Tag: Texas

WSJ | TX, AZ and FL have been some of the worst-hit states in recent days

From the Wall Street Journal on July 5

Some Hospitals in Southern, Western U.S. States Near Capacity Amid Coronavirus Outbreaks

Top officials in southern and western U.S. cities and states with growing coronavirus cases sounded the alarm Sunday, saying hospitals were near capacity and that stricter social-distancing enforcement was needed to stem the growing outbreaks.

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EMS Week Featured Service | Harris County Emergency Corps

Harris County Emergency Corps
Houston, Texas
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Meet Harris County Emergency Corps

Committed to preserving lives through clinical excellence, progressive medicine, and professional service, Harris County Emergency Corps (HCEC) is a premier EMS agency and the only Commission on Accreditation of Ambulance Services accredited agency with headquarters in Houston.

HCEC was the first EMS agency formed in the state of Texas (1933). Serving approximately 400,000 citizens in 76 square miles in north Harris County, HCEC provides 911 services for Harris County Emergency Services District No. 1. HCEC also provides event medical coverage across Texas, trains clinicians with highly specialized classes, communicates with 11 other agencies through our innovative dispatch center, and leads Houston’s first Community Health Paramedic Program.

The Harris County Emergency Corps COVID-19 Response

With the pandemic of COVID-19, HCEC has seen a remarkable team pull together to tackle new challenges in our community and our organization.  Utilizing the power of social media, website content, and informational flyers for our community, we have attempted to keep the public informed of best practices and resources available to them for assistance.  Responding to emergencies with an emphasis on patient and crew safety has been a top priority.

Harris County and the Houston area has seen some of the highest number of cases in the State of Texas. As a result, our Dispatch center incorporated new tools and protocols to screen for COVID-19 symptoms.  With our special events division not staffing large gatherings, part-time event medics are helping in the Communications center with screenings, and also by staffing dedicated PPE units.  To ensure additional protection, the Clinical department implemented aggressive PPE usage guidance and modified medical guidelines early on in the pandemic to keep our team healthy and safe.

Communication is crucial, not only with the community, but also with the staff.  As such, the HCEC Management team holds daily conference calls and connects weekly with employees through virtual Town Hall meetings.  In addition, our Infection control officer communicates regularly with Hospital partners to determine if our patients are positive for COVID-19.

The Harris County Emergency Corps Leadership Perspective

“Our team is truly remarkable. Everyone is working together with a “whatever it takes” mentality to support each other and our community to the best of our ability during the Covid-19 pandemic.  As an example, HCEC volunteered with Gallery Furniture and Kroger to help distribute over 2,000 meal kits to seniors in and around our service area.”—Jeremy Hyde, CEO

Frontline Voices from Harris County Emergency Corps

“We get a chance to see people at their worst and make their day a little better. It’s about making a difference every day, whether it’s using ALS interventions, or just holding a patient’s hand to comfort them.” – Jodie Gutierrez, 911 Paramedic

“EMS is important because it gives us a chance to help those that need us most. It provides a comfort to know that we will always be there.” – Amanda Crystal, 911 Paramedic

“EMS is important because it helps to circle and close the loop within communities and population health.”– Steven Nelson, 911 Paramedic

Taking care of employees to the best of our abilities is always a top priority for HCEC.  Executive Director Jeremy Hyde has brought in a mobile barber for the staff to get free haircuts on two different occasions during COVID.  Ed Kolczynksi, Receptionist for HCEC had this to say about the experience, “This was just amazing! HCEC cares more about their employees than any other company I’ve ever worked for, and I’ve been working for a really long time! Not to mention, I got a great haircut, and it only cost me a $5.00 tip.”

Will Barrett, HR Coordinator for HCEC offers a positive effect from COVID; “COVID has brought people together. Neighbors wave more and say hello when we see each other; some have even offered us supplies, like masks and cleaners. We have more conversations from across our lawns with one another due to limited contact with other people, whereas before, we barely communicated.”

“For EMS support staff working remote, COVID-19 has changed the way we manage our ‘new normal’. Dining room tables have become our desks, and the refrigerator has become our enemy!”—Toya Thompkins, Payroll Coordinator

“EMS is extremely important, whether in a pandemic or a “normal” day in Houston. We respond to a variety of calls each day, and for many, it is one of the worst days of their life.  I see my co-workers make a difference in people’s lives every single day.” – Anonymous 911 medic

How Harris County Emergency Corps Celebrates EMS Week

EMS Week at HCEC will be different this year in a variety of ways. Typically we have a large banquet where we celebrate milestones and provide recognition awards. This year, however, we are scheduling a company-wide picnic later in the year when it is safe to celebrate in person with our staff and their families.

EMS week is also normally filled with daily social events at HCEC. Even though COVID19 will keep us from celebrating in a group setting, we will provide drop off service at each station for meals and snack baskets and conduct contests throughout the week for each shift.  In addition, our annual Commemorative T-shirt Design contest is already underway.  Employees who submit artwork utilizing the National EMS week slogan are entered into the contest.  The winning design artist is recognized in our newsletter and social media and awarded a $100 gift card, while all employees receive a free commemorative T-shirt celebrating EMS week.

HCEC will also be surprising the staff during EMS Week with an early distribution of our annual longevity bonus.

