Legislative Program Review and Investigations Committee

Regulation of Emergency Medical Services:  Phase 2
Appendix B

Appendix B
Other State Survey of Emergency Medical Services

Survey of the Regulation of Emergency Medical Services  

 GENERAL 

1. How many licensed or certified EMS transport providers in your state at each level?

          The number of providers ranged from 1 to 25 per 100,000 population

          The average number of providers per 100,000 population was 6.5

N= 33

2. How many transport vehicles are in service in your state at each level?

          The number of transport vehicles ranged from 14 to 38 per 100,000 population  

          The average number of transport vehicles per 100,000 was 22.3

N=29
 
EMS RESPONDERS 

3.     Does the state require there will be a first responder in a medical emergency? 

__  1(3%) __ Yes

__35(97%)__  No

N=36 

3a. If yes, how? _________________________________________________________  _______________________________________________________________________ 

4.     Does the state require that an ambulance will respond in a medical emergency?
___18 (50%)___Yes
___18 (50%)___ No

N=36  

5.     If there is more than one ambulance provider in an area, does the state ensure that the dispatch system will know who to send?
___10 (29%)___ Yes
___25 (71%)___ No

N=35

5a. If yes, how?__________________________________________________________  _______________________________________________________________________ 

6.     Does the state require that the notified provider will respond? 
 ____22 (61%)__ Yes 
 ____14 (39%)__  No

N=36

6a. If yes, how?__________________________________________________________
_______________________________________________________________________ 

7.     Is the state involved in selecting or designating emergency service providers for any jurisdictions in your state?
___9 (25%)___ Yes
___27(75%)___ No

N=36

7a. If yes, how? _________________________________________________________
_______________________________________________________________________ 

7b. Are other levels of government (e.g., town or county) involved in selecting or designating emergency service providers for an exclusive area in the state?
 __29 (81%)___ Yes
 __7 (19%)___ No
N=36

EMS  DATA 

8.     Does any state agency receive EMS performance data?
___25 (74%)___ Yes
____9 (26%)__ No

N=34

9.     If yes, what type of performance data are collected and who collects that data?   

 10. Are performance data collected for the following providers? (check all that are applicable)
___22___  Commercials ambulance companies
___22___  Non-profits
___22___  Municipal agencies (fire/ town ambulance companies)
___22___  Volunteers ambulance companies 
____1__  Dispatch centers
____9__  First responders 

11. What is the primary method by which data are transmitted to the state? 
___15___ Electronically
___17__ Written
____2__ Other (Specify) _____________________________________________ 

12.  Are the data submitted to the state for:
__20_ Each call
___5_ Compiled for a period of time: ___ weekly _4__monthly _3__yearly 

13. Does the state issue any type of report on the performance data? 
___19(73%)__ Yes
____7 (27%)_  No

N= 26

14. How are data collection efforts paid for?
 __17___ State General Fund
 ___5__ Dedicated Fund Based on Fees (specify what fees)____________
 ___3__ Local Funds 
 ___7__ Providers  
 ___4__ Other (Specify)___(3 = Grants and 1 = Regional funding source)_ 

15.   If the state is not collecting EMS performance data, is any other level of government (e.g., town or county) collecting that data?
___9___ Yes (Specify) __(3 = County, 3 = Municipal, 2 = County & Muni.; and 1 = Regional)__
___10___ No

N=19

PERFORMANCE STANDARDS 

16.   Are any EMS standards for expected performance established by the state?
___18 (53%)__ Yes
___16(47%)__  No

N=34

16a. If yes, what standards are established (check all that apply)
__ 3__ Coverage (e.g., # of ambulances by population or geographic area) 
__11__ Response times (state-established response times)
__  2__ Complaints (e.g., per number of calls, etc.)
__11__ Other (specify) _____________________________________

17.   Are performance standards used to evaluate providers?
___17(59%)__ Yes 
___12 (41%)__ No

N=29

17a. If yes, what standards are considered and how are they used?________________
_______________________________________________________________________  

