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EMS Testifies at House Ways & Means Field Hearing

Written by Rob Lawrence on . Posted in Legislative, Press.

Yesterday was a proud day for EMS!


Thank you to Matt Zavadsky and Medstar Mobile Healthcare for developing this highlights clip from the recent House Ways & Means field hearing focused on emergency services.

CMS Statement on Continued Action to Respond to the Cyberattack on Change Healthcare

Written by AAA Staff on . Posted in Legislative, News, Private Insurance.

From the Centers for Medicare & Medicaid Services on March 9

The Centers for Medicare & Medicaid Services (CMS) is continuing to monitor and assess the impact that the cyberattack on UnitedHealth Group’s subsidiary Change Healthcare has had on all provider and supplier types. Today, CMS is announcing that, in addition to considering applications for accelerated payments for Medicare Part A providers, we will also be considering applications for advance payments for Part B suppliers.

Over the last few days, we have continued to meet with health plans, providers and suppliers to hear about their most pressing concerns. As announced previously, we have directed our Medicare Administrative Contractors (MACs) to expedite actions needed for providers and suppliers to change the clearinghouse they use and to accept paper claims if providers need to use that method. We will continue to respond to provider and supplier inquiries regarding MAC processes.

CMS also recognizes that many Medicaid providers are deeply affected by the impact of the cyberattack. We are continuing to work closely with States and are urging Medicaid managed care plans to make prospective payments to impacted providers, as well.

All MACs will provide public information on how to submit a request for a Medicare accelerated or advance payment on their websites as early as today, Saturday, March 9.

CMS looks forward to continuing to support the provider community during this difficult situation. All affected providers should reach out to health plans and other payers for assistance with the disruption. CMS has encouraged Medicare Advantage (MA) organizations to offer advance funding to providers affected by this cyberattack. The rules governing CMS’s payments to MA organizations and Part D sponsors remain unchanged. Please note that nothing in this statement speaks to the arrangements between MA organizations or Part D sponsors and their contracted providers or facilities.

For more information view the Fact Sheet: https://www.cms.gov/newsroom/fact-sheets/change-healthcare/optum-payment-disruption-chopd-accelerated-payments-part-providers-and-advance

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EMS.gov | HHS Announces New Performance Goals to Enhance Cybersecurity

Written by AAA Staff on . Posted in Regulatory, Technology.

EMS News

HHS Announces New Cybersecurity Performance Goals to Enhance Cybersecurity
The U.S. Department of Health and Human Services (HHS), through the Administration for Strategic Preparedness and Response (ASPR), announced on January 24, 2024, the release of new voluntary Cybersecurity Performance Goals (CPGs). These guidelines are specifically designed for the Health Care and Public Health (HPH) sector. Additionally, HHS launched a gateway website to streamline the implementation of these cybersecurity measures and facilitate access to extensive resources provided by HHS and its federal partners.

The HPH CPGs are designed to better protect the healthcare sector from cyberattacks, improve response when events occur and minimize residual risk. HPH CPGs include both essential goals to outline minimum foundational practices for cybersecurity performance and enhanced goals to encourage adoption of more advanced practices.

View Resource

As healthcare continues to embrace digital transformation, the importance of cybersecurity has never been more critical. We urge the EMS community to engage with this significant development. The new CPGs represent a proactive step by ASPR and HHS to fortify the healthcare sector’s defenses against cyber threats.

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1200 New Jersey Avenue, SE
Washington, DC 20590
nhtsa.ems@dot.gov

AAA President Strozyk to Testify Before Congressional Committee

Written by AAA Staff on . Posted in Government Affairs, Legislative, Uncategorized.

AAA President Randy Strozyk will testify tomorrow, February 14, at 10:00 am (eastern) before the Health Subcommittee of the Energy and Commerce Committee of the U.S. House of Representatives. The hearing is on “Legislative Proposals To Support Patients And Caregivers” and Randy will speak to the SIREN Reauthorization Act (H.R. 4646), EMS for Children Reauthorization Act (H.R. 6960) and legislation to reauthorize the Traumatic Brain Injury program (H.R. 7208) and certain poison control programs (H.R. 7251).

The hearing will be live streamed online at https://youtu.be/Zy-4NCuheGM.
The hearing will provide the AAA and Randy with a platform to voice support for the EMS proposals on the agenda as well as raise the need for the Committee to address our Medicare ambulance add-on payments and the EMS workforce shortage. For a copy of Randy’s written testimony and other details of the hearing, please go to the Committee website for the hearing.

Recent Announcements and New Resources on EMS.gov

Written by AAA Staff on . Posted in Regulatory.

From EMS.gov on January 24, 2024

EMS News

Recent Announcements

TODAY: Rural Emergency Medical Service (EMS) Training Grant Pre-Application Webinar

The Substance Abuse and Mental Health Services Administration (SAMHSA) is hosting a webinar scheduled for Wednesday, January 24, 2024 at 4:00 PM ET, discussing the application process for the Rural Emergency Medical Service Training Grant program. The purpose of this funding opportunity is to recruit and train EMS personnel in rural areas with a particular focus on addressing substance use disorders (SUD) and co-occurring disorders (COD) substance use and mental disorders.

