On Monday, November 29, 2021, the United States District Court for the Eastern District of Missouri – Eastern Division has issued a preliminary injunction staying the Centers for Medicare and Medicaid Services (CMS) Mandatory Vaccination Emergency Temporary Standards (ETS) which were set to take effect on January 4, 2022. This preliminary injunction currently only applies to healthcare providers in the plaintiff states.
On November 10, 2021, the States of Missouri, Nebraska, Arkansas, Kansas, Iowa, Wyoming, Alaska, South Dakota, and New Hampshire filed a nine (9) count complaint in the United States Court for the Eastern District of Missouri seeking relief from the CMS Emergency Temporary Standard (ETS) which requires certain certified healthcare facilities to mandate COVID-19 vaccination of all employees, contractors, and those performing services “under arrangement.” The complaint alleged that the ETS violates numerous provisions of the Administrative Procedures Act (APA), the Social Security Act (SSA), that CMS failed to consult with the state agencies that would be charged with enforcing such a mandate, failure to perform an impact analysis of the new rules, and several other Constitutional violations.
In the ruling, U.S. District Judge Matthew T. Schelp, agreed with the plaintiffs that a preliminary injunction was warranted because it posed an irreparable harm and that the plaintiffs demonstrated a likelihood of success on the merits of their complaint. The thirty-two (32) page ruling cites that Congress did not give CMS the authority to enact the mandatory vaccination regulations, nor authorized CMS to issue regulations that pre-empt validly enacted state legislation that contradict these new rules. The court believed that the plaintiffs would likely be able to show that CMS violated numerous administrative and rulemaking procedures.
Throughout the ruling the court cited the likelihood of significant harm to state sovereignty and how the implementation of the rule’s requirements would cause substantial economic harm to both the states and the healthcare facilities. Not only through the cost of implementation but also through the impact to a healthcare facility’s ability to provide care due to employees who refuse to get vaccinated.
This ruling is only applicable to covered healthcare facilities in the states of Missouri, Nebraska, Arkansas, Kansas, Iowa, Wyoming, Alaska, South Dakota, and New Hampshire. It is unknown if the stay will be expanded to other jurisdictions. Additionally, the OSHA Vaccination & Testing ETS is currently enjoined and OHSA has announced that they will halt implementation and enforcement associated with those rules. Despite these rulings, many EMS employers are subject to the mandatory vaccination requirements under the Safer Federal Workforce Task Force COVID-19 Workplace Safety: Guidance for Federal Contractors and Subcontractors.
I advise employers to take the initial steps toward compliance while these cases proceed through the legal system. EMS employers are already required to have policies and procedures to determine and maintain a log of their employee’s vaccination status. Additionally, many EMS employers have already been contacted by their contracted healthcare facilities who have enacted a vaccine mandate, either prior to, or in response to the CMS ETS. These facilities may still independently require your staff to be vaccinated.
I recognize that these are incredibly challenging times. If your organization has questions or need assistance deciphering or preparing for these requirements, please contact the AAA by emailing email@example.com.
This is the first of a two part Member Advisory by Tristan North and Kathy Lester on ACA Repeal & Reform. To continue reading, see Part Two: ACA Repeal & Reform – What It Means for Ambulance Services (Pt. 2).
A top priority of President Trump and congressional Republicans is to repeal and replace the Affordable Care Act (ACA). Since Republicans retook control of Congress in 2012 after passage of the ACA in 2010, they have sought to repeal the ACA. However, they had not developed a consensus on a replacement package, as they knew then-President Obama would veto the repeal bill. Now with President Trump in the White House and Republicans controlling the House and Senate, Republicans in the House have agreed upon a package and moved it through three Committees of jurisdiction: the Ways and Means Committee, the Energy and Commerce Committee, and the Budget Committee. Republicans in the Senate are less aligned and are said to be working on their own package, which is likely to differ in important ways from the House version.
For ambulance services, there are several key components to watch. These are:
In addition, there are a few other provisions that the current bills being considered do not modify, but potential could be part of the discussions at some point or in subsequent Medicare legislation. Of these, there are three that would directly impact ambulance services.
The ACA also established a permanent GPCI floor of 1.0 for “frontier” States which took effect in 2011. The designation of a “frontier” applies to those states in which 50 percent of the counties are frontier which have less than 6 people per square mile. The designation is updated with the original frontier states consisting of Montana, North Dakota, South Dakota, Utah and Wyoming. Utah is no longer deemed frontier and Nevada has been added to the list. While a complete repeal of the ACA would not impact the temporary GPCI increases as the provisions were temporary, it would eliminate frontier status.
Vice President, Paramedics Plus
President-Elect, AAA Board
Chair, Commission on Accreditation of Ambulance Services (CAAS)
Largo, Florida, USA
I grew up in a small town outside Sioux Falls, South Dakota, and obtained my EMT license at age 16. I became a paramedic in 1984 and began working in Davenport, Iowa at MEDIC EMS. After working there for 20 years and becoming Executive Director, I began at SUNSTAR Paramedics in 2004. I am the COO for SUNSTAR and Vice President of Paramedics Plus operations (Sioux Falls, Fort Wayne, and Oakland).
I have been married 31 years to my great wife, Lisa. I have two children: Delaney, a registered nurse at Florida Hospital in Orlando; and my son, Parker, a sophomore at the University of Florida. My hobbies are basketball, boating, and IndyCar Racing.
It is very diverse. As the Vice President, I really oversee daily operations and have great people who work for me. They are local and report out how things are going, daily achievements and challenges.
Paramedics Plus/ETMC is a great organization and is focused on providing great care over financial constraints. I work for a great boss, Ron Schwartz, who fully understands the industry and its daily challenges. We are both from the Midwest and work together on issues.
Sometimes it is just a challenge wearing my CAAS Chairman hat, AAA hat, SUNSTAR hat and Paramedics Plus hat. Everyday you have to decide which issues need to be the priority. Just glad I own an iPad and have a great staff!
I wake up at 0500 eveyday and read emails and try to read at least 2 newspapers. After that, I run 2-5 miles depending on my schedule. The only days I take off are travel days.
After getting to work or on an airplane, it is interacting with staff until our daily PULSE meetings. Most afternoons are teleconferences from all of our operations or AAA meetings.
I go to lunch with my staff every day whether I am in Pinellas or one of the other operations. Evenings are usually laid back, but the weekends are boating and basketball. I am usually in bed at 9:00 pm!
I have been very involved with the Commission on Accreditation of Ambulance Services (CAAS) as the representative for the AAA for the past 20 years. I am currently the Chairman of the Board and have enjoyed the AAA/CAAS relationship.
Transitioning to the AAA President will have its challenges as it is a huge responsibility. The AAA represents EMS in America, and I would like to see members embrace our organization as the “”go to”” organizations for challenges in our industry.
The AAA membership and advocacy is immeasurable in how it helps our organization every day!