REGULATION 

18.   Are emergency service providers allowed to do non-emergency (interfacility) transports?
 ___35 (100%)___ Yes
 ____0 (0%)__  No

N=35

19. Is there a determination of need (DON) process for ambulance transportation services in your state?
__13 (36%)____ Yes
__23 (64%)____  No

N=36

19a. If yes, please indicate all areas covered by the DON process. (check all that apply). 
___8___ new licensees
___0___ new vehicles
___0___ new equipment
___1___ new branch offices
___4___ upgrade in level of service
___4___ purchase of existing service by new owner
___4___ other (please specify) 

19b. If your state has a need process, are there exemptions? (check all that apply)
___0___ expenditures below a certain amount
___1___ purchase of existing service by new owner
___2___ upgrade in level of service
___6___ other (specify) ____________________________________ 

20.   If there is no need determination process in your state, are there assurances there are not more services in the system (i.e., providers, vehicles, equipment) than needed, and consumers being charged more for it?
___  4 (13%)_ Yes
___26 (87%)__  No

N= 30

20a.  If yes, how?_______________________________________________________
_______________________________________________________________________ 

21.   Is there any state-agency review or approval necessary when an ambulance company purchases another ambulance company?
___22 (61%)___ Yes
___14 (39%)___ No

N=36

22.   Are towns required to file a local Emergency Medical Services plan with the state?
___   1 (3%)__ Yes
___35(97%)__  No

N=36

 RATES

 23.   Does your state set rates for ambulance transportation services?

 _ 2 (6%)_Yes, same rates are set for both emergency services and non-emergency transports
_ 1 (3%)_Yes, different rates are set for emergency services and non-emergency
_ 0 (0%)__Yes, rates are set only for emergency services
_32(91%)_ No  

N=35

24.  If rates are set, what is the rate set? 

 N=0

25.   If there is no rate-setting, are any other consumer protections offered against excessive charges for ambulance service fees?____2= Attorney General; 1 = Contracts; 1= Insurance Department; 1 Law; 2 = Municipal Protections__

 N=7

26.   If there is no rate setting, estimate the typical charge for:

       _$ amount for emergency transport ($200 - $613; Average =$355; N= 5)
 _$ amount for non-emergency transport ($150 - $400; Average = $266; N=5)
 __don’t know

27.   Do these amounts typically include services like mileage, night calls?
 __14 (82%)___ Yes (includes)
___3 (18%)__ No (excludes)

N=17

28.   Is there any state appropriation that is dedicated to supporting emergency  transportation?
 __6 (18%)___ Yes  __$ amount ($1.3M - $9.1M; Average = $3.8M; N=5) 
 __27 (82%)___ No

N=33

  DISPATCH 

29.   What percent of your state’s population is covered by enhanced 9-1-1?
The range was 40% –100%;  6 states = 100% coverage;

N=34

30.   How many 9-1-1 answering points in your state?
The range was 1-485

N=21 

31.   Does the state mandate pre-arrival instructions (i.e., emergency medical dispatch (EMD))?
 __   2 (6%) ___ Yes 
 __34(94%)___  No

N=36

31a. If not mandated, what percent of the state’s population is covered by emergency medical dispatch?
          Range = 15%-100%;  7 = 100%; N=20 

32.   Who performs the emergency medical dispatch functions?
____28__ 9-1-1 answering points
____27__ centers that dispatch  EMS responders
____11__ emergency medical dispatch services are forwarded to a center   that specializes in such calls 
____ 9___ other (Please specify) _______________________________ 

33.   Does the state contribute to EMD? 
____9 (26%)___Yes _________$ amount annually
___25(74%)___No

N=34

34.   How is your state’s 9-1-1 system funded? 
_____5___ General Fund
____16____ Special Fund based on fees (describe the fees)__________
____17____ Local Funds
_____5___ Other (please specify)________________________________ 

35.   Is medical oversight of EMD required in your state? 
___12 (33%)____ Yes
___24 (67%)____  No

N=36

36.   If yes, how is this done? _______________________________________________ 

                                  THANK YOU FOR COMPLETING THE SURVEY! 

States responding to this program review survey included: 

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