Registration is not required for participation and a recording will be made available on the SAMHSA.gov.

Access Webinar Information Here

 

Volpe Center SBIR Program

The U.S. Department of Transportation (DOT) Volpe Center has announced the Small Business Innovation Research (SBIR) Program FY24.1 research topics and Phase I Pre-Solicitation. The pre-solicitation period for feedback ends February 6.

Review SBIR Pre-Solicitation Notice

New Resources Available on EMS.gov

Model Minimum Uniform Crash Criteria – 6th Edition

Visit EMS.gov to review the 6th edition of the Model Minimum Uniform Crash Criteria (MMUCC) recently released by NHTSA. This voluntary guideline represents a minimum, standardized set of data variables to describe motor vehicle traffic crashes in an effort to identify traffic safety problems and design countermeasures to improve driver and roadway safety. The January 2024 MMUCC guideline features the NEMSIS Universal Unique Identifier and many critical data elements specific to emergency vehicle crashes, providing more information on the people involved in these crashes as well as secondary and move-over crash data.

View Publication

 

New NIOSH Safety and Health Advisory

The latest NIOSH Safety and Health Advisory educates fire service professionals on the importance of quickly removing an unresponsive firefighter from turnout gear and self-contained breathing apparatus as well as available training techniques. NIOSH co-authored this resource with the leading national experts from the American Red Cross, Butler County Community College Public Safety Training Facility and the Firefighter Down-CPR creators (Christopher Watford and Mike Herbert).

View Advisory

 

Airway Management EBG Article

Airway management is the foundation of EMS care. The newly published Evidence Based Guideline (EBG) for prehospital airway management is based on the systematic review by the Agency for Healthcare Research and Quality (AHRQ) and includes recommendations on the different PICO (population, intervention, comparison, outcome) questions and good practice statements that summarize and operationalize these recommendations, offering EMS agencies and clinicians an opportunity to review and update their airway management strategies.

View New EBG

 

NEMSQA-Led Lights and Siren Collaborative Improves EMS Safety with Comprehensive Change Package

The National EMS Quality Alliance (NEMSQA) has released Improving Safety in EMS: Reducing the Use of Lights and Siren, a change package detailing the results, lessons learned and change strategies developed during the Lights and Siren Collaborative project. This newly released report is designed to improve EMS safety by making improvements to the use of lights and sirens.

View Report

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1200 New Jersey Avenue, SE
Washington, DC 20590
nhtsa.ems@dot.gov

CMS Finalizes Rule to Expand Access to Health Information and Improve the Prior Auth Process

Written by AAA Staff on . Posted in Regulatory.

From CMS.gov

Final rule modernizes the health care system and reduces patient and provider burden by streamlining the prior authorization process 

As part of the Biden-Harris Administration’s ongoing commitment to increasing health data exchange and strengthening access to care, the Centers for Medicare & Medicaid Services (CMS) finalized the CMS Interoperability and Prior Authorization Final Rule (CMS-0057-F) today. The rule sets requirements for Medicare Advantage (MA) organizations, Medicaid and the Children’s Health Insurance Program (CHIP) fee-for-service (FFS) programs, Medicaid managed care plans, CHIP managed care entities, and issuers of Qualified Health Plans (QHPs) offered on the Federally-Facilitated Exchanges (FFEs), (collectively “impacted payers”), to improve the electronic exchange of health information and prior authorization processes for medical items and services. Together, these policies will improve prior authorization processes and reduce burden on patients, providers, and payers, resulting in approximately $15 billion of estimated savings over ten years.

“When a doctor says a patient needs a procedure, it is essential that it happens in a timely manner,” said HHS Secretary Xavier Becerra. “Too many Americans are left in limbo, waiting for approval from their insurance company. Today the Biden-Harris Administration is announcing strong action that will shorten these wait times by streamlining and better digitizing the approval process.”

“CMS is committed to breaking down barriers in the health care system to make it easier for doctors and nurses to provide the care that people need to stay healthy,” said CMS Administrator Chiquita Brooks-LaSure. “Increasing efficiency and enabling health care data to flow freely and securely between patients, providers, and payers and streamlining prior authorization processes supports better health outcomes and a better health care experience for all.”

While prior authorization can help ensure medical care is necessary and appropriate, it can sometimes be an obstacle to necessary patient care when providers must navigate complex and widely varying payer requirements or face long waits for prior authorization decisions. This final rule establishes requirements for certain payers to streamline the prior authorization process and complements the Medicare Advantage requirements finalized in the Contract Year (CY) 2024 MA and Part D final rule, which add continuity of care requirements and reduce disruptions for beneficiaries. Beginning primarily in 2026, impacted payers (not including QHP issuers on the FFEs) will be required to send prior authorization decisions within 72 hours for expedited (i.e., urgent) requests and seven calendar days for standard (i.e., non-urgent) requests for medical items and services. For some payers, this new timeframe for standard requests cuts current decision timeframes in half. The rule also requires all impacted payers to include a specific reason for denying a prior authorization request, which will help facilitate resubmission of the request or an appeal when needed. Finally, impacted payers will be required to publicly report prior authorization metrics, similar to the metrics Medicare FFS already makes available.

