March 18, 2021, 3:54 PM EDT
Features Empress EMS and REMSA!
By Phil McCausland
During the height of the pandemic, a quiet financial crisis was brewing for ambulance companies.
As hospitals became overwhelmed and patients begged not to be taken to crowded emergency rooms for fear of potential infection, paramedics and emergency medical technicians began treating patients where they met them — outside homes, alongside roadways, in parking lots.
The trouble is that ambulance companies are only paid to transport people, not for treating them.
Now, an aid package in the American Rescue Plan and a new federal health care program could provide a financial lifeline for ambulance companies and herald a permanent shift in emergency medicine as a whole.
The attempt to reimburse ambulance companies began with a bill introduced by Sens. Catherine Cortez Masto, D-Nev., and Bill Cassidy, R-La., but the legislation was ultimately rolled into the $1.9 trillion Covid relief bill. Cortez Masto voted for the plan, and Cassidy did not.
“Our first responders have gone above and beyond in caring for patients during the pandemic, and it’s just wrong that ambulance companies weren’t getting paid unless they took patients to the hospital,” Cortez Masto said.
Also Adds Dollars to the Provider Relief Fund to Support Rural Providers and Suppliers
March 10, 2021
Moments ago, the House of Representatives joined the Senate in passing “The American Rescue Plan.” Among the many provisions, this legislation includes waiver authority to allow the Medicare program to reimburse for ground ambulance services provided during the COVID-19 public health emergency when the beneficiary has not been transported under certain circumstances. It also increases the Provider Relief Fund by $8.5 billion, targeting the money to rural providers and suppliers, including ground ambulance services.
The American Ambulance Association (AAA) worked diligently with Centers for Medicare & Medicaid Services (CMS) and the Department of Health and Human Services (HHS) to reimburse ground ambulance services when they provide health care services to a beneficiary, but because of the pandemic the beneficiary was not transported. CMS concluded and communicated in a Frequently Asked Question (FAQ) that the Social Security Act requires the beneficiary to be transported in order for Medicare to reimburse the ground ambulance provider or supplier for the care provided.
To address this problem during the pandemic, Sens. Catherine Cortez Masto (D-NV) and Bill Cassidy (R-LA) introduced S. 149 that would allow CMS to waive the statutory provision creating the barrier to reimbursement during the pandemic. More specifically, it would allow CMS to reimburse ground ambulance services responding to a 9-1-1 or equivalent emergency call even when the beneficiary is not transported when a community-wide EMS protocol prohibiting the transport is in place. Reps. Cindy Axne (D-IA), John Larson (D-CT), and Bruce Westerman (R-AR) introduced the companion bill, H.R. 1609, in the House.
The Senate included S. 149 in “The American Rescue Plan Act of 2021,” which passed the Senate 50-49 on March 6. This amended version passed the House along party lines earlier today and the President is expected to sign the bill into law before March 14.
CMS must exercise its authority under the waiver for the provision to be implemented. The AAA has already begun working with CMS to urge it to act as quickly as possible and we are coordinating this effort with the International Association of Fire Chiefs, International Association of Fire Fighters, National Association of EMTs, National Volunteer Fire Council and the Congressional Fire Services Institute.
In addition to the waiver allowing for reimbursement for treatment in place, the final bill includes $8.5 billion additional dollars for the Provider Relief Fund directed to rural health care providers and suppliers. The funds can be used for health care related expenses and lost revenues that are attributable to COVID–19. To be eligible for a payment, an eligible rural health care provider or supplier must be enrolled Medicare or Medicaid and submit to the Secretary an application that includes a justification statement, documentation of the expenses or losses, the tax identification number, assurance required by the Secretary, and any other information the Secretary requires. The expenses and losses cannot have been reimbursed from another source or another source cannot already be obligated to reimburse.
“The American Rescue Act” marks an important step forward for ground ambulance organizations who have been on the front line of the pandemic and offers important relief recognizing the unique and essential role these organizations play in community response to the pandemic.
For more information on the provisions of the bill that impact ground ambulance services, please sign up for the webinar on “The American Rescue Plan and EMS” scheduled for this Friday, March 12, at 2:00 pm (eastern).
On Saturday, the U.S. Senate passed language for Medicare coverage of emergency treatment in place of lower acuity patients by ground ambulance services providers and suppliers during the COVID-19 public health emergency (PHE). The language is from S. 149 by Senators Cortez Masto (D-NV) and Cassidy (R-LA) and passed as part of the $1.9 Trillion American Rescue Plan (H.R. 1319). The House is scheduled to vote and expected to pass the package tomorrow.
