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Legislative hurdles check hazard pay, PSOB benefits

Frustration mounts as small print delays the HEROES Act, and presents a dual standard for provider benefits for the fallen


The HEROES Act proposed $3 trillion in tax cuts and spending to address the negative health and financial impacts of the COVID-19 pandemic, but was “dead on arrival” to the U.S. Senate.


In my last EMS One-stop column, I commented on the legislative to-do list to ensure that EMS receives the federal support it deserves right now as we staff the front lines and perhaps brace ourselves for COVID-19 round two as the nation craves a return to the normality and liberty enjoyed before the lockdown.

On May 15, 2020, the much talked about HEROES Act narrowly passed from the U.S. House of Representatives by a 208 to 199 vote to the Republican-controlled Senate. The HEROES Act proposed $3 trillion in tax cuts and spending to address the negative health and financial impacts of the COVID-19 pandemic. This included benefits for the public safety community, extensions to enhanced unemployment benefits, debt collection relief, direct cash payments to households and possibly even hazard pay.

On transfer, it was declared “dead on arrival” – an unfortunate, but often used, legislative turn of phrase which signaled the bill had zero chance of success. Where does that leave us? It offers the chance to resuscitate issues that did not make it into the HEROES Act and appeal for common sense in other pieces of legislation where we are being devastated by the small print.

A dual standard for EMS sacrifice

The recent amendment to the Public Safety Officer Benefits (PSOB) to add a presumptive cause of COVID-19 in the last 45 days as a “qualifier” was without a doubt a relief for those in the governmental and volunteer arenas, to know that coverage extends to 45 days after the last shift. Sadly, PSOB was simply extended without amending the definitions of what constitutes – in EMS terms – a “member of a rescue squad or ambulance crew.”

The aforementioned small print identifies that qualified personnel must be from a “public agency” or “a nonprofit entity serving the public that is officially authorized or licensed to engage in rescue activity or to provide emergency medical services; and engages in rescue activities or provides emergency medical services as part of an official emergency response system.”

What is not mentioned, or included, are those providers from private companies that provide either 911 or interfacility mobile healthcare. Much of the nation’s 911 service is provided by private EMS, under contract to localities, and they face the same COVID-19 risks as colleagues from other elements of the prehospital response arena.

A case in point occurred when Colorado-based EMT Paul Cary died from COVID-19 complications while deployed with the FEMA Task Force in New York City. Though he was working in the hot zone, exposed to the same risks as any other responder, EMT Cary’s family will not receive the same benefits as a government/public sector crew member conducting the same task in the same town. Hopefully, we can legislate a change to the definitions, even if only for the duration of the current pandemic, but as it stands, there is a dual standard for the same sacrifice.

Demonstrating the value of EMS

A second announcement came from the Centers for Medicare and Medicaid Services (CMS). The CMS has implemented a one-year delay in the Ambulance Cost Data Collection program. The program will eventually inform the Medicare Payment Advisory Commission (MedPAC), which is required to submit a report to Congress on the adequacy of Medicare payment rates for ground ambulance services and geographic variations in the cost of service delivery.

The importance of this program is to, for once and for all, demonstrate the true costs of delivering EMS and doing business. This may lead to politicians grasping the thing we all understand – the cost of readiness – which may lead to us all receiving a fair rate for the work delivered.

COVID-19 has been the root cause of the reason to delay, but in doing so, we are pushing back our ability to show our true financial worth. To my mind, we should have continued to extract an answer.

Some good news about state-level EMS advocacy

Finally, in the words of Hollywood Star, John Krasinsky, time for some good news - #SGN. Last month, I reported on the efforts of the Professional Ambulance Association of Wisconsin, Wisconsin EMS Association, Professional Fire Fighters of Wisconsin, and Wisconsin State Fire Chiefs Association. They conducted a frank and candid joint press conference to ask for legislative and regulatory support of mobile healthcare in Wisconsin. The good news, announced Thursday by Wisconsin Governor Tony Evers: CARES Act funding totaling $100 million is pledged to support providers most at-risk for financial hardship during the pandemic, including emergency medical services; home and community-based services; and long-term care providers, such as skilled nursing facilities and assisted living facilities.

Professional Ambulance Association of Wisconsin President Chris Anderson, also director of operations of Bell Ambulance, Milwaukee, said Thursday, “We don’t know the details yet, but we’re hopeful they’ll be favorable for us.” This is a great example of the type of lobbying at the state level to achieve change for the good and benefit of our business, livelihood and industry.

All in all it has been a bittersweet EMS Week, celebrating the profession and the things we have achieved over the last few months, amidst sadness and disappointment over the losses and sacrifices made to help others. We must continue strongly in their name and also continue to advocate in their memory to keep EMS alive in the U.S.

LISTEN: EMS ONE-STOP WITH ROB LAWRENCE - Legislative hurdles check hazard pay, PSOB benefits

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Read next: How would the HEROES Act impact fire and emergency services?

Rob Lawrence has been a leader in civilian and military EMS for over a quarter of a century. He is currently the director of strategic implementation for PRO EMS and its educational arm, Prodigy EMS, in Cambridge, Massachusetts, and part-time executive director of the California Ambulance Association.

He previously served as the chief operating officer of the Richmond Ambulance Authority (Virginia), which won both state and national EMS Agency of the Year awards during his 10-year tenure. Additionally, he served as COO for Paramedics Plus in Alameda County, California.

Prior to emigrating to the U.S. in 2008, Rob served as the COO for the East of England Ambulance Service in Suffolk County, England, and as the executive director of operations and service development for the East Anglian Ambulance NHS Trust. Rob is a former Army officer and graduate of the UK’s Royal Military Academy Sandhurst and served worldwide in a 20-year military career encompassing many prehospital and evacuation leadership roles.

Rob is a board member of the Academy of International Mobile Healthcare Integration (AIMHI) as well as chair of the American Ambulance Association’s State Association Forum. He writes and podcasts for EMS1 and is a member of the EMS1 Editorial Advisory Board. Connect with him on Twitter.