KAPA nearing finish with EMS 2000 draft

By JOHN HULTGREN
Kentucky EMS Connection

OWENSBORO — The Kentucky Ambulance Providers Association is nearly finished with their wish list for the 2000 legislative session.

A near final draft of the EMS 2000 Initiative was presented at KAPA's annual membership meeting held in conjunction with the Kentucky EMS Conference at Owensboro tonight.

The full text of the draft document appears below.

KAPA plans to meet again Friday morning at 10:30 a.m. CDT at the Executive Inn in Owensboro to discuss concerns that were raised tonight, and perhaps finish the document before the end of the week.

Work on the initiative began last Spring when KAPA members met to sketch a skeletal document. Subsequent meetings followed, and KAPA vice president Ira Dyer explained that the decision was made in June to "keep the document under wraps" until a final document came out of the meeting tonight. Work on the final document, however, has been postponed until tomorrow.

Dyer explained that once the document is finished then legislative sponsors can be sought. The list will then be assigned to the Legislative Research Commission to draft the proper language and then prefiled with the appropriate legislative committees. KAPA plans to have duplicate bills in both the Kentucky House and Senate.

Some of the concerns raised by KAPA members tonight include:

• Board composition: a concern that no EMS inservice educator or middle management representation will be on the board. These people essentially must implement any continuing education requirement made by the board. KAPA president Bob Gainer conceded that this "deserves more discussion."
• Board composition: a concern that the phrase "public education entity which provides statewide educational services" excludes representation from regional or local education providers.
• Board composition: a concern over how other specialty services are represented (such as air medical services and Class III providers).
• Funding: a concern that the proposed $3.00 fee on all vehicle registrations may not create enough money to fund the board and its objectives. KAPA estimates that this will create approximately $10 million in funds, and they estimate that $4.5 million will be needed just for basic operating expenses. According to EMS Branch Manager Bob Calhoun the Branch currently receives $3.8 million in total funding (of this $1.6 million is allocated for Senate 66 Bill money, $1 million for funding the Poison Center, and $100,000 allocated for contracts, leaving only a $650,000 operating budget for the Branch).
• Paramedic scope of practice: a concern that the phrase "They shall function under the guidelines or work rules of their employer" may change the liability for the employer.
• Licensure: the general precepts of licensure imply that a practitioner can function -- to some degree -- independently. However, the language seems to tie a paramedic's ability to function to their employer. "What has changed from the existing regulation except for changing a word?" one person asked. Other concerns included wondering if paramedics would have to carry their own liability insurance, or if a paramedic could actually become his own employer. "The intent is not to restrict EMTs, but the intent is not to create independent practitioners," Dyer said.
• Quality Assurance: some members expressed their concern that the Trial Lawyers Association might use this to defeat the bill. It was pointed out that the Hospital Association lost on this issue.
• Nurses staffing ambulances: "I think the biggest danger here is the hospital administrator forcing a nurse to go out on an ambulance," said Sherman Hockenbury.
• Unfunded mandates: a concern that the current language excluded air ambulances by limiting the provision to Class I or Class III ambulances (both of which are ground ambulances by regulation).
• Training incentive: a concern of the intent to exclude private service employees. This would make it more difficult for private ambulance providers to compete with municipal providers. Some questioned whether police or firefighters, who already can collect a training incentive, could then collect both.

EMS 2000 Initiative Draft for Comment by KAPA Members
0/09/99

Kentucky Board of Emergency Services

Create a new state board that has regulatory authority over all aspects of EMS systems. This board shall be properly funded and staffed with qualified EMS personnel.

The functions of the KBML, as they relate to Paramedics and EMTs, will be transferred to this new board.

The functions of the Cabinet for Health Services, as related to First Responders, EMTs, Dispatchers, ambulance services and training institutions shall be transferred to the new board. Essentially, if it deals with EMS, the new board will have statutory authority to act and regulate.

The new board shall have the authority to institute fees, investigate, conduct hearings, discipline, suspend, revoke certifications and licenses and impose fines against individuals or agencies by the board. It shall also have the authority to enter into contracts and apply for grants and federal moneys and to disburse grants to local units of government and entities as approved by the General Assembly.

EMS related functions of the Board of Certificate of Need will be transferred to the EMS Board. The EMS Board will utilize an Administrative Law Judge for the CON review process. Licenses will be granted only upon a demonstrated need and must have the approval of the affected local units of government (City &/or County).

