From the US Department of Health and Human Services Assistant Secretary for Preparedness and Response (ASPR)
This issue of The Express highlights the following new/updated resources:
New! The Exchange, Issue 12–Special Edition: COVID-19 and Healthcare Professional Stress and ResilienceIn the months that have passed since a pandemic was declared, we have witnessed our nation’s healthcare providers working tirelessly to care for patients, with surges testing their facilities’ and their own personal resilience. This kind of work is grueling and can take a significant toll on physical and mental health. The resources developed for/highlighted in this issue can help individuals identify and address risk and the negative mental health effects of stress in themselves, their colleagues, and their staff.New: Crisis Standards of Care and COVID-19: What’s Working and What Isn’t?Speakers in this webinar discussed clinical consultation versus triage support, systems-level information sharing, coalition-level coordination activities, and recent publications/resources to help with planning efforts. Access those and the set of resources referenced during the webinar in our COVID-19 Crisis Standards of Care Resource Collection.New: Support for Overstretched Clinicians During the Ongoing PandemicIn this video, Dr. Eileen Barrett, Director of Continuous Medical Education and Graduate Medical Education Wellness Initiatives from the University of New Mexico, discusses proactive programs available to support staff during stressful times. Check out the related article in Issue 12 of The Exchange and the entire COVID-19 Healthcare Professional Stress and Resilience speaker series.New: Emergency Responder Self-Care Plan: Behavioral Health PPETaking care of oneself is difficult during a pandemic, where responders experience additional stressors related to home and personal circumstances as well as those brought on by challenging mission demands. This fillable form includes steps people can take to stay healthy and fit for duty while caring for others. The form can be completed before each mission/event and keep handy to help apply coping strategies when things get tough.New: Lessons Learned by a COVID-19 Designated HospitalThe speakers in this brief video share lessons learned when The University Hospital of Brooklyn, the primary teaching hospital for the State University of New York Downstate Health Sciences University, became the only COVID-19 designated hospital in Brooklyn.New: Armed Intruder/Active Shooter Training Module
This free short training module provides healthcare providers and other staff with an overview of strategies and protocols for an armed intruder/active shooter incident. Speakers describe the “run-hide-fight” and “secure-preserve-fight” approaches and share “Stop the Bleed” basics, a video for how to apply a tourniquet, and resources for managing stress. Though this training was created by the Mount Sinai Health System, it is applicable to other healthcare providers and healthcare systems.
COVID-19 Clinical Rounds Peer-to-Peer Virtual Communities of Practice are a collaborative effort between ASPR, the National Emerging Special Pathogen Training and Education Center (NETEC), and Project ECHO. These interactive virtual learning sessions aim to create a peer-to-peer learning network where clinicians from the U.S. and abroad who have experience treating patients with COVID-19 share their challenges and successes; a generous amount of time for participant Q & A is also provided. These webinar topics are covered every week:
The Healthcare & Public Health Sector Partnership led by ASPR’s Division of Critical Infrastructure Protection is actively engaged in responding to COVID-19. Register here to receive regular response bulletins.
From the Washington Post by William Wan on December 3, 2020
Pandemic is pushing America’s 911 system to ‘breaking point,’ ambulance operators say
Surging demand, financial strain are leaving ambulance teams exhausted and running out of funds
The coronavirus pandemic has pushed America’s 911 system and emergency responders to a “breaking point,” with ambulance operators exhausted and their services financially strained, according to the group that represents them.
The situation since the novel coronavirus struck last winter has grown so dire that the American Ambulance Association recently begged the Department of Health and Human Services for $2.6 billion in emergency funding.
From The Hill by Zack Budryk on December 3, 2020
The American Ambulance Association has warned that the emergency response system has reached a “breaking point” as the coronavirus rages across the country in a letter to the Department of Health and Human Services.
“The 911 emergency medical system throughout the United States is at a breaking point,” Aarron Reinert, the president of the American Ambulance Association, said in the Nov. 25 letter, obtained by The Hill. “Without additional relief, it seems likely to break, even as we enter the third surge of the virus in the Mid-West and West.”
Asbel Montes, AAA Payment Reform Chair, partnered with fellow member Solutions Group on this detailed HHS Tranche 3 funding video update.
Thank you to Asbel and Solutions Group for sharing!
From the HRSA Federal Office of Rural Health Policy
The Health Resources and Services Administration’s Federal Office of Rural Health Policy has released the Notice of Funding Opportunity (NOFO) for the Rural Health Care Services Outreach Program (Outreach) (HRSA-21-027). HRSA plans to award 60 grants to rural communities as part of this funding opportunity.
