which provides loan forgiveness to individuals working in frontline healthcare responding to the Covid-19 pandemic. The legislation broadly defines healthcare workers and includes those who work in both public and private EMS. It provides relief to those who participate in both Federal student loans and private loans. We are very pleased to see the introduction of this legislation as it represents the kind of broad-based coverage for both governmental and non-governmental EMS that we have been advocating for. The legislation specifically covers paramedic certification programs that are accredited as part of CoAEMSP which requires college affiliation and makes them eligible for relief as federal student loans.  The bill has broader standards than the current Public Safety Loan Forgiveness program.  S. 3828 covers front-line healthcare workers regardless of their length of service as long as they are providing Covid healthcare-related services and specifically covers “an emergency medical services worker who responds to health emergencies or transports patients to hospitals or other medical facilities”.  In addition, the student loan forgiveness for those working in EMS, would be exempt from inclusion in that individual’s taxable income.

The AAA supports this legislation and applauds Senator Whitehouse and Senator Padilla for their efforts to assist our frontline healthcare workers.

HHS IEA | COVID-19 Update for March 21, 2022

HHS Office of Intergovernmental and External Affairs COVID-19 Update for
March 21, 2022  
CASE UPDATE
New Cases (based on 7-day rolling average)

  • 79,571,321 U.S. cases
  • 17.3% decrease in new cases (7-day average), as of March 18, 2022

Testing

  • 837,949,940 tests completed (3/21)
  • 2.3% positive test rate as of the week of 3/11 – 3/17/22 (was 2.7 % last week)

Hospitalizations

  • 4,581,254 total COVID hospital admissions (3/18)
  • The 7-day average (3/12 – 3/18) number of new confirmed COVID-19 admissions decreased from 2,642 to 2,010 admissions per day

Deaths

  • 969,114 total U.S. deaths
  • The 7-day average (3/12 – 3/18) number of reported deaths decreased from 1,199 to 973 deaths per day

Vaccines

  • 558,678,770 vaccine doses administered (3/21/22)
  • 76.8% (255 million people) of the population has received 1 or more doses and 65.4% (217.1 million people) of the population have been fully vaccinated
  • 81.6% of people five years and older have received at least 1 dose and 69.5% have been fully vaccinated
VACCINE UPDATES
COVID-19 Vaccines Continue to Protect Against Hospitalization and Death Among Adults: CDC released a statement that COVID-19 vaccination continues to help protect adults against severe illness with COVID-19, including hospitalizations and death, according to two reports released in last week’s MMWR . During Omicron, COVID-19-associated hospitalization rates increased for all adults, regardless of vaccination status, but rates were 12 times higher among adults who were unvaccinated compared to adults who received a booster or additional doses. Hospitalization rates were also highest among non-Hispanic Black adults and nearly 4 times as high among Black adults than White adults during the peak of Omicron. CDC continues to recommend that everyone 5 years and older stay up to date on their COVID-19 vaccines, including a booster dose for those who are eligible. We also must work to ensure everyone has equitable access to vaccines and treatments by focusing efforts on reaching people who have been disproportionately affected, so that they can be protected from the effects of the virus, including severe illness, hospitalization, and death.

FDA to Hold Advisory Committee Meeting on COVID-19 Vaccines to Discuss Future Boosters: The U.S. Food and Drug Administration (FDA) announced a virtual meeting of its Vaccines and Related Biological Products Advisory Committee (VRBPAC) on Wednesday, April 6, to discuss considerations for future COVID-19 vaccine booster doses and the process for selecting specific strains of the SARS-CoV-2 virus for COVID-19 vaccines to address current and emerging variants. Along with the independent experts of the advisory committee, representatives from the U.S. Centers for Disease Control and Prevention and the National Institutes of Health will participate in the meeting.

One-Year Anniversary of Health Center COVID-19 Vaccine Program: Today, the U.S. Department of Health and Human Services (HHS) recognized the one-year anniversary of the Health Resources and Services Administration’s (HRSA)  Health Center COVID-19 Vaccine Program , which received funding from President Biden’s American Rescue Plan and has provided COVID-19 vaccines directly to thousands of HRSA-supported health center sites nationwide. To date, health centers have administered more than 20 million vaccines in underserved communities across the country through the HRSA program and partnerships with states.

