News & Updates

In cooperation with the American Ambulance Association, we and others have created a running compilation of local and national news stories relating to EMS delivery. Since January, 2021, 2,006 news reports have been chronicled, with 47% highlighting the EMS staffing crisis, and 34% highlighting the funding crisis. Combined reports of staffing and/or funding account for 81% of the media reports! 101 reports cite EMS system closures/agencies departing communities, and 94% of the news articles reference staffing challenges, funding issues and response times.


Click below for an up to date list of these news stories, with links to the source documents.

Media Log Rolling Totals as of 5-30-24.xlsx

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  • 12 Jun 2024 7:51 AM | Matt Zavadsky (Administrator)

    Protest erupts over ambulance contract for Kauai and Maui counties

    by: Lucy Lopez

    May 31, 2024

    https://www.khon2.com/local-news/protest-erupts-over-ambulance-contract-for-kauai-and-maui-counties/

    HONOLULU (KHON2) — A week following the Department of Health’s decision to award the ambulance contract for Kauai and Maui Counties to American Medical Response (AMR) after a competitive bid process, a protest has emerged.

    Falck USA, the unsuccessful bidder, filed a formal notice of protest Friday, citing alleged errors in the calculation of their scores and inconsistencies in the evaluation criteria utilized for the contract awards.

    STATEMENT FROM TROY HAGEN, CHIEF COMMERCIAL OFFICER FOR FALCK USA

    “We filed a notice of protest after identifying what appears to be a clear error in calculating Falck’s scores, along with inconsistencies in the evaluation criteria used to award the contracts. We look forward to opening discussions with the Department of Health and ensuring these vitally important emergency medical services contracts are awarded based on a fair and transparent process.

    Falck continues to stand ready to serve. As a foundation-owned healthcare provider, we would bring a fresh perspective, unmatched financial stability, reliable services developed around global best practices, and a deep commitment to delivering the highest quality care to the communities we serve.”

    This marks the second time that the ambulance bid process has faced protest.

    In August of last year, Falck was initially awarded the contract, but AMR filed a protest, prompting the Department of Health to restart the bidding process.

    In response to the latest protest, the Department of Health stated that it cannot proceed with the contract award until the protest is resolved and declared that it will refrain from further comments on the matter at the time.

    The protest introduces a new twist in the ongoing saga surrounding emergency medical services in Kauai and Maui Counties, leaving stakeholders and residents awaiting a resolution to ensure timely and effective ambulance services in the region.


  • 12 Jun 2024 7:46 AM | Matt Zavadsky (Administrator)

    The work begins for county run EMS

    Emergency Medical Services in Henry County could transition from Henry County Health Center to the county itself

    AnnaMarie Ward

    Jun. 5, 2024

    https://www.southeastiowaunion.com/se-iowa-union-mount-pleasant/the-work-begins-for-county-run-ems/

    MT. PLEASANT — Henry County Supervisors approved and adopted the third and final reading of a resolution which declares emergency medical services as an essential county service in Henry County.

    If all goes well and voters approve the tax levy this November, Emergency Medical Services will become a Henry County entity.

    “The Board hereby declares EMS to be a central county service in the county and hereby directs that any and all other actions be taken as necessary to proceed with the process under Iowa Code 422D.1 to declare EMS an essential county service,” Supervisor Greg Moeller read from the resolution at Thursday, May 30 Board of Supervisors meeting.

    “Now the work begins,” Henry County Health Center Chief Financial Officer David Muhs said following the board’s approval.

    According to the resolution, these “other actions” and additional work will include creating a County EMS System Advisory Council, “to assist in researching and assessing the service needs of the county and guiding implementation with respect to the potential imposition of a local options income surtax and/or ad valorem property tax for EMS in the county.”

    While declaring EMS an essential county service means the county will foot the bill, it does not mean the entire cost will be passed onto taxpayers.

    According to Muhs, the approximate cost of operating the EMS service currently is $2.4 million and the service is receiving about $2.2 million in revenue. Muhs states this revenue has been consistent percentagewise over the last five to 10 years.

    Discussions with the Board of Supervisors revealed a cap on tax levy ability for EMS will be 75 cents per $1,000 valuation.

    According to Moeller, it will be the responsibility of the County EMS System Advisory Council to “Bring it to the public to let them know that the 27 cents that the hospital now levies for ambulance services will be included in this 75-cent levy.”

