§1135.13. Ambulance Transport Alternatives Task Force; pilot program; rules and regulations

A. Within the Louisiana Department of Health there is hereby created the Ambulance Transport Alternatives Task Force, hereafter referred to as "task force". The task force shall be charged with advising the secretary of the department on its recommendation regarding the development and implementation of a pilot program for ambulance transport alternatives in the parish of East Baton Rouge. Implementation of the pilot program shall be contingent on available and appropriate funding and reimbursement rates from federal, state, and commercial payors. The task force shall provide technical assistance, as required by the department, on application to the Centers for Medicare and Medicaid Services for an innovation grant award or any other grant, waiver, or federal or state funding opportunity to support implementation and sustainment of this Section. The task force shall further establish a data collection system to assess the progress and success of the pilot program and make recommendations to the department on statewide implementation of an ambulance transport alternatives program.

B. The task force shall be composed of the following fourteen members:

(1) One member appointed by the chairman of the Senate Committee on Health and Welfare.

(2) One member appointed by the chairman of the House Committee on Health and Welfare.

(3) The secretary of the Louisiana Department of Health, or his designee.

(4) The executive director of the Louisiana Emergency Response Network, or his designee.

(5) The executive director of the Louisiana Ambulance Alliance, or his designee.

(6) The executive director of the bureau of emergency medical services, or his designee.

(7) Two members representing ambulance service providers.

(8) The administrator of the East Baton Rouge Parish Department of Emergency Medical Services, or his designee.

(9) Two members appointed by the mayor-president of East Baton Rouge Parish.

(10) The executive director of the Capital Area Human Services District, or his designee.

(11) One member representing a hospital in East Baton Rouge Parish appointed by the Louisiana Hospital Association.

(12) One member who shall be an emergency room physician appointed by the Louisiana Chapter of the American College of Emergency Physicians.

C. The task force shall convene for its first meeting to be held at the Louisiana Department of Health headquarters in Baton Rouge no later than October 1, 2016. At the first meeting the members shall elect a chairman and vice chairman and other officers as they deem appropriate. The task force shall establish a regular meeting schedule and after the first meeting, may meet at such times and places as determined by the task force members. Meetings shall be held at the call of the chairman or at the call of a quorum of members upon not less than seven days' notice. A majority of the members of the task force shall constitute a quorum. A quorum shall be present to transact any business. The members of the task force shall not be compensated for their services on the task force but may seek travel reimbursement from their respective agencies under their respective guidelines. Meetings of the task force shall be subject to laws regarding open meetings, and records of the task force shall be subject to laws regarding public records.

D. The task force shall study and evaluate all data available to carry out its duties in anticipation of the pilot program being implemented when fully funded. The task force shall evaluate and make recommendations on all matters within their jurisdiction, including but not limited to:

(1) Options for alternative transportation destinations when a patient dials 9-1-1 with a non-life-threatening, non-emergent, low acuity medical condition that does not meet the definition of emergency medical condition as defined in R.S. 22:1821(D)(2)(g)(i).

(2) Appropriate medical director oversight and additional training for paramedics, emergency medical technicians, or other personnel on specific protocols for low acuity, intoxicated, and psychiatric patients, including the addition of data fields in electronic medical records systems and a rigorous quality assurance and quality improvement process.

(3) Methods for early destination evaluation and advanced assessment to determine if a 9-1-1 patient could be safely treated at an alternative medical facility, such as an urgent care clinic, community clinic, medical group office, detoxification center, mental health hospital, or other appropriate healthcare facility.

(4) Methods for an advanced assessment to confirm that no priority symptoms exist that require treatments that can be performed only in an emergency department.

(5) Process for explaining to a patient that his medical condition may be appropriately treated at an alterative care location when the patient meets the criteria for transport to an alternative destination, including an explanation of factors such as insurance accepted, facility hours, facility capability and capacity, and the nearest appropriate location with consideration that patient choice and consent shall be the final determinant.

E. The task force is authorized to consult with the Centers for Medicare and Medicaid Services and other states that have pilot programs or statewide programs for ambulance transport alternatives to determine best practices.

F. The task force shall submit semiannual updates to the Senate and House committees on health and welfare on progress towards development of the pilot program and securing of funds for implementation of the pilot program. The first semiannual report shall be due six months after the task force convenes and subsequent reports shall be due on each October first and each April first.

G. The task force shall continue to meet until such time as either of the provisions of this Subsection is met:

(1) The task force has thoroughly assessed the issue and makes a recommendation to the legislature that a pilot program in East Baton Rouge Parish is not recommended. The task force shall notify the legislature in writing and shall include the specific reasons why the task force believes that the pilot program is not recommended. The Senate and House committees on health and welfare may jointly or separately convene a hearing within sixty days of receipt of the recommendation from the task force to review the recommendation. The committees may ask the task force for additional information or ask the task force to further study the issue. If the committees take no action, the task force shall dissolve within ninety days of giving notice to the legislature of the recommendation provided in this Paragraph.

(2) The pilot project in East Baton Rouge Parish is complete and a recommendation has been made to the legislature regarding statewide implementation. The task force shall notify the legislature in writing and shall include the specific reasons why the task force believes that statewide implementation is or is not recommended. The Senate and House committees on health and welfare may jointly or separately convene a hearing within sixty days of receipt of the recommendation from the task force to review the recommendation of the task force. The committees may ask the task force for additional information or ask the task force to further study the issue. If the committees take no action, the task force shall dissolve within ninety days of giving notice to the legislature of the recommendation provided in this Paragraph.

H. If recommended by the task force, continuation of the pilot program in East Baton Rouge Parish or statewide implementation under the provisions of this Section shall be dependent upon the availability and receipt of all funding necessary to fully implement and sustain the program. The program shall cease if funding necessary to fully implement and sustain the program is not available until such time as replacement funds are available or if any of the following occur:

(1) The legislature does not appropriate funds to replace any lost funding.

(2) State, federal, and commercial payors fail to provide reimbursement for ambulance transport alternatives as established in this Section.

(3) A majority of the transportation providers participating in the program provide data showing negative outcomes to both the provider and the patients they serve as a result of participating in the program. Negative outcomes to the provider shall include any increased liability and insurance costs which are not offset by increased revenue or protection provided by statute solely based on transport to an alternative destination.

I. Based upon the recommendation of the task force, the secretary of the Louisiana Department of Health shall promulgate the necessary rules and regulations to implement the provisions of this Section in accordance with the Administrative Procedure Act. Such rules and regulations shall include provisions for the health and safety of the patients transported to alternative destinations as well as the reimbursement methodology to cover alternative destination transport by a ground ambulance service provider to ensure that reimbursement rates are reasonable and adequate, and that coverage is available by the patient's payor source.

Acts 2016, No. 493, §1, eff. June 13, 2016; Acts 2018, No. 206, §4.