RECOMMENDATIONS
2.Support favorable reimbursement practices a. Local EMS agencies / authorities should:
1.Creating an ideal flexible legislative and regulatory environment
a. Local EMS agencies and EMS providers should : i. Be active advocates for the formation of sound EMS policy at the county, state and federal level. b. State EMS authorities should craft legislation or policy that adheres to the following principles: i. The provision of emergency medical response is an “essential service,” but states should be careful not to overly limit the providers or agencies providing that service. where EMS may provide care and the transport destinations of patients assessed and managed by EMS providers. iii. Scope of practice ought not to be strictly defined in statute so as to preserve flexibility of regulatory entities responding to emerging needs of the population being served. 1.Where scope of practice is already strictly defined, legislative and regulatory bodies should examine and address obstacles to innovation or unmet societal needs that result from current policy. iv. States should adopt a regulatory model that also allows communities to pilot and evaluate the success of innovations that stem from grassroots initiatives. States should empower their regulators with the appropriate flexibility to investigate promising innovations. v. Quality assurance activities and related communications should be protected from evidentiary discovery and liability proceedings. c. National EMS Associations should: i. Provide support to state and local EMS leaders seeking to create a regulatory environment more favorable toward innovation. ii.Advocate for federal leadership and sound national policy that promotes EMS innovation. ii.State statutes and regulations should not place limitations on the practice locations
i. Explore partnership for alternative economic models through accountable care organizations and accountable care community models. b. State EMS authorities / associations should: i. Continue to support and advocate for flexibility in EMS reimbursement. ii.Convene payer groups and EMS agency representatives periodically to encourage data exchange and explore new service offerings that might be reimbursable. iii. Consider requirements for health plans to cover EMS assessment and treatment independent of whether a patient is transported. iv. Revise legislation that affects the way Medicaid or private payers can or should reimburse EMS. v. Increase the authority and funding support for state EMS offices so they may play an active role in the encouragement, approval, evaluation, and funding of pilot programs. c. Private and public payers should: i. Reimburse EMS for assessment and treatment independent of whether a patient is transported. ii. Encourage and fund pilot programs to test new payment models. d. National EMS associations should: i. Advocate for reform of reimbursement policies at the national level. ii.Support state and local efforts and spread awareness of successful strategies. 3. Innovate While Complying with EMTALA a. Local EMS agencies should: i. Work with jurisdictional authorities or protocol committees to consider developing protocols that guide the transport of appropriate patients to locations other than emergency departments. ii.Collect data and perform research to further the science to support such protocols.
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CHAPTER 2
MOUNT SINAI HEALTH SYSTEM | UNIVERSITY OF CALIFORNIA, SAN DIEGO
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