Provided by the Kentucky EMS Branch

House Bill 405 transition issues

Background: The Kentucky General Assembly passed and the Governor signed into law House Bill 405, an act relating to Emergency Medical Services. HB 405 essentially establishes a new organization, the Kentucky Board of Emergency Medical Services, to be responsible for all EMS functions and activities related to state government. This includes but is not limited to:

• Establishing training, certification, and practice requirements for all EMS personnel including EMT-first responders, EMT-basics, EMT-instructors, and paramedics;
• Licensing, inspection, and establishing standards for ambulance services and other EMS providers;
• Issuing licenses and certificates for EMS personnel and providers and carrying out disciplinary processes against EMS personnel and providers that violate standards established by the Board;
• Developing and implementing state and regional EMS and trauma care systems plans;
• Administering an EMS matching grant program to assist local governments and other entities in purchasing ambulances, medical equipment, communications equipment, training equipment, and meeting other training or personnel costs; and
• Establishing and maintaining an emergency medical services for children program.

These activities are presently carried out by the Cabinet for Health Services and the Kentucky Board of Medical Licensure.

Timetable:The statute contains the following implementation schedule:

• September 1, 2000: Kentucky Board of EMS appointed by the Governor.
• November 1, 2000: Executive director and essential staff hired by the Board.
• January 1, 2001: Earliest date for the Board to assume responsibility for fees, funds, functions, equipment, property, and records from the Cabinet and the KBML.
• April 1, 2001: Latest date for the Board to assume responsibility and functions from the Cabinet.

Until such time as a function is transferred to the Board, it shall remain the duty and responsibility of the Cabinet and the KBML.

As part of our preparing for this transition, the following plan has been developed that addresses a number of critical issues and includes planning assumptions, planned activities, and in some cases further questions that must be resolved.

1. Establishment of the Kentucky Board of Emergency Medical Services.

Assumptions:

• Governor's office will appoint Board on September 1, 2000 per HB 405.
• Size (16 members) and composition of the Board is spelled out in statute.
• The Board is responsible for its own fiscal affairs. According to Geoff Pinkerton of the Governor's Office, it would likely be attached to the "General Government Cabinet" similar to the KBML, or the Kentucky Personnel Board. The Board's fiscal activities would be monitored by the Governor's Office for Policy and Management.

2. Phasing out the current Kentucky Emergency Medical Services Council.

Assumptions:

• Statutory authority for the Council expires with the effective date of HB 405 (July 15, 2000).
• The need for certain functions, notably review of medical protocols and clinical aspects of complaint investigations and disciplinary actions currently performed by the Council, will continue until the Board assumes those functions from the Cabinet.
• Several current and proposed EMS related administrative regulations contain references to process and procedures involving the Kentucky EMS Council, including review of specialized EMT training for procedures not included in the National Standard Curriculum, review of credentials of ambulance service medical directors, and requests for waivers from regulatory requirements submitted by ambulance providers.
• HB 405 states that the Cabinet shall carry out all previous EMS functions until such time as they are transferred to the Kentucky Board of EMS.

3. Maintenance of effort for EMS Program by the Cabinet.

Assumptions:

• Cabinet is expected to carry out all current EMS functions until the Kentucky Board of EMS is prepared to assume them (until at least January 1, 2001 but not later than April 1, 2001). The transfer of functions could occur in phases, function by function, as the Board is ready to assume each.
• Poison Center contract ($1.0 million per year) will remain with DPH after EMS Program is transferred.
• Other essential EMS functions carried out under contract must continue to support the program until the Board can evaluate them and make a determination as to their continuing need. These include:
  • EMT-basic practical skills testing (Kentucky EMT Instructors Association)
  • EMS run form data collection and analysis (UK-KIPRC)
  • Regional EMS inspectors (Cumberland Valley DHD, Lake Cumberland DHD, and Marshall County HD).