    Included in this 75 cents however, will be the 27 cents per $1,000 valuation already implemented in the Henry County Health Center’s general basic levy. These 27 cents will be rolled into the total 75 cents and taken out of the hospital’s levy.


  • 12 Jun 2024 7:25 AM | Matt Zavadsky (Administrator)

    Wayne County Commission seeks temporary EMS solution until levy takes effect

    by: Jessica Patterson

    Posted: Jun 10, 2024

    https://www.wowktv.com/news/west-virginia/wayne-county-wv/wayne-county-commission-seeks-temporary-ems-solution-until-levy-takes-effect/

    WAYNE COUNTY, WV (WOWK) – The Wayne County Commission says a newly passed levy will help emergency response in the county, but they’re working on a plan to help until that levy takes effect next year.

    The Wayne County Public Service Levy, designed to help improve emergency services, passed in the Primary Election in May by just one vote. Initially, it appeared the levy would fail, with just 59.9% of the needed 60% vote. However, once all mail-in ballots were accounted for and after canvassing, the levy pulled through by one vote.

    The Wayne County Commission took to social media this Sunday to thank those who voted in support of the levy.

    “No matter how you voted, your political affiliation or your community, the passage of this levy will benefit each person in the county at a very reasonable cost,” said the Wayne County Commission. “According to the commission, the average property owner will pay less than $100 per year for this improved service.”

    ‘It’s a problem we inherited’: Wayne County Commission talks solutions to EMS issues

    They say one goal of the levy is to create a 24/7 county-run EMS system to alleviate the county’s slow ambulance response times. Residents in the area have told 13 News the problem with response times gives them a helpless feeling after multiple instances where families have called 911 only to be told an ambulance isn’t readily available.

    Commissioners say the levy will begin providing funding for EMS and other services in July 2025. The commission also says they are working to implement a temporary strategy to improve emergency response times until the levy takes effect.


  • 12 Jun 2024 7:07 AM | Matt Zavadsky (Administrator)

    Colorado Springs' proposed city-run ambulance service voted down

    By Mary Shinn

    Jun 11, 2024

    https://gazette.com/news/colorado-springs-proposed-city-run-ambulance-service-voted-down/

    The Colorado Springs City Council voted down a new city-run ambulance service Tuesday after months of debate about whether to take over services provided by a private company.

    The council voted 5-4 not to create an ambulance service that would have been funded through fees for service, not city taxes. The vote leaves the contract with American Medical Response in place.

    Colorado Springs Fire Department Chief Randy Royal recapped the pitch for bringing the ambulance service in-house during the meeting, saying it would be self-sustaining, the city could bill patients less and it would allow the department to continue adding innovative services for low-level and behavioral health calls. The department has been recognized for unique services. For example, crews in SUVs respond to 911 calls for low-level injuries such as sprained ankles that free up others to respond to critical emergencies.

    Councilwoman Lynette Crow-Iverson was among the council members that opposed the project and pointed to an audit report that came out Thursday as proof the Fire Department was over-estimating its revenues from commercial insurance. As a city enterprise the service would have to pay for itself through Medicaid, Medicare and commercial insurance payments. Private insurance brings in the highest amount of revenue for ambulance services.

    The audit found on average comparable cities bring in about 14% of revenues from commercial insurance companies, while the Fire Department estimated about 23% of revenues could come from commercial insurance.

    "Their estimations were over significantly," Crow-Iverson said. She opposed the project along with councilmembers Dave Donelson, Mike O'Malley, Brian Risley and Michelle Talarico.

    As an enterprise fund, the city could not backfill any revenue shortfall with tax revenue.

    Crow-Iverson said the city did not have the start-up funding for the service in hand and did not provide the council with the letters of intent from donors. It was a point that Royal disputed, saying the city had monetary commitments. But officials thought it would be premature to collect the money from donors before the council voted on the issue, he said. 

    The audit also found a cash-flow risk with the proposal.

    "Given start-up costs, the uncertain actual payor mix, and the lag from time of service until cash is received, the EMS enterprise would rely upon available start-up cash during initial operations," the audit said.

    Crow-Iverson also noted that when AMR did not meet the city's time limit requirements for responding to 911 calls it was by two or three minutes and that will be solved as the agency hires additional people. The company faced a shortage of employees following the pandemic.

    "The free market will get back up to speed," she said.

