Tag: Pennsylvania

CMS Extends Temporary Moratorium (NJ, PA, TX)

On January 9, 2017, the Centers for Medicare & Medicaid Services (CMS) issued a notice in the Federal Register extending the temporary moratoria on the enrollment of new Medicare Part B non-emergency ground ambulance providers and suppliers in the states of New Jersey, Pennsylvania, and Texas. The extended moratoria will run through July 29, 2017.

Section 6401(a) of the Affordable Care Act granted CMS the authority to impose temporary moratoria on the enrollment of new Medicare providers and suppliers to the extent doing so was necessary to combat fraud or abuse. On July 31, 2013, CMS used this new authority to impose a moratorium on the enrollment of new ambulance providers in Houston, Texas and the surrounding counties. On February 4, 2014, CMS imposed a second moratorium on newly enrolling ambulance providers in the Philadelphia metropolitan areas. These moratoria have been extended every six months thereafter.

However, on August 3, 2016, CMS announced changes to its existing moratoria on the enrollment of new ground ambulance suppliers. Specifically, CMS announced that the moratoria would be lifted for the enrollment of new emergency ambulance providers and supplier, but that it would expand the enrollment moratorium on non-emergency ambulance services to cover the entire states of New Jersey, Pennsylvania, and Texas. At the same time, CMS announced the creation of a new “waiver” program that would permit the enrollment of new non-emergency ambulance providers in these states under certain circumstances.

On or before July 29, 2017, CMS will need to make a determination on whether to extend or lift the enrollment moratorium.

Have a Medicare question? AAA members, send your inquiry to Brian Werfel, Esq. using our simple form!

2016 AMBY Best Employee Program: EmergyCare, EMS Academy

Congratulations to the 2016 AMBY Award Winners

Each year, the American Ambulance Association honors best practices, ingenuity, and innovation from EMS providers across the country with our AMBY Awards. 

EmergyCare’s EMS Academy Awarded the 2016 AMBY for Best Employee Programamby-congrats-emergycare

EmergyCare | Erie, PA

In order to combat the nationwide EMS recruitment and retention crisis, EmergyCare has developed its very own EMS Academy. Recent changes to regulations have increased the amount of hours required for EMT and paramedic training, making it more expensive thus, causing more candidates to balk at completing training.  EmergyCare realized that in order to continue to grow and thrive as an organization, that it had to get out in front of the hiring crisis.

Until recently, EmergyCare and other educational institutions held EMT and Paramedic training courses on a regular basis, keeping the pool of potential clinical employees at a reasonable level. In 2010 Pennsylvania’s Department of Health Bureau of EMS decided to no longer provide testing for Paramedics due to the high cost of keeping updated tests. Instead, the Bureau decided to make National Registry testing the only viable option. In order to provide this level of testing, all paramedic programs had to be licensed and approved by the NREMT, something that required programs to be affiliated with a college or university. These requirements elongated the paramedic program due to college level prerequisite courses, and substantially increased costs, discouraging applicants.

EmergyCare’s new EMS Academy pays employees and new hires a salary while they are training so they can support their families, while providing them with an education that turn into a professional career. Before implementing their new EMS Academy, EmergyCare surveyed staff to gauge interest in such a program and the results were overwhelmingly positive.

Prior to implementing their EMS Academy, EmergyCare’s employee turnover was already extremely low – 10% compared to the industry average of 30%. That being said, EmergyCare realized that the shortage of EMTs and paramedics were a serious threat to the service’s long term financial health. EmergyCare experiences about a 2% growth in call volume annually, and in order to keep up with this growth, realized that it needed to take action to address the EMT and Paramedic shortage.

EmergyCare’s goal was to have was to have 70% of new students certified to work as replacement staff for the current EmergyCare EMTs so that they can attend paramedic training. The Academy program would also expect to have 70% of the initial students certified to work at EmergyCare as full-time paramedics. In addition to hiring and training new employees, EmergyCare’s EMS Academy is allowing current employees to seek additional education. The previous year’s Academy Paramedics help offset EmergyCare’s current shortage of paramedics, enhancing employee morale by balancing current workloads, allowing operational staff to go off duty on time, and decreasing overtime due to having additional paramedics to assist with coverage for vacations, injuries, illness, and additional turnover.

EmergyCare has seen an immediate return on investment from its EMS Academy. Since implementation, the EMS Academy has already seen the following improvements:

  • Decreased staffing shortage by 85 – 90%
  • Balanced workload of current employees
  • Decreased “Turned Calls” by 50%
  • Decreased overtime expenses

Addressing the EMT and Paramedic shortage within the EMS industry has allowed EmergyCare to continue to grow and improve employee morale and retention. The EMS Academy will continue to focus on meeting current staffing needs for EmergyCare as well as provide and market the only alternative Paramedic training program for Northwest Pennsylvania.