40 Under 40: James Campbell (Montgomery County Hospital District EMS – Conroe, TX)

40 Under 40 nominees were selected based on their contributions to the American Ambulance Association, their employer, state ambulance association, other professional associations, and/or the EMS profession.
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James Campbell
Chief of EMS
Montgomery County Hospital District EMS
Conroe, TX

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LinkedIn | Twitter
Nominated by: Misti Willingham (Montgomery County Hospital District EMS – Conroe, TX)
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Biography:

Chief Campbell joined Montgomery County Hospital District (MCHD) in June of 2018 and began his role as the Chief of EMS in March of 2019. Chief Campbell began his EMS and Fire career in 2002 in Fayetteville, North Carolina. Upon returning to Texas in 2008, Chief Campbell joined the City of Celina Fire Department, where he served as the EMS Captain for four years. Chief Campbell is currently pursuing a Bachelor Degree in Emergency Health Sciences from The University of Texas Health Science Center. Chief Campbell is committed to working closely with the MCHD Board of Directors, other first responder agencies, and hospital partners to continue a successful and collaborative healthcare model in Montgomery County. Chief Campbell is a certified member of the American College of Paramedic Executives (FACPE), serves as a member on the Governor’s EMS & Trauma Advisory Council (GETAC) EMS Committee, and is a Board Member for the South East Texas Regional Advisory Council (SETRAC). Chief Campbell’s focus continues to be a people-centered approach, working to ensure that MCHD’s employees and patients are at the center of the decision-making process. Chief Campbell is proud to help lead MCHD, an organization committed to its’ mission, vision, and core values.

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Reason for Nomination:

MCHD is honored to nominate Chief of EMS James Campbell as one of the American Ambulance Association’s Mobile Healthcare 40 Under 40. Since being named EMS Chief nearly a year ago, Chief Campbell has exemplified what it means to be a true leader. Chief Campbell came from humble beginnings, starting his career as a firefighter in Fayetteville, North Carolina, then moving on to Celina Fire Department in North Texas. The City of Celina had one ambulance when Chief Campbell took on the role as EMS Captain, but just four short years later, he is now successfully running a large, county-wide agency with a fleet of 50 ambulances and 250 EMS personnel. Montgomery County is one of the fastest-growing counties in Texas. In 2019, MCHD had more than 70,000 responses – the most in the history of our county. Thanks to Chief Campbell and the team who has come to trust and value his leadership, MCHD was able to maintain the same high level of care that our patients have come to expect.

In late 2019, MCHD received its re-accreditation from the Commission on Accreditation of Ambulance Services (CAAS), and reviewers noted zero deficiencies during the on-site inspection. MCHD is one of only three agencies in the Houston area to receive CAAS accreditation, and Chief Campbell’s guidance has been instrumental in maintaining these high standards. Fortunately, we are not the only ones benefiting from his leadership. Chief Campbell sits on the board of the Southeast Texas Regional Advisory Council (SETRAC), and the Texas Governor’s EMS & Trauma Advisory Council (GETAC) helping to advise the governor on policies affecting EMS personnel on a statewide level. While attending the Ambulance Service Manager (ASM) certification course, Chief Campbell’s team won for its project on Fatigue Risk Management in EMS, and he went on to ensure that not only our employees benefited from the program but other EMS agencies as well. Chief Campbell presented the study’s findings on the importance of rest in EMS at the 2019 Texas EMS Alliance Conference and the 2019 Pinnacle EMS Conference.

Chief Campbell’s management style is people-centered; he works to ensure his employees and our patients are at the center of his decision-making process. Chief Campbell genuinely cares about how his decisions affect the team’s members, individually and as a whole. A good illustration of this is in our turnover rate as an organization. MCHD is at 8% for 2019, which is far below the 25-30% national average for an EMS agency.

Chief Campbell keeps a journal which he uses it to remember times of success (big and small), times of failure, and other times when he’s learned valuable lessons about leadership. Chief Campbell has all the makings of a true rising leader, someone who can take a step back and be his own worst critic while also being humble enough to learn from the team around him. With everything he has already accomplished at the young age of 35, there is no doubt that Chief Campbell will continue to be a great asset, not only for MCHD, but for the future of EMS.

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View all of the 2020 Mobile Healthcare 40 Under 40 Honorees

40 Under 40: Remle P. Crowe, PhD (ESO – Austin, TX)

40 Under 40 nominees were selected based on their contributions to the American Ambulance Association, their employer, state ambulance association, other professional associations, and/or the EMS profession.
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Remle P. Crowe, PhD
Research Scientist & Performance Improvement Manager
ESO
Austin, TX

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LinkedIn | Twitter
Nominated by: Amanda Riordan
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Biography:

Dr. Remle Crowe is an expert in using data to power quality improvement and research initiatives in EMS. Remle’s career in EMS began as a volunteer EMT and instructor in Mexico City with the Red Cross. During that time, Remle also worked as a Power-train Quality Engineer at Ford Motor Company, where she received black belt training in Six Sigma quality improvement methodology. From truck clutches to clinical care, Dr. Crowe has shown how improvement science and sound research methodology work to solve problems across any field. As an EMT with a passion for advancing EMS, Remle earned her PhD in Epidemiology and has authored numerous peer-reviewed publications. Now, as a research scientist and performance improvement manager at ESO, Dr. Crowe routinely uses data to improve community health and safety.
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Reason for Nomination:

As an EMS researcher, Remle is dedicated to improving the health and safety of communities (and those who serve them) using data. Remle has authored many peer-reviewed studies on topics related to clinical care and safety, such as ketamine in the prehospital environment and pediatric medication dosing errors. Remle’s work on prehospital stroke assessment for large vessel occlusion received the award for Best Scientific Presentation at the annual meeting of the National Association of EMS Physicians in January 2020. Remle has also worked on many research studies related to the health and safety of the EMS workforce. Topics that Remle has studied include violence towards EMS professionals, clinical performance feedback, and diversity in the EMS workforce. Remle’s dissertation work related to factors associated with burnout in EMS was awarded Best Research at the 2018 International EMS Scientific Symposium.

Remle is also dedicated to supporting and mentoring new researchers. Remle is an active participant in the Prehospital Care Research Forum (PCRF) and routinely serves as faculty for the bi-annual PCRF-ESO research workshops. Remle also facilitates the monthly PCRF journal club podcast that helps promote and disseminate the latest prehospital research, while helping EMS professionals learn to read and critique scientific manuscripts.