    Councilmembers in favor of the project said they were willing to accept some risk in favor of allowing the Fire Department to innovate and potentially provide faster services 

    "People’s lives matter and responding to their critical moments should be and should always be our top concern," said Councilmember David Leinweber.

    AMR has struggled to meet the city's required response to emergencies. 

    Data show the company paid the city more than $5.7 million in fines — largely for delayed response times — between April 2020 and January 2024.

    The city was expecting to start up its new EMS service April 1, 2025. Now, the city could put out a call for companies to apply to provide services, known as a request for proposal. AMR could be among the companies to apply and could renegotiate its contract at that time.

    Mayor Yemi Mobolade, Council President Randy Helms and Royal all said they were disappointed in the council's decision in a news conference on the steps of City Hall.

    "This does set us backwards, we are not advancing," Mobolade said. "... We have got to innovate. We got to be better. We can't just do things the same way."

    Royal said by relying on a private company to provide services the community has left $35 million in Medicaid payments on the table that could bolster emergency response.

    AMR does not qualify those payments as a private company. 

    The Fire Department argued earlier in the year it could put would-be profits into services that could improve patient experiences and pay employees better. The department expected that if it had taken over the service it would have hired mostly AMR employees.

    After nine years, the department expected to have $42 million in the bank.

    "This has been the most scrutinized project I have ever been involved with," Royal said during the meeting. 

    The move to in-house services also had support from the local firefighter and police associations and Dr. Robin Johnson, the medical director for El Paso County Public Health.

    Curt Crumb, president of Colorado Springs Professional Firefighters union Local 5, said the current for-profit ambulance model holds the community back from world-class care.

    "If we continue in the current fashion, we will always have a competing interest," he said.


  • 4 Jun 2024 2:52 PM | Matt Zavadsky (Administrator)

    Like hospital emergency departments, EMS agencies are safety net providers, responding to all patients who access 911, regardless of the patient’s socio-economic status. Often, EMS agencies provide medical care to these patients, but are not compensated for those services, either by insurers, or the patients themselves (uninsured/self-pay).

    Uncompensated care exacerbates the on-going financial crisis in EMS, which is a key driver of the EMS staffing crisis. An industry news tracker has chronicled over 2,000 local and national EMS news reports since 2021, and 82% of the news reports highlight the EMS economic and staffing crisis.

    The Academy of International Mobile Healthcare Integration (AIMHI) and the National Association of Emergency Medical Technicians (NAEMT) recently distributed a survey related to the impact of uncompensated care in EMS. 28 agencies representing diverse types of EMS systems in both urban and rural communities responded to the survey. PWW|AG analyzed the data provided by the respondents and has summarized the findings.

    Download the summary report here.

    Download the data set here.

    The results from the survey detail the level of uncompensated care provided by the respondents, and we applied these finding to the U.S. EMS systems to quantify the likely cost of unreimbursed care to America’s EMS agencies.

    Findings:

    • Data from survey respondents for 2019, 2021 and 2023 reveals that self-pay patients represent 13.3% of the overall patients treated by the EMS agencies that responded to the survey.
      • For these patients, the average collection across the agencies was $232.30, on an average patient charge of $1,538.41, representing a 15.1% collection rate.
    •  Data recently provided by the Public Consulting Group (PCG) derived from Medicaid cost reports found that in 2021, the average provider cost for responding to a call and transporting a patient to a hospital was $2,351.34.
      • Therefore, for 13.3% of EMS responses, on average, the uncompensated care cost is $2,119.04 per patient ($2,351.34 - $232.30).
    • According to a report from the National Association of State EMS Officials (NASEMSO), there were 15.9 million EMS patient transports in 2018.
      • Applying the uncompensated patient percentage of 13.3%, this means that 2,114,700 of these transports are provided at a loss of $2,119.04 per transport, for a total cost of uncompensated care of $4.5 billion.










  • 4 Jun 2024 9:26 AM | Matt Zavadsky (Administrator)

    Interesting perspective by a former insurance regulator. 

    ---------------------

    Opinion: Ambulance importance

    By BRENDAN WILLIAMS

    06-04-2024

    https://www.concordmonitor.com/My-Turn-Ambulance-bill-NH-state-house-55420534

    Brendan Williams is the president and CEO of the New Hampshire Health Care Association.

    It is a story often told: A bipartisan New Hampshire Senate bill, in this case co-sponsored by over half the Senate, passes the Senate and is eviscerated in the House.

