• Wisconsin EMS Advisory Board update from Chairman Jerry Biggart and committee member Dana Sechler.  Patrick Ryan discussed Community Pararmedicine legislation being introduced soon at the State Capitol.  >> Click to listen now!

• Making Medicare "Add-on Payments" Permanent with American Ambulance Association Senior VP of Government Affairs Tristan North, Washington, D.C.  Medicare payments account for a minimum of 50% of an ambulance service's payer mix.  >> Click to listen now!

• State EMS Office Updates about new regional coordinators, changes to FAP funding with State EMS Director James Newlun.  >> Click to listen now!

Standby for Tones Blog
Hello, my name is...

He’s seen a few presidents, and he’s known a few good decades. Right now, he’s hanging out with me, because his head laceration is impressive. Fire did a great job of bandaging the wound up, but no one’s addressed the puddle of blood just yet. His speech is slurred, refined but slurred. I’m making his acquaintance as I put on my three lead, take my first blood pressure, scope out the oxygen saturation level. Everything checks out within normal parameters, so I press on. No odor of alcohol, blood sugar also within what I’d like to see. He cocks his head, then, looks at me.

“I sound funny.”

“Funny ha, ha?” I ask lightly, carefully watching him. 

“My words – like I’ve been drinking. I haven’t been.”

There it is, then. Altered from his baseline – and he knows it. Assessment continues, he denies loss of consciousness, denies any neck pain, CMS is intact, on down the line. Cervical collar in place, we assist him to a standing position and with the cot positioned behind, guide him to be seated. Securing him with straps, wheeling him to the truck, loading him within. Once inside, transport begins as secondary assessment shows no new findings. Eyes equal, round and reactive to light – I go on down the familiar road of assessment. I keep up a light banter about the weather, the circumstances surrounding the purpose of my arrival at his home today. I circle back around some details so he ends up re-answering questions he’s already answered. His answers remain on point, consistent.

>> Click to read more of the story...

In the end, seven pieces of draft bill legislation were considered by the Joint Legislative Council, with six bill drafts approved for introduction to the full legislature by the Joint Legislative Council.  The only bill draft to not be approved involved creation of a fire service district authorizing the district to levy a property tax and impose special charges.   >> Click to review draft bill legislation voted on by the Joint Legislative Council. 

According to PAAW Executive Director Joe Covelli, "It is apparent anything with a fiscal note or tax wasn't being considered or moved forward, so that really handcuffed the Study Committee.  The legislative bill drafts to address the EMT volunteer shortage are largely centered around three main themes:  license renewal, income tax and length of service credits, and adding first responders to the Funding Assistance Program.  These measures may help if they become law, but is it enough to increase firefighter and EMT recruitment and retention?  Time will tell."  Covelli added, "I think we still need to look at how EMS is delivered and better resource management.  That's on us as an industry to work together and figure out".

EMS Product Savings

Deadline to submit recent three-month purchase rebate is March 31, 2017

Attorney General Brad Schimel announced February 1, he has renewed the State’s agreement with Amphastar Pharmaceuticals, which established a rebate program for the heroin and prescription painkiller antidote naloxone. Naloxone, often branded as Narcan, can be administered as a nasal spray or injection and works within minutes to reverse the effects of an opioid overdose.
 
“When an individual has overdosed on prescription painkillers or heroin, we only have a few minutes to intervene and save that person’s life,” said Attorney General Schimel. “I appreciate Amphastar’s willingness to partner with the State and provide those on the frontlines of this battle with financial relief.”
 
Amphastar Pharmaceuticals has agreed to continue providing a $6 rebate for each Amphastar naloxone syringe purchased by public entities in Wisconsin from now until February 1, 2018.

“Since 2013, we have been working to expand access to lifesaving opioid antagonists like naloxone,” said Rep. John Nygren. “While these medications can be expensive, our state has worked with Amphastar on an agreement that ensures the affordability of these important medications. Measures like this save lives, and I’m looking forward to working with my legislative colleagues, the medical community, law enforcement and the Attorney General, and recovery advocates statewide on more efforts that will help combat Wisconsin’s opioid epidemic.”
 
State, county, and local government agencies, as well as law enforcement and other public and government entities that distribute naloxone are eligible for the Amphastar naloxone rebate.

