BY MARY STEURER
BISMARCK, N.D. (North Dakota Monitor) – To help prevent gaps in ambulance services across the state, the North Dakota EMS Association is calling on lawmakers to implement a new program under the Department of Health and Human Services.
Adam Parker, co-chair of the association’s advocacy committee, brought the proposal before the Legislature’s Health Services Committee last month.
Many North Dakota ambulance services are in a pinch due to recruitment and retention issues, among other factors, according to the EMS Association. North Dakota could lose as many as 30 providers over the next decade, Parker told the committee at a previous meeting.
Under North Dakota law, when an ambulance service closes, the nearest neighboring service is required to take on the shuttered provider’s response area, Park said. This mandate isn’t backed by any funding, so remaining providers don’t get any additional financial support to help them deal with the extra service calls.
Emergency service providers sometimes shut down with very little or no prior notice. One ambulance service recently told Health and Human Services that it feared it could shutter within days because it had several staff members quit, according to Parker.
The EMS Association says more regulatory action from the Department of Health and Human Services could help identify and assist struggling ambulance services before sudden closures occur.
Under the proposed legislation, that might mean working out a plan to help the provider stay open.
When a closure cannot be avoided, Health and Human Services would help the ambulance service close in a way that’s less disruptive to its community and neighboring emergency service providers.
“The goal would be that those closures are controlled closures,” Parker said. “They’re planned — they’re not on a spur-of-the-moment decision.”
Health Services Committee Chair Sen. Kristin Roers, R-Fargo, said the legislation could be a lifeline for ambulance services on their last legs.
“I would imagine that, even though we don’t all love having someone come in and kind of take over, at that moment, any help is good help,” she said.
Under the proposed legislation, the agency would be tasked with contacting ambulance services and local governments in the area the providers serve in the following circumstances:
- When a service isn’t following state or federal laws or regulations — say, if it’s missing service calls or not responding as quickly as it’s supposed to.
- When a service shows a substantial likelihood of failure.
- When a service indicates it intends to close or change its licensure level, which dictates the kinds of EMS assistance it can administer to a community.
The Department of Health and Human Services would put the ambulance services and local governments on notice about any laws the agency believes they’re violating, as well any resources available to assist them, Parker said.
Under the proposed program, an ambulance service contacted by the agency would then have to respond with a plan to address the issues at hand.
That could include requesting a waiver from Health and Human Services to temporarily or permanently set aside certain service requirements.
For instance, all ambulance services in North Dakota are required by law to operate 24/7. If the service doesn’t have enough people to staff a full week, it could request a waiver from the state to only be available Monday through Friday.
“Our hope is that we don’t have to have those waivers, but really, what the legislation does is just try to free up the options and the flexibility because we can’t predict what’s going to happen in every single area,” Parker said.
If the ambulance service does not adequately respond to the state’s outreach, doesn’t make meaningful progress correcting issues identified by Health and Human Services or indicates it cannot adequately respond to emergency calls, the agency would classify it as a distressed provider.
The service would also earn this designation if it is expected to close or change its licensure level in less than 60 days.
Once an ambulance service is officially considered distressed, the department would take more involved regulatory action. The department would appoint a coordinator to develop a plan for resolving the issues in the ambulance service’s response area, as well as a contingency plan.
In the meantime, the coordinator would be required to make sure that the area still receives adequate EMS services.
“They have ambulances that they’ve purchased, they have staff that they can potentially put people in that area for that short period of time,” Parker said, referring to the Department of Health and Human Services.
The plan would ultimately have to go before the department and the local community for approval.
Parker said the EMS Association doesn’t yet have any specifics about how the program would be paid for, but its general position is that the ambulance service and the community it serves should foot the bill.
“If not, the problem that I would see is that, what is the incentive for them to develop a plan?” he said during the meeting.
How would Health and Human Services figure out when an ambulance service is on the verge of failure?
That’s a separate issue, Parker said. It’s difficult to tell when providers need assistance because a lot of factors that could be used to determine whether one is struggling — like when a service misses an emergency call — are not reported to regulatory authorities.
Parker said he would support changing state law to require ambulance services to notify the state any time a provider does not respond to a service call.
“An ambulance service just not responding to a call should never happen,” Parker said.
Roers said since the proposal is relatively new, she hasn’t had time to gauge how people feel about it.
“So far, I have not heard any negative feedback,” Roers said. “But that might just mean that people are unaware.”
Tim Wiedrich, chief of the Department of Health and Human Services’ Health Response and Licensure Section, said at the meeting that agency leaders had yet to review the proposed legislation.
The committee directed Legislative Council to prepare a draft of the bill for consideration at its next meeting in September.
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