The American Ambulance Association along with the International Association of Fire Chiefs, International Association of Firefighters, National Association of EMTs and National Volunteer Fire Council pushed for passage of the bill language.
S. 149 would authorize the Centers for Medicare and Medicaid Services (CMS) to waive the transport requirement under Medicare for treatment in place for 9-1-1 or equivalent ambulance responses in which community EMS protocols dictate that the patient not be transported to a facility. The waiver would apply during the public health emergency.
Similar to other waivers provided by Congress for Medicare coverage during the pandemic, CMS would not be required to implement the policy. However, CMS has done so in all other situations and has also made the coverage retroactive to the beginning of the PHE. Upon passage of the language, the AAA will strongly advocate for CMS to implement the waiver and make it retroactive.
The AAA will be offering educational services to our members on the requirements of the proposed new policy and how to bill for covered services.
The draft bill by Senate Democrats on a Budget Reconciliation package includes the language of S. 149 which would waive the transport requirement under Medicare for certain 9-1-1 ground ambulance services during the public health emergency. The Senate is expected to consider the package as soon as tomorrow.
Senators Catherine Cortez Masto (D-NV) and Bill Cassidy, M.D. (R-LA) introduced S. 149 on February 3 which is supported by the AAA, International Association of Fire Chiefs, International Association of Firefighters, National Volunteer Fire Council and National Association of EMTs.
Under S. 149, the Centers for Medicare and Medicaid Services (CMS) would have the authority to waive the requirement that a patient must be transported to a medical facility in order for a ground ambulance service organization responding to a 9-1-1 emergency call to be reimbursed by Medicare when there is a community-wide EMS protocol restricting the transport of the patient. Ground ambulance service organizations whose paramedics and EMTs are on the frontlines of this pandemic are struggling financially due to the reduction in ambulance transports and higher costs such associated with responding to medical emergencies that cannot be reimbursed because of the transportation requirement. S. 149would greatly help address part of that problem and recognizes the critical role that ground ambulance service organizations are playing in controlling hospital surges and reducing the spread of COVID-19 .”
The House has already passed their version of Budget Reconciliation and would still need to pass a Senate version before sending to the President. S. 149 would provide CMS with the authority and, if passed, the AAA would advocate for the agency to exercise that authority and follow through with the waiver starting at the beginning of the public health emergency.
Yesterday, Senators Catherine Cortez Masto (D- NV) and Bill Cassidy, MD (R-LA) introduced legislation (S. 149) to allow for Medicare reimbursement under certain circumstances of treatment in place by ground ambulance service organizations during the COVID-19 public health emergency. The AAA applauds the efforts of Senators Cortez Masto and Bill Cassidy as well as the Senate Finance Committee and Leadership.
S. 149 would provide the Centers for Medicare and Medicaid Services (CMS) with the authority to waive the requirement that a patient be transported to a medical facility in order for the ground ambulance service provider or supplier to receive Medicare reimbursement. The waiver would apply to 9-1-1 emergency ambulance services in which the transport did not occur as a result of “community-wide EMS protocols” due to the public health emergency. While the bill would not apply to situations in which a patient declines transport due to COVID-19 exposure concerns as advocated by the AAA, S. 149 is a significant step in the right direction to recognize ground ambulance services not being reimbursed during the pandemic.
The American Ambulance Association (AAA) along with the International Association of Fire Chiefs (IAFC), International Association of Firefighters (IAFF) and National Association of Emergency Medical Technicians (NAEMT) have spearheaded efforts for the Congress to provide CMS with waiver authority for treatment in place. We will be pushing to include the language of S. 149 in the COVID-19 stimulus package currently being negotiated between the White House and the Congress.
The American Ambulance Association Urges Immediate Passage of S. 149 to Allow CMS to Support Local Ground Ambulance Service Responses to the Public Health Emergency
Treatment in Place Supports Patients and Sustains 9-1-1 EMS Providers During the COVID-19 Pandemic
Washington, DC, February 2, 2021 – The American Ambulance Association (AAA), our nation’s voice for ground ambulance service organizations commends Senators Catherine Cortez Masto (D-NV) and Bill Cassidy, M.D. (R-LA) for the introduction of S. 149 and urges its immediate passage. This legislation would remove a statutory barrier that has stopped ground ambulance service organizations from being reimbursed for health care services they provide consistent with local emergency medical service (EMS) protocols.
“S. 149 will empower ground ambulance service organizations to better meet the emergency medical needs of their communities, which are struggling during the pandemic,” stated AAA President Shawn Baird. “I applaud Senators Cortez Masto and Cassidy for their leadership on introducing this vital piece of legislation, as well as the Senate Finance Committee and Leadership for their support of these efforts.”