The Outreach Program administered by HRSA’s FORHP focuses on expanding the delivery of health care services to include new and enhanced services exclusively in rural communities. Applicants are required to deliver health care services through a consortium of at least three health care provider organizations, use an evidence-based or promising practice model to inform their approach, and demonstrate health outcomes and sustainability by the end of the four-year performance period.
In addition to funding Outreach programs through the regular Outreach track, in FY 21, FORHP will also afford applicants a unique opportunity to take part in a national effort that targets rural health disparities through a second track called the “Healthy Rural Hometown Initiative.” This initiative was created through the HHS Rural Task Force and driven by findings from a report published by the Centers of Disease Control and Prevention (CDC) that noted that the number of preventable death from the five leading cause of death in rural areas was higher than those in urban areas. Unfortunately, these findings echo earlier CDC research on the rural disparities in avoidable or excess death in 2017.
The Healthy Rural Hometown Initiative (HRHI) is an effort that seeks to address the underlying factors that are driving growing rural health disparities related to the five leading causes of avoidable death (heart disease, cancer, unintentional injury/substance use, chronic lower respiratory disease, and stroke). The goal of the HRHI track is to demonstrate the collective impact of projects that better manage conditions, address risk factors and focus on prevention that relate to the leading causes of death in rural communities. This track should be a good fit for applicants who want to identify and bridge the gap between the social determinants of health and other systemic issues that contribute to achieving health equity with regards to excess death in rural communities. Furthermore, this is a rural-specific and community-based approach to addressing these disparities and represents a new and more targeted strategy given the enduring health gaps between rural and urban populations.
Of the successful 60 award recipients, HRSA aims to award approximately 45 to regular Outreach track applicants and at least 15 to HRHI applicants for a ceiling amount of up to $200,000 (Regular Outreach) or $250,000 (HRHI) total cost (includes both direct and indirect, facilities and administrative costs) per year (and final numbers will be subject to how applicants score).
The HRHI is part of an ongoing multi-year effort by FORHP to highlight how rural community health efforts can improve health at the local level. We are encouraging rural health stakeholders to join us in this broader effort while also taking on the challenge of addressing these long-standing rural health disparities related to the five leading causes of death.
NOTE: The eligibility criteria for this program has changed and now includes all domestic public and private, nonprofit and for-profit entities with demonstrated experience serving, or the capacity to serve, rural underserved populations. Urban-based organizations applying as the lead applicant should ensure there is a high degree of rural control in the project. The applicant organization must represent a network that includes at least three or more health care provider organizations and, at least 66% (or two-thirds) of consortium members must be located in a HRSA-designated rural area.
Please review the guidance in its entirety for more information about eligibility criteria and specific program requirements. Visit www.grants.gov to review the Outreach NOFO and apply. Learn about the Outreach Program.
A webinar for applicants is scheduled on Tuesday October 13, from 3-4:30 p.m., EST. A recording will be made available for those who cannot attend.
For more information about this funding opportunity, contact the Program Coordinator, Alexa Ofori, at RuralOutreachProgram@hrsa.gov.
The online portal for ambulance service providers and suppliers to submit applications for additional funding under the HHS Provider Relief Fund is now open.
Apply Soon for Funds!
While providers and suppliers have until November 6 to apply for funding, we strongly recommend that AAA members submit applications as soon as you are prepared as funding is on a first-come, first-served basis. HHS allocated a total of $20 billion for this round of funding.
Attend Today’s AAA Funding Webinar
The AAA will be hosting a webinar today, Monday, October 5, at 11:00 am (eastern), on how to apply for the funds and what information you will need in applying.
Thank You AAA Members!
As reported by the AAA on October 1, the additional funds are a direct result of the efforts of the AAA and our members and we thank all of you who reached out to the White House or your members of Congress advocating for the funds.
Although President Donald Trump promised Newsmax earlier this month that he would “certainly look into it,” several ambulance professionals and their representatives have since told us they have seen none of the operating funds in question from the Department of Health and Human Services.
The Department of Health and Human Services (HHS) recently announced that it would be extending the deadline for health care providers to apply to receive general distribution funding from the HHS Provider Relief Fund. The deadline to apply for these funds was previously June 3, 2020.
On March 27, 2020, President Trump signed into law the Coronavirus Aid, Relief, and Economic Security Act (CARES Act). As part of that Act, Congress allocated $100 billion to the creation of a “CARES Act Provider Relief Fund,” which will be used to support hospitals and other healthcare providers on the front lines of the nation’s coronavirus response. An additional $75 billion was allocated as part of the Paycheck Protection Program and Health Care Enhancement Act, bringing the total “Provider Relief Fund” up to $175 billion. This $175 billion will be distributed to health care providers and suppliers to fund healthcare-related expenses or to offset lost revenue attributable to COVID-10.