The Professional Ambulance Association of Wisconsin (PAAW) was instrumental in bringing the Narcan rebate program to Wisconsin in 2016, and working closely with Attorney General Brad Schimel's office.
 
More information can be obtained from the DOJ website at https://www.doj.state.wi.us/news-releases/ag-schimel-renews-rebate-agreement-manufacturer-lifesaving-opiate-antidote

Purchases made between November 1, 2016, and January 31, 2017, qualify for the rebate under the previous contract; however, to receive a rebate check a DOJ approved form must be submitted no later than March 31, 2017.   To claim the rebate or learn more about it, refer to the links below.

>> Amphastar Pharmaceuticals, Inc. Contract
>> Naloxone Rebate - Press Release
>> Naloxone Rebate Instructions
>> Naloxone Rebate Account Form
>> Naloxone Purchase Summary Rebate Form (Quarter 4 - Nov, Dec, Jan)

Wisconsin Attorney General Brad Schimel announced the first rebate program on March 23, 2016, during a press conference at Ryan Brothers Ambulance, Madison.

>> Click for more information about the DOJ announcement and rebate program.

State EMS Section Updates

>>  Click to listen now on-demand.

On January 24, State of Wisconsin EMS Director James Newlun, photo insert, joined PAAW Executive Director Joe Covelli for an EMS to the Point podcast.  The podcast is just over 25 minutes.

The interview offers an update on several important topics.  They discussed: 

• Changes to the Funding Assistance Program (FAP),
  
• Adding two new regional coordinators to staff and changing staff responsibilities to operate in regions versus past practice by level of license,
• Recent work by the Legislative Study Committee and pending introduction of EMS legislation by the Legislative Council,
  
• EMT and First Responder renewals, and
• Upcoming deadlines in transitioning to WARDS Elite.

>>  Click to listen now on-demand.

State Licensing 

The Wisconsin Department of Health Services (DHS) EMS Office will open the 2018-2020 Provider Renewal process on August 1, 2017, through June 30, 2018.  Individual providers must complete all educational requirements prior to completing and submitting the 2018-2020 Provider Renewal application. 

The deadline to complete the 2018-2020 Provider Renewal application is June 30, 2018, to obtain a current certification or license that is valid until June 30, 2020.

All Wisconsin EMS provider applications are completed in the E-Licensing system. The important renewal dates to remember for 2018-2020, are:

A license or certification that has been expired for two years or more may only be reinstated by successful completion of the initial education, training and examination requirements.

All continuing education is a personal responsibility.  >> Click to review Memo 1701 that provides information and re-certification requirements.  

EMS Product Savings
Deadline to submit recent three-month purchase rebate is March 31, 2017

A statewide program to reimburse ambulance services and other qualifying agencies $6.00 per vial of Narcan is soon approaching, according to the one-year agreement between Wisconsin's Department of Justice (DOJ) and Narcan manufacturer Amphastar Pharmaceutical.  The Professional Ambulance Association of Wisconsin (PAAW) was instrumental in bringing the rebate to Wisconsin, which is valued at approximately $6.00 per syringe, or a 25% savings.

Purchases made between November 1, 2016, and January 31, 2017, qualify for the rebate, but to receive a rebate check a DOJ approved form must be submitted no later than March 31, 2017.   To claim the rebate or learn more about it, refer to the links below. 
>> Amphastar Pharmaceuticals, Inc. Contract
>> Naloxone Rebate - Press Release
>> Naloxone Rebate Instructions
>> Naloxone Rebate Account Form
>> Naloxone Purchase Summary Rebate Form (Quarter 4 - Nov, Dec, Jan)

Wisconsin Attorney General Brad Schimel announced the rebate program on March 23, 2016, during a press conference at Ryan Brothers Ambulance, Madison.

>> Click for more information about the DOJ announcement and rebate program.

Mark Mandler came to the EMS Section as a limited term employee in 2016. He has assisted with operational plan and protocol reviews.  In the released announcement, Mr. Newlun wrote, "Mark has proven his ability to assist services, EMS directors and medical directors. He has been directly involved in the review of community paramedic programs".

