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.
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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.
DEA Ruling - Protecting Access to Emergency Medications Act of 2017
NAEMSP won a hard fought victory for our membership in 2016 (2017), by lobbying for and achieving passage of the "Protecting Access to Emergency Medications Act of 2017", a bill that addressed significant hazards for EMS practice and controlled substances. The much-anticipated DEA rules package for the application of the Bill have finally been published in the federal register for public comment that ended on 12/4/20. We are continuing to monitor and will update the membership when a rule is published.
The "Protecting Patient Access to Emergency Medications Act of 2017," (hereafter the "Act") which became law on November 17, 2017, amended the Controlled Substances Act to allow for a new registration category for emergency medical services agencies that handle controlled substances. It also established standards for registering emergency medical services agencies, and set forth new requirements for delivery, storage, and recordkeeping related to their handling of controlled substances. In addition, the Act allows emergency medical services professionals to administer controlled substances outside the physical presence of a medical director or authorizing medical professional pursuant to a valid standing or verbal order. The Drug Enforcement Administration proposes to amend its regulations to make them consistent with the Act and to otherwise implement its requirements.
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