The new board shall consist of fifteen (15) persons appointed by the Governor. The EMS Board will be made up of the following persons:

• 1 Paramedic not serving in an educational, management or supervisory capacity.
• 1 Emergency Medical Technician - Basic not serving in an educational, management or supervisory capacity.
• 1 EMT-First Responder not serving in an educational, management or supervisory capacity.
• 1 Physician having a primary practice in the delivery of emergency medical care.
• 1 Citizen having no direct involvement in the delivery of medical or emergency services.
• 1 Representative of a public education entity which provides statewide EMS educational services.
• 1 Mayor of a city that operates, either directly or through contract services, a licensed Class I ambulance service.
• 1 County Judge Executive from a county that operates, either directly or through contract services, a licensed Class I ambulance service.
• 1 Chief Operating Officer of a Volunteer staffed, licensed Class I ambulance service.
• 1 Chief Operating Officer of a Fire Service based, licensed Class I ambulance service.
• 1 Chief Operating Officer of a hospital based, licensed, Class I ambulance service.
• 1 Chief Operating Officer of a private, licenses, Class I ambulance service.
• 1 Chief Operating Officer of a licenses Class I ambulance service operated by a unit of government not described above.
• A member of the Kentucky House of Representatives shall serve as an ex-officio member.
• A member of the Kentucky Senate shall serve as an ex-officio member.

The board shall meet a minimum of six (6) times each year. Initial term for the first seven (7) members is three (3) years. Terms for the remaining eight (8) members is two (2) years. Reappointments shall be for a two (2) year term. A board member shall not serve more than three (3) consecutive terms.

The board may establish committees and sub-committees as necessary. Members of these committees and sub-committees may include non-board members.

Members of the Board and of all committees shall be reimbursed for their actual expenses when carrying out official duties of the Board.

The board shall employ an Executive Director, office and field staff. The minimum qualifications of the Executive Director will be spelled out in the statute. The executive director shall serve at the pleasure of the Board. The executive director shall be responsible for the supervision and operations of all staff members.

The board shall employ an Attorney for work on a full time basis. The attorney shall report to and serve at the pleasure of the Board.

The board shall employ or contract with a physician. This physician shall serve as the state medical director. The physician shall report to and serve at the pleasure of the board.

The board shall be funded by the General Assembly imposing a $3.00 fee on all vehicle registrations. This fee will be used exclusively for funding the activities of the EMS Board and grants and other incentives to local governments or other providers of emergency medical services.

Issues Related to Paramedic's and EMT's Scope of Practice

Paramedics and Emergency Medical Technicians shall be licensed. They shall function under the guidelines or work rules of their employer.

Paramedics and Emergency Medical Technician-Basics shall function in both emergency and non-emergency out-of hospital situations.

Issues Relating to Reimbursement

Insurance programs operated or regulated by the Commonwealth of Kentucky shall reimburse licensed ambulance services for services provided and supplies used. Payment for services shall not be tied or otherwise restricted to the transport of an ill or injured person.

Include the "prudent lay-person" definition for "emergency."

Require auto insurance carriers to pay for ambulance bills.

The Kentucky Medicaid program to reimburse ambulance providers at a rate equal to that established by the federal Health Care Finance Agency for Medicare reimbursement.

Issues Related to Quality Assurance Programs

The activities of a quality assurance programs shall be non-discoverable in civil cases.

Training

The EMS Board shall establish standards for and certify training institutions or other organizations to conduct EMS education and training programs.

Issues Relating to "Senate Bill 66" Funding

Funding under this grant process will be re-written to replicate the process currently utilized by the Kentucky State Fire Commission grant program. The current source of funds shall remain. They may be supplemented by other funds available to the Board.

Issues Related to Registered Nurses

Clarify that Registered Nurses may be employed and permitted to function on licensed Class I and Class III ambulances at both the basic and advanced level without the presence of a Paramedic being required.

Issued Related to Unfunded Mandates

The Kentucky Board of EMS shall not increase the requirements of Class I or Class III ambulance services or persons licensed or certified by the Board without providing moneys to fund the new requirements.

Training Incentive Fund

Establish, operate and maintain a statewide training incentive fund to provide $3,000.00 annually to every Paramedic or EMT-B employed by a Kentucky unit of government (including EMS Tax District boards) that operates a licensed, Class I ambulance service or regulated medical first response agency.

The language for this issue shall mimic current statutory language.

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