There's a lot of talk these days about community paramedicine, but no one has done much about it--until now. On April 6, Minnesota Gov. Mark Dayton signed Chapter 12 of the 2011 legislative session, authorizing establishment of the first-ever statewide community paramedicine program. The bill was authored by two Republican legislators: Sen. Julie Rosen and Rep. Tara Mack.
In all, there were 19 drafts of the bill, says O.J. Doyle, EMS consultant and lobbyist for the Minnesota Ambulance Association, who worked long and tirelessly with Buck McAlpin, director of government affairs for North Memorial Medical Center in suburban Minneapolis, to get the bill passed. "We were at somewhat of a disadvantage because no other state has done this and there was no template to follow," says Doyle. "Some entity has to be responsible for overseeing what the community paramedics (CPs) do, which, in our case is the state EMS Regulatory Board, so we had to include language in the bill for that. You have to set up a chain of command, and you have to establish training criteria so all CPs are trained in a consistent manner across the state.
"Because there is no history, it's difficult to figure out a fee schedule or how much will be paid for what services are given," Doyle continues. "So we inserted language saying the commissioner of human services, who regulates all the state health plans, is responsible for calling together a work group that will establish the practice parameters and then the reimbursement mechanism to be used. It will then go to the legislature in January 2012, and they will put the fee schedules into statute."
In the meantime, says Doyle, CPs can begin providing care, but they won't be reimbursed by the state. "There are a couple of pilot projects in the works that may allow for them to be reimbursed as part of those specific pilot projects," he says, "and there are five health insurance companies that carry state payer programs that could reimburse." According to McAlpin, the mandatory reimbursement legislation applies only to health coverage administered by the state of Minnesota. The health plans or health insurers are a separate issue.
"The reason we wanted it in state law is because it legitimizes what we're doing, and when other non-governmental insurers see the state has adopted it, they will be less hesitant to try something that's new to them," says Doyle.
In order to apply for the CP program, paramedics must have a minimum of 2 years' experience. The curriculum, which will require 120 hours of additional training, has just been approved by MNSCU--the Minnesota State College and University System--and will include things like minor suturing, vaccinations, drawing blood, checking kids' ears for infections, and recognizing mental health and chemical dependency issues in order to route those patients to proper care.
"One of our concerns was, if you had community paramedics going out on their own to provide care, it could conflict with our ambulance licensing laws," says Doyle. "So the statute says a CP program must be administered through an ambulance service."
Now that the bill has passed, what's next?
"The Minnesota Ambulance Association will be pulling together a work group of affected parties to put down on paper the way we envision the community paramedic interacting with the community and flesh out some of the details," says Doyle. "We want to create a template so local agencies will have a place to start, and they can adapt it to their own needs. We're also trying to come up with some grant dollars to help pay for training. One benefit of this program is that it's potentially another revenue stream for ambulance services. Rural areas are increasingly hard-pressed with decreases in reimbursement and difficulty getting paid, and this will help ambulance services continue to exist in those areas."