Senate passes bill implementing EMS ‘treat-in-place’ model for privately insured

Sen. Mike Maroney, R-Marshall, sits at his desk during the Senate floor session on Wednesday, Feb. 21, 2024, in Charleston, W.Va. (Will Price | West Virginia Legislative Photography)

Months after West Virginia’s congressional delegation called on the national Centers for Medicare & Medicaid services to implement a new treatment model to alleviate stress on EMS, lawmakers in the Senate advanced a bill that would do similar for private insurers in the state.

Senate Bill 533 unanimously passed the Senate on Wednesday, and will now advance to the House for introduction. If adopted, the bill would allow EMS providers in the state responding to people with private insurance to implement a “treat-in-place” model of care.

Under that model, after making a call to 911 a consenting patient could be diverted to a “lower-acuity” facility outside of hospitals and emergency rooms for treatment. This includes federally qualified health care centers, a doctor’s office, an urgent care center and mental and behavioral health facilities. First responders would also have the option to triage and treat patients on the scene when possible and coordinate with telehealth providers on how best to serve the patient.

“This bill tries to open up other possibilities for the patient than the ER,” said Sen. Mike Maroney, R-Marshall, while presenting the bill to the Senate on Wednesday. “It just gives them more choice to keep the crowds out [of hospitals] and keep the EMS guys in the field.”

Proponents for the treat-in-place model — including the West Virginia EMS Coalition and the state Hospital Association — believe it could reduce crowding in understaffed hospitals as well as allow underfunded EMS to collect more insurance payments for services rendered. As it currently stands, EMS can only receive payments through insurance if a patient is taken and admitted to a hospital for care.

The proposed bill would require private insurers to reimburse EMS agencies treating, triaging or transporting patients to alternative care centers at the same rate they would if a patient was transported to an emergency room.

“EMS only has the potential to bill for less than 40% of responses due to health insurance limitations that require ambulance agencies to transport to an emergency room to receive reimbursement. SB 533 is a step towards addressing this problem and recognizing EMS as a health care provider not just transportation,” said Chris Hall, executive director of the state EMS Coalition, in an emailed statement. “This legislation will strengthen EMS readiness, improve patient care and provide relief to overcrowded hospital emergency rooms.”

SB 533 is similar to a proposed bill in the House, which has been pending in the House Judiciary Committee since passing the House Committee on Fire Departments and Emergency Medical Services last week.

Unlike the model that Sens. Shelley Moore Capito, R-W.Va., and Joe Manchin, D-W.Va., and Reps. Carol Miller, R-W.Va., and Alex Mooney, R-W.Va, requested CMS to adopt at the federal level in September, the language in the Senate’s bill would make it apply to emergency calls for any conditions.

The congressional delegation’s requested model would have only been for emergency calls for three conditions: a hypoglycemia evaluation for diabetics, an asthma or COPD evaluation and a seizure evaluation for people with a preexisting condition.

According to data gathered by the West Virginia Hospital Association, about 15,000 people sought care for these conditions in emergency departments across the state in 2022, but were not admitted to the hospitals. The association estimates that, if the treat-in-place model were adopted by government sponsored insurance — like Medicaid, Medicare and the Public Employees Insurance Agency, which combined cover about 75% of insured residents in the state — the more conservative model alone could save West Virginia approximately $3 million annually in unnecessary emergency room visits. Estimated savings for private insurers are unclear at this time.

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