2023 Government Relations Academy and EMS Medical Director Advocacy Day

June 7-8, 2023

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Advocates for Emergency Medical Services (AEMS) began as a coalition of major EMS organizations that was founded October 22, 2002, dedicated to promoting, educating and increasing awareness among decision-makers in Washington on issues affecting EMS providers. AEMS supported all providers of EMS, whether they were fire, hospital, volunteer, third service, or nongovernmental based, by monitoring and influencing legislation and regulatory activity involving EMS and raising awareness among lawmakers on issues of importance to EMS. Beginning in 2015, Advocates for EMS became part of NAEMSP and is no longer working as a coalition. Please contact the NAEMSP Advocacy Committee if you have questions.
 

H&K Health Dose - March 7, 2023
H&K Health Dose - January 24, 2023

 

Congressional Outlook - September, 2022
The House and Senate return from August recess for an abbreviated September session before hitting the campaign trail ahead of November midterms. The current federal fiscal year ends September 30 so on the docket this month is a short-term continuing resolution which would extend current funding levels closer to the end of the year in order to defer budget negotiations until after midterms and give lawmakers additional time to negotiate a 2023 budget.
 
Lingering healthcare priorities that could see possible action in September or during a post-election "lame duck" session include telehealth, Medicare Part B physician payment cuts (see Proposed Medicare Payment Changes- bottom of page 2), ongoing COVID relief, an expiring payment boost for physicians participating in Advanced Alternative Payment Models, mental/behavioral health, and prior authorization reform for Medicare Advantage plans.
 
Several healthcare-related items are also set to expire before the end of the year pending further action from Congress. Chief among those of concern to NAEMSP members are Medicare add-on payments for ground ambulance services and adjustments for low-volume and Medicare-dependent hospitals. Importantly, this could provide another opportunity for some of these other priorities to make it over the finish line before year’s end.
 
NAEMSP-Championed CAROL Act Establishes a New National Registry of Cardiac Arrest
NAEMSP and the American Heart Association (AHA) teamed up to support the passage of the Cardiovascular Advances in Research and Opportunities Legacy (CAROL) Act. Congressman Andy Barr (R-KY) spearheaded the legislation to honor the legacy of his late-wife Eleanor “Carol” Leavell Barr, who passed away at 39 from sudden cardiac death. The Act supports research and public awareness of valvular heart disease through the U.S. Department of Health and Human Services (HHS). Of particular interest to NAEMSP, it also establishes a national cardiac arrest registry.
 
The CAROL Act unanimously passed through the U.S. House of Representatives on Dec. 8, 2022, sending it to the Senate, where it was referred to the Committee on Health, Education, Labor and Pensions (HELP) for further action, where committee staff made a few changes of concern to AHA and NAEMSP including removing authorization language for sudden cardiac arrest surveillance which if finalized would impact the advancement of the cardiac arrest registry. The change was based on technical assistance from the Centers for Disease Control and Prevention (CDC). Accordingly, NAEMSP and the AHA have diligently educated leadership and committee staff on the importance of adding the language back. Thanks to these efforts, NAEMSP has been assured by Senate HELP committee staff that they will reincorporate the language as the Senate looks to pass the legislation later this month.
 
 
NAEMSP Pursues GAO Study Related to EMS Oversight
For some time, NAEMSP has been leading multi-pronged advocacy efforts around a direct reimbursement framework for medical oversight for pre-hospital care, which is crucial for safe and effective EMS care. A central component of these efforts has been seeking dedicated compensation for online and offline medical direction by EMS physicians to medical personnel in the field, which is currently not reimbursable under Medicare. EMS physician oversight should be viewed as a fundamental element of EMS quality and safety and those physicians should be compensated by CMS. Further, NAEMSP is exploring the concept of EMS-specific Conditions of Participation (CoPs), which are minimum safety and quality standards required for an entity to participate in the Medicare program. Most other forms of organized medicine are subject to CoPs for the protection of patients, and a lack of these standards in EMS leads to an inconsistent practice of EMS medicine nationally.
 
