Colorado — the last state regulating EMS at the county level — to assume regulatory authority of providers
After July 1, 2024, minimum standards for emergency medical services will move from the county-level to the state because of the Ambulance Service Sustainability and State Licensing law, which was enacted in June.
A 20-member task force including Red, White & Blue Fire Protection District Chief James Keating will determine those standards, which could lead to major impacts in Colorado’s rural communities.
“This is something that should be a great concern to the public, especially in the smaller counties,” Keating said.
By Jan. 1, 2024, the Colorado Department of Public Health and Environment is required to adopt rules regarding minimum standards, and by July 1, 2024, local jurisdictions will be authorized to grant ambulance services the ability to operate in their area.
Colorado is the only state that currently regulates EMS services at the county level, according to the Colorado Department of Public Health and Environment, but in 2024, ambulance services will need to meet state minimum standards for equipment, staffing, medical oversight and general and vehicle liability insurance standards, as well as potential rules imposing application and licensing fees.
Keating sees the fees as a possible barrier to local agencies if it’s done poorly.
In a not-for-profit industry like EMS, licensure fees and the other associated costs of regulation can impact smaller agencies serving rural communities, he said, adding that many rural agencies across the state and country already suffer staffing shortages. There are more open positions than available paramedics in Colorado. While attending an international firefighting and EMS conference last week, he said he saw agencies across the country recruiting talent off the exposition floor.
He said staffing hasn’t been and issue in Summit County, but it is becoming an issue for EMS providers. Local agencies are well-staffed but are having a harder time filling new vacancies as paramedics leave or retire.
Summit County’s regulations will be brought up to modern standards by the new law, Keating said. In addition, counties across the state will now maintain the same standards, easing the burden on some EMS providers that serve more than one county.
So while the task force could implement new fees for providers, the regulations are expected to make certification more streamlined and reduce the “strangling” costs associated with seeking Medicare and Medicaid reimbursement, Keating said. Medicare and Medicaid reimbursements may be sought by more powerful agencies at the state level, freeing up small providers’ time and money, Keating added.
Counties will still retain some authority over their local EMS providers. The county can authorize providers to handle certain duties in the county, such as managing 911 calls or ferrying patients from St. Anthony Summit Hospital in Frisco to a Denver-area medical center. The county currently authorizes Stadium Medical to handle inter-hospital transfers, while Summit Fire & EMS and Red, White & Blue Fire Protection District have authorization to cover 911 calls.
The county will still handle those authorizations while the state oversees EMS services. Keating said it’s not certain who will handle the approval process, whether it’s the Department of Public Health and Environment or a higher state board.
Overall, Keating said it’s surprising the state of Colorado maintained county-level standards for so long.
Keating spent 12 years on the Kansas state EMS board, and he said he hopes to bring that experience to the 20-member task force, since many rural EMS agencies pair with local fire departments, which is the case with Red, White & Blue and Summit Fire & EMS. He’ll represent Colorado fire chiefs on the task force. The task force will feature EMTs, physicians, county commissioners and state lawmakers.
The 20 members were appointed to the task force in August with representatives from both rural and urban areas of Colorado. The group will issue reports and recommendations on consistent statewide standards for ground and air ambulance services, equitable access, sustainable funding, and staffing and retention.
The task force’s work will culminate in 2027, after completing five phases of work. The first phase will cover recommendations for a new regulatory framework with emergency medical services — this will include regulatory fees — a topic Keating said is his chief concern because of their impact on smaller organizations. Other topics and phases include addressing inequities and disparities in access to EMS, workforce recruiting and retention issues, financial sustainability of EMS, and the general long-term sustainability of EMS. Keating said he expects the task force to have its first batch of recommendations ready by mid-2023.
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