TESTING AND TREATMENT
FDA Safety Communication on At-Home COVID-19 Tests: The FDA  issued a safety communication  to alert people of the potential for harm if FDA-authorized at-home COVID-19 tests are not used according to the manufacturer’s test instructions. The FDA is also reminding people to keep the tests out of reach from children and pets. The FDA has received reports of injuries caused by the incorrect use of at-home COVID-19 tests, such as people putting the test chemicals in their eyes, due to the small vials of test solution were mistaken for eye drops. The FDA is also aware of children putting small plastic vials in their mouth and swallowing test solution. This safety communication provides:

  • Recommendations for people using FDA-authorized at-home COVID-19 diagnostic tests
  • Background on the issue and the FDA’s actions
  • Instructions for reporting problems with at-home COVID-19 testing to the FDA

EUA for At-Home Test: The FDA issued an emergency use authorization (EUA) for PHASE Scientific International, Ltd.’s INDICAID COVID-19 Rapid Antigen At-Home Test, an OTC #COVID19 antigen diagnostic on March 16. The FDA is committed to increase the availability of appropriately accurate and reliable at-home COVID19 diagnostic tests, and to facilitate consumer access to these tests.

RESEARCH
COVID-19-Associated Hospitalizations Among Adults During SARS-CoV-2 Delta and Omicron Variant Predominance: CDC released an MMWR on COVID-19-associated hospitalizations among adults during SARS-CoV-2 Delta and Omicron variant predominance by race/ethnicity and vaccination status from fourteen states between July 2021 – January 2022. SARS-CoV-2 infections can result in COVID-19–associated hospitalizations, even among vaccinated persons. In January 2022, unvaccinated adults and those vaccinated with a primary series, but no booster or additional dose, were 12 and three times as likely to be hospitalized, respectively, as were adults who received booster or additional doses. Hospitalization rates among non-Hispanic Black adults increased more than rates in other racial/ethnic groups. All adults should stay up to date with COVID-19 vaccination to reduce their risk for COVID-19–associated hospitalization. Implementing strategies that result in the equitable receipt of COVID-19 vaccinations among persons with disproportionately higher hospitalizations rates, including non-Hispanic Black adults, is an urgent public health priority.

Effectiveness of mRNA Vaccination in Preventing COVID-19-Associated Invasive Mechanical Ventilation and Death: CDC released an MMWR on the effectiveness of mRNA vaccination in preventing COVID-19-associated invasive mechanical ventilation and death in the United States from March 2021 – January 2022. COVID-19 mRNA vaccines provide protection against COVID-19 hospitalization among adults. However, how well mRNA vaccines protect against the most severe outcomes of COVID-19–related illness, including use of invasive mechanical ventilation (IMV) or death, is uncertain. Receiving 2 or 3 doses of an mRNA COVID-19 vaccine was associated with a 90% reduction in risk for COVID-19–associated IMV or death. Protection of 3 mRNA vaccine doses during the period of Omicron predominance was 94%. COVID-19 mRNA vaccines are highly effective in preventing the most severe forms of COVID-19. CDC recommends that all persons eligible for vaccination get vaccinated and stay up to date with COVID-19 vaccination.

Marvin B. Figueroa, Director
U.S. Department of Health and Human Services
Intergovernmental and External Affairs
200 Independence Ave., S.W.
Washington, D.C. 20201

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Brave of Heart Scholarship

The Brave of Heart Fund was founded in May 2020 by the Foundations of Cigna and New York Life and administered by E4E Relief. It was established to provide charitable grants and emotional support services to families of frontline healthcare workers, volunteers, and support staff whose lives were lost in the fight against COVID-19.

Now, the Brave of Heart Fund continues to honor the hard work and sacrifice of healthcare workers and their families via scholarship funding for their spouses, domestic partners, and children.

Applications are now being accepted online.

Up to $25,000.00 annually is available in scholarship funding, depending on an eligible applicant’s academic focus, student status, and other criteria.

Eligible Applicants

  • Must be a spouse, domestic partner, or child of a healthcare worker, volunteer, or support staff whose life was lost in the fight against COVID-19.
  • Must plan to enroll in accredited studies at the undergraduate or graduate levels, in community college, or in vocational and technical schools.
  • May be non-traditional students and individuals enrolled in part-time coursework.
  • Do not have to be previous recipients of Brave of Heart Fund grants; recipients of previous grant funding are also still eligible.

