Paying for emergency services

A bill to provide funds for regionalizing emergency medical services in some parts of Wyoming failed to make it through three readings in the 2024 budget session of the Legislature, leaving the source of funding for such efforts in limbo. Campbell County Health EMS, who provides ambulance and emergency medical services for Weston County, has suggested that the county consider joining a regional EMS as a way to help fund EMS services in the county moving forward.

Campbell County Health EMS manager Shane Kirsch presented a review of funding and 2023 service to the Newcastle City Council at its Feb. 5 meeting. He discussed with the council the status of the EMS Regionalization Grant of American Rescue Plan Act dollars through the Wyoming Department of Health and whether a third-party consultant should conduct an EMS system assessment.

He also proposed that voters con- sider enacting an EMS taxing district, which Wyoming started allowing in 2023 through Senate File 43, instead of using general funds from the city budget to provide Campbell County Health EMS with a yearly stipend.

“I think communities need to be involved and have a say in what level of emergency medical services they feel is appropriate for their community,” Kirsch said in a phone interview with the News Letter Journal on April 19.

EMS Regionalization Grant

In 2022, the Wyoming Legislature appropriated $10 million in ARPA funds to the Wyoming Department of Health for establishing EMS regionalization pilot opportunities for five trauma regions across the state. The funds were also intended for investigating other options to improve access and reduce costs of EMS, according to the department website.

Campbell County Health EMS received a Do Fund letter from the state for about $3.8 million for EMS regionalization, stabilization and training, Kirsch said in a Feb. 16 email.

In their 2024 session, Wyoming legislators attempted to pass a similar measure, Senate File 132, which would have provided millions of additional dollars, if matching funds were received, for the same purpose of establishing an emergency medical services regionalization pilot opportunity for the state’s five trauma regions and for investigating other options for EMS to improve access and reduce costs. The bill passed through both chambers in March but was suspended indefinitely on its second pass through the Senate during budget negotiations late in the session.

There is another possible funding source, however. Wyoming did receive $584 million in ARPA funding, Kirsch said, explaining that the Wyoming Hospital Association is involved in an effort to change the verbiage on the funding request so that the state will provide the funding, but Kirsch is unsure how long that might take. The EMS agencies for Campbell County Health, Laramie County and Cody Regional Health applied for funding and are pushing to receive the money.

“None of us received any funding,” he said. “I believe Fremont County did receive some ARPA funds under the EMS Regionalization Grant and they ended up buying two ambulances with it, but that’s the only amount of money that I know that has been spent.”

EMS taxing district

Kirsch said that in Weston County he has been promoting the use of a community sales tax to fund EMS services through an EMS taxing district, based on mill levy, instead of having taxpayers pay for EMS subsidies through general fund appropriations. That would bring in around $400,000 at most, per year. Campbell County Health EMS currently receives about a $100,000 subsidy from the city of Newcastle and about $35,000 from Weston County. An EMS taxing district is specifically for EMS services, unlike a hospital taxing district, like Campbell County has, or a rural health care district, like Johnson County has.

“The subsidies really help kind of offset costs to staff, being as the volume doesn’t exist for us to be a totally sustainable option in those smaller communities,” he said.

The annual operations cost for a 24-hour, everyday service, per ambulance, is about $500,000 for a basic life support crew of two emergency medical technicians basics, or about $800,000 for a crew that can perform advanced-lifesaving skills, which allows advanced life-support-level response. Costs increase to about $1.1 million for a crew of two paramedics. (Chapter 17 of the Wyoming Department of

Health’s Rules and Regulations for Wyoming Emergency Medical Services Act of 1977 has descriptions of the various levels of service providers.)

Cost-based reimbursement

Yet another opportunity for funding could lie in partnering with another regional entity to access reimbursement dollars from the state and federal government. In September 2022, Campbell County Health and Sheridan Memorial Hospital announced they were creating the Wyoming Regional EMS to provide ambulance services for Sheridan and Sheridan County, and Kirsch suggested Weston County officials consider joining that organization.

“Due to the nature of the critical access hospital with not another licensed ambulance service, depending on where Upton is at, there is a potential that we could apply for cost-based reimbursement if Weston County were to join up with the management team of Wyoming Regional EMS and helps manage ambulance services in Weston County,” Kirsch explained.

For rural EMS districts, there must be a 35-mile exclusion zone where there is no other ambulance service, and there must be coordination with a facility that is a critical access hospital, he said.

Generally, EMS receives a reimbursement rate of about 30 to 60 cents per $1 that it charges, according to Kirsch.

“At cost-based reimbursement, we would be reimbursed at either 98% or at 101%, but that is only on patients that qualify for Medicare and Medicaid,” he said.

Consultant assessment

Another path that could bring in funding is a third-party consultant assessment.

The Wyoming Department of Health has historically supported some grant funding opportunities for an EMS needs assessment in certain locations across the state, according to Kirsch. For example, Campbell County Health’s last EMS needs assessment was in 2016, and it is currently looking into whether it can receive another assessment.

There are grant funding opportunities for implementing a master plan after the completion of a needs assessment, and Kirsch said that Weston County, Newcastle or Upton officials could tell the state if they want an EMS needs assessment for their communities.

According to Kirsch, Campbell County Health’s grant writer, Yvette Land, is going to ask the state whether Campbell County Health’s assessment and master plan implementation funding could cover Sheridan and Weston counties, too, as a regionalized system.