In addition to helping advance EMS research, Remle has been an important contributor to quality improvement efforts in EMS. EMS is at a pivot point, moving from using data for compliance to leveraging data for improvement. Remle has joined those leading the charge, now in her third year as faculty on the National Association of EMS Physicians’ Quality and Safety Course. In this course, participants embark on a year-long journey to make real, measurable improvement at their EMS organizations following the Institute for Healthcare Improvement’s Model for Improvement framework. As a self-proclaimed data nerd, Remle is committed to breaking things into their simplest parts and removing the intimidation factor from research and improvement science to help members of the EMS community define and focus on measures that matter.

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View all of the 2020 Mobile Healthcare 40 Under 40 Honorees

Annual 2021 Session Submissions Are Now Open!

Please note that all session selections for the AAA 2020 Annual Conference & Trade Show have been made. The full agenda is posted to the #Ambucon20 website. If you are interested in speaking NEXT YEAR in 2021, please complete the form below. Thank you for your support and participation!

AAA 2021 Session Proposals Due January 31, 2021
AAA Annual Conference & Trade Show
November 1–3, 2021
Gaylord Texan | Grapevine, Texas | #Ambucon21

The American Ambulance Association Annual Conference & Trade Show brings together mobile healthcare leaders from across the country to learn, network, and plan for the future of our industry. AAA Annual is committed to empowering our participants with the insights and best practices they need to serve their patients as well as operate efficiently and profitably.

Speaking at the AAA Annual Conference & Trade Show is your opportunity to share best practices and insights with your peers as you build your personal brand. We invite you to submit your session proposals before January 31, 2021.

Topics

Sample speaking proposal topics considered include, but are not limited to:

  • Recruitment, Retention, and Human Resources
  • Operations, Risk Management and Safety
  • Management and Supervision
  • Leadership Development & Structure
  • Improved Fleet Maintenance/Management
  • Clinical/Quality Assurance Program
  • Reimbursement/Patient Accounts
  • Innovation, Technology, and Communications
  • Emerging Healthcare Trends/Hot Topics
  • Healthcare Reform/Public Health

Session Formats & Lengths

AAA is focused on engaging attendees interactively in every session. This year, we are seeking submissions in the following formats:

  • 15 Minute Quick Take (similar to TED Talks)
  • 50 Minute Sunrise Session (Early morning energizers. These could be a walking session, yoga gathering, coffee-shop meetup, or another creative idea you have to get the day started off right!)
  • 50 Minute Lecture or Panel (traditional conference formats)
  • 60 Minute Interactive Session (Format ideas to get you thinking.)

Sessions may be either classroom style or set for small workgroups. Audience involvement is encouraged.

Compensation

Please be advised that participation as a presenter is strictly on a voluntary basis. AAA is unable to pay speaker fees or travel and lodging expenses. However, speakers selected for 50- and 60-minute sessions will receive ONE complimentary speaker registration

Proposal Instructions

ALL proposals must be submitted through our online form below by January 31, 2021. AAA is unfortunately unable to consider proposals received after the deadline. Applicants may submit up to three session proposals.

Thank you for your interest in lending your time and talent to the American Ambulance Association’s members. We look forward to reviewing your proposal!

2021 Annual Conference & Trade Show Call for Presentations

Thank you so much for your interest in speaking at the 2021 AAA Annual Conference and Trade Show. The deadline for submissions is January 31, 2021. Applicants may submit up to three proposals. Audience involvement is highly encouraged. Please be advised that participation as a presenter is strictly on a voluntary basis. AAA is unable to pay speaker fees or travel and lodging expenses. Participation will be at your own expense for your own exposure and promotion.
  • AAA membership is required to present at our conference.
  • 50–75 word description of your proposed session for marketing purposes. Please include concrete, actionable takeaways your participants will be able to apply immediately.
  • For ALL co-presenters, please list Name Job TItle Company Name Email Address
  • Is this content geared to those who are new to the topic, intermediate, or advanced?
    Select the tracks most appropriate for this proposed session.
  • Please list your past speaking experience, including event names and dates.
  • Please provide a brief biography of yourself.
  • Ex: https://twitter.com/amerambassoc
  • Ex: https://www.linkedin.com/in/amandariordan/
  • This field is for validation purposes and should be left unchanged.

 

40 Under 40: Dan Gillespie (Allegiance Mobile Health – Georgetown, TX)

40 Under 40 nominees were selected based on their contributions to the American Ambulance Association, their employer, state ambulance association, other professional associations, and/or the EMS profession.
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Dan Gillespie
Chief Operating Officer
Allegiance Mobile Health
Georgetown, TX

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LinkedIn
Nominated by: David Lee (Allegiance Mobile Health – Georgetown, TX)

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Biography:

Dan Gillespie is an experienced senior level executive with over 15 years of healthcare experience. Dan has a proven track record of success in growth strategy, P&L management, cost reduction techniques, merger & acquisitions, and operations management.

Dan truly cares about his patients and will do whatever it takes to deliver high quality care. Among his employees, Dan has developed a culture of empowerment with an emphasis on enabling growth from within the organization. Dan approaches each patient individually from the perspective of how best to meet their needs and solve their problems in an innovative and open-minded fashion. This can be seen by the fact that Dan puts over 1,000 miles a week on his truck in order to be able to meet in-person with patients, staff, and organizational leadership.

Dan has a Bachelor of Science in Business Administration/Organizational Leadership from the University of Indianapolis where he graduated in the top of his class. Dan simultaneously attended Ivy Tech State College of Indiana where he majored in Accounting.

Dan’s experience in business is multifaceted from private to publicly traded corporations, non-profit healthcare systems, and public sector government owned operations.