HHS ultimately elected to allocate these funds through a $50 billion “general allocation,” and multiple smaller “targeted allocations.”
Under its general allocation program, HHS intended to provide health care providers with funds roughly equal to 2% of the provider’s 2018 “net patient revenue,” i.e., the provider’s total revenues from patient care minus provisions for bad debt, contractual write-offs, and certain other adjustments. This general allocation was made in two tranches, with the first tranche being distributed to all providers in mid-April. This first tranche was made based on provider’s 2019 Medicare revenues. As a result, any provider that received payments from the Medicare Fee-for-Service Program in 2019 automatically received an initial relief payment. However, HHS required providers to submit an application to receive relief funding as part of the second tranche. The deadline for applying for the second tranche of relief funding was June 3, 2020.
Scope of New Extension
HHS indicated that the new extension is limited to health care providers that missed the June 3, 2020 deadline to apply for the second tranche of relief funding. The extension also applies to providers that were ineligible for the first tranche of relief funding due to a recent change of ownership. The specific situations that HHS indicated would meet the requirements for the extension include:
Health care providers that meet one of the requirements listed above will have until August 28, 2020 to submit an application for additional relief funds. This deadline aligns with the extended deadline for other eligible Phase 2 providers, such as Medicaid, Medicaid Managed Care, CHIP, and dental providers.
Applications should be submitted through the CARES Provider Relief Fund webpage, which can be found at: https://cares.linkhealth.com/#/.
Today, the U.S. Department of Health and Human Services released the HHS Secretary’s Report on Addressing Surprise Billing. The report, called for in Section 7 of President Trump’s Executive Order 13877, Improving Price and Quality Transparency in American Healthcare to Put Patients First, outlines critical steps, including Congressional action, to implement the Administration’s principles on surprise billing. Sound surprise billing legislation will not only protect patients but will encourage a fairer, more transparent, patient-centered healthcare system that benefits all Americans.
“Americans have the right to know what a healthcare service is going to cost before they receive it,” said HHS Secretary Alex Azar. “President Trump and his administration have done their part to deliver historic transparency around the prices of many procedures. Now it’s time for Congress to do what we all agree is necessary: combat surprise billing with an approach that puts patients in control and benefits all Americans.”
Surprise medical billing is a widespread and costly problem in the United States, and the need to address it has been highlighted during the Public Health Emergency (PHE) presented by COVID-19. Research shows that 41 percent of insured adults nationwide were surprised by a medical bill in the past two years alone, and that two thirds of adults worry about their ability to afford an unexpected medical bill. At a time when Americans are increasingly seeking medical care, practices such as surprise billing leave many patients vulnerable to the financial burdens presented by a nationwide pandemic.
HHS has taken regulatory and administrative action to increase price transparency permanently. On June 24, 2019, President Trump signed Executive Order 13877. Following direction from this Executive Order, HHS published two rules supporting the Administration’s mission to improve accessibility of healthcare price information to help patients make informed decisions about their use of healthcare services. The first, poised to go into effect January 1, 2021, requires hospitals operating in the United States to establish, update, and make public, at least annually, a list of their standard charges for the items and services that they provide. The second companion proposed rule would demand similar transparency from most group health plans and issuers of health insurance coverage within both the individual and group markets.
To supplement this progress, Congress must take additional action to build on the achievements of the Administration to eliminate the threat of surprise billing once and for all. This should be accomplished with the following principles in mind, as laid out by the Trump Administration on May 9th, 2019:
If done swiftly, a remarkable burden will be lifted from the shoulders of millions of Americans. By building on the foundation placed by Executive Order 13877, there is an opportunity to fill the remaining gaps and solve comprehensively a longstanding flaw, equivalent to price-gouging, within our healthcare industry.
July 20, 2020
The purpose of this notice is to inform Provider Relief Fund (PRF) recipients that received one or more payments exceeding $10,000 in the aggregate from the PRF of the timing of future reporting requirements. Detailed instructions regarding these reports will be released by August 17, 2020.
Congress appropriated funding to reimburse eligible health care providers for health care related expenses or lost revenues attributable to coronavirus. The Health Resources and Services Administration (HRSA) is administering the distribution of payments under the PRF program, funded through appropriations in the Coronavirus Aid, Relief, and Economic Security (CARES) Act (P.L. 116-136) and the Paycheck Protection Program and Health Care Enhancement Act (P.L. 116-139). Each recipient of a payment from the PRF that used any part of that payment agreed to a set of Terms and Conditions (T&Cs) which, among other obligations, require each recipient to submit reports to the Department of Health and Human Services (HHS). The reports shall be in such form, with such content, as specified by the Secretary of HHS in future program instructions directed to all recipients. HHS will be releasing detailed reporting instructions by August 17, 2020.