    This particular story involves Senate Bill 407, which addresses what insurers pay for ambulance services.

    As it passed the Senate, it would require insurers to pay rates that are fair, as part of a genuine negotiation between an insurer and an ambulance company. In the absence of an agreement between the insurer and the provider, the Senate would require that the insurer pay rates set by the local government or contracted entity subject to a public process, or rates tied to what Medicare pays, or the billed charges, whichever is the least expensive amount.

    Sound reasonable? It certainly would be great for Granite Staters who too often today can find that ambulance services are hard to access, particularly in rural areas, because of the costs of inflation, including wages.

    A report issued last year by New Hampshire Ambulance Association surveyed 150 emergency medical service leaders, and 98% of them said the system was in urgent need of attention. One ambulance company alone had 50 job openings it couldn’t fill because reimbursement was not high enough to compete in the job market. Other companies were going out of business.

    In contrast, health insurance companies seem to be doing okay. For example, even after nearly bringing down the U.S. healthcare system due to one of its myriad subsidiaries, which handles insurance billing, experiencing a cyberattack that could have been avoided with simple cybersecurity, UnitedHealth Group has a market cap of $455.93 billion as I write this. That’s thirty times bigger than the size of the state of New Hampshire’s current two-year budget.

    As a former state insurance regulator, I can attest to the fact that for providers and patients alike to be chiseled by health insurers is as American as apple pie. I paid $9,100 out-of-pocket last year even though I was “insured” — an experience too many can relate to. Health insurers are even buying up medical practices so that they can steer those they insure to themselves, cleverly bypassing the already generous Affordable Care Act limits on how much they can pocket. One major New Hampshire insurer was reimbursing less for ambulance services than it did a decade ago. Why? Because it can get away with it.

    As it passed the Senate, SB 407 would apply a very small leveling to this uneven playing field and benefit all Granite Staters who need an emergency response or transportation to a health care provider. The current crisis has, for example, burdened hospitals when an ambulance is not available to transport a patient ready for discharge into a long-term care setting. Yet in the House, this good bill got turned into a study.

    It is a classic legislative move: When you don’t want to do something you just study it. I cannot count how many study committees I have been a part of that have completely failed to accomplish anything substantive. And then sometime later another study committee studies the same thing.

    The Senate has refused to concur in the House approach and there is now a conference committee between the two legislative chambers.

    The House should yield to the Senate position. Especially in a state as rural as ours, the well-being of Granite Staters, including some of our most vulnerable citizens, depends on having a viable ambulance sector.


  • 30 May 2024 4:36 PM | Matt Zavadsky (Administrator)

    Excellent news out of New York!

    Nice to see another state begin the process to authorize Medicaid to pay for Treatment in Place (TIP) and Transport to Alternate Destinations (TAD), as well as designate EMS as an essential service.

    -------------------

    New York state Senate passes measures aimed to support emergency medical service providers

    By Luke Parsnow New York State

    May 29, 2024

    https://spectrumlocalnews.com/nys/central-ny/politics/2024/05/29/n-y--state-senate-passes-bills-aimed-to-support-emergency-service-providers

    The New York state Senate on Wednesday passed a legislative package aimed to expand resources for emergency service providers, Democratic leadership announced.

    The legislation is made up of bills that would:

    • authorize Medicaid reimbursements to emergency medical service agencies for providing emergency medical care to Medicaid enrollees without requiring the transportation of these patients from the place where medical care was administered. It would also permit Medicaid payments to be made to EMS services when they transport individuals to alternative care facilities instead of only hospitals. 
    • permit more ambulance services and advanced life support first responders to store, administer and distribute blood. All ambulances, whether airborne or grounded, would qualify to transfuse blood products to patients to resuscitate them during transport.
    • allow the state Department of Health to charge ambulance service providers a universal service assessment fee to cover increased medical assistant payment rates for their services.
    • increase the volunteer firefighters’ and ambulance workers’ personal income tax credit from $200 to $800 for eligible individuals, and from $400 to $1,600 for eligible married joint filers.
    • declare general ambulance services as an essential service, establish special districts for the financing and operation of generation ambulance services, and provide for a statewide comprehensive emergency medical system plan.

