NOTE: As provided in LFC policy, this report is intended for use by the standing finance committees of the legislature.  The Legislative Finance Committee does not assume responsibility for the accuracy of the information in this report when used in any other situation.



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F I S C A L I M P A C T R E P O R T





SPONSOR: Lyons DATE TYPED: 03/06/01 HB
SHORT TITLE: Amend Emergency Medical Services Fund Act SB 302/aSFC
ANALYST: Esquibel


APPROPRIATION



Appropriation Contained
Estimated Additional Impact
Recurring

or Non-Rec

Fund

Affected

FY01 FY02 FY01 FY02
N/A



(Parenthesis ( ) Indicate Expenditure Decreases)



Duplicates HB614

Relates to Appropriation in the General Appropriation Act of 2000 of $3 million for emergency medical services.



SOURCES OF INFORMATION



Department of Health (DOH)

NM Health Policy Commission (HPC)



No Response

Taxation and Revenue Department (TRD)

Association of Counties



SUMMARY



Synopsis of SFC Amendments



The Senate Finance Committee amendments to Senate Bill 302 remove the general fund appropriation of $6,400.0. The Senate Finance Committee's reported out version of HB2 et al, as amended, includes $600.0 in general fund for the purposes of the bill.



Synopsis of Original Bill



Senate Bill 302 amends the Emergency Medical Services Fund Act and expands the scope of emergency medical services (EMS) funded by DOH with an increase in the appropriation from $2.9 million annually to $6.4 million dollars for FY02 and subsequent fiscal years. The provides for the following:





Significant Issues



DOH indicates at current funding levels, the EMS Fund Act is capable of funding approximately 47% of the requests submitted to the local funding program (75% of the EMS Fund). In order to provide adequate resource to the existing 316 EMS services statewide, the Statewide EMS Advisory Committee determined that a $6.4 million appropriation would be necessary to meet current EMS system demands.

PERFORMANCE IMPLICATIONS



Ensuring the adequacy of the statewide EMS and trauma system is a DOH commitment included in its strategic plan under Program Area 2--Health Systems Improvement and Public Health Support Systems. Goal A is to "Ensure access to and quality of basic health systems such as primary care and rural health, and emergency medical services." Objective 2 is to "Provide timely and comprehensive emergency medical services" with a commitment to ensure that 90% of individuals are served by a comprehensive EMS response within 10 minutes. The EMS Fund Act is a critical program to ensure the maintenance of this objective.



FISCAL IMPLICATIONS



The appropriation of $6,400.0 contained in this bill is a recurring expense to the general fund. Any unexpended or unencumbered balance remaining at the end of FY02 would not revert to the general fund.



HB2 et al currently contains approximately $3 million for carrying out the provisions of the EMS Act.



ADMINISTRATIVE IMPLICATIONS



DOH indicates existing DOH Regulation 7 NMAC 27.5, EMS Fund Act, would need to be amended to comply with the revised EMS Act.



OTHER SUBSTANTIVE ISSUES



DOH indicates the EMS Fund Act provides critical annual funding for vehicles, equipment, training, and operational expenses to about 316 EMS services (ambulances and medical-rescue squads). These services provide safety-net, pre-hospital, emergency and non-emergency care, to the people of New Mexico, 24 hours per day, 7 days per week on an immediate call basis. EMS services use the annual EMS Fund Act distributions, which currently range from $1,500 (entry) to a maximum of $20,000 (advanced level, high response service), to pay for operational expenses including fuel, maintenance, medical/other supplies and equipment, medical direction, continuing education, and training for personnel.



The EMS First Response Services (about 200 statewide), which are typically rural, volunteer, fire-department based services, are not allowed to charge for reimbursement and depend on their annual EMS Fund Act distribution almost exclusively to pay for the cost of equipment, operations and training. Ground ambulance services are allowed to charge for services, but these reimbursement rates are heavily regulated by federal government (Medicare and Medicaid) and state government (Public Regulation Commission). The development of managed care has negatively impacted private and public ambulance services. Every reimbursement is scrutinized and denials of claims tend to be about 20-30 % of those submitted. Recently, the Federal Health Care Financing Authority developed a new ambulance fee schedule that is expected to further cut rates of reimbursement. These services also depend on the EMS Fund Act to supplement their reimbursements to pay for their operational costs and training.



One of the changes in SB 302 would allow the roughly 50 Emergency Medical Dispatch Agencies (911 operations which provide limited medical advice) to apply for limited support through the special funding projects program (22% of the EMS Fund). The distribution process would be determined by regulation and funds would cover limited items such as physician medical direction and training. DOH began regulating emergency medical dispatchers in 1995; however, they have not been eligible to receive any funding assistance through the EMS Fund Act. The Department of Finance and Administration provide some training funds, but these are limited only to course fees. This amendment will allow emergency medical dispatch agencies to become more integrated with the overall pre-hospital delivery system, which ultimately will help to reduce injury and improve treatment given from the initial call for assistance.



SB 302 would also amend the EMS Fund Act to allow services to request a distribution of "No more than one percent of the amount appropriated…" which is a change from the existing $20.0 cap for funding. This would allow the larger EMS services that respond to the majority of calls statewide to receive a more appropriate share of the fund, as determined by DOH rules.





POSSIBLE QUESTIONS



1. Based on what rationale has the federal Health Care Financing Administration determined EMS costs and reimbursements should be reduced?



RAE/ar