These reporting instructions will provide directions on reporting obligations applicable to any provider that received a payment from the following CARES Act/PRF distributions:
The reports will allow providers to demonstrate compliance with the T&Cs, including use of funds for allowable purposes, for each PRF payment. HRSA plans to provide recipients with Question and Answer (Q&A) Sessions via Webinar in advance of the submission deadline. Additional details will follow regarding the Q&A Sessions.
The reporting system will become available to recipients for reporting on October 1, 2020.
As a result of the continued consequences of Coronavirus Disease 2019 (COVID-19) pandemic, on this date and after consultation with public health officials as necessary, I, Alex M. Azar II, Secretary of Health and Human Services, pursuant to the authority vested in me under section 319 of the Public Health Service Act, do hereby renew, effective July 25, 2020, my January 31, 2020, determination that I previously renewed on April 21, 2020, that a public health emergency exists and has existed since January 27, 2020, nationwide.
News Release from the U.S. Department of Health and Human Services | Monday, July 20, 2020
Yesterday, the Office for Civil Rights (OCR) at the U.S. Department of Health and Human Services (HHS) is issuing guidance to ensure that recipients of federal financial assistance understand that they must comply with applicable federal civil rights laws and regulations that prohibit discrimination on the basis of race, color, and national origin in HHS-funded programs during COVID-19. This Bulletin focuses on recipients’ compliance with Title VI of the Civil Rights Act of 1964 (Title VI).
To help ensure Title VI compliance during the COVID-19 public health emergency, recipients of federal financial assistance, including state and local agencies, hospitals, and other health care providers, should:
OCR is responsible for enforcing Title VI’s prohibitions against race, color, and national origin discrimination. As part of the federal response to this public health emergency, OCR will continue to work in close coordination with our HHS partners and recipients to remove discriminatory barriers which impede equal access to quality health care, recognizing the high priority of COVID-19 testing and treatment.
Roger Severino, OCR Director, stated, “HHS is committed to helping populations hardest hit by COVID-19, including African-American, Native American, and Hispanic communities.” Severino concluded, “This guidance reminds providers that unlawful racial discrimination in healthcare will not be tolerated, especially during a pandemic.
“Minorities have long experienced disparities related to the medical and social determinants of health – all of the things that contribute to your health and wellbeing. The COVID-19 pandemic has magnified those disparities, but it has also given us the opportunity to acknowledge their existence and impact, and deepen our resolve to address them,” said Vice Admiral Jerome M. Adams, Surgeon General, MD, MPH. “This timely guidance reinforces that goal and I look forward to working across HHS and with our states and communities to ensure it is implemented.”
To read the new OCR Bulletin, please visit: Title VI Bulletin – PDF
To learn more about non-discrimination on the basis of race, color, national origin, sex, age, and disability; conscience and religious freedom; and health information privacy laws, and to file a complaint with OCR, please visit: www.hhs.gov/ocr.
For more OCR announcements related to civil rights and COVID-19, please visit: https://www.hhs.gov/civil-
May 29, 2020
Dr. Jon Krohmer, NHTSA, HRTF EMS/Pre-hospital Team Lead
Kate Elkins, NHTSA, HRTF EMS/Pre-hospital Deputy Team Lead
911, the universal number to call for emergency help nationwide, is a proven, life-saving service to the public. NHTSA’s Office of EMS oversees the National 911 Program, which envisions an emergency response system that best serves the public, providing immediate help in all emergency situations. This presentation covered the current Emergency Medical Services (EMS) Environment, Impacts and Next Steps for EMS in regards to COVID-19, and EMS and Fire Impacts on Community Lifelines.
On May 26, the AAA sent a letter to HHS Secretary Alex Azar and CMS Administrator Seema Verma, requesting improvements to the Medicare Accelerated and Advance Payment (MAAP) Programs. The nation’s response to the COVID-19 pandemic is putting an increased financial strain on emergency medical services, and ground ambulance service providers and suppliers already faced significant funding challenges. The suggested improvements include:
The AAA believes the improvements to the MAAP discussed above would provide short-term financial relief to ambulance service providers and suppliers nationwide and allow us to continue our critical work during this difficult time for our country. Read our letter HERE.
On May 1, 2020, CMS updated its “COVID-19 Frequently Asked Questions (FAQs) on Medicare Fee-for-Service (FFS) Billing.” The full document can be viewed by clicking here.
In the updated FAQ, CMS answers three important questions related to ambulance vehicle and staffing requirements: