VAA CONCERNED WITH NEW EMS LEGISLATION!


   On May 7th 2010 the House and Senate passed bill H.647 which, while a Workers Compensation Bill, has
within its text legislation which will significantly change the way EMS is regulated and provided within the State
of Vermont.   The bill was delivered to the Governor on May 26th and awaits his signature.

	Until April 23rd, H.647 dealt with workers compensation. When the bill was sent from the house to the
senate, the senate sent the bill to the Economic Development, Housing and General Affairs Committee. There
Senators Illuzi, Choate, Shumlin, and Campbell attached language to the bill that will change the way
emergency medical services are provided and regulated in the state. The VAA does not know who specifically
participated in providing the language of the amendment. While testimony was taken in committeet the majority
of EMS services in the state were never given notice of these important changes, and the VAA only discovered
this amendment after the bill came out of conference and was passed by a straight up or down vote on May 7th.

	The Executive Committee of the VAA sent a letter to the Governor on May 10th expressing our concerns
with the bill. While the committee did not object to the entire amendment, the committee did write to express
our concern about the how the amendment was inserted into H.647 and expressed displeasure with the 
manner in which its sponsors chose to avoid input or discussion with the  overall EMS community.

   The VAA is not sure what prompted this amendment but its champions, Senator Illuzzi and Matt Vinci of the
Vermont Professional Firefighters Association, state that the amendment is only aimed at the following; 

	(a)	encourage retention of volunteer EMS personnel by waiving the testing requirement every two years
	and instead require continuing  education as with other medical professionals;
	(b)	allow nationally certified military medics with the Vermont National Guard to become Vermont EMS
	personnel without the need to 	take up to a year long class and pass an examination every two years;
	(c)	encourage registered nurse  practitioners and physician's assistants to volunteer or work for rescue
	squads;
	(d)	expand the scope of practice for EMS personnel in Vermont;
	(e)	allow advance certified EMS, e. g., EMT-I and paramedics, to serve on ambulances licensed as
	EMT-Basic. 

	However, the VAA feels this amendment was written with little thought to how it will affect the provision and
regulation of EMS in the state. The VAA believes the amendment was written without proper vetting, and is
confusing and contradictory. As presented, it could seriously erode protections for the public which have been
in place for years. It creates great confusion as to what had been a predictable means to certification, and it
creates far more questions than answers regarding medical direction, scope of practice and licensing requirements.
The Executive Committee of the VAA met on May 26th and even after doing a sentence by sentence, line by
line analysis of the amendment's language, the committee came to a conclusion that it could not determine what
the author(s) were trying to communicate in some of the paragraphs.  After speaking to some legislators, the
committee was assured that all of our concerns will be addressed and/or fixed during the rule making process.
	
	The VAA is in the process of attempting to meet with the authors of the bill to determine what the intent of
the legislation was and to determine what their objectives are.  Once these points have been clarified and the
committee understands the intent, it will be much easier to establish a course of action.  The VAA understands
that our members are very concerned, but would request that you work with the VAA so that a uniform and
informed voice is presented rather than a mixed message. 

	The VAA must make sure that Vermont EMS providers are represented by the best and the brightest in
Vermont to improve the EMS rules and will need your input. EMS Providers in Vermont need to make sure that
they have the right people to represent them on the study committee formed by this legislation to study
Statewide Licensing of EMS Providers.  The VAA does have one seat, and of the 13 EMS districts, there are
only 3 representatives from those all of those districts that may sit on the committee. Those representatives are
to be chosen by the Speaker of the House Shap Smith and the President pro tempore of the senate
Senator Shumlin.  

	Therefore, the VAA recommends that EMS districts come together and lobby for whom they would like to
represent them as they will have three representatives, a medical director, a volunteer provider and one other.
Failure of the districts to lobby for candidates of their choosing may allow the selection of individuals who may 
not represent the wishes of the districts and cause an imbalance of representation from or by any one district.
	
	While the aforementioned legislation will be in effect as soon as the governor signs the bill, the rules for
Advance Emergency Medical care will have to be updated not later than March 1, 2011 to accommodate all of
the changes in this legislation.  The leadership and members of the VAA and EMS Districts will need to
maintain a unified, vocal and visible presence during the revision of the rules to ensure that the health
and welfare of the citizens of Vermont is protected.  It is the goal of the VAA to make sure these rules when
finished represent at least minimum standards and that medical oversight and quality improvement are
maintained or are even enhanced.
	
	This legislation while not perfect, does present the opportunity for a very positive change in the
development of a cohesive and  regionalized EMS system in Vermont. Keep in touch with your legislators' to
monitor the progress and ask them to keep you involved with any legislation regarding EMS.  If you have any
questions or concerns, please direct them to any member of the VAA's Executive Committe.



Download the EMS Portion of H.647 as passed by the Governor

 


Download Key Vermont EMS Issues 
 Download a Medicaid Reimbursement Bullet Paper
 Download a Detailed Medicaid Reimbursement Paper
 Download a Medicare vs. Medicaid Reimbursement Chart