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KAPA circulates draft EMS 2000 initiative By JOHN
HULTGREN LOUISVILLE — The Kentucky Ambulance Providers Association has whittled down their ideas for the next state legislative session -- discussed during their retreat at Greenbo Lake State Park last month -- to a discussion document of the "key issues." The following memorandum was mailed this week to KAPA board members for circulation among the providers throughout Kentucky. "We have been going over it with the various associations as we can get to them," said Bob Gainer, KAPA president. "This is just one of the steps in reaching the final document," Gainer said yesterday, calling the memorandum just "another discussion document." Gainer added that "We need and are actively soliciting comments from all of the EMS-related folks." Those comments may either be e-mailed or faxed to:
MEMORANDUM KY Ambulance Providers Association TO: Executive Board Members KAPA As directed by the President, I have met with James Ritchey to discuss the document and the intent of the KAPA Board that came out of our meeting at Greenbo Lake State Park. Since that time, discussions have been held with Norm Lawson to get an idea of just how much of the document is feasable and how to teak it in a manner that will meet out intent and increase the liklihood of passage. Attached is that document for your review and comment. I need your help at this time. Please look it over and get your comments back to me as soon as possible. You can send them via e-mail (prefered) idyer@louky.org; FAX (502) 574-1470 or phone (502) 574-3126. Once I receive your comments I will incorporate them into an updated document for your next review. When this process is complete, we need to get the final product out to every member as soon as possible. I encourage you to share this document with the members in your region now. Listen to their needs and concerns and incorporate them in your response to me. This is going to be a long process. If it is going to happen - we all must be prepared to make the time to follow through on a daily basis. Also enclosed is:
Stay safe. Ira B. Dyer II KAPA - VP Enclosures EMS 2000 Initative Draft for Comment by KAPA Members Kentucky Board of Emergency Medical Services Create a new state board that has regulatory authority overall 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, will be transferred to this new board. The functions of the Cabinet for Health Service, as related to First Responders, EMT's, 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, discipline, suspend, and impose fines against individuals or agencies governed 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 recommendations of the affected local units of government (City &/or County). The new board shall consist of seven (7) persons appointed by the Governor. Each person must maintain his/her license or certification as an EMT or Paramedic during tenure on the board. The EMS Board will be made up of the following persons:
The board shall meet a minimum of six (6) times each year. Initial term for the first four (4) members is three (3) years. Terms for the last three (3) members is two (2) years. Re-appointments shall be for a two (2) year term. A board member shall not serve more than two (2) consecutive terms. The board may establish committees as necessary. Members of these committee's may include non-board members. 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 board shall employ an Attorney for work on a full time basis. The board shall employ or contract with a physician. This physician shall serve as the state medical director. The board shall be funded by the General Assembly imposing a $2.00 fee on all vehicle license tags. This fee (2 for Life) will be used exclusively for funding the activities of the EMS Board and grants to local governments or other providers of emergency medical services. Issues Related to Paramedic's and EMT's Scope of Practice Paramedic's and Emergency Medical Technicians shall be licensed. Their employment will not be dependent on a physician's "approval or extension of delegated practice". This will permit them to function under the guidelines or work rules of their employer. This action will also address the "Due Process" issue and the most recent issue of EMT-B's assisting performing more "advanced procedures. It then simply becomes an employment issue. Include language that will permit Paramedics to function in non-emergency as well as emergency situations. This should be directed towards the out-of hospital arena and not directed towards working within the hospital. Issues Relating to Reimbursement Require charges and payment to be based upon the services rendered and not tied soley to transport. Include the "prudent lay-person" definition for "emergency". Require auto insurance carriers to pay for ambulance bills regardless of "fault". Require the Kentucky Medicaid program to reimburse ambulance providers at [pick one]
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. The EMS Board will not get into the business of certifying instructors. That is simply an employment issue for the Training Institution to address. Issues Relating to "Senate Bill 66" Funding Funding under this grant process will be re-written to require/permit: Local government/provider (including ambulance taxing districts) to determine the actual need and use of funds at their own local level. Only stipulation is that such funds can only be used for the direct provision of EMS. This will do away with the moneys set aside soley for the purchase of ambulances. Put it all in one fund for use by the local government/provider as needed. In all cases the county or city must apply for funding in order to be considered for the grant moneys. The moneys will be disbursed among those that apply and not based soley upon the number of counties in the Commonwealth. There are two options for the disbursement of the grant money (we need to select one): (A) Grant moneys shall be provided to local units of government for Class I Ambulance Services based upon the population of the area served. This will be based upon a per capita formula or the EMS response volume within the county. A maximum dollar amount will be established according to the county population. Example:
OR (B) Grant money will be split into three (3) distinct components for use of the money. These are:
I personally feel that Option "B" is the best way to go. [Ira] We will need to complete a fiscal impact study to determine the amount of funds that can be raised under the "2 for Life" process. To cover the cost of the S.B. #66 project and meet our overall intent the EMS Board will need about 4.5 million per year) [Ira] 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. Issues Related to Unfunded Mandates The Kentucky Board of EMS shall not increase the requirements of Class 1 or Class III ambulance services or persons licensed or certified by the Board without providing moneys to fund the new requirements.
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