Application Deadline

For Fall 2022 semester scholarships:
April 20, 2022

3:00PM Central Standard Time

House Energy & Commerce Hearing on COVID-19 Frontlines

On March 2, the House Energy and Commerce Subcommittee on Oversight and Investigations held a hearing on “Lessons from the Frontline: COVID-19’s Impact on American Health Care.” Subcommittee Chair Diane DeGette (D-CO) and members Lorie Trahan (D-MA) and Tom O’Halleran (D-AZ) referenced the important role of EMS during their comments. The AAA submitted written comments for the hearing record requesting that the Subcommittee help address the EMS workforce shortage, access to grant funding for all EMS provider types and stability with funding for ground ambulance services. Here is a link should you want to watch a recording of the hearing.

 

Read the AAAs Written Comments Here

NAEMT | Quick Survey on EMS Utilization of COVID-19 Waivers

EMS Utilization of COVID-19 Waiver Survey

TAKE SURVEY
Please help our industry understand how EMS has utilized the current COVID-19 waivers. The results of this survey will be used to educate federal regulators and elected officials on EMS reimbursement reform. The survey will take no longer than five (5) minutes to complete and will ask how your ambulance agency has utilized the waivers throughout the COVID-19 pandemic.

 

During the ongoing Public Health Emergency (PHE), CMS issued four waivers to assist ambulance agencies. Separate from the CMS ET3 project, these waivers allowed for reimbursement for transporting to alternate destination of care, treatment in lieu of transport, hospital at home utilizing community paramedics, and telehealth facilitation.

 

We kindly ask that ONE leader from your agency take the survey before March 14. No identifiable information will be shared or distributed. NAEMT will share the results of the survey with its members and participants.

Thank you for taking time to participate in this survey to advance EMS!

TAKE SURVEY

HRSA Federal Office of Rural Health Policy Updates

From HRSA’s Federal Office of Rural Health Policy

What’s New

HRSA Rural Public Health Workforce Training Network Program – applications due March 18.  HRSA anticipates awards for more than 30 community-based organizations that will join an effort to train and place public health professionals in rural and tribal areas.  Eligible applicants include minority-serving institutions of higher education, Critical Access Hospitals, community health centers, nursing homes, Rural Health Clinics, substance use providers, and state or local workforce development boards.  Each grantee will receive approximately $1.5 million for a three-year project.  FORHP will hold a webinar for applicants on Wednesday, January 5 at 1:00 pm ET.  For those unable to view online, see the Events section below for dial-in information.

HRSA Rural Residency Planning and Development (RRPD) Program  – deadline extended until January 11. The Health Resources and Services Administration (HRSA) revised the program sustainability requirements and extended the deadline for RRPD grant applications. Applicants should review the changes and can resubmit their applications if needed. HRSA will only review your last submitted application. This program aims to increase opportunities for physicians to train in rural residencies. A total of $10.5 million will develop 14 new rural residency programs accredited by the Accreditation Council on Graduate Medical Education (ACGME). Eligible applicants include rural hospitals, GME consortiums, and tribal organizations. For questions, email RuralResidency@hrsa.gov.

HRSA Small Health Care Provider Quality Improvement Program Funding Opportunity – applications due March 21. HRSA will be making approximately 40 awards of up to $200,000 each to support the planning and implementation of quality improvement activities in rural communities. Applicants must be rural domestic public or private nonprofit entities with demonstrated experience serving, or the capacity to serve, rural underserved populations in a HRSA-designated rural area. FORHP will hold a technical assistance webinar for applicants via Zoom on Wednesday, January 26, 2022 from 2-3 p.m. ET. A recording will be available for those who cannot attend.

Share Your Experiences on Rural Emergency Preparedness and ResponseThe Rural Health Information Hub (RHIhub)  wants to hear about how rural communities, health care facilities, public health departments, first responders, tribes, rural serving organizations, and others have had to adapt, collaborate, and innovate in the face of disasters and public health emergencies. They are looking for examples of lessons learned, successes, challenges, or other helpful information to highlight related to emergency preparedness, response, and recovery for a variety of disasters. Examples will be shared in an emergency preparedness toolkit on the RHIhub website.