Congratulations to the entire EmergyCare Team for your EMS Academy’s selection as the 2016 AMBY Winner for Best Employee Program.

CMS Moratoria Update

The Centers for Medicare & Medicaid Services Lifts Moratoria on Enrollment of Part B Emergency Ground Ambulance Suppliers in All Geographic Locations; Moratoria for Part B Non-Emergency Ground Ambulance Suppliers Extended

Effective July 29, the Centers for Medicare & Medicaid Services (CMS) has lifted the temporary moratoria in all geographic locations for Part B emergency ground ambulance suppliers.  Beginning in 2013, CMS placed moratoria on Medicare Part B ground ambulance suppliers in Harris County, Texas, and surrounding counties (Brazoria, Chambers, Fort Bend, Galveston, Liberty, Montgomery, and Waller).  In February 2014, CMS announced it would add six more months to these moratoria and add Philadelphia, Pennsylvania, and surrounding counties (Bucks, Delaware, and Montgomery), as well as the New Jersey counties of Burlington, Camden, and Gloucester.  Since that date, CMS extended the moratoria four additional times, most recently in February of this year.

CMS considers qualitative and quantitative factors when determining if there is a high risk of fraud, waste, and abuse in a particular area and whether or not it should establish a moratorium.  If CMS identifies an area as posing an increased risk to the Medicaid program, the State Medicaid agency must impose a similar temporary moratorium as well.  CMS also consults with the Office of the Inspector General (OIG) within the Department of Health and Human Services (HHS) and the Department of Justice (DOJ) when identifying potential areas and providers/suppliers that should be subject to a temporary moratorium.  Finally, CMS also considers whether imposing a moratorium would have a negative impact on beneficiary access to care.  In areas where there is a temporary moratorium, the policy does not apply to changes in practice location, changes to provider/supplier information (e.g., phone number, address), or change in ownership.  Temporary moratoria remain in place for six months, unless CMS extends the policy through notice in the Federal Register.

CMS may lift a moratorium at any time if the President declares an area a disaster under the Robert T. Stafford Disaster Relief and Emergency Assistance Act, if circumstances warranting the imposition of a moratorium have abated, if the Secretary of HHS has declared a public health emergency, or if, in the judgment of the Secretary of HHS, the moratorium is no longer needed.  After a moratorium is lifted, providers/suppliers previously subject to it will be designated to CMS’s “high screening level” for six months from the date on which the moratorium was lifted.

CMS has announced it will lift the moratoria on new Part B emergency ambulance suppliers in all geographic locations because the Agency’s evaluation has shown the primary risk of fraud, waste, and abuse comes from the non-emergency ambulance supplier category and that there are potential access to care issues for emergency ambulance services in the areas with moratoria.  New emergency ambulance suppliers seeking to enroll as Medicare suppliers will be subject to “high risk” screening.  If enrolled, these suppliers will be permitted to bill only for emergency transportation services.  They will not be permitted to bill for non-emergency services.

The moratoria remain in place for Medicare Part B non-emergency ground ambulance suppliers for all counties in which moratoria already are in place in New Jersey, Pennsylvania, and Texas.

 

MAC Novitas March 2016 Updates to Ambulance Services

On March 4, Novitas Solutions, Medicare Administrative Contract managers for several jurisdictions, asked AAA to share the following information with ambulance services.

March 4, 2016 – Letter to Ambulance Providers | March 4, 2016 – Letter to Beneficiaries

Jurisdictions Covered By Novitas

  • The Medicare Administrative Contract (MAC) Jurisdiction L (JL), which spans Pennsylvania, New Jersey, Maryland, Delaware and Washington D.C.;
  • The Medicare Administrative Contract (MAC) Jurisdiction H (JH), which spans Colorado, Oklahoma, New Mexico, Texas, Arkansas, Louisiana, Mississippi, Indian Health Service (IHS) and Veterans Affairs (VA); and
  • The payment processing for the Federal Reimbursement of Emergency Health Services Furnished to Undocumented Aliens contract, as authorized under Section 1011 of the 2003 Medicare Modernization Act.

Medicaid Waivers to End Coverage of Non-Emergency Transportation

By David M. Werfel, Esq | AAA Medicare Consultant
Updated February 16, 2016

Federal law requires that state Medicaid programs cover necessary transportation to and from health care providers in order to ensure access to care. However, as a result of Medicaid expansion under the Affordable Care Act and cost increases, recently, a few states have asked CMS to waive the requirement for non-emergency transportation so they can end coverage of non-emergency transportation.

CMS granted waivers to Iowa and Indiana. Pennsylvania received permission, but the subsequent change in the governor’s office altered the state’s expansion plans and state officials ultimately chose not to use it. Arizona has a pending request to provide prior authorization.

