2002_Annual_EMS_Compliance

Regulation of Emergency Medical Services (1999)

In March 1999, the program review committee authorized a study focusing on the three cornerstones of business regulation of Connecticut's emergency medical services (EMS):

· assignment of exclusive service areas for emergency ambulance providers -- called primary service areas (PSAs);

· setting of maximum rates that ambulance providers are allowed to charge; and

· determination of need for licensing and certification.

The study was conducted in two phases; the first phase produced proposed legislation, which was considered during the 1999 session of the General Assembly, but did not pass. The second phase of the study focused on rate setting and determination of need for EMS, as well as refining options for EMS data collection from phase one. Recommendations concerning these areas were drafted in legislation for the 2000 legislative session (sSB 164). At the same time, the Public Health Committee raised a bill (sHB 5287) addressing only recommendations surrounding EMS data collection. Late in the legislative session, many aspects of the program review bill were merged with the public health legislation. The public health bill was further refined after public hearings and input from the regulated communities, towns, and other interested parties before passing both houses and becoming law (P.A. 00-151). Two agencies - Department of Public Health (DPH) and Department of Public Safety (DPS) - are responsible for implementing the legislative changes required in the act. The committee intends to continue monitoring compliance with recommendations made on EMS, since many areas have compliance dates in the future and others have only achieved partial compliance. The progress on compliance for 2002 is summarized below.


Summary of Compliance with Committee Recommendations
*Recommendation*	*Status*	*DPH Response*
By October 1, 2001 DPH shall develop an EMS data collection system	Partial	DPH reports that since May 2000 each EMS licensed or certified ambulance has been completing a one-page survey on services, which DPH continues to use as the basis of its data collection. Through September 30, 2002, there were 155,457 9-1-1 EMS calls, but there was only partial provider reporting, so this number is undercounted. (The average response time was 8 minutes). A first responder was on the scene prior to an ambulance in about 25% of the cases (fewer than the one-third last year), with an average response time of slightly less than five minutes. DPH believes that publication of the data prompts changes to improve local EMS practices. However, the data collection system remains a paper-based system, and implementation of the automated system is significantly behind schedule. The OEMS director left to take another position during 2002, which further delayed decisions and action steps regarding the system. A vendor was selected to install the system during 2002 and DPH states it should be ready for testing by late summer of 2003. To date DPH has not used any of the funding mandated through P.A. 00-151 (a the surcharge on phone bills) and has thus far been financing efforts through a federal block grant for the already existing Trauma Registry. DPH intends to incorporate the EMS and trauma data collection efforts and when the full system is operational anticipates using the $750,000 built up since FY 01 from the annual $250,000 mandated funding.
Not later than March 31, 2002, DPH must compile the response data by time ranges or fractile response times and report them to the General Assembly and post the report on the agency's website.	Partial	DPH has collected response time data for 2002 and submitted them in report format with its compliance response. Many of the providers, however, had not submitted any data beyond June 2002, and DPH indicates it relies on the EMS regional coordinators to remind providers of their responsibility to submit the data. DPH now has EMS provider response data on its website, but the data are not yet reported in the fractile response ranges mandated in statute. DPH indicates it will be working on this, as well as discussing with the Office of Statewide Telecommunications (OSET) to merge the data collected by the two agencies into one report.
By July 2001, DPH shall, with the advice of the EMS Advisory Board, develop local EMS plans and performance agreements as guides for municipalities	Full	DPH developed a document, which includes a checklist of components necessary for a comprehensive local EMS system, to guide municipalities in the development of their local EMS plans, and performance agreements.
By July 2002, each municipality shall establish a written local EMS plan.	Partial	Regional EMS coordinators report variation in compliance with EMS plan development. The Southwest region indicated full compliance on the part of all 14 of its member towns with plan development and also that the quality of the plans was good. In the other regions, compliance was spotty, with about only half the towns with developed plans. Reasons for non-compliance were lack of resources, knowledge, or local authority issues. Only one region submitted written information on compliance despite requests from committee staff for such material.
By July 2002, research and develop outcome measures for the EMS system and report those to the Public Health Committee, and annually thereafter track and report on those measures.	Partial	DPH has created a Plan for Performance Improvement for EMS systems that aims to help them evaluate their systems in four areas - system performance; customer satisfaction; financial outcomes; and patient outcomes. Each system is assumed to develop its own measures and collect the data necessary to assess the first three areas. DPH, with the help of the Trauma Committee, will select outcome measures for used by the American College of Surgeons for trauma patients and systems.
Establish a pilot program to assess the effect of assigning a PSA to a selected provider with right of first refusal by the current PSA holder	DPH role complete	Committee believes DPH fulfilled its statutory obligation to develop a plan of action to implement the pilot program (a copy of the plan was submitted with the agency's response. DPH also held a hearing in March 2001 on the plan. Three EMS providers testified against the planned pilot, and no one testified in favor. DPH also reported that no town expressed any interest in being considered for the pilot; therefore carrying out the pilot cannot be accomplished.
Streamline rate-setting process	Partial	During the 2001 legislative session, DPH supported legislation eliminating rate setting for ambulances, but it did not pass. In the June 2001 Special Session, however, rate-setting statutes were changed to add a health care inflation index, with services accepting only the inflation increase to submit only abbreviated rate filings and have automatic approval. The inflation increase allowed for 2003 rates was 4.8%; thus the 2003 threshold rate for BLS requiring only an abbreviated filing is $316 (up $14 from 2002. Only 14 providers of the 119 BLS providers (although some of the largest) charge rates higher than $316. To date, rate-setting changes have not been proposed in regulation.
Streamline determination of need process	Partial	DPH completed a report -- based on earlier studies including the committee's 1999 EMS Phase Two report and one conducted by NHSTA -- that called for providing higher thresholds for additional services before a need review was necessary. However, this would have required statutory and regulatory changes, and DPH reports there was not consensus in the EMS community to implement those changes.
*Recommendation*	*Status*	*DPS Response*
By January 1, 2001, each public safety answering point (PSAP) is required to submit information regarding 9-1-1 medical calls on a quarterly basis to DPS. DPS is required to submit the information to DPH and make it available on its website.	Partial	DPS has collected the information from PSAPs and compiled a report for the last seven quarters. As required, the report gives fractile response times from receipt of the call to when the call is dispatched. DPS reports 58 of the 108 PSAPs (54%) have been in full compliance with this requirement since the data collection program began. Another 46 PSAPs have missed one or more quarterly EMS data submissions. Four PSAPs have not reported any information for the entire period, including East Hartford, Meriden, New Britain, and Rocky Hill. The Office of Statewide Emergency Telecommunications has notified non-reporting PSAPs of their statutory obligation, provided training, publicized requirements at user group meetings and in newsletters, and offered technical assistance to all PSAPs to facilitate compliance. The legislation does not authorize DPS to take any enforcement action for continued non-compliance.
By July 1, 2004, each PSAP is required to provide emergency medical dispatch (EMD) or arrange for EMD to be provided. DPS is required to oversee EMS implementation, and by July 1, 2001, is responsible for ensuring an EMD training course is available to PSAP personnel.	Partial	DPS has established all the elements for PSAPs to adopt an EMD program and be reimbursed for training. This year DPS reports that 21 of the 108 PSAPs have approved EMD programs. Fourteen of the 21 PSAPS have sent a total of 189 telecommunications staff to EMD training. Reimbursement costs to date have been $41,052.