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Reason for Nomination:

Dan has approached the EMS Industry with the perspective of how can quality of care be improved through innovation and empowerment while demonstrating the business acumen to allow these changes to be sustainable. Dan has risen quickly throughout his career and manages one of the largest ambulance services in the nation, but he always credits his team before himself. Dan truly cares about his patients, employees, and customers and he lives the core values of CLIMB (Compassion, Leadership, Integrity, Modern, and Benevolent). Dan has already made an impact on our industry and he has the passion, aptitude, and experience to take EMS and its role in the Healthcare System to the next level.

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View all of the 2020 Mobile Healthcare 40 Under 40 Honorees

Spotlight: Desiree Partain, Medstar Mobile Healthcare

Desiree Partain
Mobile Integrated Healthcare Manager
Medstar Mobile Healthcare
Fort Worth, Texas

Other Titles & Roles

MIH Manager at Large, IBSC, NAEMT member

Tell us a little about yourself.

Born and raised in sunny San Diego, California. I have a military ( marine grandfather and navy grandfather, brother, and nephew) and first responder (law enforcement mother) family background. Days were spent in the water, whether it was our backyard pool or the beach. My parents instilled a strong work ethic in me at a young age that began as the neighborhood babysitter, to various positions at assisted living facilities and finally in EMS. I learned to take pride in the things I had and my work, whether it was completing a household chore, a writing assignment at school, or the vehicles I owned.

Your history with EMS

My mother was a police officer in the town I was raised in so the police and fire department was often my home away from home. I can remember being so fascinated with the ambulance and in admiration of the paramedics when I would go to visit. I told my parents when I was little that when I grew up, I would become a paramedic. After graduating high school, I began the series of classes to obtain my EMT. When 9/11 occurred, I remember sitting in my advanced first responder class that day and knowing that I had made the best decision to be apart of the first responder industry. I got EMT certification in 2002 and my first EMS job that same year. I began the paramedic academy in 2005 where I was the academy leader and valedictorian. I received my paramedic certification and began working on the ambulance in 2006. I was also working for an air ambulance company and an adjunct instructor. In 2009, I moved to Fort Worth, Texas to gain further experience on the ambulance. I took a critical care course in 2010 and began working as a critical care/mobile health paramedic in 2011. I obtained my Bachelors in Health and Human Services in 2013 and began a quality assurance/training coordinator position specific for mobile integrated healthcare in 2014. In 2015 I began working as the MIH Manager where I obtain my CCP-C and CP-C certification and completed my Masters in Healthcare Administration in 2018.

What do you enjoy most about your job?

I love people and being able to help someone who may be having one of the worst days of their life. I view my position in EMS as more of an opportunity to be a life changer than a life saver. Being in management, my position is to lead other life changers. On the mobile integrated healthcare and critical care side, I love being a part of the innovation and out-of-the-box thinking. It’s great to be able to come to work and be in an environment that embraces change rather than the status quo of “we’ve always done it that way” type of thinking.

What is your biggest professional challenge?

Staying current. EMS and healthcare is in a constant state of change and with those changes comes new processes, protocols, and general information that need to be learned. Remaining current with the changes on top of daily responsibilities can be a challenging balancing act.

What is your typical day like?

Working in the administrative side of EMS, a typical day often involves multiple meetings either on or off site. I generally allow myself some time in the morning to go over my tasks for the day, read, and respond to emails. In between meetings, I will work on projects and to-do’s and filter questions or issues with team members. The end of the day is spent reviewing meeting notes, action items and my plan for the following day.

What are your predictions for EMS 10 years from now?

My vision for EMS 10 years from now is an industry that is even more integrated with the overall healthcare system. The use of systems to further enhance efficiency and communication in the emergency and non-emergency settings. Integrated care that starts at the time of the 9-1-1 call with the most appropriate resource deployment, on-scene management whether its offering care without transport or transport to a healthcare facility aside from an emergency room.

What advice would you give to someone new to EMS?

Take pride in what you do in this industry from your uniform appearance, to your ambulance, to the patients you serve, and to yourself. Take care of you first by practicing self care and finding a healthy balance between your personal and professional life. Create professional goals for yourself whether its through education, positions, or organizations and hold yourself accountable to accomplish those goals.

Remembering Joe Huffman

It is with great sadness the American Ambulance Association announces the passing of long-time member and leader Joe Huffman.

Obituary 

Joe (Joel Claude) Huffman, a long- time member of the American Ambulance Association Board of Directors answered his Last Call July 1, 2019. after a long battle with Leukemia.

Born August 11, 1954, Mr. Huffman died at his home in Garland surrounded by his family and friends.

From his funeral service at First United Methodist Church of Richardson Mr. Huffman was taken in an ambulance rather than a hearse to Grove Hill Memorial  Park in Dallas The funeral procession included 17 ambulances and 14  command vehicles, as well as a police honor guard  and other mourners.  Following a rendition of Amazing Grace on  bagpipes first responders performed The Last Call ceremony.

A licensed paramedic, Mr. Huffman was also active in professional organizations, serving on the board of directors of American Ambulance Association for 18 years and as a member many more years.

He served as president of the Texas Ambulance Association for two years, and was on its executive board many of the more than 30 years he was a member

While president of the Texas Ambulance Association, Mr. Huffman  was instrumental in drafting legislation which established standards for Emergency Medical Services in Texas.

At the time of his death Mr. Huffman had been Special Events Coordinator of American Medical Response for 16 years, providing standby service at Cowboy Stadium, ATT stadium, the Cotton Bowl, Lone Star Park in Grand Prairie as well as many others.

Mr. Huffman had worked at the State Fair of Texas First Aid Station for 45 years, never missing a day.  Twenty-three of those years he was director of the station.  He formerly owned Dallas Ambulance for 11 and a half years. Adding these years of service, Mr. Huffman packed 142 ½ years of service into the 64 years and 10 months of his life.

The son of a locomotive engineer, Mr. Huffman was an avid collector of model trains and railroad memorabilia. He was a lifetime member of the American Museum of Railroads at Frisco, Tx., where he has donated his extensive collection of model trains and railroad memorabilia.