The rule also requires impacted payers to implement a Health Level 7 (HL7®) Fast Healthcare Interoperability Resources (FHIR®) Prior Authorization application programming interface (API), which can be used to facilitate a more efficient electronic prior authorization process between providers and payers by automating the end-to-end prior authorization process. Medicare FFS has already implemented an electronic prior authorization API, demonstrating the efficiencies other payers could realize by implementing such an API. Together, these new requirements for the prior authorization process will reduce administrative burden on the healthcare workforce, empower clinicians to spend more time providing direct care to their patients, and prevent avoidable delays in care for patients.

In response to feedback received on multiple rules and extensive stakeholder outreach HHS will be announcing the use of enforcement discretion for the Health Insurance Portability and Accountability Act of 1996 (HIPAA) X12 278 prior authorization transaction standard to further promote efficiency in the prior authorization process. Covered entities that implement an all-FHIR-based Prior Authorization API pursuant to the CMS Interoperability and Prior Authorization Final Rule (CMS-0057-F) who do not use the X12 278 standard as part of their API implementation will not be enforced against under HIPAA Administrative Simplification, thus allowing limited flexibility for covered entities to use a FHIR-only or FHIR and X12 combination API to meet the requirements of the CMS Interoperability and Prior Authorization final rule. Covered entities may also choose to make available an X12-only prior authorization transaction. HHS will continue to evaluate the HIPAA prior authorization transaction standards for future rulemaking.

CMS is also finalizing API requirements to increase health data exchange and foster a more efficient health care system for all. CMS values public input and considered the comments submitted by the public, including patients, providers, and payers, in finalizing the rule. Informed by these public comments, CMS is delaying the dates for compliance with the API policies from generally January 1, 2026, to January 1, 2027. In addition to the Prior Authorization API, beginning January 2027, impacted payers will be required to expand their current Patient Access API to include information about prior authorizations and to implement a Provider Access API that providers can use to retrieve their patients’ claims, encounter, clinical, and prior authorization data. Also informed by public comments on previous payer-to-payer data exchange policies, we are requiring impacted payers to exchange, with a patient’s permission, most of those same data using a Payer-to-Payer FHIR API when a patient moves between payers or has multiple concurrent payers.

Finally, the rule also adds a new Electronic Prior Authorization measure for eligible clinicians under the Merit-based Incentive Payment System (MIPS) Promoting Interoperability performance category and eligible hospitals and critical access hospitals (CAHs) in the Medicare Promoting Interoperability Program to report their use of payers’ Prior Authorization APIs to submit an electronic prior authorization request. Together, these policies will help to create a more efficient prior authorization process and support better access to health information and timely, high-quality care.

The final rule is available to review here: https://www.cms.gov/files/document/cms-0057-f.pdf.

The fact sheet for this final rule is available here: https://www.cms.gov/newsroom/fact-sheets/cms-interoperability-and-prior-authorization-final-rule-cms-0057-f.

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EMS.gov | National Engagement Open Now for NERIS Draft Data Framework

Written by AAA Staff on . Posted in Regulatory.

The US Fire Administration (USFA) and Fire Safety Research Institute (FSRI) have announced the commencement of a national engagement period for the National Emergency Response Information System (NERIS) Draft Data Framework. This period will end on January 19, 2024.

The EMS community is invited to offer feedback on the Draft Core NERIS Data Framework, which includes essential data schemas crucial for NERIS operations, designed to provide the EMS and fire community with the necessary data and tools for improved decision-making and enhanced incident preparedness. These schemas include:

  • Incident Data schema, ensuring detailed and accurate recording of incident specifics for effective response and analysis
  • Computer-Aided Dispatch (CAD) schema, designed for capturing incident timing, location, and initial types
  • Fire Department Specification schema, characterizing fire department capabilities and community coverage

Access the Draft NERIS Data Framework and submit feedback by January 19, 2024. To submit feedback, access the feedback submission form below after reviewing the Framework.

Submit Feedback

For accessibility requests or further assistance, please contact NERIS@ul.org.

RFP | State EMS Policy Whitepaper & Strategic Consulting

Written by Amanda Riordan on . Posted in AAA HQ, State-Level Advocacy.

Request for Proposal

State EMS Policy Whitepaper Development & Strategic Consulting Services

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Overview and Objectives

The American Ambulance Association (AAA) seeks proposals from qualified consulting firms to provide strategic services in the field of ambulance and emergency medical services. The selected firm will work collaboratively with the Association to identify opportunities, analyze state landscapes, develop policy recommendations, and manage the project efficiently.

About the American Ambulance Association

Caring for People—First.
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. AAA’s 1500+ organizational members serve cities and counties in all 50 states.