4. Work to maintain current staffing levels in order to maintain the Cabinet's ability to carry out EMS functions until an orderly transfer of functions can be accomplished.

Assumption:

• Existing staff may not be willing or available to stay with program until transfer can be accomplished.
• Should staff leave, the desirability of recruiting replacement staff and the program's ability to recruit replacement staff is highly doubtful.
• The Cabinet is expected to carry out all EMS functions until the Kentucky Board of EMS is prepared to assume them.

5. Status of disciplinary actions in progress at time of transfer of Cabinet EMS functions to the Kentucky Board of EMS.

Assumptions:

• The Cabinet has a continuing obligation to ensure compliance with licensure and certification requirements.
• From time to time it is necessary to issue statements of deficiencies (SOD) against ambulance services that require an approved plan of corrections to be submitted by the provider.
• In rare instances, the Cabinet is faced with the decision to suspend or revoke the license of an ambulance provider for cause.
• EMS personnel are also subject to disciplinary actions that result in denial, revocation, suspension, and probation of their certification. In such cases, the individual is entitled to a hearing process as described in regulations.
• EMS training and testing agencies are monitored by the EMS Branch for compliance with applicable regulations; it sometimes becomes necessary to revoke, suspend or place the training or testing program on probation.
• Any such action taken by the Cabinet may be unresolved prior to the Cabinet transferring program responsibility to the Kentucky Board of EMS.
• Section 28 of HB 405 states: "All causes relating to the provision of Sections 1 to 26 of the Act pending before the Cabinet for Health Services on January 1, 2001, shall be transferred to the Kentucky Board of Emergency Medical Services no later than April 1, 2001.

6. Budgetary issues.

Assumptions:

• The approved budget for the EMS program in the next biennium is:

• Of that amount, $1,000,000 is dedicated to funding the Kentucky Regional Poison Center through a contract that will continue to be administered by the Cabinet.
• This amount is slightly less than the current annual budget for the EMS program.
• During FY 2001, the Cabinet's EMS activities will be funded out of the approved budget for activities that will continue through at least January 2001, and as late as April 2001.
• In addition, the Kentucky Board of Emergency Medical Services will begin activities in September, 2000, and presumably expend funds for space, staff, and office operations shortly thereafter.

7. Provisions for resource transfer to the Kentucky Board of Emergency Medical Services.

Assumptions:

• Section 28 of HB 405 states that the Kentucky Board of EMS, the Cabinet, and the Kentucky Board of Medical Licensure may implement a transfer of fees, funds, functions, equipment, personal property, and records at any time mutually agreed upon after January 1, 20001, but no later than April 1, 2001.
• The Kentucky Board of EMS will make its own decision regarding office space needs and location based on its needs and the availability of funds.

8. Emergency Medical Services for Children Program grant funding.

Assumptions:

• The 1998 Kentucky General Assembly enacted legislation authorizing an Emergency Medical Services for Children program within the EMS program. The statute was permissive and with implementation of the program dependent on the availability of funding through state, federal and other sources.
• House Bill 405 contains similar language with regard to the EMS program and the Kentucky Board of Emergency Medical Services.
• The University of Kentucky currently receives federal funding to operate an EMS for Children program within Kentucky. That program is in its final year of implementation funding with funds available to run the program through Spring, 2001.
• Federal funds are available to state EMS programs to maintain core EMSC activities after completion of the implementation phase. The amount available for these "partnership" grants would be approximately $100,000 per year.
• A grant application would have to be prepared and submitted by the EMS agency (Kentucky Board of EMS) in November 2000 for possible funding by April 2001.
• The University of Kentucky EMSC project staff (Susan Pollack, MD, Principal Investigator) may be willing to assist in grant preparation. This cooperation may be contingent on an understanding that some portion of the activities in the new grant would be performed by UK under a contract or similar arrangement.
• The workload of the current EMS program staff may not permit a significant commitment of time and expertise necessary to prepare a competitive grant application. Therefore, outside assistance may be required.

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