Mr. Huffman graduated from W.W. Samuel High School, attended SMU and earned an A.A. degree at Eastfield Community College.

Memoriam gifts may be sent to the Leukemia and Lymphoma Society of North Texas.

A lifelong resident of Dallas, Mr. Huffman is survived by his Beloved Cheryl Hale of Tyler; a sister, Joyce Huffman Prock, of Bedford; two brothers, Jack W. Huffman and his wife, Donna of Richardson; and James (Jimmy) Huffman of Dallas.

Also, four nieces, Dana Huffman and Melanie Bullock of Richardson; Leslie Prock Norton and husband Andrew, of Bedford; and Angel Marie Huffman Dellinger and husband, Scott, of Crandall.  Two nephews Erik Prock of Ft. Worth and Jason Huffman, of Richardson, who is deceased. Great nieces Jaylyn Scott Norton of Bedford; Denise Marie Dellinger of Crandall; and Caroline Huffman of Richardson.  Three great nephews, Jack Michael Huffman of Richardson; Dylan Scott Dellinger and Devon Scott Dellinger of Crandall. He was preceded in death by his parents, James J. (Happ) Huffman and Florence Bolin Huffman.

 

Federal District Court Judge Strikes Down the ACA

On December 14, 2018, a federal district court judge for the Northern District of Texas issued a ruling striking down the Affordable Care Act (ACA) on the grounds that the Individual Mandate was unconstitutional, and that the rest of the law cannot withstand constitutional scrutiny without the Individual Mandate.

District Court Judge Reed O’Connor’s decision relates to a lawsuit filed earlier this year by 20 states and two individuals. The plaintiffs argued that the Tax Cuts and Jobs Act of 2017 — which amended the Individual Mandate to eliminate the penalty on individuals that failed to purchase qualifying insurance effect January 1, 2019 — rendered the Individual Mandate unconstitutional. The plaintiffs further argued that the Individual Mandate was inseverable from the rest of the ACA, and, therefore, that the entire ACA should be struck down.

The defendants in this case were the United States of America, the U.S. Department of Health and Human Services (HHS), Alex Azar, in his capacity as the Secretary of HHS, and David J. Kautter, in his capacity as the Acting Commissioner of the Internal Revenue Service (IRS). 16 states and the District of Columbia intervened as additional defendants.

In order to properly understand the district court’s ruling, it is necessary to revisit the Supreme Court’s 2012 decision on the constitutionality of the ACA, National Federal of Independent Business v. Sebelius (NFIB). In that case, 26 states, along with several individuals and a business organization challenged the ACA’s Individual Mandate and Medicaid expansion provisions as exceeding Congress’ enumerated powers. In a complicated decision, the majority of Justices ruled that the Individual Mandate was unconstitutional under Congress’ authority to regulate interstate commerce, but that the provision could be salvaged under Congress’ authority to lay and collect taxes. In reaching this conclusion, the majority of Justices focused on the “shared responsibility payment” aspect of the Individual Mandate, which imposed a tax on those individuals that failed to purchase or otherwise obtain qualifying health insurance. The majority of Justices concluded that the shared responsibility payment was a “tax.” It was therefore constitutional under the Congress’ general taxing authority.

In sum, the Supreme Court ruled that Congress lacked the power to compel individuals to buy qualifying health insurance, but that it could constitutionally impose a tax on those that failed to purchase or otherwise obtain qualifying health insurance.

In the current case, the court was asked to reconsider the Individual Mandate in light of the TCJA, which “zeroed” out of the shared responsibility payment, effective January 1, 2019. The plaintiffs argued that the Individual Mandate could no longer be justified as a valid exercise of Congress’ taxing authority. The federal government and its agents did not necessarily contest the plaintiffs’ argument with respect to the Individual Mandate. By contrast, the intervening states and the District of Columbia argued that the Individual Mandate could continue to be construed as a tax because it continues to satisfy the factors set forth by the Supreme Court in NFIB.

Judge O’Connor sided with the plaintiffs, holding that, because the Individual Mandate would no longer trigger a tax beginning in 2019, the Supreme Court’s ruling on this point in NFIB was no longer applicable. He therefore concluded that the Individual Mandate could no longer be upheld under Congress’ taxing authority. Judge O’Connor then fell back on the Supreme Court’s previous holding that the Individual Mandate, as a stand-alone command, remained unconstitutional under the Interstate Commerce Clause. Judge O’Connor then ruled that the Individual Mandate could not be severed from the rest of the ACA. On this point, the judge cited the express provisions of the ACA, as well as the Supreme Court’s decisions in NFIB and King v. Burwell.

What this decision means

On its face, the decision strikes down the Affordable Care Act in its entirety. However, the ruling is likely to be appealed to the Fifth Circuit Court of Appeals. Most legal experts expect that, regardless of the decision at the Circuit Court, the case is likely to make its way up to the Supreme Court.

Pending the resolution of these appeals, the Administration has adopted a “business as usual” approach. The White House has already indicated that it will not attempt to enforce the ruling during the appeals process. CMS Administrator Seema Verma recently tweeted that the decision will have “no impact to current coverage or coverage in a 2019 plan.”

The American Ambulance Association will continue to monitor this case as it makes its way through the appeals process, and we will notify our members of any new developments.

CMS Extends Moratorium on Non-Emergency Ground Services

CMS Extends Temporary Moratorium on Non-Emergency Ground
Ambulance Services in New Jersey and Pennsylvania

On January 30, 2018, 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 and Pennsylvania. The extended moratoria will run through July 29, 2018.

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 moratoriums were subsequently extended on August 1, 2014, February 2, 2015, July 28, 2015, and February 2, 2016.