    “Emergency medical service providers are the backbone of our healthcare system in times of crisis. This legislative package ensures they have the support and resources necessary to continue their life-saving work,” state Senate Majority Leader Andrea Stewart-Cousins said in a statement. “By addressing financial, operational, and systemic challenges, we are reaffirming our commitment to the health and safety of all New Yorkers.” 

    State lawmakers are pushing their priorities before the legislative session ends on June 6.


  • 23 May 2024 9:19 PM | Matt Zavadsky (Administrator)

    EMS Leaders –

    This could be a good springboard to engage with your communities to provide essential training on hands-only CPR, AED, Stop the Bleed and perhaps naloxone administration.

    It could also help demonstrate value for your agency!

    ----------------------

    Half of Americans not equipped to provide life-saving treatment in a crisis, poll finds

    Emergency room physicians provide tips on how people can be better prepared

    By Melissa Rudy Fox News

    May 22, 2024

    https://www.foxnews.com/health/half-americans-equipped-provide-life-saving-treatment-crisis-poll-finds

    Only half the people in the U.S. feel they could be helpful in an emergency situation, a new poll found.

    The Ohio State University Wexner Medical Center surveyed a national sample of 1,005 Americans, finding that only 51% of them knew how to perform hands-only CPR if needed.

    In cases of serious bleeding, only 49% said they could assist, and 56% said they would be equipped to help someone who was choking.

    The data was collected via phone and email from April 5 to April 7 of this year.

    "The key takeaways from our survey are that patient outcomes would improve if the general public learned some basic life-saving measures in the areas of hands-only CPR, choking rescue and bleeding control," Nicholas Kman, M.D., emergency medicine physician at Ohio State Wexner Medical Center and clinical professor of emergency medicine at The Ohio State University College of Medicine, told Fox News Digital. 

    "We can save lives while we wait for first responders to arrive."

    "For every minute that passes, the chance of survival drops, and if they do survive, there’s less chance of a good neurologic outcome."

    Data shows that 70% to 80% of cardiac arrests occur in the home and 20% happen in a public place, according to Kman.

    HELP DESPERATELY NEEDED: AMERICAN HEART ASSOCIATION LAUNCHES 'NATION OF LIFESAVERS' PROGRAM

    "Outcomes are poor when the arrest is unwitnessed at home," he told Fox News Digital. 

    "Just think, the person with the medical emergency could be your loved one in your house. You may have to provide life-saving treatment until first responders arrive."

    Heimlich maneuver

    Data shows that 70% to 80% of cardiac arrests occur in the home and 20% happen in a public place, a researcher said.

    Based on the survey findings, Kman advised the public to get trained in life-saving measures — particularly hands-only CPR, choking and serious bleeding.

    "Look for training that may be offered through community days at hospitals, schools, libraries, community organizations, religious institutions, volunteer groups, festivals and sporting events," he suggested.

    "We’re responsible for each other."

    Organizations and websites such as the American Red Cross, the American Heart Association and Stop The Bleed may offer these courses for free or low cost, Kman noted. 

    After learning the skills, it’s important to practice them, the doctor said.

    "We would love the public to learn how to do hands-only CPR and practice the skill of doing CPR every six weeks," Kman said.

    Performing CPR

    Based on the survey findings, researchers advised people to get trained in life-saving measures, particularly hands-only CPR, choking first-aid and serious bleeding assistance.

    "As with any skill, practice builds confidence. If we don’t practice it, we lose that skill."

    The OSU survey did have some limitations, Kman acknowledged.

    "The survey was a convenience sample of a cross-section of Americans," he told Fox News Digital.

    "Most demographics were equally represented, but different regions do better at this than others, and their cardiac arrest results and survival reflect that," he continued.

    "States and countries that prioritize training the public have higher survival rates."

    Emergency room

    "When you’re trained in these lifesaving skills, you’ll know how to recognize the signs that someone needs help and buy time until the [first] responders can get there," a doctor said.

    Dr. Kenneth Perry, an emergency department physician in South Carolina, was not involved in the survey but said he was surprised that more people don’t feel unprepared.

    "Even for medical professionals, having a medical emergency occur without preparation can be a very stressful event," he told Fox News Digital.

    "It is very important for people to have basic lifesaving skills."

    The easiest and most helpful skill that people should learn is how to operate an automated external defibrillator (AED). These are located in many public places, such as gyms, malls and even some public walkways, according to Perry. 

    "These devices are the best way to save a person who is suffering from cardiac arrest," he said.

