Earlier this year, newspaper accounts reported situations where ambulances took too long to respond to calls, or did not come at all.  Also, issues concerning reimbursement for ambulance transport services were raised.  Thus, the program review committee called for a study of the regulation of emergency medical services. 

        The committee authorized a scope of study on March 9, 1999.  The focus of the examination targeted the three cornerstones of business regulation of emergency medical services:

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

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

·     determination of need for license and certification.

 

        The scope called for an identification of areas in need of change and proposed legislation that could be acted upon in the 1999 legislative session.  Subsequently, phase one of this report was issued in May 1999 and focused primarily on the designation of PSAs.  The committee found there was need for some corrections in the system, but concluded radical alternatives would be more disruptive than remedial to a system in place for more than 20 years. 

 

The recommendations contained in the previous report maintained the current regulatory system and the assignment of PSAs, but proposed policy enhancements to improve the ability of both local and state government to perform oversight functions of emergency medical services.  The committee’s eight recommendations were incorporated in sHB 6662 but did not pass during the last session.  The committee also authorized a second phase of the EMS study to examine areas the regulatory components it was unable to fully consider during phase one because of its abbreviated time frame.

 

This report, phase two, addresses the two other regulatory components of the EMS system -- rate setting and determination of need.  In addition, this report describes emergency medical dispatch and examines the need for basic data collection. 

 

Overall, the committee found the state’s regulatory mechanisms have not kept pace with the changes in the health care marketplace or the emergency medical services field.  The  recommendations approved by the committee serve to: streamline the current regulatory requirements for rate setting and determination of need; raise the level of Medicaid reimbursement for ambulance transports; improve the collection of essential performance data; and expand the availability of emergency medical dispatch throughout Connecticut.  In addition, the report raises some concerns about how the Department of Public Health (DPH) has discharged EMS regulatory duties. 

 

        Information for this report was obtained from a number of sources including:  interviews with staff of the Department of Public Health and other state agencies; town managers and other municipal officials involved with EMS; certified and commercial EMS service providers; and EMS representative groups.  The committee also held a public hearing on September 9, 1999.  In addition to DPH, 16 persons testified on various aspects of EMS.

 

        Other states were surveyed to determine how they regulate and monitor EMS services.  The survey results are presented in Appendix B.  A second survey was distributed to the state’s 108 public safety answering points (PSAPs), the centers that handle all 9-1-1 calls in Connecticut.  The PSAPs represent an important link in the EMS delivery system and the survey elicited information about their ability to collect data and perform emergency medical dispatch.  The results are included in Appendix C.

 

Report Organization

 

        This report contains five chapters.  Chapters I and II present an analysis of the current rate-setting and determination of need processes, as well as recommendations to streamline both these areas.  Chapter III provides findings and recommendations related to EMS data collection efforts.  Chapter IV describes the components of emergency medical dispatch and contains recommendations for expanding the availability of this service.  Chapter V details some management control deficiencies exhibited by DPH in the EMS area, and proposes the new DPH administration raise its level of attention to EMS.

 

Agency Response  

        It is the policy of the Legislative Program Review and Investigations Committee to provide agencies subject to a study with an opportunity to review and comment on the recommendations prior to publication of the final report.  The response from the Department of Public Health is available in hard copy reports only.