In order to provide support for this framework on Capitol Hill, NAEMSP advocated for the authorization of a study by the Government Accountability Office (GAO) in the Fiscal Year (FY) 2023 appropriations legislation that would assess current data related to physician compensation linked to oversight of EMS care, as well as examine the current landscape around CoPs in other areas of medicine and how to potentially phase CoPs into EMS medicine. Simultaneously, NAEMSP is actively pursuing Congressional champions to help ensure the report's authorization and eventual completion. NAEMSP believes this report will be a vital first step as we seek to address EMS physician compensation issues with Congressional leaders.
 
 
NAEMSP Advocates for Publication of Final DOJ Rule on Dispensing Controlled Substances
NAEMSP advocates continue to work with Capitol Hill and the Department of Justice on a long-awaited final rule that would create guidelines for EMS entities to register with the Drug Enforcement Agency (DEA) to dispense controlled substances in the field and provide overall requirements for EMS programs handling controlled substances. This important rule was authorized under the NAEMSP-championed Protecting Patient Access to Emergency Medications Act of 2017 (Public Law 115-83), sponsored by Reps. Richard Hudson (R-NC), G.K. Butterfield (D-NC), and Raul Ruiz (D-CA), among others.
 
NAEMSP leaders had a productive meeting with DEA officials and submitted official comments in response to the proposed rule back in December 2020. However, the final rule has since been long-delayed and remains at the Department of Justice (DOJ) for secondary review. NAEMSP is currently working with members on Capitol Hill to help motivate DOJ to release the final rule as soon as possible.
 
 
NAEMSP Advocates for Medications in Critical Shortage
In May 2022, the Administration for Strategic Preparedness and Response (ASPR) and the Advanced Regenerative Manufacturing Institute (ARMI) jointly released a report entitled “Essential Medicines Supply Chain and Manufacturing Resilience Assessme  nt.” The report included several medicines previously included in NAEMSP’s advocacy regarding drugs in shortage. However, there were a couple of medications not included on the list. Accordingly, NAEMSP reached out to both ASPR and ARMI to alert them to the fact that saline and lactated ringers should both be included. Additionally, in a recent joint call with the FDA and Bound Tree Medical Supplies it was suggested that Fentanyl orders be placed as soon as possible so that orders may be fulfilled as the product becomes available. NAEMSP will continue to pursue advocacy related to medications in shortage and will keep members apprised of any updates on these efforts. We also encourage members to reach out to [email protected] or [email protected] with any medications or supplies that they find are in critical shortage.
 
  
NAEMSP Comments to CMS on Proposed Medicare Payment Changes for 2023
On July 7, the Centers for Medicare & Medicaid Services (CMS) released its proposed annual Medicare Physician Fee Schedule with proposed policy changes impacting Medicare Part B services in calendar year 2023. NAEMSP submitted comments (see attached) in response to the rule primarily focused on illustrating the importance medical direction and oversight by a trained EMS physician to patient outcomes and quality of care. In our comments, we argue that HHS should reinvest savings from the Repetitive, Scheduled Non-Emergent Ambulance Transport Model back into EMS care, specifically for medical direction and oversight by an EMS physician. We also supported the inclusion of questions pertaining to medical directors as part of the Medicare Ground Ambulance Data Collection System.
 
NAEMSP also expresses its concern over a proposed 4.4% reduction to the Medicare Part B conversion factor, which accounts for a 0% update under the Medicare Access and CHIP Reauthorization Act (MACRA), expiration of a 3% increase to mitigate the impact of previous coding changes, and the statutorily required budget neutrality adjustment to account for coding changes proposed in the rule. Amending any of these factors would require an act of Congress. Notably, several other major physician organizations including the American Medical Association have actively been lobbying for Congress to approve a 4.5% positive adjustment as well as an annual inflation-based update. The final rule is expected by early November.
 