On August 3, 2016, CMS announced changes to the moratoria on the enrollment of new ground ambulance suppliers. Specifically, CMS announced that: (1) the enrollment moratoria would be lifted for the enrollment of new emergency ambulance providers and supplier and (2) the enrollment moratoria on non-emergency ambulance services would be expanded 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. The revised moratorium on newly enrolling non-emergency ground ambulance providers was subsequently extended on January 9, 2017 and July 28, 2017.

On September 1, 2017, CMS issued a notice on its website indicating that it had elected to lift the moratorium on the enrollment of new Part B non-emergency ambulance suppliers in Texas, effective September 1, 2017. CMS indicated that this decision was made to assist in the disaster response to Hurricane Harvey.  CMS published formal notice of the lifting of this moratorium on November 3, 2017.

On or before July 29, 2018, CMS will need to make a determination on whether to extend or lift the enrollment moratorium.


Have any Medicare questions? Contact Brian at bwerfel@aol.com

Is the TX Moratorium Ending?

Is CMS Ending the Temporary Moratorium on Enrollment of New Non-Emergency Ground Ambulance Providers in Texas?

On September 2, 2017, the Centers for Medicare and Medicaid Services (CMS) posted a notice on its website that it was lifting the temporary moratorium on the enrollment of new Part B non-emergency ambulance suppliers in Texas, effective September 1, 2017.  CMS indicated that the lifting of this temporary moratorium was intended to aid in the disaster response to Hurricane Harvey.

For reasons I will discuss in greater detail below, this explanation has struck a number of commentators as curious.  These commentators have speculated that this may notice may foretell a permanent elimination of the enrollment moratorium for non-emergency ground ambulance providers in Texas.

Background on Temporary Moratorium on New Enrollments in Texas

The Affordable Care Act granted CMS several new tools to combat fraud, waste, and abuse in the Medicare, Medicaid, and Children’s Health Insurance Programs.  This included Section 6401(a), which granted the CMS Secretary the authority to impose temporary moratoria on the enrollment of new Medicare, Medicaid, or CHIP providers to the extent the Secretary determined that doing was necessary to prevent fraud and abuse.

The implementation of the first enrollment moratorium under this new authority was made on July 30, 2013, when CMS announced enrollment moratoria on new home health agencies in Chicago, Illinois, and Miami, Florida, as well as on new ground ambulance suppliers in the Houston, Texas metropolitan area.  On January 30, 2014, CMS expanded the enrollment moratorium on new ground ambulance suppliers to the Philadelphia, Pennsylvania metropolitan area.  CMS subsequently extended these enrollment moratoria every 6 months thereafter, up to July 29, 2016.  On that date, CMS announced that it was making several significant changes to the enrollment moratoria:

  1. It was lifting the moratoria on the enrollment of new emergency ground ambulance suppliers in both areas;
  2. At the same time, it was expanding the moratorium on the enrollment of new non-emergency ground ambulance suppliers to the entire states of New Jersey, Pennsylvania, and Texas.

CMS further announced the creation of an “Enrollment Moratoria Access Waiver Demonstration” program that would permit non-emergency ambulance providers in those states to apply for a waiver (i.e., to permit them to enroll in the Medicare, Medicaid, or CHIP Programs) to the extent they could demonstrate an access to care issue.

Temporary Lifting or Permanent Elimination?

The Medicare enrollment process is a lengthy one.  Following the submission of an enrollment form (CMS-855b), it typically takes the Medicare contractor up to 60 days to review the form and approve it.  Moreover, the Medicare contractor will frequently request additional information, which can add up to several months to the process.  Once approved by the Medicare contractor, the application is passed along to the Site Review Contractor for a visit to the enrollee’s physical practice locations.  All told, it is not unusual for the process to take 4-6 months from start to finish.  The time limits for enrollment in Medicaid and CHIP are similar.

It seems unlikely that a ground ambulance supplier that temporarily responded to the areas affected by Hurricane Harvey would go through the enrollment process, especially considering they would likely be seeking reimbursement for their efforts either directly through the Federal Emergency Management Agency (FEMA) and its contractor, or through the existing 1135a waiver program.  For this reason, it seems logical to assume that an ambulance supplier would only go through the enrollment process only if it intends to permanently establish operations in the affected area.

Editor’s Note: it is possible that CMS intended to address storm damage to an enrolled provider’s existing practice locations, i.e., the lifting of the moratorium would make it easier for these providers to add additional practice locations while they repaired their existing facilities.  However, there is nothing in CMS’ website notice that suggests that this was intended to be limited to existing enrolled providers.  This is simply speculation on my part.

CMS indicated that it would be publishing a notice in the Federal Register formally announcing the lifting of the enrollment moratorium.  A month ago, it was assumed by most commentators (myself included) that the notice would make clear that the lifting of the moratorium was temporary, and that it would set a date for its re-establishment.  However, it has now been more than a month since CMS announced the lifting of the moratorium, and that notice has yet to appear in the Federal Register.  The longer we go without an announcement from CMS, the more this starts to look like a permanent lifting of the moratorium.

What This Means Today to Non-Emergency Ambulance Suppliers in Texas

The lifting of this moratorium applies to new enrollments in Medicare, Medicaid, and the Children’s Health Insurance Program (CHIP).  Therefore, as of today, and pending a subsequent re-establishment of the enrollment moratorium by CMS, Part B ground ambulance suppliers in Texas that are not otherwise enrolled as non-emergency ground ambulance suppliers will now be permitted to enroll in the Medicare, Medicaid, and CHIP Programs.  The lifting of the moratorium will also permit companies that are already enrolled as non-emergency ambulance suppliers to add additional practice locations throughout the state.  CMS has indicated that both new enrollments and changes in enrollment to add additional practice locations will be subject to “high” screening under 42 C.F.R. §424.518(c)(3)(iii).


Have an issue you would like to see discussed in a future Talking Medicare blog?  Please write to me at bwerfel@aol.com.

