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SPONSOR: |
HBIC |
DATE TYPED: |
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HB |
1007/HBICS |
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SHORT TITLE: |
Transfer Ambulance Regulation |
SB |
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ANALYST: |
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APPROPRIATION
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Appropriation
Contained |
Estimated
Additional Impact |
Recurring or
Non-Rec |
Fund Affected |
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FY03 |
FY04 |
FY03 |
FY04 |
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$375.0 |
Recurring |
General
Fund |
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$60.0 |
Non-Recurring |
General
Fund |
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(Parenthesis
( ) Indicate Expenditure Decreases)
Relates to Relates to HJR 13, 14
Responses
Received From
Department
of Health (DOH)
Public
Regulation Commission (PRC)
Energy,
Minerals and Natural Resources Department (EMNRD)
SUMMARY
Synopsis
of Bill
The House Business and Industry Committee Substitute to House Bill 1007 proposes to transfer the regulation of ambulance services from the PRC to the Department of Health.
Significant
Issues
·
Section 1 would amend Section
·
Section 2 would amend the definitions
section of the EMS Act, Section 24-10B-3 to change “State Corporation
Commission” to the DOH.
·
Section 3 would amend the duties of the
Injury Prevention and EMS Bureau to remove subsection 24-10B-4.B, NMSA 1978
which states “provision of technical assistance to the public regulation
commission…”
·
Section 4 would amend the Personnel
Licensure section of the EMS Act to remove a portion of subsection 24-10B-5.A. which states “When setting requirements for the licensure of
persons also subject to the Ambulance Standards Act, the Bureau shall consult
with the State Corporation Commission.”
·
Section 5 would amend the definition
section “Indigent and County Health Care Act”, Section
·
Sections 6-8 would amend the definitions,
duties and applicability sections of the Ambulance Standards Act, Section
65-6-1, et seq., NMSA 1978, to remove the Public
Regulation Commission and to add the DOH.
The
following new sections are added to HB1007 Substitute that were
not in HB653 Substitute:
·
Section 9 removes ambulance standards
from the list of programs staffed by the Transportation Division.
·
Section 10 amends the definition of
“common motor carrier” to specifically exclude ambulances.
·
Section 11 adds a temporary provision to
transfer personnel, property, contracts and references in law on
A special subcommittee of the Legislative Council, the Public Regulation Commission Subcommittee, has discussed the transfer of ambulance regulation recently. The task of the subcommittee was to make recommendation on the structure of the PRC. The conclusion was that the PRC be restructured to focus only on utility and telecommunications regulation. It was recommended that the non-utility functions of the PRC be transferred to other departments. Regulation of ambulance services was identified as non-utility function. The specific recommendation is shown below as reported in the PRC subcommittee report:
Ambulance
Services. A
It
remains unclear in HB 1007 Substitute whether or not the Public Regulation
Commission would continue to review and approve rates
and charges for ambulance services. On
page 12, lines 22 and 23, in amending the Indigent Hospital and County Health
Care Act, HB 1007 indicates that, “The rates and charges established by the
public regulation commission tariff shall govern as to allowable cost.” If the PRC is going to retain this
responsibility, it is unclear how that would be coordinated with the
application process and granting of certificates of public conveyance and
necessity that the bill proposes to shift to the Department of Health. Although rate setting would be appropriate
given the PRC’s expertise in this area, this again
demonstrates the lack of coordination between the PRC and the Department of
Health in the preparation of this legislation.
FISCAL IMPLICATIONS
The bill provides in Section 11 for the transfer of all personnel,
appropriations, money, records, equipment, supplies and other property of the
public regulations commission to the DOH.
The transfer of the PRC’s current resources
dedicated to ambulance regulation would not be adequate according to DOH.
The bill would impose a substantial new workload and resulting fiscal
requirement for the DOH. Section 11 of HB 1007 Substitute would transfer
unknown resources including personnel, funding, contracts, documents and
vehicles to the Department of Health. It
is not clear what resources the Public Regulation Commission has dedicated to
regulating ambulance services except for one FTE inspector position. It is
anticipated that HB 1007 Substitute may only provide about 20% of the resources
needed to regulate ambulance services effectively. Other significant resources will be needed to
manage this program consistently and effectively.
DOH indicates that HB 1007 Substitute would significantly under-fund DOH
to provide statewide regulation of critical, complex and highly technical components
of the ambulance industry. More specifically, based upon the planning that was
accomplished in the late 1990s, and recognizing that the rate setting aspects
would be retained by the PRC, the DOH would require a recurring appropriation
of at least $375,000 and five (5) additional full time equivalent personnel,
including program management and actuarial capacity. Depending upon whether or not the PRC retains
the rate setting authority and responsibility for ambulance services, the above
amount might be reduce by 1 FTE and $60,000. Since it is unlikely that DOH
would get any vehicle resources, the first year would also require an
additional, one time appropriation of $60,000 for capital acquisition of two
vehicles and computer equipment.