 
CMS Issues Highly Anticipated Third Surprise Billing Rule
On August 19, HHS, along with the Departments of Labor and Treasury, released a third rule implementing provisions of the No Surprises Act. Most notably, the rule clarifies that the qualifying payment amount (QPA), i.e. median payer negotiated rate for a given service in a given region, is no longer the “presumptive” final payment amount, and that dispute resolution entities should instead select an offer that best represents the value of the service after considering the QPA and all permissible information submitted. This clarification follows a federal court's ruling in February which sided with the Texas Medical Association’s argument that the agency's original interpretation stretched beyond the confines of the original statute. NAEMSP submitted comments in response to the 2021 rule (see attached) expressing serious concerns with several provisions, including the Departments’ original interpretation of the QPA relative to the other elements included in the legislation.
 
The latest August 2022 rule additionally includes certain enhanced transparency provisions including requiring plans to provide additional information when they “downcode claims” and directing dispute resolution entities to provide written explanations for all of their decisions (not only those where they do not select the QPA). In addition, the rule directs IDR entities not to “double count” information already reflected in the QPA or that does not affect the value of the service being provided. However, since payers are not required to show how they calculated QPA or provide the underlying data used to make these calculations, it is unclear how this would be evaluated.
 
On September 14, a Request for Information (RFI) was released on advanced explanation of benefits (AEOB) and good faith estimate (GFE) requirements for insured individuals, which was previously deferred in earlier rulemaking. The questions in the RFI span several topics including the scope of what information should be included in the estimates and the estimated scope of burden on providers. Comments are due November 15.
 
 
CMS Issues Guidance to Hospitals and Physicians on EMTALA Obligations
Following the Supreme Court’s decision in Dobbs v. Jackson Women’s Health Organization, the Centers for Medicare & Medicaid Services (CMS) released guidance on July 11, 2022, (following Executive Order 14076, Protecting Access to Reproductive Healthcare Services) clarifying that termination of pregnancy would in some cases be the appropriate course of treatment under the Emergency Medical Treatment and Labor Act (EMTALA). Specifically, EMTALA requires that all patients receive appropriate medical screening, stabilizing treatment, and transfer, if necessary, “irrespective of any state laws or mandates that apply to specific procedures.” Further, it stipulates that physicians and hospitals “have an obligation to follow the EMTALA definitions [including ‘emergency medical condition’], even if doing so involves providing medical stabilizing treatment that is not allowed in the state in which the hospital is located.”
 
In a letter to providers issued concurrently with the guidance, HHS Secretary Becerra stated that “a physician or other qualified medical personnel’s professional and legal duty to provide stabilizing medical treatment to a patient who presents to the emergency department and is found to have an emergency medical condition preempts any directly conflicting state law or mandate that might otherwise prohibit such treatment.” The guidance also notes that hospitals and physicians could be subject to civil monetary penalties (up to $119,942 per violation for large hospitals) for refusing to provide necessary stabilizing treatment or an appropriate transfer to a hospital with the ability to provide stabilizing treatment. In response, the State of Texas, on July 14, 2022, filed a lawsuit in federal district court seeking to block the administration from implementing the aforementioned guidance. We are likely to see continued legal action around this federal vs state preemption issue. 

On Thursday, January 21, 2021, President Biden unveiled his National Strategy for the COVID-19 Response and Pandemic Preparedness and took executive actions (EOs) to implement the effort. The EOs were aimed at: 

1. Ramping up COVID-19 testing and vaccines and establish a COVID-19 Pandemic Testing Board;
2. Directing  agencies to use the Defense Production Act to compel companies to make supplies needed to combat the pandemic;
3. Expanding public health workforce and clinical care capacity;
4. Improving access to affordable care and ensuring COVID-19 testing is free, including for uninsured individuals;
5. Protecting workers through revised employer guidance and increased enforcement efforts;
6. Fully reimbursing states for National Guard personnel and emergency supplies (through September 30, 2021); and
7. Addressing inequities, including across racial, ethnic, and rural/urban lines. 

