Analysis of The Public Health Security and Bioterrorism Response Act of 2002

Following is an analysis by the American Ambulance Association (AAA) of the recently passed Public Health Security and Bioterrorism Response Act.

The House and Senate passed legislation to bolster the nation's defenses against bioterrorism (HR 3448) on May 23, 2002. The bill now awaits the President's signature. The legislation aims to improve the ability of federal state and local authorities to coordinate responses to a chemical and/or biological attack and strengthens food and water safety.

The bill authorizes $4.2 billion for fiscal 2003. These funds will be added to the $2.9 billion appropriated in December for fiscal year 2002.

Breakdown of funding:

  • $1.9 billion in grants to state and local governments over two years;
  • $653 million for improving public health response at hospitals: $135 million in FY 2002; $518 million in FY 2003;
  • $1.6 billion for FY 2002-2003 for medical supplies; and
  • $1.9 billion for R&D for new drugs and vaccines.
The American Ambulance Association launched an aggressive campaign for the inclusion of specific language in the bill during the last few months of the House and Senate conference of the bioterrorism legislation. Although the goal of the campaign was to insert language in the Statement of Managers report to clarify FEMA reimbursement problems at the local level, it was also the Association's hope that Congress would acknowledge that ambulance providers play a critical role in the nation's emergency response.

The Association was successful in accomplishing these goals: ambulance providers are explicitly named in several key sections of the bill. Where ambulance providers are not explicitly named, the legislation has better clarified the role of private contractors in the emergency response system, now enabling private ambulance providers a greater ability to resolve reimbursement issues through FEMA in the event of a declared disaster.

The Secretary of Health and Human Services (HHS) is tasked in the legislation to establish a national response plan to bioterrorism events. The plan will include studying the efficacy of local emergency response methods and will include studying the effectiveness of services provided by private companies who contract with local governments. We expect the report to show that private ambulance providers are a significant part of many local response systems and that indeed they may be the only provider of ambulance services in some areas. This will help set the precedent for clearer reimbursement systems for all private contractors, not just ambulance service providers. The report is due 180 days from the enactment of the legislation.

The bioterrorism legislation tasks the President with appointing an Assistant Secretary to the Secretary of Health and Human Services. The Assistant Secretary will be responsible for coordinating the efforts of HHS and the Administration with state and local governments to bolster the local emergency response system and evaluate the progress of the system in meeting the criteria of the national plan. In particular, HHS will work with private service providers under the National Disaster Medical System (NDMS). When the Secretary activates the National Disaster Medical System, private service providers can be assigned to provide services in anticipation of an attack and to respond to the needs of victims of an attack. The legislation implies that ambulance service providers will be among those eligible for assignment. A test of the National Disaster Medical System will be conducted during the first year of the enactment of the legislation.

HHS will be redesigning the National Disaster Medical System to better accommodate the nation's response to a biological and chemical attack. The Secretary will establish criteria for the operation of the NDMS that will include participation agreements for private entities.

The bioterrorism legislation acknowledges that the Department of Justice in addition to FEMA has the ability to assist emergency response personnel. This enables ambulance providers to access funding for training and equipment that was previously limited to fire-based EMS only.

Training grants will be available to increase the number of EMS personnel in a given community if HHS determines that a shortage of EMS personnel proves to be a hindrance to the emergency response system. This grant program could be used to establish and/or supplant efforts by an American Ambulance Association foundation.

The Statement of Managers language, included in the legislation, explicitly cites ambulance providers. This formal acknowledgement signifies that Congress holds ambulance providers in esteem for their key role in the nation's response efforts. Additionally, it sets the precedent for clarifying reimbursement issues at the local level and it allows ambulance service providers greater leverage in affecting policy changes.

Statement of Managers Language:
"...the Managers expect the working group to take into account the role and expertise of the Agency for Toxic Substances and Disease Registry. Additionally, the Managers encourage the working group to recognize the role of private ambulance services, especially when they may be the only ambulance services in the area."

Statutory language also acknowledges the role of ambulance personnel in the emergency response system. Sections of the legislation pertain to establishing a working group to assist with the design of a national response plan. The working group will be established by the Secretary of HHS who will work with Administration officials from the Dept. of Agriculture, the Attorney General, FEMA, Dept. of Labor and other offices to provide consultation, assist in coordinating and making recommendations for responding to and preparing for a biological or chemical attack. The explicit mention of "ambulance personnel" in the statutory language implies that ambulance providers, regardless of type, will be involved in the working group and have the ability to advocate for changes and enhancements to bioterrorism response plans and policy decisions.

The legislation establishes a "hold-harmless" clause for services provided under Medicare, Medicaid and SCHIP during an emergency. Ambulance providers will be able to receive reimbursement without penalty and it allows the Secretary to waive reimbursement requirements such as conditions of participation for providers, provider licensing requirements, sanctions for physician self-referral, sanctions relating to transferring patients in an emergency, and deadlines for filing reports for periods of up to 90 days.

Lastly, the AAA advocated successfully the argument that some communities rely solely on private contractors to provide ambulance services-and that these contractors have continued through the years to enhance efforts to respond to emergencies. As such, the legislation tasks the General Accounting Office to report on the ability of private contractors to enhance local responses to emergencies. Because the report will recognize the vital role private contractors play in the response system, it will provide incentives for changes in policy and regulations to better protect the vitality of the ambulance industry.

Courtesy of the American Ambulance Association (AAA)

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