Spread the Word About Vaccine Boosters. The U.S. Department of Health & Human Services released new resources – posters, flyers, videos, and talking points – to help promote the extra protection from COVID-19 boosters.  All vaccinated adults aged 18+ are eligible for a booster.  Search by zip code to find nearby locations providing adult and pediatric vaccines and boosters for COVID-19 and the flu at vaccines.gov.

Ongoing: HRSA Payment Program for RHC Buprenorphine-Trained Providers.  In June 2021, HRSA launched an effort to improve access to substance use disorder treatment by paying for providers who are waivered to prescribe buprenorphine, a medication used to treat opioid use disorder.  Rural Health Clinics (RHCs) still have the opportunity to apply for a $3,000 payment on behalf of each provider who trained to obtain the waiver necessary to prescribe buprenorphine after January 1, 2019.  Approximately $1.5 million in program funding remains available for RHCs and will be paid on a first-come, first-served basis until funds are exhausted.  Send questions to DATA2000WaiverPayments@hrsa.gov. There is ongoing availability of a free online course for waiver eligibility training from the American Osteopathic Academy of Addiction Medicine and the Providers Clinical Support System.


COVID-19 Resources

NARHC Assistance with Federal Programs for COVID-19 Testing, Vaccine Distribution, and Provider Relief FundThe National Association of Rural Health Clinics (NARHC) has background information and guidelines in its collection of technical assistance webinars for all COVID-related programs designated for Rural Health Clinics.

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

Rural Health Clinic Vaccine Distribution (RHCVD) Program.  Under the program, Medicare-certified RHCs will receive direct COVID-19 vaccines in addition to their normal jurisdictions’ weekly allocation.  Contact RHCVaxDistribution@hrsa.gov for more information.

Community Toolkit for Addressing Health Misinformation. The new resource asks for participation from individuals, teachers, school administrators, librarians, faith leaders, and health care professionals to understand, identify, and stop the spread of misinformation.  The toolkit includes common types of misinformation and a checklist to help evaluate the accuracy of health-related content.

Online Resource for Licensure of Health Professionals.  As telehealth usage increased during the pandemic, FORHP funded new work with the Association of State and Provincial Psychology Boards to reduce the burden of multi-state licensure.  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.

HRSA COVID-19 Coverage Assistance Fund.  HRSA will provide claims reimbursement at the national Medicare rate for eligible health care providers administering vaccines to underinsured individuals.

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.

CDC COVID-19 Updates.  The Centers for Disease Control and Prevention (CDC) provides daily updates and guidance, including a section specific to rural health careCOVID-19 Vaccination Trainings for new and experienced providers, and Tips for Talking with Patients about COVID-19 Vaccination.

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 telemedicine platforms, such as an app on a mobile device. Hear from participating clinicians, and email to learn more and sign up.

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 Grant 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.

New: Reaching Farm Communities for Vaccine Confidence.  The AgriSafe Network is a nonprofit organization that provides information and training on injury and disease related to agriculture.  Their health professionals and educators created a social media toolkit that aims to provide clear messages about COVID-19 vaccination for agriculture, forestry, and fishing workers.


Funding and Opportunities

SAMHSA Grants for Rural Emergency Medical Services Training – February 14.  The Substance Abuse and Mental Health Services Administration (SAMHSA) will make 27 awards of up to $200,000 each to recruit and train emergency medical services (EMS) personnel with a focus on mental and substance use disorders.  Eligible applicants are rural EMS agencies operated by a local or tribal government and non-profit EMS agencies.


Policy Updates

Send questions to ruralpolicy@hrsa.gov.

Medicare Rule Adds 1,000 Physician Residency Slots and Other GME Policies.  Last week, the Centers for Medicare & Medicaid Services (CMS) finalized several graduate medical education (GME) proposals that will enhance the health care workforce and fund additional medical residency positions in hospitals serving rural and underserved communities.  This Fiscal Year 2022 Medicare Inpatient Hospital Payment Final Rule adds 1,000 new Medicare-funded residency positions prioritizing hospitals that serve areas with the greatest needs. It also allows new opportunities for rural teaching hospitals participating in an accredited rural training track to increase their full time equivalent (FTE) caps.  The rule also allows hospitals beginning a new medical residency training program to reset their FTE caps and per-resident amounts under qualifying circumstances.  Rural hospitals seeking a cap reset must start new residency training programs by December 2025.  Finally, CMS seeks comments on alternative methods to prioritize additional FTE resident cap slots and the review process to determine eligibility for per resident amounts or FTE cap resets in specified situations.