1. Propose or issue no rule in any manner until a department or agency head appointed or designated by President Biden reviews and approves the rule;
2. Withdraw any rules that have already been sent to the Office of the Federal Register (OFR) for publication but which have not yet been published;
3. Consider postponing by 60 days the effective date of any such rules already sent to OFR for publication (or otherwise issued) but which have not yet taken effect, “for the purpose of reviewing any questions of fact, law, and policy the rules may raise;” and
4. Following the 60-day freeze, for those rules that raise substantial questions of fact, law, or policy, consult with the director of the Office of Management and Budget (OMB) and take further appropriate action in consultation with the OMB Director. 

1. Dan Barry to serve as acting HHS general counsel;
2. Nikki Bratcher-Bowman to serve as HHS' acting assistant secretary;
3. Felicia Collins to serve as HHS' acting assistant secretary for health;
4. Robinsue Frohboese to serve as acting director of HHS' Office for Civil Rights; and
5. Christi Grimm to temporarily serve as acting HHS inspector general. 

In addition, Biden has appointed Sean McCluskie to serve as HHS' permanent chief of staff. McCluskie has long served as an aide to Becerra. Biden also appointed Micky Tripathi as HHS' national Coordinator for health IT, which does not require the Senate's confirmation.  See more information here on acting leadership and HHS appointments.
 
Finally, of note, Representative Brett Guthrie (R-KY) will replace Representative Michael Burgess (R-TX) as Ranking Member of the House Energy and Commerce Health Subcommittee.   Regarding Senate leadership positions, the Senate is operating on the organizing resolution from the last Congress, when the GOP was in the majority. Until a power-sharing agreement is reached, Republicans will continue to chair committees, and new members cannot be added.

- update provided by Holland & Knight
 

DEA Ruling - Protecting Access to Emergency Medications Act of 2017

COVID-19

Click here for a message from our partners at Holland & Knight, released Thursday, March 19.

Click here for NAEMSP's COVID-19 Resources.
Click here for CMS's latest guidance on EMTALA.
 

2020 Government Relations Academy (GRA)

Unfortunately, due to COVID-19, the 2020 Government Relations Academy has been canceled.


 

Current Issues

NAEMSP ADDRESSES DRUG SHORTAGE ISSUES AMIDST LEGISLATIVE ACTION AROUND THE OPIOID EPIDEMIC

July 9, 2018

NAEMSP introduces NAEMSP PAC

Click here to donate to the NAEMSP PAC or download the PAC Donation Form.

EMS Physicians gather on Capitol Hill to Address

Critical Drug Shortages Affecting Patient Care

WASHINGTON, DC (April 16, 2018) – Members of the National Association of EMS Physicians (NAEMSP) gathered in Washington, D.C. last week to advocate for issues affecting quality out-of-hospital emergency medical care, including ongoing drug shortages affecting EMS providers.

Click here for more information.

BIPARTISAN BILL PREVENTING DELAYED EMERGENCY MEDICAL CARE SIGNED INTO LAW

EMS Physicians Applaud the Signing of the Protecting Patient Access to Emergency Medications Act WASHINGTON, DC (November 20, 2017) – The National Association of EMS Physicians (NAEMSP) applauds the signing into law of the Protecting Patient Access to Emergency Medications Act (H.R. 304), which unanimously passed the House of Representatives in January and the Senate in October. The bill reestablishes the ability of emergency medical care providers, such as paramedics, to administer certain life-saving medications to critical patients without unnecessary delay, which was put in question by recent U.S. Drug Enforcement Agency (DEA) regulatory deliberations. It also strengthens DEA oversight of emergency medical services (EMS).

Click here for more information.

