MACo’s EMS Initiative passed the Senate before the crossover deadline and made its way to the House. 

Yesterday marked crossover, a significant point during the General Assembly’s annual 90-day legislative session. If a bill has not been passed in its originating chamber, the legislation is probably dead. One of the Maryland Association of Counties (MACo) top legislative initiatives made it over the hurdle, passing the Senate before the midnight deadline. While counties have some reason to be optimistic, many things can happen in 20 days. Below is a breakdown of this initiative and the road ahead to Sine Die.

Breakdown of the MACo EMS Initiative

Every year, MACo chooses a handful of top issues that are important to counties. These select issues highlight the association’s advocacy efforts and bring attention to what matters most to county leaders. Part of the 2022 panel of issues was resetting how Maryland funds its Emergency Medical Services (EMS). Current law, which was last updated in 1999, only authorizes EMS providers to bill up to $100 per ride to a hospital. No other services provided either in the field or while in transit are eligible for reimbursement. Healthcare has changed significantly within the last century. Volunteer, municipal, and county EMS services are struggling to survive, especially in the midst of a national opioid crisis and a global pandemic. This is why MACo made it a top priority to advocate for a statutory realignment of Maryland’s definition of care and compensation to recognize and enhance EMS’s role in our healthcare system.

MACo’s plan sought to accomplish four primary objectives:

• Raise the current EMS reimbursement rate to one that more reasonably connects to service costs in today’s dollars. The current $100 rate would be increased through reasonable $25 yearly increments, eventually reaching $300. This would represent the first change in EMS reimbursements since 1999 ─ an overdue recognition of the substantial costs borne by providers ─ and would help slowly close the large gap in their operating funding.
• Establish reimbursement for care provided in the field. Maryland’s EMS companies are trained and equipped to remedy a substantial range of calls onsite but when transport does not occur, those calls are tagged as “treatment not transport” and no reimbursement is made. These often life-saving services deserve recognition as medical care. The rise of opioid-related overdose calls during the related epidemic has elevated this essential and time-sensitive service as a central part of EMS duties. The rate for reimbursement would mirror the transport reimbursement rate.
• Allow for transport to facilities other than a hospital emergency room. Amidst the COVID epidemic, there are widespread reports of overwhelmed hospitals and calls for noncritical patients to go to another facility when that is appropriate. Not every EMS call requires high-level emergency care; often alternative medical facilities like urgent cares, mental health facilities, and others are more appropriate venues to address these medical emergencies. By transporting to other facilities when appropriate, we can ensure patients are being seen as quickly as possible while also relieving pressure on a medical system reeling from the pandemic.
• Allow for Mobile Integrated Health (MIH) as an effective and reimbursable method of care delivery. Similarly to transporting to alternative facilities, in many circumstances, onsite service is more appropriate than transport to any facility. Forward-thinking governments and volunteer companies are also deploying ambulances and mobile equipment to effect service beyond mere response-and-delivery. Mobile Integrated Health and similar offerings to bring needed care to residents underserved by easily accessible providers has proven to be a very effective tool to combat health care disparities. Its growing use has increased resident access to important screenings, vaccinations, and prenatal care. In each case, these clear best practices are frequently conducted without the State recognizing that any medical care has taken place for the purposes of reimbursement.

Journey in Both Chambers

MACo’s EMS initiative was cross-filed in both the Senate and House of Delegates. Senators Gallion and Corderman co-sponsored the Senate version (SB295), and Delegate Hornberger sponsored the House version (HB44). While the House version did not make the circuit through committee and onto the floor before crossover, the Senate was able to pass its version with amendments.

Senate Amendments

The Senate included three amendments when it passed SB 295:

• The date to complete the study on MIH funding was moved back from November 2023 to November 2024. (Little to no impact on county governments.)
• A study was added for the Maryland Institute for Emergency Medical Services Systems (MIEMSS) to examine emergency and non-emergency interfacility transports. This study is due to the Senate Finance Committee and the House Health and Government Operations Committee by December 31, 2022. (Little to no impact on county governments.)
• Funding increases for transport and treatment would end June 30, 2025. (Fund reimbursement increases for three years instead of until the reimbursement rate reaches $300. This equates to a $75 increase in the reimbursement rate between FY2023 and FY2025.)

The Road Ahead

SB 295 is expected to be assigned to the House’s Health and Government Operations Committee. MACo will have 20 days between now and April 11 to advocate for this legislation and see it through the House. Should the House make further amendments, the bill will more than likely go to a conference committee where representatives from the House and Senate will come together and work out the final language. It is a victory in and of itself to still be on the board at this point during legislative session, and this bill is very much still alive. The next three weeks will be make or break for EMS funding reform, and it is entirely possible events may run to the last second on Sine Die.

More on MACo’s Advocacy:

Follow MACo’s advocacy efforts during the 2022 legislative session on MACo’s Legislative Tracking Database.
Learn more about MACo’s 2022 Legislative Initiatives.
Read more General Assembly News on MACo’s Conduit Street blog.