CMS Lifts Moratorium Enrollment Non-Emergency Providers (TX)

In order to assist with the disaster response to Hurricane Harvey, CMS has announced that it has lifted the temporary moratorium on the enrollment of new Part B non-emergency ambulance suppliers in Texas, effective September 1, 2017. The lifting of this moratorium applies to new enrollments in Medicare, Medicaid, and the Children’s Health Insurance Program (CHIP). CMS indicated that it will publish a notice in the Federal Register to formally announce the lifting of the moratorium.

As a result, Part B ambulance suppliers that are not otherwise already enrolled as non-emergency ambulance provider in the State of Texas will be permitted to enroll in the Medicare Program. The lifting of the moratorium will also permit companies that are already enrolled as non-emergency ambulance suppliers to add additional practice locations throughout the state. CMS has indicated that both new enrollments and changes in enrollment to add additional practice locations will be subject to “high” screening under 42 C.F.R. §424.518(c)(3)(iii).

CMS Extends Moratorium on Non-Emergency Ground Ambulance

CMS Extends Temporary Moratorium on Non-Emergency Ground Ambulance Services in New Jersey, Pennsylvania, and Texas

On July 28, 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 January 29, 2018.

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.

On August 3, 2016, CMS announced changes to the moratoria on the enrollment of new ground ambulance suppliers. Specifically, CMS announced that: (1) the enrollment moratoria would be lifted for the enrollment of new emergency ambulance providers and supplier and (2) the enrollment moratoria on non-emergency ambulance services would be expanded 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. The moratoria have been extended on these terms every six months thereafter.

On or before January 29, 2018, CMS will need to make a determination on whether to extend or lift the enrollment moratorium.

Alabama Governor Signs REPLICA Compact

Governor Kay Ivey recently signed into law Alabama’s REPLICA legislation, HB250. Alabama joins ten other states—Colorado, Texas, Virginia, Idaho, Kansas, Tennessee, Utah, Wyoming, Mississippi, and Georgia—in this forward-thinking interstate compact.

REPLICA, the Recognition of EMS Personnel Licensure Interstate Compact,  recognizes the day-to-day movement of EMS personnel across state lines. It extends the privilege to practice under authorized circumstances to EMS personnel based on their home state license, as well as allows for the rapid exchange of licensure history between Compact member states..

Learn more about how REPLICA participation can help your state at http://www.emsreplica.org.

Congressman Kenny Marchant to Receive AAA Legislative Honor

Congressman Kenny Marchant to
Receive AAA Legislative Recognition Award

For Immediate Release
Contact:
Amanda Riordan
ariordan@ambulance.org
703-610-0264

Washington, DC – The American Ambulance Association (AAA) will honor Congressman Kenny Marchant of Texas with a Legislative Recognition Award in appreciation of his advocacy for emergency medical services.

Congressman Marchant will be presented this award in June in Washington, DC by AAA’s Texas Stars of Life—EMS personnel selected for their excellence and dedication. This year’s Stars from the Lone Star State are Chris Eachen of Paramedics Plus; Cindy Hitchcock of American Medical Response; Rhonda Dees-Lockwood, and Sloane Brown of Acadian Ambulance Service; and Thomas Faticone, Daniel Dormady, and Elizabeth Roden of MedStar Mobile Healthcare.

Congressman Marchant was selected for the Legislative Recognition Award for his support of the Medicare ambulance temporary add-on increases and the super rural bonus payment.

AAA President Mark Postma notes, “Congressman Marchant has been a trusted advocate for health care and emergency medical services, both in Texas and across our country.”

Elected to the U.S. House of Representatives in 2004, Congressman Marchant represents Texas’s 24th congressional district. Congressman Marchant serves on the House Ways and Means Committee Subcommittees on Health and Tax Policy, as well as on the House Ethics Committee.

In appreciation of his ongoing service to the ambulance services of the United States, AAA is proud to honor Congressman Marchant with a Legislative Recognition Award.

# # #

About the American Ambulance Association

Founded in 1979, the AAA represents hundreds of ambulance services across the United States that participate in emergency and nonemergency care and medical transportation. The Association serves as a voice and clearinghouse for ambulance services, and views prehospital care not only as a public service, but also as an essential part of the total public health care system.

AAA Stars of Life

The Stars of Life program celebrates the contributions of ambulance professionals who have gone above and beyond the call of duty in service to their communities or the EMS profession. Stars of Life honors the dedication of these heroes while shining light on the critical role EMS plays in our healthcare infrastructure. This year, 101 EMS professionals will be honored as the 2017 Stars of Life. Meet the stars at www.stars.ambulance.org.

AAA Mission Statement

The mission of the American Ambulance Association is to promote health care policies that ensure excellence in the ambulance services industry and provide research, education, and communications programs to enable its members to effectively address the needs of the communities they serve.

REPLICA Compact Enacted

REPLICA Meets Goal, Interstate Compact Becomes Official

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

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

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

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

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

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

###

Congressman Kevin Brady Receives AAA Legislative Honor

Congressman Kevin Brady to Receive
2017 AAA Legislative Recognition Award

For Immediate Release
Contact:
Amanda Riordan
ariordan@ambulance.org
703-610-0264

Washington, DC– The American Ambulance Association (AAA) will honor Congressman Kevin Brady of Texas with a Legislative Recognition Award in appreciation of his advocacy for emergency medical services.
Congressman Brady will be presented this honor in June in Washington, DC by AAA’s Texas Stars of Life—EMS personnel selected for their excellence and dedication. This year’s Stars from the Lone Star State are Chris Eachen of Paramedics Plus; Cindy Hitchcock of American Medical Response; Rhonda Dees-Lockwood, and Sloane Brown of Acadian Ambulance Service; and Thomas Faticone, Daniel Dormady, and Elizabeth Roden of MedStar Mobile Healthcare.

Congressman Brady was selected for the Legislative Recognition Award for his leadership on health care issues and help ensuring the extension of the Medicare temporary ambulance add-on payments.
AAA President Mark Postma notes, “Congressman Brady has been a trusted advocate for health care and emergency medical services, both in Texas and across our country. The AAA is proud to present him with a Legislative Recognition Award.”