EMS PHYSICIANS FLY-IN TO TALK MEDICAL CARE ACCESS & QUALITY

NAEMSP Members Discuss Senate Bill Reintroduction, Bestow EMS Award to Congressman

WASHINGTON, DC (April 25, 2017) – Members of the National Association of EMS Physicians (NAEMSP) gather in Washington, D.C. this week to advocate for the Protecting Patient Access to Emergency Medications Act (H.R. 304), and other issues affecting access to and quality of out-of-hospital emergency medical care, such as EMS payment reform.

Click here for the full press release.

CBO RELEASES SCORE OF ACA REPEAL AND REPLACE LEGISLATION

The Congressional Budget Office (CBO) has just released its score of the ACA repeal and replace legislation, the American Health Care Act, currently moving through the House of Representatives and scheduled to be marked up by the House Budget Committee on Wednesday. The score estimates that if the legislation is enacted there would be 14 million more people uninsured in 2018 as compared to current law, increasing to 24 million in 2026.

House Ways and Means and Energy and Commerce Committees Unveil ACA Repeal/Replace Bill

AHA Timeline

The "Protecting Patient Access to Emergency Medications Act of 2016" (H.R. 304) Grassroots Advocacy (formerly H.R. 4365)

HR 304 passed the House on 1/9/2017! Next stop - the Senate!

Click here for a summary (posted 6/1/2016)

Click here for section by section (posted 6/1/2016)

NAEMSP Members Descend Upon Capitol Hill

(April 20, 2016) NAEMSP members participated in EMS On The Hill Day to advocate for several legislative initiatives including support for H.R. 4365, Protecting Patient Access to Emergency Medicine Act of 2016. H.R. 4365 will clarify that the current practice of physician Medical Directors overseeing care provided by paramedics and other emergency practitioners via "standing orders" is statutorily allowed and protected.

In preparation for the Hill Day, NAEMSP members participated in Holland & Knight's Government Relations Academy, which gave them the tools to successfully advocate for this vital legislation. NAEMSP members sharpened and refined their advocacy skills, and gained new ideas and knowledge from the Academy speakers. Attendees heard from Preston Bell who serves as a top aide to the bill's chief sponsor, Representative Richard Hudson (R-NC-6), and they had a dialogue with former Congressman Jim Davis and former Chief Counsel for the House Judiciary Committee (Subcommittee on Constitution) Kathryn Lehman. They also had the opportunity to learn about the reimbursement landscape from Brett Baker from the Senate Finance Committee.

NAEMSP and our coalition partners have been working with Representative Hudson's office to craft this legislation and gain support from additional Members of Congress. H.R. 4365 had six original sponsors when it was introduced in January 2016. Today, as a result of NAEMSP advocacy efforts – including the recent Hill Day – the bill has 67 cosponsors, which consist of 43 Republicans and 24 Democrats representing multiple regions of the country. Since the Hill Day, 26 Members of Congress have cosponsored H.R. 4365 and we anticipate that more Members of Congress will offer their support.

NAEMSP and our coalition partners have been working diligently to secure a hearing on the bill. Accordingly, we anticipate a hearing in mid-May. We are also solidifying Senate sponsors and anticipate introduction of companion legislation in the Senate soon.

Background: The "Protecting Patient Access to Emergency Medications Act of 2016" (H.R. 4365), sponsored by Rep. Richard Hudson (R-NC), will allow EMS agencies to continue using standing orders from their medical director to administer approved medications to their patients under the Drug Enforcement Administration (DEA). For background, a one page-summary and section-by-section are included in the toolkit.

Now that the bill has been introduced, we need all NAEMSP members to reach out to their Members of Congress in the House of Representatives and urge them to co-sponsor our bill. Note we will engage in Senate outreach once a companion bill is introduced.

When a Member of Congress cosponsors a bill, it publicly shows their support for the bill. With thousands of bills being introduced each year, bills with many cosponsors are more likely to make it to the next phase of the process.

The importance of grassroots initiatives cannot be overstated. A well-organized and informed grassroots advocacy effort can effectively convey the importance and urgency of an issue to policymakers. We need you to join us in carrying the message to your lawmakers. They need to hear from folks on the ground in their districts!