CMS Suspends Enforcement of Vaccine Mandate While Court Ordered Injunctions Remain in Effect (pdf). This month, CMS issued a memo to State Survey Agency Directors indicating that the agency will not enforce the new rule stipulating vaccination for health care workers in certified Medicare/Medicaid providers and suppliers (including nursing facilities, hospitals, dialysis facilities and all other provider types covered by the rule). Health care facilities may voluntarily choose to comply with the Interim Final Rule at this time.


Learning Events and Technical Assistance

Assistance for Rural Public Health Workforce Funding Applications – Wednesday, January 5 at 1:00 pm ET.  FORHP will hold a one-hour webinar via Zoom for those applying for the Rural Public Health Workforce Training Network Program.  Applications are due March 18th for the grant that will invest $48 million to place newly trained public health professionals in rural areas.  To dial in:  1-833-568-8864; Participant Code: 86083981. Contact RPHWTNP@hrsa.gov for more information or a recording of the webinar.


Resource of the Week

Federally Qualified Health Centers and the Health Center ProgramThis recently updated topic guide at the Rural Health Information Hub includes new FAQs on Medicare reimbursement for telehealth services, insight on financial and operational performances of health centers, and the differences between a Federally Qualified Health Center and a Rural Health Clinic.


Approaching Deadlines

Last Day for RHCs to Spend COVID-19 Testing Funds – December 31

Department of Labor Stand Down Grants for Veterans Services – December 31

USDA Guaranteed Loans for Rural Rental Housing – December 31

COVID-19 Extension for Medicare Graduate Medical Education (GME) Affiliation Agreement  – January 1

Treasury Department New Markets Tax Credit Program – January 3

CDC Grants for New Investigators/Research for Interpersonal Violence Impacting Children/Youth – January 4

HRSA Family-to-Family Health Information Centers (F2F HICs)  – January 5

NIHB/CDC Building Capacity for Tribal Infection Control – January 7

Nominations Sought for Indigenous Health Equity Committee – extended to January 7

NIH Research for AI/AN End-of-Life Care – January 8

Burroughs Wellcome Fund Seed Grants for Climate Change and Health – January 10

USDA Farm to School Grants – January 10

HHS Grants for Family Planning Services – January 11

HRSA Rural Residency Planning and Development (RRPD) Program – extended to January 11

HRSA Nurse Corps Loan Repayment Program – January 13

HRSA Nurse Faculty Loan Program – January 13

HRSA Rural Communities Opioid Response Program – Implementation – January 13

SAMHSA Grants for Rural Emergency Medical Services Training – February 14

CDC Research on Telehealth Strategies for PrEP and ART – January 18

Comments Requested: DEA Regulation of Telepharmacy Practice – January 18

NIH Researching Behavioral Risk Factors for Cancer in Rural Populations – January 18

Department of Labor YouthBuild Program – January 21

CDC Centers for Agricultural Safety and Health – January 24

ACL Empowering Communities for Chronic Disease Self-Management – January 25

ACL Empowering Communities to Deliver and Sustain Falls Prevention Programs – January 25

CDC Seeking Public Input on Work-Related Stress for Health Workers – Extended to January 25

HRSA Delta Region Rural Health Workforce Training Program – January 25

CDC Cancer Prevention and Control for State, Territorial, and Tribal Organizations – January 26

HRSA Access to HIV Services for Women and Children – January 28

HRSA Rural Health Network Development Planning Program – January 28

HHS COVID-19 and Health Equity Impact Fellowship – extended to January 31

HHS Technology Challenge for Racial Equity in Postpartum Care – January 31

HRSA Centers of Excellence for Training Minorities in Health Professions – January 31

SAMHSA-American Psychiatric Association Diversity Leadership Fellowship – January 31

HRSA Leadership Education in Adolescent Health – February 1

Indian Health Service Forensic Healthcare Services for Domestic Violence Prevention – February 2

