|
|
|
Registration Is Available for TEMSA's Medicare Cost Data Collection Reporting Seminar
TEMSA's November 25 Seminar in Fort Worth
Registration is now available for TEMSA's November 25 seminar in Fort Worth. Click here to register.
The Centers for Medicare and Medicaid Services (CMS) released its calendar year (CY) 2020 proposed payment rule for the Physician Fee Schedule (PFS) on July 29, 2019, and it included the proposal for Medicare’s new ambulance cost data collection program.
To review:
- TEMSA has had two seminars on the subject, and TEMSA’s next seminar will be Monday, November 25 in Fort Worth.
- In exchange for renewing the ambulance extender policy, Congress included a provision in the Balance Budget Act of 2018 that will require ground ambulances to submit to a cost data collection program to collect cost, revenue, utilization, and other information determined appropriate by the Secretary of Health and Human Services (HHS).
- According to CMS: “Such system must be designed to collect information: (1) needed to evaluate the extent to which reported costs relate to payment rates under the AFS; (2) on the utilization of capital equipment and ambulance capacity, including information consistent with the type of information described in section 1121(a) of the Act; and (3) on different types of ground ambulance services furnished in different geographic locations…”
This long-awaited proposed rule provides what could be the framework. Click here to view the actual proposal. It begins on page 532.
This summary is provided for informational purposes only. The American Ambulance Association will present another seminar with TEMSA on Monday, November 25 in Fort Worth. Click here for details.
Key Dates
The following is an overview of the key dates.
Click here to read TEMSA's full analysis.
|
|
Siddons-Martin Emergency Group: Thank You to EVOLUTION'S Gold Sponsor
Thanks to Siddons-Martin Emergency Group for serving as one of EMS EVOLUTION's gold sponsors. Click here to learn more about Siddons-Martin Emergency Group.
|
|
October 23 Stakeholder Meeting to Address Texas' New Surprise Billing Law
SB 1264
The Texas Department of Insurance (TDI) announced that the proposed rules for the state's new ban on surprise billing - SB 1264 - will be published in the Texas Register on September 27. In addition, TDI will hold a stakeholder meeting on October 23. (The state of Texas does not have jurisdiction over ERISA plans.)
As a reminder, EMS agencies are exempt from SB 1264's ban on surprise billing. Lawmakers listened to our argument that taxpayers will have to pay if patients do not pay their ambulance bill.
TDI shared the following information with stakeholders:
SB 1264 was signed June 14, giving TDI about 90 days to get a rule proposal published in time to meet the law’s January 1, 2020, implementation date. We want to update you on the substantial effort that has been undertaken to put these important consumer protections in place. These efforts include:
- TDI is coordinating with other agencies that have roles in implementing SB 1264, which authorizes the appropriate licensing agencies to adopt rules as needed to implement the law and discipline providers who violate the prohibition on balance billing. Texas Medical Board staff say they are developing rules related to SB 1264 for consideration by the board during its October meeting.
- We’re gathering information from firms with potential benchmarking databases to determine those that meet the SB 1264 requirements.
SB 1264 has been compared to dispute resolution and arbitration in New York and New Jersey so we met with officials in those states to get more information on their processes and experience. We developed a comparison chart on the state laws. Key differences include:
- Texas law doesn’t define “usual and customary.” New York defines it as the 80th percentile of all charges based on FAIR Health benchmark data.
- Texas requires arbitrators experienced in contract and insurance laws. New York’s dispute resolution is performed by physicians and professional billing coders.
- We had a meeting on July 29 and sought input from stakeholders on the development of the proposed rules. Your input has been an important part of this process, and we’ve posted the comments we received on our SB 1264 webpage.
Proposed rules
To meet SB 1264’s challenging timeline, TDI focused on the elements required by statute. Conforming changes and issues outside the scope of SB 1264 may be addressed in other rule projects. The proposed rules amend the current mediation rules and create mandatory binding arbitration procedures through a portal on TDI's website. Specifically, the rules:
- Describe how mediation or arbitration may be requested.
- Specify timelines and required notifications for mediation and arbitration.
- Create guidelines for informal settlement teleconferences.
- Establish procedures for mediation and arbitration, including what information must be submitted.
- Outline requirements for allowing arbitration parties to review and respond to information submitted by the other party.
- Describe the required explanation of benefits notice concerning the availability of mediation and arbitration.