    "If the person has an abnormal heart rhythm that can be brought back to normal with electricity, this device will save that patient."

    This is a very time-sensitive process, however — it must happen as early as possible, the doctor advised.

    "Early defibrillation is directly correlated with the best outcomes for patients who suffer an out-of-hospital cardiac arrest."

    Ultimately, Kwan, said, "we're responsible for each other."

    "When you’re trained in these lifesaving skills, you’ll know how to recognize the signs that someone needs help and buy time until the responders can get there."


  • 20 May 2024 12:00 PM | Matt Zavadsky (Administrator)

    Continuation of telehealth reimbursement models available through the current CMS waivers will be beneficial to EMS because they help facilitate protocols that include a telehealth consult as part of an EMS Treatment in Place (TIP) protocol by allowing providers to be reimbursed for telehealth services originating at the patient’s residence, and without an established patient:provider relationship.

    And because the current waivers allow telehealth providers to reimburse ambulance agencies for the facilitation of provider requested telehealth services.

    Salient waiver language, with links, included at the end of the article.

    ------------------

    House committee advances bill to extend telehealth rules

    MICHAEL MCAULIFF

    May 08, 2024

    https://www.modernhealthcare.com/politics-policy/telehealth-rules-waiver-extension-congress

    Congress took the first step Wednesday to extend expiring telehealth rules, hospital at home services and other programs aimed at rural hospitals.

    The House Ways and Means Committee passed the Preserving Telehealth, Hospital, and Ambulance Access Act of 2024 by a vote of 31-0, setting it up for passage by the full House later this year.

    The bill would extend for two years telehealth rules adopted during the pandemic that are due to expire at the end of the year, as well as extend similar rules for Medicare's hospital at home program for five years.

    The measure also expands the practitioners eligible to bill Medicare for telehealth services to physical therapists, occupational therapists, audiologists and speech language pathologists. And it allows federally qualified health centers and rural health clinics bill Medicare for telehealth services, and delays in-person visit requirements for remote mental healthcare.

    "One of our top priorities on this committee is helping every American access healthcare in the community where they live, work and raise a family. In rural America, in small towns, families often struggle to get healthcare," Ways and Means Committee Chair Jason Smith (R-Mo.) said. "Without this bill, beneficiaries will no longer be able to talk to their doctors or receive acute hospital care from the comfort of their home, starting at the end of this year."

    While the bill received broad bipartisan support, many of the Democrats on the committee complained that Republicans failed to include significant fraud prevention measures.

    "it's difficult to view this bill as progress with regard to fraud since it gives [the Centers for Medicare and Medicaid Services] no new authority, and no new enforcement tools," said Rep. Lloyd Doggett (D-Texas).

    "There's much more to do here to protect consumers," said the ranking Democrat on the committee, Rep. Richard Neal (Mass.)

    Republicans agreed that more should be done to target fraud, but suggested it should be addressed in a different, broader bill.

    One potentially controversial provision in the bill requires pharmacy benefit managers that work with Medicare Part D plans to de-link the compensation they pay themselves from the rebates they secure based on drugs' high list prices. Rep. Brad Schneider (D-Ill.) said the provision will save the government about $500 million, although official estimates were not yet available. The provision does not apply to the broader commercial market, though Schneider and Rep. Nicole Malliotakis (R-N.Y.) both called for expansion of the provision to the commercial market. Large PBMs oppose such provisions.

    Other extensions in the bill cover Medicare’s Low Volume Adjustment and the Medicare-Dependent Hospital Program, which give rural hospitals bonus payments, and are due to expire at the end of 2024. The payments would be extended until September 2025. The bill includes a nine-month extension for Medicare add-on payments for ambulance services in areas with poor access. Republicans opposed amendments to add more time to the extensions, saying they were not paid for.

    The committee is still considering several other bills designed to ease stresses on rural hospitals. Among them:

    • ·         The Preserving Emergency Access in Key Sites Act of 2024, which would boost ambulance payments for hospitals in locations that are hard to reach.
    • ·         The Rural Hospital Stabilization Act of 2024 to boost grants to rural hospitals.
    • ·         The Rural Physician Workforce Preservation Act of 2024 to require that 10% of 1,200 recently approved Medicare graduate medical education training slots go to rural hospitals.
    • ·         The Second Chances for Rural Hospitals Act of 2024, which would allow rural hospitals that closed as long ago as 2017 to reopen as Rural Emergency Hospitals, which receive $276,000 monthly payments from Medicare to support 24-hour emergency services.

