FISCAL NOTE

Date Requested: March 09, 2017
Time Requested: 01:44 PM
Agency: Health and Human Resources, WV Department of
CBD Number: Version: Bill Number: Resolution Number:
2908 Introduced HB2906
CBD Subject: Health, Military and Veterans


FUND(S):

0407 - CENTRAL OFFICE GENERAL ADMINISTRATIVE FUND, 5203 - EMERGENCY MEDICAL SERVICES OPERATIONS, 5205 - EMERGENCY MEDICAL SERVICES AGENCY LICENSURE FUND

Sources of Revenue:

General Fund,Special Fund,Other Fund Federal

Legislation creates:

Neither Program nor Fund



Fiscal Note Summary


Effect this measure will have on costs and revenues of state government.


The purpose of this bill is to move the Office of Emergency medical Services from the Bureau for Public Health to the Department of Military Affairs and Public Safety, and to provide the Emergency Medical Services Council with authority and oversight over the Office of Emergency Medical Services. This proposed legislation would transfer the Office of Emergency Medical Services (OEMS) from the Department of Health and Human Resources (DHHR) to the Department of Military Affairs and Public Safety (DMAPS); transfer powers and duties exercised by the Commissioner of the Bureau for Public Health with respect to OEMS to the Secretary of DMAPS; continue the Emergency Medical Services Advisory Council as the Emergency Medical Services Commission, reconstitute the Commission, describe composition of the Commission, set terms for members of the Commission, and define duties and powers of the Commission; and provide qualifications for certain OEMS staff. DHHR assumes that DMAPS would be responsible for all costs associated with transferring OEMS to DMAPS. Therefore, there would be no costs to DHHR related to the transfer. Additionally, there would be no costs to DHHR related to the transfer of powers and duties from the Commissioner of the Bureau for Public Health with respect to OEMS to the Secretary of DMAPS, proposed changes to the Emergency Medical Services Advisory Council, or qualifications provisions for certain OEMS staff. The total FY2017 operating budget for OEMS is approximately $5.2 million which includes $4.3 in general revenue funds; $718,000 between the Emergency Medical Services Operations and Emergency Medical Services Licensure special revenue funds; and approximately $178,000 between two federal grants. Given that this proposed legislation specifies that the special revenue Emergency Medical Services Agency Licensure Fund shall be administered by the OEMS director, DHHR assumes that this fund would transfer to DMAPS. DHHR also assumes that the intent of this legislation is to transfer all other OEMS allocated funds to DMAPS. It is important to note that revenues for special revenue accounts may vary therefore, the $718,000 in not available every year for expenditure. While DHHR assumes that DMAPS would be responsible for transferring OEMS encumbered purchase orders, sub-recipient grants, tower leases, and rental agreements to DMAPS or DMAPS would negotiate new contracts to replace existing ones prior to transfer of funds, consideration should be given to the following: OEMS currently has $1.2 million encumbered for various purchase orders, sub-recipient grants, and rental agreements, including OEMS office space and communication tower leases. DHHR is committed to paying invoices against these encumbrances with or without OEMS. Sufficient funds to cover encumbrances in effect at the time OEMS transfers to DMAPS should remain with DHHR until the encumbrances transfer to DMAPS or DMAPS issues new contracts to replace them. OEMS, along with other BPH programs, are currently funded under a Centers for Disease Control and Prevention federal grant, titled Enhanced State Surveillance of Opioid-Involved Morbidity and Mortality. OEMS is not the primary recipient of this grant. OEMS' allocation under the grant is $38,813. OEMS is the primary recipient of a grant from the Health Resources and Services Administration (HRSA), titled Emergency Medical Services for Children State Partnership Grant Program (EMSC), in the amount of $138,881. DHHR assumes that DMAPS would become the applicant agency for this HRSA funded grant. DHHR assets which support OEMS and its programs include the statewide Emergency Medical Services communications system which provides necessary medical command communication to emergency medical service providers. DHHR assumes that the communication system (microwave towers, radios, and associated equipment as well as FCC frequencies licensed to DHHR) would transfer to DMAPS.



Fiscal Note Detail


Effect of Proposal Fiscal Year
2017
Increase/Decrease
(use"-")
2018
Increase/Decrease
(use"-")
Fiscal Year
(Upon Full
Implementation)
1. Estmated Total Cost 0 0 0
Personal Services 0 0 0
Current Expenses 0 0 0
Repairs and Alterations 0 0 0
Assets 0 0 0
Other 0 0 0
2. Estimated Total Revenues 0 0 0


Explanation of above estimates (including long-range effect):






Memorandum


OEMS includes Communications, EMS and Trauma. All areas are essential components of the healthcare system in West Virginia. The focus of this proposed legislation is emergency medical services (EMS). Public Health's focus is on improving the health of communities and includes physicians, nurses and epidemiologists, as well as injury prevention, environmental health and disaster preparedness/response specialists, among others. EMS agencies are embedded in the communities and are natural partners with public health. OEMS and EMS agencies are relied upon for health and medical disaster response. For example, during preparedness activities related to Ebola Virus Disease, it was critical that public health had access to EMS agencies and in turn, EMS agencies had access to public health. EMS agencies are response partners and provide input to the planning process. During Ebola planning, OEMS and EMS agencies coordinated and exercised with the Bureau for Public Health's (BPH) Center for Threat Preparedness, Office of Epidemiology and Prevention Services, Office of Environmental Health Services, and Office of Laboratory Services. Public health provides the medical direction necessary to ensure that patients with highly contagious diseases are appropriately triaged and transported to facilities public health has determined can provide appropriate care. The inclusion of OEMS in BPH ensures quick and efficient access to physicians and other public health professionals. Public health epidemiologists interface directly with hospitals for surveillance of disease outbreaks and injury. In a disease outbreak or disaster, the more efficiently EMS agencies can connect with public health officials and deploy, the less risk of death, severe illnesses and injuries. Public Health is concerned with access to health care. Partnerships between BPH and EMS agencies have facilitated the development of Community Paramedicine pilot projects which will increase the public’s access to health care while reducing health care costs. When Community Paramedicine is not an option, EMS agencies transport patients to hospitals. It is important that all partnerships and working relationships that have been developed are maintained for success of EMS program. The Emergency Medical Services Commission proposed is currently in place in Kentucky and does include additional layers of government. West Virginia’s current system includes the Emergency Medical Services Advisory Council (EMSAC) which functions similarly to the Commission proposed except it is not the employer. In West Virginia, it is more streamlined with BPH serving as the employer and EMSAC serving as the advisor. The EMSAC provides a bottom up approach for EMS agencies. Direction to OEMS comes from EMSAC, Regional Medical Directors and the many other committees that advise OEMS including Medical Policy and Care, Trauma and Emergency Care, and EMS for Children. The greatest impact of any reduced level of service would be felt by the public in need of EMS services.



    Person submitting Fiscal Note: Bill J. Crouch
    Email Address: dhhrbudgetoffice@wv.gov