Scope of Services

The consulting firm shall provide the following services:

  • Planning and Strategy Session: Convene a strategy session with key AAA leaders to prioritize states for research and opportunity development.
  • State Landscape Research and Analysis: Conduct comprehensive research and analysis for no fewer than ten states, focusing on:
    • State statutes, regulations, and Medicaid policies for ambulance services.
    • Medicaid fee schedules for ambulance services.
    • State policies on balance billing and treatment in place.
    • Initiatives addressing ambulance workforce shortage, including the use of grants and ARPA funds, with a particular focus on availability or potential availability for non-governmental EMS providers.
  • Policy Recommendation Development: Collaborate with AAA to develop in-depth state-level policy recommendations on the topics of EMS workforce recruitment and retention, balance billing, and treatment in place.
  • Whitepaper Development: Write, edit, and publish no fewer than three in-depth whitepapers focused on state-level EMS recruitment and retention, balance billing, and treatment in place policy. The whitepapers should be suitable for use by EMS providers and state level legislators and regulators seeking to identify state EMS policy best practices.
  • Project Management & Communication: Provide robust project management, including regular client meetings to review goals and progress during the development of policy recommendations and whitepapers. Facilitate regular coordination and progress review calls and monthly written updates.

All deliverables should be received in calendar year 2024.

Fees and Expenses

Proposals must include a detailed fee structure, including hourly rates for various personnel and any applicable prorated fees. A fixed total or capped amount is strongly preferred over uncapped “time and expenses” billing.

Submission Guidelines

Proposals should be submitted by January 31, 2024 to info@ambulance.org with the subject line “State EMS Whitepaper Proposal.” Proposals should include a detailed approach to the scope of services, a proposed timeline for deliverable development, detailed qualifications of the team, and a clear fee structure. Submitters should include examples of past work of similar scope in the broader healthcare field.

Selection Criteria

Proposals will be evaluated based on the firm’s experience, approach to the project, team qualifications, and cost-effectiveness. Notification will be delivered by February 29, 2024.

 

 

GAO | Roll Out of IDR Process for Out-of-Network Claims Has Been Challenging

Written by AAA Staff on . Posted in Regulatory.

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Private Health Insurance: Roll out of Independent Dispute Resolution Process for Out-Of-Network Claims Has Been Challenging

GAO-24-106335Published: Dec 12, 2023. Publicly Released: Dec 12, 2023.

Fast Facts

Individuals with private health insurance can receive “surprise bills” for the difference between what a provider charged and what their insurance paid.

A 2021 law prohibits surprise billing for some services, and directed the Departments of Health and Human Services, Labor, and Treasury to give providers and insurers a forum to resolve disputes about how much insurers should pay for out-of-network care.

But the rollout has been challenging. As of June 2023, over 490,000 disputes have been submitted, a much larger number than anticipated by the agencies.

And 61% of the disputes are unresolved as of June 2023.

A man holding papers while looking at a laptop.

Highlights

What GAO Found

The No Surprises Act directed the departments of Health and Human Services (HHS), Labor, and Treasury to establish a federal independent dispute resolution process. The process, which was effective April 2022, is a voluntary forum for health care providers and health insurance issuers to resolve disputes about how much should be paid for out-of-network care. The payment determinations are made by certified dispute resolution entities, which serve as arbiters. The Centers for Medicare & Medicaid Services (CMS)—an agency within HHS—administers the independent dispute resolution process.

The three departments reported that parties submitted nearly 490,000 disputes from April 2022 through June 2023. About 61 percent of these disputes remained unresolved as of June 2023. According to officials from the departments, a primary cause of the large number of unresolved disputes is the complexity of determining whether disputes are eligible for the process.

Number of Out-of-Network Disputes in the Federal Independent Dispute Resolution Process by Calendar Quarter, April 15, 2022—June 30, 2023

The groups GAO interviewed described a challenging roll out of the independent dispute resolution process, including a higher-than-expected dispute volume. For example, the departments anticipated about 22,000 disputes in 2022, but received nearly 490,000 through June 2023. Four groups told GAO the departments did not account for the experience of states with similar processes when making the estimate. Disputing parties and certified entities also described the broader effects of those challenges, such as backlogs resulting in delays in payment determinations. The departments have taken some actions to address challenges, such as conducting pre-eligibility reviews on submitted disputes.

To address concerns from insurers and providers, CMS and Labor look into complaints; however, stakeholder groups expressed concern with what they describe as a lack of response to submitted complaints. The departments reported limited ability to increase enforcement efforts due to budget constraints. HHS has requested a budget increase for the process, and the departments are revisiting the administrative fee amount, which is intended to cover the costs of the process, and plan to issue updated program rules.

Why GAO Did This Study

About two thirds of individuals in the United States receive their health coverage through private health plans. Balance billing is when insured patients receive a bill from a health care provider for the difference between the amount charged and the payment received from the health insurance issuer. An unexpected balance bill is referred to as a “surprise bill” and may create a financial strain for patients. For individuals with private health insurance, the No Surprises Act prohibits providers from balance billing in certain circumstances and directed the three departments to establish the federal independent dispute resolution process.

