New bill tackles direct ambulance reimbursements

(The Center Square) — Harrisburg lawmakers launched a bipartisan effort to address a financial crisis that is forcing many of the state’s emergency medical service providers to shut down.

Rep. Jill Cooper, R-Export, recently proposed legislation to establish fair rates and direct reimbursement for EMS services regardless of the provider’s status in the insurance network.

EMS providers are mandated to deliver 24/7 emergency services to local municipalities, regardless of a patient’s insurance coverage or ability to pay.

Most people think the service is free – paid for by taxes, just like police and firefighters, or paid by their insurance companies, Cooper told The Center Square. The reality is that unless emergency services are needed, people may not fully understand how they work. They simply assume they will always be there – and when they call 911, they expect an ambulance to arrive quickly.

Another misconception, she said, is that it’s just a ride to the hospital, but, in many cases, it’s a hospital on wheels. It’s a complex business that is necessary and can make the difference between life and death for many.

She added that the current model is not working, noting that approximately 49 providers have ceased operations in the commonwealth in the last two years.

The closures highlight a statewide crisis in the EMS system which is also being impacted by increased demand and staff shortages.

By law, if a company closes its doors, another one must cover that location, regardless of how taxed they are in their current service area. This, Cooper said, could lead to longer response times, and most people won’t realize there is a crisis until they call 911 and help doesn’t arrive quickly enough.

She stated it is difficult to quantify the number of people who may lose a loved one due to delayed ambulance arrivals. Without action, she warned that the problem will only become more apparent over time.

Approximately 30 legislators have signed on to the bill, Cooper said, and they are meeting with stakeholders and fine-tuning it to find a workable solution for all. The goal is for insurance companies to pay EMS providers directly, so they can focus on what they do best – which is saving lives – not having to chase down payments owed them.

Rep. Lisa Borowski, D-Newtown Square, is a cosponsor of the bill, and a co-chair with Cooper on the Fire and EMS Caucus. She told The Center Square the problem was identified to her long ago while serving as commissioner in Radner Township, and she’s grateful to join Cooper on this legislation.

She explained that when EMS provides care and transportation for an insured individual, the bill is sent to the insurance company. However, the check is issued to the individual, who is responsible for paying the bill. Unfortunately, this payment is often not made to the EMS company.

While some companies have staff or can hire a collection agency to go after the money, many do not have the ability, so bills go unpaid and are written off.

Municipalities are responsible for providing the service, or at least contracting for it, Borowski said, which is a huge expense. For smaller municipalities with tighter budgets, it can be a challenge.

“So, if this is something we can do to help generate more revenue for the responding EMS, it would be a really good thing,” she said.

Cooper said she expects to introduce her legislation within the next several weeks.

“As state legislators, we need to ensure the members of our community are provided with emergency medical services in times of need,” she said. “This bill will provide reliable financial reimbursement so local EMS providers can focus on performing their mission of saving lives.”

According to the Pennsylvania Bureau of Emergency Medical Services 2021 EMS Data Report, the EMS system was comprised of 1,259 agencies that responded to 2,447,932 calls for service.