Supporting First Responders During COVID-19

We acknowledge the risks you take every single day, just by showing up to do your job. We also recognize the increased risk and burden placed upon you and your families during the COVID-19 Crisis. Your duty to serve conflicts with your own safety, and that is a stress most will never understand. We thank you for showing up day after day, while the rest of the community must remain at home. We thank you for your bravery and dedication to serving others every day, and especially during this crisis. The intention of this kit is to provide resources to help preserve your own resilience and mental health, as well as that of your family. Additionally, it strives to highlight areas you can monitor for yourself and your peers during this crisis, in order to seek help early in coping with the unique stress you experience. Many first responders are experiencing increased levels of depression, anxiety, insomnia and stress. You are not alone in these feelings, and there are resources to help you get through them.

CMS to Pay for Alternate Destinations

The Centers for Medicare and Medicaid Services (CMS) just announced that it will pay for transports to alternative destinations and pause the repetitive, scheduled non-emergency prior authorization program for the ambulance industry during the COVID-19 Public Health Emergency. CMS just issued an Interim Final Rule establishing that, during the COVID-19 Public Health Emergency, CMS will expand the list of Medicare covered destinations to include all destinations that are equipped to treat the condition of the patient consistent with Emergency Medical Services (EMS) protocols established by state and/or local laws where the services will be furnished. Approved alternative destinations may include, but are not limited to: Any location that is an alternative site determined to be part of a Hospital, Critical access hospital (CAH) or skilled nursing facility (SNF); Community mental health centers; Federal qualified health clinic (FQHCs); Rural health clinics (RHCs); Physicians’ offices; Urgent care facilities; Ambulatory surgery centers (ASCs); Any location furnishing dialysis services outside of an ESRD facility when an ESRD facility is not available; and The beneficiary’s home This destination expansion applies to emergency and non-emergency ground ambulance transports of beneficiaries from any point of origin during the Public Health Emergency for COVID-19. Please note, this list of covered alternative destinations during the pandemic applies to all ambulance services in the U.S. and is completely separate and apart from the ET3 pilot program scheduled to begin later this Spring. So, these alternative destinations apply to everyone during this COVID-19 pandemic. CMS has not issued additional guidance on destination modifiers, and the Rule does not waive medically necessary requirements for transports to these alternative destinations.

Senate Passes Economic Stimulus Package Several Provisions Help Ambulance Services!

The U.S. Senate passed an economic stimulus package in response to the coronavirus (COVID-19) outbreak. The House is expected to consider the legislation in the next few days. As a result of the efforts of the AAA and our members who are also on the front line of the response to COVID-19, we were able to improve the final package. The package includes several provisions that will provide urgent financial assistance and resources to ambulance service organizations and our employees. The provisions are consistent with requests made by the AAA, although they target a broader constituency consistent with much of the rest of the stimulus package. The provisions in the package related to our requests are as follows: Health Care Provider Provisions $100 Billion Grant Program: Direct funding to public entities, Medicare or Medicaid enrolled suppliers and providers, and for-profit entities and not-for-profit entities as the Secretary may specify to reimburse for health care related expenses or lost revenues that are attributable to coronavirus. Ambulance service suppliers and providers will file applicants for funding with the Department of Health and Human Services. Sequestration Delay: Suspension of the 2% sequestration cut in Medicare funding for ambulance service and other providers and suppliers. The suspension would begin May 1 and end December 31, 2020 with sequestration then extended from 2029 to 2030. Telehealth: Authorizes the Secretary to waive any of the current requirements in statute for telehealth services during the emergency. Business Provisions Payroll Tax Deferral: Employers including ambulance service organizations starting upon enactment of the legislation will defer payment of their 6.2% share of the payroll tax through December 31, 2020. Half of the tax will be due by the end of 2021 and the second half by the end of 2022. Small Business Loans: Provides $350 billion in loans under the Payment Protection Program for employers including ambulance service organizations with 500 or fewer employees. Loans available up to $10 million per employer. Emergency Responder Provisions $45 Billion Disaster Relief Fund: Grants made available under the FEMA Public Assistance Program to state and local governments to address the recovery from COVID-19 including reimbursement for medical response, PPE and backfilling positions. The funding highlights the critical need for access by emergency responders to PPE and other resources. For-profit ambulance service organizations would be eligible for funding through their state or local government. If your organization faces an issue with government officials as to eligibility, please provide them the FEMA Fact Sheet: Public Assistance for Ambulance Services which in 2009 the AAA had successfully encouraged FEMA to issue. $3.5 Billion Child Care Grants: Provides funding for childcare programs for essential workers including emergency responders such as paramedics and EMTs. Not all of the provisions the AAA had advocated for inclusion in the package were addressed in some way. This is likely not the last legislative package that the Congress develops to combat COVID-19 and we will advocate for our provisions to be included in future packages. We will also continue to push these issues through regulatory and other legislative efforts as outlined below. Regulatory and Additional Legislative Efforts Coverage of Treatment in Place and Alternative Destination On March 11, the American Ambulance Association (AAA) sent a letter to CMS Administrator Seema Verma asking the agency to wave regulatory restrictions for treatment in place and transport to alternative destinations and for Medicare to cover these services related to potential COVID-19 cases. CMS had initially indicated they do not think they have the authority to wave the restrictions under the 1135 Waiver, but the AAA is continuing to work with CMS to provide payment for these services when provided to Medicare beneficiaries. A press release from the House Republican leadership suggests that this issue is being addressed. Employee Tax Credit for EMS Training and Uniforms While the stimulus package includes reimbursement for training and equipment for first responders, it did not include the specific request for an above-the-line tax credit for paramedics and EMTs for training and uniforms paid by the employee. Earlier this year, AAA representatives had met with staff of Congressman Suozzi (D-NY), who sponsored the tax credit language which passed the House late last year, on how we can press the Senate to consider the provision. The AAA will continue to work with Congressman Suozzi on other opportunities to pursue the tax credit. Federal Benefits during COVID-19 for All Paramedics and EMTs Several paramedics and EMTs who worked for private ambulance service organizations lost their lives on September 11, 2001, while responding to the aftermath of the attacks on the World Trade Center. Then-Attorney General John Ashcroft extended Public Safety Officers Benefits (PSOB) to the surviving family members of those paramedics and EMTs. The AAA is sending a letter to Attorney General William Barr asking him to provide the same consideration for paramedics and EMTs responding to the COVID-19 outbreak. MAAS Will Keep Fighting With our Federal partners, we will continue to press the Congress and federal agencies for help to ensure ambulance service organizations and our paramedics and EMTs serving on the front lines of the COVID-19 pandemic have the necessary resources and financial assistance to serve their communities. We greatly appreciate the efforts of all of our members who contacted their members of Congress in support of relief and resources for ambulance services.