The Consolidated Appropriations Act, 2021, includes a provision for GAO to review the federal independent dispute resolution process. This report describes (1) the number and types of disputes submitted between April 2022 and June 2023, and the status of their resolution; (2) selected stakeholders’ experiences with the process, and agency actions to address challenges; and (3) how federal agencies oversee the process.

GAO reviewed published reports, relevant federal laws, regulations, and guidance; and interviewed officials from CMS and Labor. GAO also interviewed five selected health care providers or their representatives, which accounted for nearly half of all submitted disputes as of December 2022. In addition, GAO interviewed three issuers, three certified entities that arbitrate the disputes, and 10 stakeholder groups.

For more information, contact John E. Dicken at (202) 512-7114 or dickenj@gao.gov.

NHTSA Request for Information: Emergency Medical Services Education Agenda 2050

Written by AAA Staff on . Posted in Regulatory.

From Regulations.Gov

NHTSA published a request for information on October 13, 2023, seeking comments from all sources (public, private, government, academic, professional, public interest groups, and other interested parties) on the planned re-envisioning of the 2000 EMS Education Agenda for the Future: A Systems Approach. Due to the limited comments received and some informal feedback indicating that the initial comment period was too short, NHTSA is announcing the reopening of the comment period for the RFI in order to solicit additional comments and request responses to specific questions provided in the document. The comment period for the RFI was originally scheduled to end on October 31, 2023. It will now be reopened and will end on March 31, 2024.

Dates

The comment period for the RFI published on October 13, 2023 at 88 FR 71081 is reopened and extended to March 31, 2024.

For Further Information Contact

Clary Mole, EMS Specialist, National Highway Traffic Safety Administration, U.S. Department of Transportation is available by phone at (202) 868–3275 or by email at Clary.Mole@dot.gov.

Addresses

Comments must be submitted by one of the following methods:

• Federal eRulemaking Portal: go to http://www.regulations.gov. Follow the online instructions for submitting comments.

• Mail: Docket Management Facility, M–30, U.S. Department of Transportation, West Building, Ground Floor, Rm. W12–140, 1200 New Jersey Avenue SE, Washington, DC 20590.

• Hand Delivery or Courier: West Building Ground Floor, Room W12–140, 1200 New Jersey Avenue SE, between 9 a.m. and 5 p.m. Eastern Time, Monday through Friday, except Federal holidays. To be sure someone is there to help you, please call (202) 366–9322 before coming.

Regardless of how you submit your comments, you must include the docket number identified in the heading of this document.

Note that all comments received, including any personal information provided, will be posted without change to http://www.regulations.gov. Please see the “Privacy Act” heading below.

You may call the Docket Management Facility at (202) 366–9322. For access to the docket to read background documents or comments received, go to http://www.regulations.gov or the street address listed above. We will continue to file relevant information in the docket as it becomes available. To be sure someone is there to help you, please call (202) 366–9322 before coming. We will continue to file relevant information in the Docket as it becomes available.

Privacy Act: In accordance with 5 U.S.C. 553(c), DOT solicits comments from the public to inform its decision-making process. DOT posts these comments, without edit, including any personal information the commenter provides, to http://www.regulations.gov, as described in the system of records notice (DOT/ALL–14 FDMS), which can be reviewed at https://www.transportation.gov/privacy. Anyone is able to search the electronic form of all comments received into any of our dockets by the name of the individual submitting the comment (or signing the comment, if submitted on behalf of an association, business, labor union, etc.). You may review DOT’s complete Privacy Act Statement in the Federal Register published on April 11, 2000 ( 65 FR 19477–78 ).

Supplementary Information

On October 13, 2023, NHTSA published a RFI to obtain public comments to inform EMS Education Agenda 2050, and request responses to specific questions provided in this document. For convenience purposes, NHTSA is republishing introductory information, background materials and questions from its RFI in this notice.

I. Introductory Information

In 2012, the National EMS Advisory Council (NEMSAC) convened a national roundtable meeting on EMS Education Agenda for the Future: A Systems Approach. In a 2014 report on these proceedings, NEMSAC advised that stakeholders at the State and local level had just begun to experience the full impact of the evolution toward a national integrated system of education for EMS personnel. While stakeholders were reticent to move forward with a new education agenda, they did provide feedback about themes that should be considered in the future publication. From the feedback collected at the meeting, NEMSAC developed recommendations to be used in the eventual re-envision of the agenda for EMS. These recommendations are summarized below:

  • Educational content should retain the flexibility accorded by the National EMS Education standards, but programs should use nationally recognized evidence-based guidelines to drive local curriculum development.
  • The National EMS Information System data, evidence-based research, and practice analyses should be sourced in developing evidence-based guidelines and curriculum.

• Mobile Integrated Healthcare has received considerable attention from the EMS Community. This and other alternative community-based healthcare delivery models (of the future) should evoke an expanded foundational knowledge and critical thinking capabilities that will poise future EMS practitioners to be able to evolve with the changing healthcare system or rapidly adjust to emerging healthcare crises.