- Provide for data submission to the benchmarking database organization.
|
|
Physician Feedback on DSHS's Stroke & Trauma Facility Designation Rule Re-Writes
DSHS Hosted Stakeholder Meetings
The Texas Department of State Health Services (DSHS) recently held a series of stakeholder meetings to discuss the upcoming re-write of the state's trauma and stroke facility designation rules.
Stakeholders are now offering feedback to DSHS.
Click here to read organized medicine's feedback regarding the stroke proposal. Feedback on the trauma proposal will be coming in the near future.
|
|
It's Already Time for Interim Studies in the Texas Legislature; TEMSA Makes Two Requests
New Funding Models and Labor Shortages
While the Texas Legislature just wrapped up three months ago, it is already time to submit potential interim charges for the Texas Legislature to study in the months leading up to the 2021 Texas Legislature.
TEMSA submitted two requests to the Texas Senate Committee on Health and Human Services: new EMS funding models and labor shortages.
Click here to view TEMSA's requests.
|
|
Consumer Data Reporting Industry Sues Texas Over New Law
SB 1037
The Consumer Data Industry Association, a Washington, DC-based trade association, filed a lawsuit against the state of Texas over SB 1037, which prohibits consumer reporting agencies from reporting a patient's bad debt related to surprise billing (beyond the deductible, co-pay, and co-insurance for out-of-network services) for emergency care. SB 1037 defines the providers as facilities, emergency care providers, and health care practitioners.
Click here to read the lawsuit.
Click here to learn more about SB 1037. (The engrossed version is the version that was signed into law.)
|
|
Texan Named to Federal Government's New Air Ambulance Billing Task Force
Asbel Montes of Acadian Ambulance
Asbel Montes of Acadian Ambulance was the lone Texan who was named to the U.S. Department of Transportation's new Air Ambulance Billing Advisory Committee. To review:
- The task force was created by the Federal Aviation Association Act in 2018.
- The U.S. House Ways & Means Committee pressured the department to create the task force.
- The task force will submit a report to a House and Senate committee within 180 days.
|
|
State Insurance Commissioners Call for Congress to Regulate Air Medical Bills
Thirty-Two State Insurance Commissioners
Thirty-two state insurance commissioners wrote to Congress in support of the Senate proposal that would ban balance billing by air medical providers. "The tactics that are being employed by the bad actors within the air ambulance industry are nothing but a delay strategy to allow them to continue to continue to use balance billing as a business model," the commissioners wrote.
Texas' commissioner signed the letter. Click here to view the letter.
Congress returned from its August recess last week, and the U.S. House Ways & Means Committee is expected to introduce its own package to address surprise billing within the next few days. So far, none of the proposals have included ground ambulance in the ban on surprise billing.
While the Senate committee's proposal for surprise billing addresses air medical, the House committees do not appear to be as interested in the air medical issue.
|
|
Do You Want to Become More Active in TEMSA? Join a Committee or Invite TEMSA to Your Town
A number of attendees at EMS EVOLUTION 2019 asked how they can become more engaged. The best way is to join a committee.
Click here to view TEMSA's committees. Reply to this e-mail with your interest.
Also, TEMSA would be pleased to make presentations at your RAC meetings or help you with hosting a lawmaker at your EMS agency. Simply reply to this e-mail with your interest.
|
|
TEMSA's Career Center; Submit Your Job Postings
Click here to visit TEMSA's career center.
|
|
How Do You Send a Message to TEMSA's Listserv?
Open to Texas EMS Agencies
If you are a member of TEMSA's listserv, you can send an e-mail to it through this e-mail address:
texas-ems-alliance-listserv@googlegroups.com
|
|
If you would like to join the listserv, reply to this e-mail.
|
|
Thanks to Our Sponsors for EMS EVOLUTION 2019
Title
Gold
Silver
Aladtec
Columbia Southern University
Digitech Computer
Emergicon
EMS Management & Consultants
Ferno
1st Pass Healthcare Solutions
Grant Mercantile Agency
Health Claims Plus
Henry Schein
Life-Assist
NAAC
Nationwide Recovery Systems
Nav Central
R1
Radcliffe Bobbitt Adams Polley PLLC
Rescue Lift
School of EMS
Solutions Group
Stryker
VFIS of Texas
Wakefield & Associates
|
|
|
|
|
|
|