Elected to the U.S. House of Representatives in 1996 from Texas’s 8th congressional district, Congressman Brady is the Chairman of the House Ways and Means Committee.

# # #

About the American Ambulance Association

Founded in 1979, the AAA represents hundreds of ambulance services across the United States that participate in emergency and nonemergency care and medical transportation. The Association serves as a voice and clearinghouse for ambulance services, and views prehospital care not only as a public service, but also as an essential part of the total public health care system.

AAA Stars of Life

The Stars of Life program celebrates the contributions of ambulance professionals who have gone above and beyond the call of duty in service to their communities or the EMS profession. Stars of Life honors the dedication of these heroes while shining light on the critical role EMS plays in our healthcare infrastructure. This year, 101 EMS professionals will be honored as the 2017 Stars of Life. Meet the stars at www.stars.ambulance.org.

AAA Mission Statement

The mission of the American Ambulance Association is to promote health care policies that ensure excellence in the ambulance services industry and provide research, education, and communications programs to enable its members to effectively address the needs of the communities they serve.

2017 AAA Legislative Awards

Status of the American Health Care Act

Today, citing “growing pains” of his Republican majority, Speaker Paul Ryan (R-WI), in consultation with President Donald Trump, determined not to proceed with a planned vote on the American Health Care Act (AHCA), which repealed and replaced important elements of the Affordable Care Act (ACA).  The Speaker indicated that the House Republican Caucus “came up short” in the number of votes needed for the bill.  House Republican Leadership had been moving AHCA through the Chamber at a rapid pace.  The bill was officially released on March 6, and had been changed several times to try to appease various conservative and moderate voting blocs within the Republican Caucus.  The Congressional Budget Office (CBO) originally estimated the bill would reduce federal deficits by $337 billion, and subsequently downgraded the deficit reduction to $150 billion based on additional substantive policy changes to the bill.  The CBO estimates the bill would have increased the country’s number of uninsured by about 24 million people.

In negotiating the provisions of AHCA, the House Republican Leadership had faced a constant seesaw, as efforts to appease one ideological bloc upset the other.  Ultimately, throughout the day in advance of the scheduled vote, an increasing number of moderate Republicans, including Appropriations Committee Chairman Rodney Frelinghuysen (R-NJ), announced they would vote against the bill.  As the moderates disappeared, not enough members of the conservative Freedom Caucus decided to support the bill.

As disarray in the House Republican Caucus occurred, there appeared to be a similar lack of consensus amongst their Republican colleagues on the Senate side.  While Senate Leadership had planned to move the bill directly to the Senate floor as fast as within a week of receipt from the House, there were a number of Senators from a range of political perspectives with serious concerns about the bill.  On one side of the Republican spectrum, Senators Rand Paul (KY), Mike Lee (UT) and Ted Cruz (TX) had planned to push the limits of what can be included in a reconciliation bill to make it more conservative. Senator Paul had advocated for repealing the ACA in full and dealing with the replacement later on. On the other side, more moderate or “purple state” Members like Senators Susan Collins (ME), Lisa Murkowski (AK), Rob Portman (OH), Cory Gardner (CO) and Dean Heller (NV) raised concerns about insurance affordability and the expedited rollback of Medicaid expansion in the House version of the bill. Other Senators who will likely play a prominent role in any further health reform developments include physician Senator Bill Cassidy (LA), and Senator Tom Cotton (AR), who advocated all along to slow the process down. Republicans can only lose two Senators and still pass any health reform bill, with the vote of Vice President Mike Pence breaking the tie.

As a next step, House and Senate Republican Leadership plan to take more time to develop consensus in any future approach to health reform.  How much time is unclear – but it seems unlikely the bill will be the legislative focus in the short term.  Instead, there will likely be a cooling-off period on health reform legislative activity, since the fundamental disagreements within the caucus are not easily fixed.  There will continue to be significant messaging against ACA from conservatives, and there is the potential that the idea of “repeal and delay” may gain more traction.  Nonetheless, in the short term, the Speaker indicated he would move on to other items on his conference’s agenda – including tax reform.  Keep in mind, however, that since health-related tax provisions are a major component of the tax code, it would not be surprising to see some health issues resurface in tax reform.

The Speaker indicated that he expects the ACA marketplace to get worse – specifically citing rising premium costs.  In his own remarks on the failure to pass AHCA, the President suggested the Democrats will own any rising premiums, and provided a rare moment of optimism for the day when he indicated that a bipartisan health care reform bill may be achievable in the future when that happens.   As the Legislative Branch takes time to develop consensus, more focus will be placed on the Executive Branch.

We expect HHS Secretary Tom Price and White House Budget Director Mick Mulvaney to take an increasingly important role in driving the health agenda.  It is unclear at this point whether the Trump Administration will let ACA drift in the wind, take administrative actions to try to improve the marketplace, or even actively work to derail it further.  A likely bellwether as to the Administration’s intent is how it approaches the pending litigation over cost-sharing reduction (CSR) subsidies.  The House had sued the Obama Administration over the program, which funnels federal dollars to insurers to help keep out-of-pocket costs manageable for lower-income individuals, saying the funding had to be appropriated.  But after the inauguration, the House and Trump Administration sought a stay of the case until May 22 to allow time to resolve the issue.  If the Administration agrees to fold, the subsidies would be cut off, leading to further market instability.  If the House folds, the CSR payments would continue into the indefinite future.

From a health care legislative perspective, 2017 will still be far from a quiet year.  The President has proposed significant changes in the funding levels of important discretionary health programs.  Those budget battles will now move more front and center on the legislative agenda.  Furthermore, there continue to be “must pass” pieces of health care legislation, including CHIP reauthorization, FDA User Fee legislation, and certain Medicare extenders legislation.

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