  • EMS educators should begin a career in academia with expertise in adult learning, educational theory, curriculum development, and competency evaluation but also possess experiential knowledge in evidence-based care.

In the 10 years since NEMSAC’s roundtable meeting, the national EMS education system continued to evolve—especially during the COVID–19 pandemic. In late 2021, the Federal Interagency Committee on EMS (FICEMS) began sponsoring listening sessions to inform a consensus-driven, national report entitled, FICEMS: EMS and 911 COVID–19 Response White Paper. This publication cited challenges and solutions collected during stakeholder listening sessions for the EMS education system. Among the challenges, EMS education stakeholders cited scarcity (in some cases deficits) in resources for education, rigidity of curriculum delivery modalities, the increased employer demands on students, and inconsistent or delayed responses to the needs of the national EMS education system as major contributors that led to the breakdown in the EMS workforce pipeline.

Prior to the COVID–19 pandemic, NHTSA published EMS Agenda 2050: A People-centered Vision for the Future of EMS (Agenda 2050). This collaborative project set a vision for a people-centered EMS systems that serves every individual in every community across the Nation. Later this year, NHTSA and its partners will begin a new project to develop EMS Education Agenda 2050. This project will not replace but build upon the achievements of the 2000 EMS Education Agenda for the Future: A Systems Approach to lead a national conversation around the future vision for EMS Education and EMS as a profession.

II. Background

NHTSA, in partnership with Health Resources and Services Administration, published EMS Education Agenda for the Future: A Systems Approach ( Education Agenda ) in 2000. This document was founded on the broad national EMS education system concepts introduced in the EMS Agenda for the Future (1996). The Education Agenda described a consensus vision of an EMS education system with a high degree of structure, coordination, and interdependence. It proposed a less prescriptive system that offered educators flexibility in creating a student-centered learning environment and a process for accommodating future advancements in technology and medicine. The proposed system maximized efficiency, consistency in instructional quality, and entry level graduate competency by prescribing a high degree of structure, coordination, and interdependence. To achieve this vision, the education system of the future centered on five integrated primary components:

  • National EMS Core Content
  • National EMS Scope of Practice Model
  • National EMS Education Standards
  • National EMS Education Program Accreditation
  • National EMS Certification

After the Education Agenda was published, stakeholders began implementing their respective integrated system components. Almost 25 years later, the national EMS education system has successfully evolved into one that exemplifies both consistency and flexibility. System interdependencies have helped to avoid duplication of effort in curriculum and education program development, evaluating the minimum competencies of graduates, certification and licensing processes, and facilitation of practitioner reciprocity.

In 2020, the EMS education system interdependencies modernized by the Education Agenda were tested. Challenges presented by the COVID–19 pandemic forced a variety of adaptations. Traditional education programs reported a lag in students’ capabilities of achieving the programmatic competencies requirements for graduation. The lag was attributed to a variety of causes including a focus on pandemic response activities over training and education, employer demands on working students, and the rigidity of in-person, classroom-based education delivery models. After the majority of programs adjusted to the challenges, lags in graduation were cured, and students achieved programmatic competencies at rates similar to those pre-pandemic. The response to the pandemic did not impact education programs only. The impact to EMS agency daily operations was felt as well. During the COVID pandemic, agencies experienced increases in EMS activation and response rates which created additional stressors for student EMS practitioners already working in a high stress job environment but also enrolled in an EMS education program. These stressors were a major contributor to a migration of practitioners away from the EMS workforce. Agencies and organizational stakeholders asserted that it could be education program graduation requirements causing breakdown in the workforce pipeline; however, there were no observed decreases in graduation or certification testing rates. These observations prompt two questions: If graduation and certification testing rates have remained unchanged, why have agencies reported recruitment and retention issues? If graduates are not entering the EMS workforce, where are they finding jobs?

With agencies experiencing increased demand and a deficiency in qualified EMS practitioners to respond to it, service delivery models had to evolve. To bridge the gap in community-based care resources, community paramedicine and mobile integrated healthcare (CP–MIH) service delivery models increased in prevalence, and improvised training programs were used to close new job-specific competency gaps among existing EMS practitioners and individuals in training. Other themes brought to the forefront during the pandemic include addressing healthcare disparities; the use of EMS data as a tool for surveillance and nationwide quality of care improvements; and a greater value to having an EMS workforce that is not only equitable, inclusive, and accessible, but as diverse as the community it serves. These themes, evolving service delivery models, and the subsequent evolution of competencies needed by practitioners suggest that it is time for NHTSA to gather our partners to begin a new conversation about the future of EMS Education and EMS as a profession in the United States.

III. Questions Regarding EMS Education Agenda 2050

Responses to the following questions are requested to help plan the revision of the Education Agenda. Please be as specific as possible and as appropriate please provide references.

1. What are the most critical issues facing EMS education system that should be addressed in the revision of the EMS Education Agenda ? Please provide specific examples.

2. What progress has been made in implementing the EMS Education Agenda since 2000?

3. How have you used EMS Education Agenda ? Please provide specific examples.

4. As an EMS Stakeholder, how might a revised EMS Education Agenda be most useful to you?

5. What significant changes have occurred in the EMS education system at the national, Federal, State, and local levels since 2000?

