The inability of some states to put a price tag on an essential service designation is a common pushback in many states. The patchwork of reimbursement and funding streams adds to the conundrum!

----------------

Amid funding concerns, lawmakers reject push for EMS as essential service

Aedan Hannon

Jul 5, 2023

https://trib.com/news/local/business/health-care/amid-funding-concerns-lawmakers-reject-push-for-ems-as-essential-service/article_27e71736-144a-11ee-a228-77812ef90cd7.html

Lawmakers on a legislative health panel declined last week to move forward with a draft bill that would have made emergency medical services (EMS) an essential service in Wyoming and seen the state contribute directly to ambulance care for the first time.

The failed proposal to establish a state-backed grant program for EMS providers comes as first responders and the state wrestle with the sustainability of Wyoming’s fragile and precipitous ambulance infrastructure, a problem rooted in unstable funding and a declining workforce that those involved say has no clear or immediate solutions.

Members of the Joint Labor, Health and Social Services Committee split over the proposal to make EMS an essential service during last week’s interim meeting in Evanston. Their vote ensured that the committee will not sponsor the draft bill during the 2024 legislative session and likely signifies that EMS will not garner the status in the near future.

Under the draft bill, local governments across Wyoming would have been required to provide ambulance services for the first time. Unlike firefighting and law enforcement, which are designated “essential services,” EMS is not, meaning that counties and cities don’t have to pay for ambulance services or ensure that their residents have access to them.

With the added requirement, the proposal would have created a state-funded grant program administered by the Wyoming Department of Health to cover the EMS costs that local governments could not afford, guaranteeing the survival and operation of ambulance providers across the state.

During the health committee’s first interim meeting in April, lawmakers voted by a slim 7-6 margin to draft an EMS essential service bill. The panel heard from EMS providers and the Wyoming Hospital Association who testified that state funding and labeling ambulance care an essential service would help to address some of the financial challenges making EMS increasingly difficult to sustain.

The second time around lawmakers on the health committee were again skeptical. They questioned the financial consequences of an EMS requirement, as well the role of the state in what some argued is a local issue.

“In order to move this bill forward we would need to know what the fiscal impact would be,” said Rep. Ben Hornok, R-Cheyenne. “And we don’t have that.”

Hornok, Rep. Jeanette Ward, R-Casper, and Sens. Anthony Bouchard, R-Cheyenne, and Lynn Hutchings, R-Cheyenne, pointed to the money that the state has previously funneled into EMS. A memo from the Legislative Service Office highlighted the state’s “EMS Sustainability Trust,” which was created in 2009 with $500,000 from the state’s Tobacco Settlement Trust Fund to pay for needs assessments for EMS providers. The state has also invested another $15 million in federal pandemic funds toward stabilizing EMS agencies and “regionalization pilots” to improve ambulance services across Wyoming.

“I think it’s important that we’re provided information about … where’s that money gone so that we can make an informed decision,” Hutchings said.

Wyoming has a patchwork of EMS services. Some agencies are private, others are run by hospitals, counties or rural health districts, making it difficult to pin down exactly how much the state would need to contribute, Jen Davis, the health and human services adviser for Gov. Mark Gordon, told lawmakers.

The state’s EMS agencies currently depend on local revenue and insurance reimbursement, but part of the problem is that ambulances are typically only reimbursed for transporting patients to hospitals or other health care facilities, EMS and health care officials testified in April. According to the Wyoming Department of Health, roughly 35% of all EMS calls are uncompensated in the state, leaving ambulance agencies and local governments on the hook to make up for those costs.

Some of those on the committee expressed concern that adding state funding wouldn’t fix the reimbursement issues plaguing the industry, which stem in part from federal Medicaid and Medicare rules that categorize EMS agencies as transportation rather than health care providers. But those who testified urged lawmakers to address a worsening situation for ambulance agencies.

“Medicare is a key component to this, but it’s also a place where we don’t have control either,” Davis said. “We still have an issue that we have to solve.”

Amid the hesitation, Sen. Fred Baldwin, R-Kemmerer, a co-chair of the committee, cautioned lawmakers about the potential consequences of inaction after Hornok advocated for the committee to see what impact a new bill allowing county boards to form EMS districts would have before taking action.

“If we wait until we see whether that works or not, we may well lose some EMS districts,” Baldwin said.

Davis told lawmakers that she knew of some communities who were considering creating EMS districts, which would require a local vote to raise property taxes to fund the new districts. Others have told the Governor’s office that would not be able to finance them, she said.

As the committee wavered, Davis acknowledged that there are no easy solutions to Wyoming’s EMS challenges. But, she said: “We have to do something.”