    Democrats suggested that because of objections they raised, the bills would not pass in the Democratic-controlled Senate. Republicans argued that the House should not worry what the Senate might do.

    Whether the Senate ever takes up the specific bills, passing them through the committee and likely through the full House makes them available for negotiations that are likely to begin once the November elections are over and Congress grapples with unfinished business.

    "Many of these bills won't become law," Neal said. "There's much more we could have done and likely we will do, post-election time."

    Waiver Language:

     EXPANSION OF TELEHEALTH WITH 1135 WAIVER: Under this new waiver, Medicare can pay for office, hospital, and other visits furnished via telehealth across the country and including in patient’s places of residence starting March 6, 2020. A range of providers, such as doctors, nurse practitioners, clinical psychologists, and licensed clinical social workers, will be able to offer telehealth to their patients. Additionally, the HHS Office of Inspector General (OIG) is providing flexibility for healthcare providers to reduce or waive cost-sharing for telehealth visits paid by federal healthcare programs. Prior to this waiver Medicare could only pay for telehealth on a limited basis: when the person receiving the service is in a designated rural area and when they leave their home and go to a clinic, hospital, or certain other types of medical facilities for the service.

    https://www.cms.gov/newsroom/fact-sheets/medicare-telemedicine-health-care-provider-fact-sheet

    --------------------

     [CMS-1744-IFC]

    RIN 0938-AU31

    Medicare and Medicaid Programs; Policy and Regulatory Revisions in Response to the COVID-19 Public Health Emergency

    AGENCY: Centers for Medicare & Medicaid Services (CMS), HHS.

    ACTION: Interim final rule with comment period.

    “….. We note that in specifying that direct supervision includes virtual presence through audio/video real-time communications technology during the PHE for the COVID-19 pandemic, this can include instances where the physician enters into a contractual arrangement for auxiliary personnel as defined in § 410.26(a)(1), to leverage additional staff and technology necessary to provide care that would ordinarily be provided incident to a physicians’ service (including  services that are allowed to be performed via telehealth). For example, physicians may enter into contractual arrangements with a home health agency (defined under section 1861(o) of the Act), a qualified infusion therapy supplier (defined under section 1861(iii)(3)(D) of the Act), or entities that furnish ambulance services in order to utilize their nurses or other clinical staff as auxiliary personnel under leased employment (§ 410.26(a)(5)). In such instances, the provider/supplier would seek payment for any services they provided from the billing practitioner and would not submit claims to Medicare for such services. For telehealth services that need to be personally provided by a physician, such as an E/M visit, the physician would need to personally perform the E/M visit and report that service as a Medicare telehealth service.”

    https://www.cms.gov/files/document/covid-final-ifc.pdf


  • 20 May 2024 6:09 AM | Matt Zavadsky (Administrator)

    Latest state law designed to help assure patients are not in the middle of billing disputes between providers and insurers.

    A downloadable copy of the bill is at the link in the news report.

    ---------------------

    Here’s a new law to help Hoosiers with surprise ambulance bills

    by: Jana Garrett

    May 17, 2024

    https://www.tristatehomepage.com/news/indiana-news/heres-a-new-law-to-help-hoosiers-with-surprise-ambulance-bills/

    HENDERSON, Ky. (WEHT) – According to the Indiana House Republicans, State Representative Tim O’Brien supported a new law that would will require health insurance companies to reimburse for ambulance services that are not part of a person’s coverage plan.

    According to a report by Health Affairs, about 28% of emergency trips in a ground ambulance result in a potential surprise bill. Officials say these bills can place a “significant” financial burden on patients, often leaving them with “overwhelming” expenses they may struggle to pay.

    Rep. O’Brien says going forward, those who use an out-of-network ambulance service will be protected from having to pay more for that service than their in-network rate plus either their deductible or copay. Out-of-network ambulance providers must now accept either the patient’s in-network rate plus their deductible or copay, or the 400% of the Medicare rate for those services.

    Rep. O’Brien says currently, there is no set time frame in which an ambulance service must receive payment from health plan providers. Under this new law, service providers must receive payment within 30 days of the claim being filed.

    Officials say House Enrolled Act 1385 goes into effect July 1.


    Here’s a new law to help Hoosiers with surprise ambulance bills


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