Legislation Aims To Help Rural Emergency Ambulance Services

For some five years Pickens County struggled with shortfalls in ambulance service. Rural, uninsured, or underinsured residents faced significant challenges accessing emergency care, as the service relied heavily on patient payments and limited subsidies, making it difficult to maintain adequate staffing. That led to the county losing it's one ambulance and becoming dependent on assistance from Lamar County.

Thanks to the work of the Alabama Fire College, State Rep. Ron Bolton, local leaders and others; the county now has ambulance coverage. Now there is a bill pending in the House Ways and Means General Fund Committee that would impose reimbursement requirements to help fund emergency responses.

Ambulances services in other West Alabama counties, including Greene, are dealing with problems making ends meet.

House Bill 400, sponsored by Dadeville Rep. Ed Oliver (R-81) could come to the rescue. It would require health insurers to reimburse ambulance providers at a set percentage of the federal Medicare rate and establish coverage for “treat in place” services, when emergency medical personnel provide care on scene without transporting a patient to a hospital.

The bill also would prohibit balance billing, preventing providers from billing patients for amounts beyond their required cost-sharing once insurance has paid.

The Debate

Tuscaloosa/Pickens County Rep. Ron Bolton (R-61) told Tuscaloosa Thread he backs the bill. "HB 400 is a bill we've been working on for the past couple of years to help sustain our ambulance services, specifically those that operate in rural areas," he wrote in a text message. "This bill when passed will increase insurance reimbursements to ambulance operators to help sustain their operations and pay Paramedics and other staff."

It is those reimbursements that sparked extensive, and at times emotional debate in the committee hearing.

In reply to Tuscaloosa Thread, Tuscaloosa Rep. Bill Lamb (R-62) said he typically does not support mandates, "This bill will probably increase insurance in a very small amount. However, it also has the potential to significantly reduce health care costs. An example would be the treatment in place and the balance payment portion."

Lamb believes there may be some amendments added before the bill comes out of committee that would improve its chance for approval.

The service that can make a difference between life and death is "at a breaking point" according to rural EMS operator Stephen Wilson. He told the committee that EMTs and paramedics are grossly underpaid, leading to staffing shortages that leave some rural areas without ambulance service.

Vicki McElroy, a paramedic who experienced the shortfalls in Pickens County, reflected on how the closure of rural hospitals, like the one in Carrollton, results in long response times that have led to several deaths. She pointed out that transport times can exceed an hour.

The proposed mandate is getting significant pushback from the powerful insurance industry. Lawmakers like Rep. Arnold Mooney (R-43) said he is concerned about a growing number of mandates moving through the Legislature. He also took the side of insurers, telling the committee he supports rural ambulance providers but objects to shifting costs to policyholders.

The legislation has the backing of the Association of County Commissions of Alabama. Executive Director Sonny Brasfield, a Tuscaloosa native told the committee, “It’s not very often that we stand before you and say, ‘Let’s do a mandate. That should tell you what kind of crisis we believe we’re in.”

What's Next?

No vote was taken and the committee carried over House Bill 400 with plans to place it on the agenda for a vote next week.