Indian Health Service Substance Abuse and Suicide Prevention Program – February 2

Indian Health Service Zero Suicide Initiative – February 2

National Health Service Corps Loan Repayment Programs – Extended to February 3

CDC Research to Prevent Firearm-Related Violence and Injuries – February 4

RWJF Summer Health Professions Education Program for Underrepresented Minorities – February 5

HRSA Predoctoral Training in Public Health Dentistry and Dental Hygiene – February 7

SAMHSA Harm Reduction Program – February 7

VA Supportive Services for Veteran Families – February 7

USDA Farm and Food Worker Relief Grants – February 8

IHS Tribal Self-Governance Negotiation – February 10

IHS Tribal Self-Governance Planning – February 10

CDC Strengthening Infection Prevention – February 11

CDC Evaluating Substance Use Prevention Incorporating ACEs Prevention – February 22

HRSA Mobile Health Training – Nurse Education, Practice, Quality and Retention – February 22

USDA Rural eConnectivity Broadband Loan and Grant Program – February 22

Rural Communities Opioid Response Program-Behavioral Health Care Technical Assistance (RCORP-BHCTA) – March 9

HRSA Rural Public Health Workforce Training Network Program – March 18

HRSA Small Health Care Provider Quality Improvement Program – March 21

FCC/USAC Rural Health Care Connect Fund – April 1

FCC/USAC Telecommunications Program – April 1

USDA Local Food Purchase Assistance Program – April 5


Ongoing Opportunities

CFPB Rental Assistance Finder

HHS/DoD National Emergency Tele-Critical Care Network

Extended Public Comment Period for FCC’s COVID-19 Telehealth Program

FCC Emergency Broadband for Individuals and Households

FEMA COVID-19 Funeral Assistance

HRSA Payment Program for Buprenorphine-Trained Clinicians – Until Funds Run Out

AgriSafe Nurse Scholar Program – March 2022

AHRQ Health Services Research Demonstration and Dissemination Grants – September 2022

AHRQ Research to Improve Patient Transitions through HIT – December 2022

American Indian Public Health Resource Center Technical Assistance

ASA Rural Access to Anesthesia Care Scholarship

Burroughs Wellcome Fund Seed Grants for Climate Change and Health – Quarterly through August 2023

CDC Direct Assistance to State, Tribal, Local, and Territorial Health Agencies

CDC Training Pediatric Medical Providers to Recognize ACEs

Delta Region Community Health Systems Development Program

Department of Commerce American Rescue Plan Funding for Indigenous Communities – September 2022

Department of Commerce: Economic Development Assistance Programs

Department of Labor Dislocated Worker Grants

DRA Technical Assistance for Delta Region Community Health Systems Development

EPA Drinking Water State Revolving Fund

FEMA/SAMHSA Crisis Counseling Assistance and Training Program (CCP)

GPHC & RWJF: Rapid Cycle Research and Evaluation Grants for Cross-Sector Alignment

HRSA Technical Assistance for Look-Alike Initial Designation for the Health Center Program

Housing Assistance Council: Housing Loans for Low-Income Rural Communities

HUD Hospital Mortgage Insurance Program

IHS Tribal Forensic Healthcare Training

IHS/DOD Medical Supplies and Equipment for Tribes (Project TRANSAM)

NARHC Certified Rural Health Clinic Professional Course

NIH Project Talk Initiative Host Site Applications

NIH Dissemination and Implementation Research in Health – May 2022

NIH Practice-Based Research for Primary Care Suicide Prevention – June 2022

NIH Research – Alcohol and Other Substance Use – Various Dates Through August 2022

NIH Research: Intervening with Cancer Caregivers to Improve Patient Outcomes – September 8, 2022

NIH Research on Minority Health/Health Disparities – September 8, 2022

NIH Research on Palliative Care in Home/Community Settings – September 8, 2022

NIH Intervention Research to Improve Native American Health – Various Dates Until September 2023

NIH Researching the Role of Work in Health Disparities – Various Dates Until September 2024

NIH Special Interest Research – Pandemic Impact on Vulnerable Children and Youth – May 2024

Nominations for Federal Advisory Commission on HIV, Viral Hepatitis, and Sexually Transmitted Diseases