6. What significant changes will impact the EMS education system in the next 25 years?

7. How might the revised EMS Education Agenda contribute to enhanced EMS for children?

8. How might the revised EMS Education Agenda support and/or promote data-driven and evidence-based improvements in EMS education systems and EMS practitioner practice?

9. How could the revised EMS Education Agenda enhance collaboration among EMS systems, health care providers and facilities, public safety answering points, public health, public safety, emergency management, insurers, and others?

10. How could the revised EMS Education Agenda be used to promote community sustainability and resilience?

11. How could the revised EMS Education Agenda contribute to improved coordination for disaster response, recovery, preparedness, and mitigation?

12. How could the revised EMS Education Agenda enhance the exchange of evidence-based practices between national, Federal (and military), State, and local levels?

13. How could the revised EMS Education Agenda support the seamless and unimpeded transfer of military EMS personnel to roles as civilian EMS providers?

14. How could the revised EMS Education Agenda support interstate credentialing of EMS personnel?

15. How could the revised EMS Education Agenda support improved patient outcomes in rural and frontier communities?

16. How could the revised EMS Education Agenda lead to improved EMS systems in tribal communities?

17. How could the revised EMS Education Agenda promote a culture of safety among EMS personnel, agencies, and organizations?

18. Are there additional EMS attributes that should be included in the revised EMS Education Agenda ? If so, please provide an explanation for why these additional EMS attributes should be included.

19. Are there EMS attributes in the 2000 EMS Education Agenda that should be eliminated from the revised edition? If so, please provide an explanation for why these EMS attributes should be eliminated.

20. What are your suggestions for the process that should be used in revising the EMS Education Agenda ?

21. What specific agencies/organizations/entities are essential to involve, in a revision of the EMS Education Agenda ?

22. Do you have any additional comments regarding the revision of the EMS Education Agenda ?

(Authority: 23 U.S.C. 403(b)(1)(A)(iv); 49 CFR 1.95; 501.8)

Issued in Washington, DC.

Nanda Narayanan Srinivasan,
Associate Administrator, Research and Program Development.
[FR Doc. 2023–25551 Filed 11–17–23; 8:45 am]
BILLING CODE 4910–59–P

National Biodefense Science Board (NBSB) Public Meeting on November 30, 2023

Written by AAA Staff on . Posted in Regulatory.

The next public meeting of the National Biodefense Science Board (NBSB) will be held virtually on Thursday, November 30, 2023, from 12:30 to 4:00 p.m. ET.  Advanced registration is required.  To register for the webinar and for additional meeting information, visit the NBSB public meeting page.  We encourage you to share this engagement opportunity broadly across your network.

The NBSB will discuss and vote on two set of recommendations related to COVID-19 pandemic lessons; Project NextGen vaccine and therapeutic products, priorities for future medical countermeasure attributes as requested by the Biomedical Advanced Research and Development Authority; and disaster preparedness training.  Drafts of the recommendations for public review will be on the NBSB webpage as soon as they are available.

Anyone may submit questions or comments to the board members by email to (NBSB@hhs.gov) ahead of the meeting.  If time allows, the NBSB board members will address as many written comments as possible.  Requests to speak during the public meeting should be sent to (NBSB@hhs.gov) by 5:00pm ET on November 23, 2023.  Please provide the speaker’s full name, organization, and a full explanation of the intended topic.  Presentations that contain material with a commercial bias, advertising, marketing, or solicitations will not be allowed.  All meeting materials will be made publicly available on the NBSB public meeting page.  For additional information or questions about this event, please contact (NBSB@hhs.gov).

American Sign Language translation and Communication Access Real-Time Translation will be provided during the meeting.

EMS.gov | Input Requested: EMS Education Agenda 2050

Written by AAA Staff on . Posted in Regulatory.

EMS News

Input Requested: EMS Education Agenda 2050

NHTSA plans community-lead revision of 1996 Education Agenda, tackling education to clinicians
The National Highway Traffic Safety Administration (NHTSA) is seeking public comment regarding the upcoming revision of the 2000 EMS Education Agenda for the Future: A Systems Approach. This new effort will apply the concepts of the EMS Agenda 2050 to EMS Education and the profession’s standing in the U.S. The output of this community effort will be EMS Education Agenda 2050, setting the path for the development of “EMS clinicians of the future” as identified in the EMS Agenda 2050.

Responses from the EMS community to specific questions provided are essential to create a successful framework for this revision.

Provide Comments

NHTSA encourages insights from a diverse range of sources, including but not limited to the public, private sectors, government agencies, academia, and other stakeholders. The primary focus of this initiative is to gauge the progression of the integrated national education system for EMS personnel over the decades. Input from the EMS community is crucial to this endeavor.

Comments may be submitted here through March 31, 2024. For further information, contact Clary Mole, EMS Specialist at the National Highway Traffic Safety Administration, at Clary.Mole@dot.gov.

