From the Pennsylvania Department of Health, Bureau of Emergency Medical Services

This EMS Information Bulletin (EMS-IB) supersedes all previously published EMS-IBs related to COVID-19 exemptions as a result of the Disaster Declaration or continuance thereof.

Effective at 11:59 pm June 30, 2022, all regulatory exceptions issued as part of the COVID-19 disaster declaration will expire. This means that all crews must meet legal staffing standards as of July 1, 2022. Any agency that is currently using out-of-state providers to fulfill staffing requirements must immediately stop the use of these providers effective 11:59 pm, June 30, 2022.

However, the Bureau of EMS (Bureau) recognizes the need to evaluate staffing models and has reviewed all authorities granted to the Bureau. As such the Bureau is authorizing all Basic Life Support (BLS) ambulances in the Commonwealth to staff utilizing the provisions of Act 17 of 2020 without making application to the Department, utilizing the provisions outlined below.

Act 17 of 2020 amended the EMS Systems Act to permit the Department of Health (Department) to grant exceptions to the ambulance staffing standard for Basic Life Support (BLS) ambulances.

Pursuant to the Act, exceptions were only to be granted in cases where there were extraordinary reasons and in the best interest of the EMS system and patient care.

On July 6, 2020 the Bureau of EMS (Bureau) issued EMSIB 2020-27 Act 17 of 2020 BLS Ambulance Staffing Exceptions. This document established the general criteria and process for staffing waiver applications.

Despite the termination of the declaration of disaster emergency, the Department finds the continued effects of COVID-19 as well as staffing shortages are impacting the overall EMS system and constitute an extraordinary circumstance.

As a result, and in the best interest of the EMS system the Department is issuing the following staffing exception in accordance with its authority outlined in Act 17 of 2020.

Exception 1:
At the time of patient transport, a BLS ambulance must be operated by a certified Emergency Medical Services Vehicle Operator (EMSVO), and the patient must be attended by an EMS provider at or above the level of an Emergency Medical Technician (EMT).  This exception is effective immediately and will remain in effect until this EMS-IB is superseded or voided by the Department.

Please direct any questions regarding this memo to your regional council.

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From HEALTHCAREDIVE

The unanimous opinion found a 2018 change in how outpatient drugs were paid out was unlawful because the HHS did not follow statute requirements.

The U.S. Supreme Court on Wednesday sided with hospitals in a case challenging an HHS cut to outpatient drug payments for hospitals that treat low-income patients.

The unanimous decision caps a four-year court battle between the American Hospital Association and the HHS, with billions of dollars in play.

The court’s opinion, written by Justice Brett Kavanaugh, found that the HHS did not follow the law when it changed the rate of payments under the 340B drug discount program from the average sales price of the drugs plus 6% to the average sales price minus 22.5%.

The AHA argued the cut amounted to $1.6 billion annually for 340B hospitals.

In a statement Wednesday the hospital group, along with America’s Essential Hospitals and the Association of American Medical Colleges, said it was pleased with the decision.

“Now that the Supreme Court has ruled, we look forward to working with the Administration and the courts to develop a plan to reimburse 340B hospitals affected by these unlawful cuts while ensuring the remainder of the hospital field is not disadvantaged as they also continue to serve their communities,” the groups said.

The law gives the HHS two options for setting outpatient drug rates. One sets a rate for all hospital groups based on the average sales price from drug manufacturers. The other allows the agency to vary the rates by hospital group, but only if it has taken a survey of hospitals and has that data available.

Until 2018, the HHS had set rates across all hospital groups. But the cut that applied only to 340B hospitals, which serve low-income and rural communities, came without survey data. Lawyers for the HHS said during oral arguments in December that such surveys were “very burdensome on the hospitals” and provided inaccurate data.

The AHA and three individual hospitals argued this violated the law, and on Wednesday the Supreme Court agreed.

In his 14-page opinion, Kavanaugh said that without a survey, the HHS should not have cut rates only for one segment of hospitals. “The text and structure of the statute make this a straightforward case,” he wrote.

The ruling reverses a 2020 decision from the U.S. Court of Appeals for the District of Columbia, which sided 2-1 with the HHS. That opinion stated the rate cut was “a fair, or even conservative, measure of the reduction needed to bring payments to those hospitals into parity with their costs to obtain the drugs.”

While 340B hospitals won out in this case, the drug discount program has not been without its critics.