Brian Sandoval Governor Marta Jensen Acting Administrator Division of Health Care Financing and Policy COMMUNITY PARAMEDICINE: Decreasing Health Care Equity Gaps in Rural and Frontier Nevada Division of Health Care Financing and Policy Policy Development and Program Management Sheri Eggleston, SPSS III June 7, 2017

Health Equity Gaps Health equity gaps are huge in rural and frontier Nevada! By health equity gaps, we mean that health services in rural and frontier Nevada are significantly less available than in more populated areas. This leads to higher incidences of chronic diseases, hospital re-admission and mortality in rural and frontier Nevada.

Health Equity Gaps- Data from JAMA Variable- Death Rate for Chronic Respiratory Diseases, both sexes. Rural Nevada has high rates, therefore healthcare equity gaps. Source: Dwyer-Lindgren L, Bertozzi-Villa A, Stubbs RW, Morozoff C, Kutz MJ, Huynh C, Barber RM, Shackelford KA, Mackenbach JP, van Lenthe FJ, Flaxman AD, Naghavi M, Mokdad AH, Murray CJL. US County-Level Trends in Mortality Rates for Major Causes of Death, 1980-2014. JAMA. 2016;316(22):2385-2401. doi:10.1001/jama.2016.13645

A Solution in Community Paramedicine Many jurisdictions have implemented Community Paramedicine as a method of decreasing health equity gaps in their rural and frontier areas. The vision was to use EMS services (EMT, AEMT, Paramedic) under licensure of a Primary Care Physician. Originated in 1996, major development by stakeholders in 2002 and 2009.

Community Paramedics (Rural AZ)

Success Story (Minnesota)

Success Story (Georgia)

Nevada Specific Information DPBH, EMS program Three EMS agencies endorsed (REMSA, Humboldt, East Fork) 18 individuals endorsed Southern Nevada Health District Community paramedicine services not yet implemented in the region Medicaid reimbursement One EMS agency billing for services (as of last quarter)

Medicaid Policy Goals Improve access and health care services to the medically underserved Close patient care gaps Improve chronic disease management Decrease unnecessary ambulance responses Decrease emergency room visits and hospital admissions or readmissions

Provider Qualifications EMT, AEMT, or paramedic Community paramedic endorsement Nevada’s Division of Public and Behavioral Health (DPBH), State EMS program Southern Nevada Health District Must possess a service of scope agreement, based upon the paramedic’s skills, with the Medical Director of the ambulance service under which they are employed. The Medical Director must be enrolled as a Nevada Medicaid Provider.

Provider Qualifications The ambulance service needs to have a medical director that is a physician. The physician definition is in NAC 450B.205: NAC 450B.205 “Physician” defined. (NRS 450B.120) “Physician” means a physician licensed pursuant to chapter 630 of NRS or an osteopathic physician licensed pursuant to chapter 633 of NRS.

Reimbursable Services Evaluation/health assessment; Chronic disease prevention, monitoring and education; Medication compliance; Immunizations and vaccinations; Laboratory specimen collection and point of care lab tests; Hospital discharge follow-up care; and Minor medical procedures within their scope of practice as approved by the Medical Director; Home safety inspection; and A tele-health originating site

More information is available outside in the lobby! Questions? More information is available outside in the lobby! Contact Information: Sheri Eggleston, SPSS III Sheri.eggleston@dhcfp.nv.gov 775-684-7577