When Iowa was granted the waiver, a beneficiary survey was conducted to determine the impact on access to care. The survey found some beneficiaries with incomes under the poverty level did not have transportation to or from a healthcare visit. Other beneficiaries said a lack of transportation could prevent them from getting a physical exam in the coming year. However, CMS stated the cases of negative impact were not statistically significant enough to discontinue the waiver.

As a result of the complaints, Sen. Ron Wyden (D-OR) and Sen. Frank Pallone, (D-NJ) asked the Government Accountability Office to investigate the impact of these waivers. The report is not expected in the near future. However, when issued, it could embolden other states to seek a waiver.

WTAE Shows 25% of Ambulance Calls Unpaid

WTAE Pittsburgh’s Action News recently published a great video investigative piece by Paul Van Osdol on the realities of ambulance funding.

So who pays for these and other non-transport calls?

“The folks that go to the hospital end up paying for the 25 percent that we don’t transport,” Porter said.

But even that does not cover the entire cost, and as a result, ambulance companies are hurting.

A survey of Allegheny County EMS services found 75 percent of them are losing money. On average, they collect only 43 percent of the amount they bill.

“That is frightening when you think about the EMS system as a whole,” Porter said. “The risk is burnout of EMS crews, overworked EMS crews, delayed response time, inadequately trained staff.”

Read the full article, and see their fantastic video, over at WTAE.com.

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Wall Street Journal: Paramedics Aren’t Just for Emergencies

Yesterday’s Wall Street Journal featured several promising community paramedicine programs, as well as some great quantitative results.

“Paramedics are a readily deployable, nimble, clinically trained resource who can help close a gap in American health care,” Dr. Schoenwetter says…

From March 2014 to June 2015, the Geisinger mobile health team prevented 42 hospitalizations, 33 emergency department visits and 168 inpatient days among 704 patients who had a home visit from a paramedic, Geisinger calculates. In the case of heart-failure patients, hospital admissions and emergency-room visits were reduced by 50%, and the rate of hospital readmissions within 30 days fell by 15%. Patient satisfaction scores for the program were 100%.”

Read the full article on wsj.com. (Hat tip to Matt Zavadsky.)

CMS Extends Ambulance Enrollment Moratoria

On July 25, 2015, CMS issued a notice extending the temporary moratorium for enrollment of new ambulance suppliers in the Texas counties of Brazoria, Chambers, Fort Bend, Galveston, Harris, Liberty, Montgomery and Waller, as well as in Philadelphia and the surrounding counties of Bucks, Delaware, Montgomery (Pennsylvania), Burlington, Camden and Gloucester (New Jersey). This notice will appear in the Federal Register on July 28, 2015.

House Votes in Favor of Permanent Doc Fix, Bill Moves to the Senate

Earlier today, the U.S. House of Representatives voted in favor of H.R. 2, doing away with Medicare’s sustainable growth-rate formula and passing a permanent doc fix. The 392-37 vote was overwhelmingly bipartisan. As we reported on March 24, thanks to our champions on Capitol Hill, a 33-month extension of the temporary Medicare ambulance increases was included in the bill. If enacted, the bill would extend the deadline for expiration of Medicare ambulance relief from March 31 until December 31, 2017.

The Senate still needs to pass the bill and is working on a short time-line before they adjourn for recess. Senate Republicans and Democrats have expressed concerns about different aspects of the bill so it is unclear whether the chamber will consider H.R. 2 before it recesses. It is also uncertain if Congress would pass a short-term extension to give the Senate more time or if CMS would be required to formalize its 14-day claim hold policy should H.R. 2 not be enacted before March 31.

In addition to Medicare ambulance relief, the package also includes language from the Protecting Integrity of Medicare Act (H.R. 1021) expanding the current prior authorization pilot programs on repetitive BLS non-emergency ambulance transports in South Carolina, Pennsylvania and New Jersey. Starting in January 2016, the bill would expand the programs to Delaware, DC, Maryland, North Carolina, West Virginia and Virginia. The program would then expand nationwide starting in January 2017.

The AAA will continue to push for the Medicare Ambulance Access, Fraud Prevention and Reform Act (S. 377, H.R. 745). S. 377 and H.R. 745 would make the current temporary ambulance increases permanent and place our industry in a strong position moving forward for data-driven reforms to the ambulance fee schedule. S. 377 and H.R. 745 would also address fraud and abuse with repetitive BLS non-emergency dialysis transports. While a similar program to the current pilot programs. The prior authorization within S. 377 and H.R. 745 would apply only to dialysis transports and would institute additional safeguards to ensure timely prior authorization for medically necessary transports.

I want to thank all AAA members, staff and consultants who continue to work tirelessly on extending essential Medicare ambulance relief. We will keep you posted of new developments.

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