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VA Final Rule Delayed One Year

Written by Meghan Winesett on . Posted in Government Affairs, News.

Hot off the press! The Department of Veteran’s Affairs has announced a one year delay of the VA Final Rule. This delay pushes implementation of the final rule to February of 2025.

We want to thank all of our AAA members, partner organizations, and legislative champions for their collaborative efforts and commitment to securing this critical delay.

Please see the following press release from the Office of Senator Tester. 

Following Tester Efforts, VA Takes Action to Avoid Potential Reduction in Air and Ground Transportation Services

VA delays rule that could have resulted in severe reductions in access to emergency ground and air transportation services in Montana

(Big Sandy, Mont.) – Following sustained efforts from U.S. Senator Jon Tester to protect rural veterans’ access to lifesaving emergency medical transportation services, the Department of Veterans Affairs is delaying a rule to change reimbursement rates for special mode transportation, including air and ground ambulances. This delay will give VA more time to work with stakeholders and Congress to implement the rule in a way that would ensure access and availability of emergency transportation to veterans and civilians, especially in rural America.

“The availability of emergency air and ground transportation services in Montana and rural America can be the difference between life and death,” said Tester, Chairman of the Senate Veterans’ Affairs Committee. “VA’s hasty implementation of its rate change for these services could have been the final straw for providers in rural America, and I’m glad to see VA answering my call and taking steps to fix this reimbursement issue. VA still has a lot more work to do, and I’ll continue pushing my VA Emergency Transportation Access Act to ensure VA gets this rule right for veterans and anyone who calls rural America home.”

VA’s rule was set to go into effect in February 2024, despite significant opposition from Tester, transportation providers, and Veteran Service Organizations. Now, VA is committing to delaying the rule’s effective date until February 2025, which would give the Department more time to work with providers to ensure the rule will not negatively impact their services and ability to serve veterans, especially those in rural and hard-to-reach areas. The previous implementation timeline of rate reductions could have resulted in emergency transportation providers severely reducing services, closing bases, or even billing veterans for the remainder of their costs in order to shoulder the financial impacts of this change. 

Tester has led the bipartisan charge to push back on the Biden Administration’s proposed rule change and protect Montana veterans’ access to emergency medical transportation services since day one. In September 2022, he wrote to VA Secretary Denis McDonough to express his concerns with VA’s rule, and in February of this year, he called on the Secretary again to delay this rule. This September, he introduced the bipartisan VA Emergency Transportation Access Act to bar VA from reducing rates of pay and reimbursement for special mode transportation providers, including ground and air ambulances, unless the Department meets certain requirements that ensure rate changes will not reduce veterans’ access to this essential service.

The Senator also recently secured a bipartisan amendment to prohibit VA from implementing this rule in fiscal year 2024 to a key Senate bill that passed earlier this month.

Tester’s efforts have been applauded by emergency medical service leaders in Montana and across the nation. Earlier this month, the Senator was awarded Legislator of the Year by the American Ambulance Association for his work to push back on VA’s rule.

Register Now: FICEMS Meeting on December 6

Written by AAA Staff on . Posted in Regulatory.

Federal Interagency Committee on EMS to
Hold Virtual Meeting on December 6

 Advanced public comment period open until Wednesday, November 29
The Federal Interagency Committee on EMS (FICEMS) was established by Congress in 2005 to ensure coordination among Federal agencies supporting local, regional, state, tribal, and territorial EMS and 911 systems. FICEMS provides a forum for Federal agencies and staff to collaborate to improve EMS delivery across the nation.

FICEMS will host a virtual meeting Wednesday, December 6, 2023, at 1 pm ET.

Register Now

Updates will be provided by FICEMS agency representative members, NEMSAC and subgroups of the Technical Working Group, and NHTSA’s Office of EMS will share the status of projects, including:

  • National Roadway Safety Strategy (NRSS)
  • EMS Data Summit 2.0 & National EMS Information System (NEMSIS)
  • National 911 Program
  • First Responder Mental Health & Wellness

Guest Presentations include:

  • Longitudinal Inquiry of Fire & EMS (LIFE) Health Study with Ashish R. Panchal, MD, PhD, NREMT
  • System Assessment & Validation for Emergency Responders (SAVER) Program with Norm Kaufmann, Program Manager, DHS
  • Radiological/Nuclear Response & Recovery (RNRR) Program with Eliot Calhoun, Program Manager, DHS

Members of the public are invited to provide advanced public comment by emailing FICEMS@dot.gov with “FICEMS Feedback” in the subject line by Wednesday, November 29 at 12 pm ET. There will also be opportunities for the public to ask questions or submit comments through the webcast live chat feature.

NHTSA is committed to providing equal access to this meeting for all program participants. Persons with disabilities in need of accommodation should send their request to Clary Mole by phone at (202) 868-3275 or by email to Clary.Mole@dot.gov no later than by Wednesday, November 29 at 12 pm ET. A sign language interpreter and closed captioning services can be provided through the Zoom meeting platform upon request.

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1200 New Jersey Avenue, SE
Washington, DC 20590
nhtsa.ems@dot.gov

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