[Congressional Record Volume 146, Number 53 (Wednesday, May 3, 2000)]
[Senate]
[Pages S3332-S3333]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




  SENATE RESOLUTION 302--EXPRESSING THE SENSE OF THE SENATE THAT THE 
 HEALTH CARE FINANCING ADMINISTRATION SHOULD CONSIDER CURRENT SYSTEMS 
  THAT PROVIDE BETTER, MORE COST EFFECTIVE EMERGENCY TRANSPORT BEFORE 
PROMULGATING ANY FINAL RULE REGARDING THE DELIVERY OF EMERGENCY MEDICAL 
                                SERVICES

  Mr. TORRICELLI (for himself and Mr. Lautenberg) submitted the 
following resolution; which was referred to the Committee on Finance:

[[Page S3333]]

                              S. Res. 302

       Whereas the State of New Jersey developed and implemented a 
     unique 2-tiered emergency medical services system nearly 25 
     years ago as a result of studies conducted in New Jersey 
     about the best way to provide services to State residents;
       Whereas the 2-tiered system established in New Jersey 
     includes volunteer and for-profit emergency medical 
     technicians who provide basic life support and hospital-based 
     paramedics who provide advanced life support;
       Whereas the New Jersey system has provided universal access 
     for all New Jersey residents to affordable emergency 
     services, while simultaneously ensuring that those persons in 
     need of the most advanced care receive such care from the 
     proper authorities; 
       Whereas the New Jersey system currently has an estimated 
     20,000 emergency medical technicians providing ambulance 
     transportation for basic life support and advanced life 
     support emergencies, over 80 percent of which are handled by 
     volunteers who are not reimbursed under the medicare program 
     under title XVIII of the Social Security Act; 
       Whereas the hospital-based paramedics, also known as mobile 
     intensive care units, are reimbursed under the medicare 
     program when they respond to advanced life support 
     emergencies;
       Whereas the New Jersey system saves the lives of thousands 
     of New Jersey residents each year, while saving the medicare 
     program an estimated $39,000,000 in reimbursement fees;
       Whereas when Congress requested that the Health Care 
     Financing Administration enact changes to the emergency 
     medical services fee schedule as a result of the Balanced 
     Budget Act of 1997, including a general overhaul of 
     reimbursement rates and administrative costs, it was in the 
     spirit of streamlining the agency, controlling skyrocketing 
     healthcare costs, and lengthening the solvency of the 
     medicare program;
       Whereas the Health Care Financing Administration is 
     considering implementing new emergency medical services 
     reimbursement guidelines that would destabilize or eliminate 
     the 2-tier system that has developed in the State of New 
     Jersey: Now, therefore, be it
       Resolved, That it is the sense of the Senate that the 
     Health Care Financing Administration should--
       (1) consider the unique nature of the emergency medical 
     services delivery system in New Jersey when implementing new 
     reimbursement guidelines for paramedics and hospitals under 
     the medicare program under title XVIII of the Social Security 
     Act; and
       (2) promote innovative emergency medical service systems 
     enacted by States that reduce reimbursement costs to the 
     medicare program while ensuring that all residents receive 
     quick and appropriate emergency care when needed.

  Mr. TORRICELLI. Mr. President, I rise today to submit a resolution 
that would greatly improve the lives of thousands of New Jersey 
residents.
  Healthcare in New Jersey has a long history of innovation and 
advancement. From the large number of pharmaceutical companies that 
create new medicines, to the hospitals and facilities where innovative 
therapies are develop, New Jersey remains one of the most progressive 
healthcare States in the country. This State was one of the first to 
introduce and pass a comprehensive patient's bill of rights, and one of 
the first to recognize the importance of expanding access to healthcare 
to children and low income families.
  One of New Jersey's greatest innovations, and one which truly 
demonstrates the community based approach which has been so successful, 
is the development of our Emergency Medical Services (EMS) system. The 
current EMS system in New Jersey, which has been in place for roughly 
25 years, was designed as a modern remedy to the age old problem of 
guaranteeing access to emergency transport, while at the same time 
preserving local involvement in the delivery of services and preventing 
skyrocketing costs.
  The New Jersey EMS system accomplished all three goals by 
establishing a two-tiered approach to emergency transport. This two-
tiered system includes volunteer and for-profit Emergency Medical 
Technicians (EMTs) who provide basic life support (BLS), and hospital-
based paramedics, who provide advanced life support (ALS). Basic and 
advanced life support are differentiated by the status of the victim, 
with the most serious injuries, such as heart attacks, treated by ALS 
paramedics.
  The two-tiered system has been an unqualified success in New Jersey, 
providing universal access for all residents to affordable emergency 
services, while simultaneously ensuring that those persons in need of 
the most advanced care receive it from the proper authorities. The 
system allows almost 500 local volunteer emergency medical technician 
(EMT) squads to blanket the entire State with quick and effective 
initial responses to emergencies. In the case of more serious 
emergencies, paramedics are strategically stationed at various 
hospitals throughout the State to provide secondary assistance. In 
either case, the EMTs will generally transport patients to the hospital 
with the paramedics, if necessary, along to provide care.
  There are currently an estimated 20,000 EMTs providing ambulance 
transportation for virtually all BLS and ALS emergencies, close to 
400,000 calls each year. It is estimated that over 80 percent of these 
calls are handled by volunteers who are not reimbursed by Medicare. In 
contrast, the hospital-based paramedics, also known as mobile intensive 
care units (MICUs), are reimbursed by Medicare when they respond to ALS 
emergencies, just as all other paramedics.
  Unfortunately, the great success of this system would be jeopardized 
if the Health Care Financing Administration (HCFA) finalizes plans to 
implement new rules regarding the reimbursement of EMS services. The 
new HCFA EMS guidelines propose to only provide reimbursement to 
hospital-based paramedics. This would have the effect of requiring them 
to be the only responders to provide transport for all victims in order 
to be reimbursed by Medicare. This, in turn, would eliminate the two-
tier structure by solely recognizing MICUs, and thus also eliminate the 
need for volunteer EMS units, which currently provide the bulk of the 
transport. Under the new rules, there would be no incentive for EMS 
units to respond to calls of they know their mission has been given to 
MICUs.
  While I applaud HCFAs intentions in releasing the new rules, which 
are designed to control costs by enforcing one, standardized, system 
throughout the country, I am dismayed by the impact this will have on 
New Jersey. Our system, when compared to the system HCFA is set to 
approve, would save an estimated $39 million annually, due to the 
preponderance of BLS calls and the large number of EMS volunteers who 
respond to these calls. But beyond the cost savings, the elimination of 
EMS units would jeopardize the prompt service that New Jersey residents 
have come to rely on.
  The resolution I am submitting today seeks to emphasize the benefits 
of two-tiered EMS in my State, and request that HCFA do its best to 
preserve this highly beneficial and cost effective system. HCFA has 
always been a strong supporter of measures that improve the delivery of 
healthcare services, while lowering the cost to taxpayers. I believe 
that once they have been made fully aware of the importance of this 
issue, the agency will act responsibly and include an exemption for New 
Jersey.
  It is my hope that the Senate will see the importance of supporting 
my resolution, not just for the impact it will have on the residents of 
my State, by also for the statement it will make about the Heath Care 
Financing Administration's mission.

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