Application Process Live for Small Business Relief Funding

Michigan’s small businesses impacted by the COVID-19 virus can now apply for grants and loans through the Michigan Small Business Relief Program, the Michigan Economic Development Corporation announced today. The program will provide up to $20 million in grants and loans to provide economic assistance to Michigan’s small businesses that have been negatively impacted by the COVID-19 virus, and in turn help support workers and their families facing economic uncertainty during the outbreak. Information on how to apply, as well as eligibility criteria, is available at www.michiganbusiness.org/covid19. The grants and loans under the Michigan Small Business Relief Program will support businesses facing drastic reductions in cash flow and the continued support of their workforce and may be used for working capital to support payroll expenses, rent, mortgage payments, utility expenses, or other similar expenses that occur in the ordinary course of business. Key information to know about the application process includes: -There is one application, regardless of whether a business is applying for a grant or a loan. A business may receive a grant or a loan, but not both. -Businesses who do not receive grants may still be considered for loans. -The grants will be administrated by 15 regional economic development organizations throughout the state, which combined cover all 83 counties in Michigan. All applications or recommendations for Michigan Small Business Relief Program loans will be referred from the partner EDOs to the MEDC for evaluation and disbursement . Businesses should go to https://www.michiganbusiness.org/covid19/ to apply. The Michigan Small Business Relief Program grants, authorized by the Michigan Strategic Fund on March 19, will be administered by 15 local and nonprofit economic development organizations (EDOs) around Michigan, covering all 83 counties in the state. These EDOs are responsible for reviewing applications of small businesses in their region and entering into agreements with eligible small businesses. Each EDO will establish a review committee that may include representatives from local workforce agencies, local SBDC representatives, business and nonprofit leaders, among others. The full list of EDOs administering Michigan Small Business Relief grants and the counties they will serve is below. Local and nonprofit EDOs across Michigan applied for the grant funds and were selected based on capacity to administer the program and ensure coverage to small businesses in all 83 counties in Michigan. The $10 million in loans through the Michigan Small Business Relief Program will be referred to the MEDC from the local EDO partners where it will be reviewed by a loan review committee including the Chief Business Officer and Senior Vice President of Business Development Projects. All loans made through the Michigan Small Business Relief Program will be approved through Michigan Strategic Fund delegated authority. In addition to the Michigan Small Business Relief Program, michiganbusiness.org/covid19 also features other resources for businesses across Michigan to assist them in recovering from economic losses as a result of the COVID-19 virus. This includes U.S. Small Business Administration emergency loans, the Pure Michigan Business Connect virtual procurement and donation platform, support services offered through the SBDC and more. The MEDC has also developed a FAQ for Michigan businesses and communities at michiganbusiness.org/covid19-faq.

MDHHS Allows Temporary Licenses for EMS Personnel

The Division of EMS and Trauma (DET) is actively involved with response to the COVID-19 pandemic. There are areas of the state that are approaching crisis standards of care. There are no Pearson Vue testing sites open and only essential workers are allowed to leave their homes. EMS providers are critical to the infrastructure of emergency response. Therefore, effective March 23, 2020, and in accordance with Section 333.20952, the department will grant a nonrenewable temporary license to an individual who has made proper application to DET for licensure as a medical first responder (MFR), emergency medical technician (EMT), advanced emergency medical technician (AEMT), or paramedic and who has successfully completed all the requirements for licensure, except for the NREMT cognitive and psychomotor examinations. This temporary license will be valid for 120 days from the date of issue. Due to the exigent circumstances around this pandemic, there will be no fee for this temporary license. An individual holding a temporary license shall practice only under the direct supervision of a licensed EMS provider at the same level or higher, i.e. an EMT can practice under another EMT, etc. All individuals who are issued a temporary license will be eligible for a full license, upon submitting a proper application to DET, with the required licensure fee, and completion of the NREMT cognitive and psychomotor examinations. It is the sincere hope that this measure will help EMS agencies and providers who are working diligently on the front lines to combat COVID-19. If you have any questions or concerns, please contact Sabrina Kerr, EMS Section Manager, at kerrs3@michigan.gov. Your service to Michigan EMS is greatly appreciated.