Under S. 149, the Centers for Medicare and Medicaid Services (CMS) would have the authority to waive the requirement that a patient must be transported to a medical facility in order for a ground ambulance service organization responding to a 9-1-1 emergency call to be reimbursed by Medicare when there is a community-wide EMS protocol restricting the transport of the patient. “Ground ambulance service organizations whose paramedics and EMTs are on the frontlines of this pandemic are struggling financially due to the reduction in ambulance transports and higher costs such associated with responding to medical emergencies that cannot be reimbursed because of this transportation requirement,” said Baird. “This bill would greatly help address part of that problem and recognizes the critical role that ground ambulance service organizations are playing in controlling hospital surges and reducing the spread of COVID-19 .”
The legislation would benefit patients by reducing their risk of exposure to the virus, which is often the focus of the local protocols requiring them to remain at home. It would also help hospitals experiencing surges during the pandemic by allowing hospital beds to be reserved for higher acuity patients.
The AAA will help push for swift passage of the bill. President Baird called on the Congress to address the legislation as part of negotiations on a new COVID-19 economic relief package. “The American Ambulance Association fully endorses S. 149 and we ask for all members of Congress to help their ground ambulance service organizations, their patients, and the communities they serve by supporting passage of this bill.”
The American Ambulance Association safeguards the future of mobile healthcare through advocacy, thought leadership, and education. AAA advances sustainable EMS policy, empowering our members to serve their communities with high-quality on-demand healthcare. For more than 40 years, we have proudly represented those who care for people first. For more information about the AAA visit our website at www.ambulance.org.
By the time the EMTs reached my hotel room in Austin, Tex., I was already unconscious on the floor. Moments earlier I had dragged myself to the phone and called for help as chest pains began to overwhelm me. I later learned those first responders resuscitated me more than once as they used their medical training to keep me alive until we arrived at the hospital. That’s where doctors and nurses and a lot of machines took over. I had suffered a major heart attack. The care I received at that medical center was extraordinary. But not for the immediate care I received from that small team of EMTs, I never would have made it.
That was back in 2017. I’ve since recovered and feel great, often thinking about those heroic first responders, whom I was lucky enough to meet and personally thank a year later. I especially think of them and their colleagues today as COVID-19 creates huge budget problems for local governments that threaten their jobs and our nation’s ability to respond to this and future crises.
Ridge was governor of Pennsylvania and first U.S. Secretary of Homeland Security. He co-chairs the Bipartisan Commission on Biodefense.
From Home Health Care News
As hospitals continue to experience overcapacity challenges due to the COVID-19 emergency, 911 ambulance crews and community paramedics have found themselves treating more patients at home.
Historically, ambulance crews and community paramedics — both of which operate in the emergency medical services (EMS) space — have always provided some degree of care in the home setting. To do so, they’ve often worked alongside traditional home health and home care agencies, too.
“There’s been a certain amount of care [or treatment] in the home for many years,” Hanan Cohen, paramedic and director of corporate development at Empress EMS, told Home Health Care News. “On the 911 system, it’s not at all uncommon for an EMS crew to respond to a multitude of emergencies. After assessing and, sometimes, treating the person, … they may decide not to go to the hospital.”
Thank you to Hanan Cohen of Empress EMS / PatientCare EMS Solutions for this enlightening discussion about EMS treatment in place on Bloomberg Radio.
(EMS portion begins at 54:12)
Visit the New York Times website to watch this excellent video featuring AAA member Seniorcare.
“Bye, Mommy, I Love You’: Medics and Coronavirus Patients Make Hard Decisions
By Yousur Al-Hlou, Leslye Davis and Will Miller on June 3, 2020
Our ride with New York City medics during the coronavirus peak revealed a new side to their job: guiding patients on whether to go to the hospital.
Thank you to PEW Stateline journalist Michael Ollove for taking the time to learn about EMS economics from AAA Payment Reform Chair Asbel Montes and Professional Ambulance Association of Wisconsin President Chris Anderson.
Stay-at-home orders have paused many activities that resulted in emergency calls, such as traffic accidents and shootings, said Chris Anderson, director of operations for Bell Ambulance in Wisconsin. As for non-emergency transportation, many people want to avoid health facilities now if they can, he said.
Asbel Montes, a senior vice president with Acadian Companies, a Louisiana-based firm operating 500 ambulances in Louisiana, Mississippi, Tennessee and Texas, said emergency calls have dropped by 30% and non-emergency calls by 70%.