ADMINISTRATIVE IMPLICATIONS
As
indicated above, the administrative implications of HB 1007 Substitute for DOH
to accomplish the transfer of responsibilities to regulate the ambulance
industry are beyond DOH current capacities. The DOH would require at least four
(4) new full time equivalent (FTE) personnel, or perhaps 5 if the rate setting
function is also to switch to DOH, and a recurring appropriation of at least
$375,000 annually ($315,000 if rate setting is included). The additional staff
would include a Staff Manager, one FTE to provide administrative and fiscal
support, two FTE’s to accomplish ambulance service inspections, and an
actuarial position if needed. A
transitional period would be required to allow the Department to promulgate new
regulations and acquire needed resources including two vehicles. Additional
legal resources would also be required to staff the issuance of certificate of
public conveyance and necessity, enforcement of standards, and application processes. If such resources are provided, the DOH could
manage this program effectively and efficiently and enhance the ambulance
industry for the health and safety of all New Mexicans.
The bill would move
regulation of ambulances along with undetermined existing resources at the
Public Regulation Commission including manpower, funding and vehicles to the
Department of Health. The PRC has historically dedicated only one position
specifically to ambulance inspections and, beyond that has absorbed the
workload within its regulatory infrastructure of the Transportation
Division. DOH states that most parties,
including the PRC, indicate that the current resource commitment has been
totally inadequate to do a quality job in ambulance regulation. The ambulance
regulation program would include three significant areas including establishing
an “issuance of certificate of public conveyance and necessity through
regulation; setting and maintaining standards for ambulance services, including
performing inspections of ambulance services and registered medical-rescue
services annually; and enforcing standards to ensure compliance. DOH notes that these are complex activities
that cannot be accomplished by existing staff at the DOH Injury Prevention and
EMS Bureau.
The PRC employs 1 FTE for regulation of ambulance standards at a cost of $40.0.
HB
1007 Substitute conflicts with the changes recommended in SB 527 to enact
comprehensive amendments the EMS Act. Of
concern is that if HB 1007 Substitute were enacted subsequent to SB 527, some
of the substantive changes and the renumbering would affect the changes in SB
527 and may eliminate some of the important changes to the EMS Act.
TECHNICAL ISSUES
DOH
indicates that:
·
Article XI, Section 2 of the NM
Constitution provides that the Public Regulation Commission shall have
responsibility for the regulation of “transportation companies, including
common and contract carriers.” Legal counsel for the PRC believes this “may”
need to be amended to allow DOH to regulate ambulances. However, Section
65-2-82. F. of the Motor Carrier Act defines “common motor carrier” with
exclusions for “farm carriers” and “commuter vanpools”. It appears therefore
that the Legislature has excluded at least two classes of transportation from
the definition and could do so again as it attempts in
HB 1007CS. However, there may still be a constitutional question about this
transfer.
·
On page 12, lines 22-23 of the bill,
“rates and charges” are still being established by the “public regulation
commission tariff”. Is it the intent of the bill to keep these determinations
at the PRC?
OTHER SUBSTANTIVE ISSUES
Since
the 1974 enactment of the Ambulance Standards Act (Sec. 65-6-1, et.seq., NMSA 1978 the Public Regulation Commission (PRC)
and its predecessor, the State Corporation Commission, has been exclusively
responsible for the regulation of certificated ambulance services (currently
about 110 statewide) and, more recently, registered medical-rescue services
(about 40 statewide). This regulation and oversight of ambulance services
includes issuing certificates of convenience and public necessity on a
franchise-type basis, conducting inspections, approving rates, overseeing
transportation standards, and the regulation of health and medical standards
for the industry.
In
1994, the Federal National Highway Traffic Safety Administration performed a
review of the New Mexico EMS System and listed among their top recommendations
for system improvement, in the executive summary to the report, to “shift all
EMS-related responsibilities, including monitoring quality assurance activities
and the regulation and inspection of ground ambulance services from the State
Corporation Commission (now PRC) to the EMS Bureau (now Injury Prevention and
EMS Bureau). The redirection of
resources should include sufficient personnel to meet required inspection
schedules and perform other necessary duties.”
The
DOH and the Statewide EMS Advisory Committee did some preliminary planning in
1997, to explore moving regulation of ambulances to the DOH. The State Corporation Commission resisted
this change and committed itself to improving its oversight and regulation of
the ambulance industry. However, it was determined at the time that to perform
this regulatory program adequately would require significant new staff
positions and resources for the DOH.
In
the summer of 2002, the PRC under new leadership began to express interest in
getting out of the ambulance regulation business. After some discussions, the
Secretary of Health sent a letter to the Public Regulation Commissioners
recommending that the regulation of the health and medical standards aspect
could be moved from the Public Regulation Commission to the DOH, but that DOH
was not prepared or equipped to take on the rate setting or certificate of need
process. There was no response to the
DOH Secretary’s letter and there has been no contact or discussion from the PRC
with the DOH, or the Statewide EMS Advisory Committee or with its own Ambulance
Advisory Committee since that time. DOH
believes that HB 1007 Substitute is an effort to transfer the PRCs statutory
responsibilities to the DOH without adequate planning, collaboration or
identification of resources to enable a positive transition to occur for the
benefit of
Nationally, Patient
Transportation (ambulance services) is one out of designated 16 components of
the Emergency Medical Services System, as outlined in the “EMS Agenda for the
Future”. Emergency Medical Services is
considered as a critical, safety net health and medical program.
Once the issue of rate setting is clarified, add an appropriation section of $315,000-$375,000 including the establishment of 4 or 5 new FTEs, depending upon what the transfer of funds and positions from the PRC would produce.
Amend Section 2, Section 24-10B.-3.G. to change the name of the Bureau to the “Injury Prevention and EMS Bureau”