Nominations for National Advisory Committee on Migrant Health

Primary Care Development Corporation Community Investment Loans

Rural Graduate Medical Education Planning and Development

RWJF Investigator-Initiated Research to Build a Culture of Health

RWJF Pioneering Ideas Brief Proposals

SBA Guaranteed Loans for Small Business

Southeast Rural Community Assistance Loans

Tribal Grant Writing Training

USDA Community Facilities Program

USDA Community Food Projects Technical Assistance

USDA Drinking Water and Waste Disposal for Rural and Native Alaskan Villages

USDA Economic Impact Initiative Grants

USDA Emergency Community Water Assistance Grants

USDA Healthy Food Financing Initiative Technical Assistance

USDA Intermediary Relending Program

USDA Rural Business Development Grants

USDA Rural Business Investment Program

USDA Rural Energy Savings Program

USDA SEARCH – Special Evaluation Assistance for Rural Communities and Households (for Water/Waste Projects)

USDA Summer Food Program

USDA Technical Assistance for Healthy Food Financing Initiative

USDA Telecommunications Infrastructure Loans

USDA Funding for Rural Water and Waste Disposal Projects

USDOT Rural Opportunities to Use Transportation for Economic Success (R.O.U.T.E.S)


The Announcements from the Federal Office of Rural Health Policy are distributed weekly. To receive these updates, send an email with “Subscribe” in the subject line.

 

5th Circuit Lifts Injunction on CMS Mandatory Vaccine Requirement for Half of U.S.

On December 15, 2021, the United States Court of Appeals for the Fifth Circuit issued a ruling which modifies an earlier court national injunction related to the CMS mandatory vaccination rules.  In the latest ruling, the court upheld the injunction issued by the United States District Court for the Eastern District of Missouri as it applied to the fourteen (14) plaintiff states, Louisiana, Montana, Arizona, Alabama, Georgia, Idaho, Indiana, Mississippi, Oklahoma, South Carolina, Utah, West Virginia, Kentucky, and Ohio.  However, it overturned the lower court’s expansion of that injunction to other, non-plaintiff states, in the injunction.  Meaning that between the 5th and 8th Circuit Court rulings, the CMS mandatory vaccination injunction only applies to the following 24 states:

5th Circuit Plaintiffs: Louisiana, Montana, Arizona, Alabama, Georgia, Idaho, Indiana, Mississippi, Oklahoma, South Carolina, Utah, West Virginia, Kentucky, Ohio

8th Circuit Plaintiffs: Missouri, Nebraska, Arkansas, Kansas, Iowa, Wyoming, Alaska, South Dakota, North Dakota and New Hampshire.

States not covered by the CMS mandatory vaccination injunction:

California, Colorado, Connecticut, Delaware, Florida, Hawaii, Illinois, Maine, Maryland, Massachusetts, Michigan, Minnesota, Nevada, New Jersey, New Mexico, New York, North Carolina, Oregon, Pennsylvania, Rhode Island, Tennessee, Texas, Vermont, Virginia, Washington, and Wisconsin

This decision, follows another mandatory vaccine related decision issued by the United States Court of Appeals for the Eleventh Circuit which criticized the Louisiana court for expanding the CMS vaccine mandate nationwide given that a Florida District Court had already refused to issue an injunction and because it felt that it was likely that the mandate was likely authorized under current CMS rules.

What does this mean for employers?

If you are an employer in one of the states not covered by an injunction, you should consult with any covered healthcare facility that your organization performs services under contract. These covered healthcare facilities will be required to mandate vaccination for their staff and for any contractor staff that interacts with their employees or patients.  Additionally, they will be seeking proof that your staff is vaccinated against COVID-19, unless they have a protected medical or religious accommodation.

Employers should have already taken the initial steps toward compliance with the CMS mandatory vaccination rules, including having a list of all employees with their vaccination status.  Additionally, employers should have an established policy related to mandatory vaccination and a procedure for requesting and processing an exception/accommodation requests. Lastly, healthcare institutions may independently institute mandatory vaccination rules for their employees and can require this of anyone entering their facility, including EMS staff.

We will continue to keep you post as these cases proceed through the legal system. These facilities may still independently require your staff to be vaccinated. If your organization has questions or need assistance deciphering or preparing for these requirements, please contact the AAA by emailing hello@ambulance.org.