Prior to coming to the EMS Section, Mark volunteered as both a firefighter and an EMT.  Mark holds a paramedic license, various fire service certifications, and is currently completing his law degree at the University of Wisconsin-Madison Law School. Mark will be the EMS regional coordinator for Regions 6, and 7.

Rick Stenson has served as an EMS professional for the past 13 years in both the municipal and private sectors, working in both urban and rural settings. Rick has worked as a licensed EMT since 2004, a Critical Care Paramedic since 2008, and has served as a BLS, ACLS, or PALS Instructor for most of his career. Rick will be the EMS regional coordinator for Regions 4, and 5.

With this change, current EMS staff member Ray Lemke moved from First Responder/BLS/Education Coordinator into the Coordinator spot for Regions 1, 2, and 3. 

According to the announcement, Mark, Rick and Ray's responsibilities will be within the seven Healthcare Coalition Regions.  >> Click for Healthcare Coalitions Regions map.  This is a departure from past practice whereby coordinators were assigned by level of licensed provider, i.e., paramedic, intermediate, advanced EMT, basic, first responder, etc.

Coordinators will work with all EMS professionals, Training Centers, Technical Colleges, and agencies within their regions.  The Wisconsin EMS statewide system is comprised of over 600 ambulance services, emergency first responders, and training centers, and 16,500 individual licensed providers.

EMS Live in Wisconsin Podcast

>> Click for on-demand playback of this podcast.

In 2016, the number of non-emergent ambulance transports in the state totaled between 1,100 and 1,200 BLS and ALS runs per month.  In 2013, that number was between 200 and 400.  A dramatic increase.

According to MTM General Manager Danielle Dale, "We manage transportation for just under one-million eligible members in the state's Medicaid program".  Transportation includes bus, member or personal caretaker mileage reimbursement, taxis, wheelchair vans and non-emergent ambulances."

The Professional Ambulance Association of Wisconsin's President Patrick Ryan, along with board members Dana Sechler and Larry Knuth, have been holding regular conference calls the past few months with MTM to open lines of communication, and remedy some of the operation and billing challenges between ambulance services and MTM, the state's third party Medicaid transportation broker since 2013.

Two items highlighted in the podcast, include:

1. A two-day rule to file post-authorization with MTM for hospital to discharge, or hospital to hospital transfers.  Many ambulance services have difficultly submitting their bill within two-days, and any bill sent after two-days is declined.  MTM recently established a dedicated email address to help streamline the process.  In Illinois, MTM's contract with the state is a bit more forgiving with a post-authorization rule of 30-days.
   
2. If an ambulance is dispatched emergent, but the call is later deemed and billed non-emergent there is a black hole whereby the transporting ambulance service cannot file a billable claim.  Of course, this type of call was not pre authorized and is not included in the two-day post authorization rule.  Under this circumstance, MTM won't offer forgiveness and will decline the claim since they must follow the contract established with the Wisconsin Dept. of Health, so the transporting ambulance service can't bill and must write it off as non collectable.
   

To help hospitals and ambulance services with the process, file a claim and hopefully be reimbursed in a timely manner, MTM has offered a >> fact sheet to navigate.  The new email address to file a two-day post-authorization claim is wipostauth@mtm-inc.net.  To file an appeal, email ambulanceappeals@mtm-inc.net.

On Tuesday, January 10, PAAW completed an EMS Live in Wisconsin podcast with MTM General Manager Danielle Dale and Transportation Manager Chris Behling.  >> Click for on-demand podcast playback.

"The votes are in" as they say.  However, this time it's another step in the process to correct one of the biggest challenges facing emergency services in Wisconsin and the nation - building up the number of community volunteer firefighters and EMTs.

The process started with the state's Joint Legislative Council creating a study committee on volunteer firefighter and EMT shortages.  Study committee members began their work in July, and concluded it this past December by individually casting ballots for proposed legislation.   >> Click for study committee vote tallies by proposed legislation.

The next step is for the Joint Legislative Council to schedule a meeting to receive the committee's report and hold votes on proposed legislation they wish to move forward to the full legislature, to include public hearings.

On Tuesday, December 13, PAAW completed an EMS Live in Wisconsin podcast with Legislative Study Committee members John Eich and Dana Sechler.  Both offered an update on work of the committee, pending vote and what it all means.  >> Click for on-demand podcast playback.