Department of Health and Human Services Community Paramedicine Brian Sandoval Governor Richard Whitley Director State of Nevada Department of Health and Human Services Community Paramedicine Marta Jensen, Administrator Division of Health Care Financing & Policy November 7, 2017 Helping People. It’s who we are and what we do.

Healthcare Access in Nevada Community healthcare resources are needed Hospitals are working towards developing healthcare systems based on value, quality and population health Policymakers are embracing alternative care methods and payment models

What is Community Paramedicine? Community paramedicine services can fill patient care gaps in local health care systems and prevent unnecessary services while improving the health care experience for the recipient. Rather than emergency based, Community Paramedicine is primary care centered Services are delivered according to a recipient- specific plan of care under the supervision of a Nevada-licensed primary care provider.

What Community Paramedicine Is Not Replacement of other healthcare providers or services. New project to divert revenue away from other healthcare organizations Increase in scope of practice for EMS providers

Legislative Initiatives Stakeholder Involvement Broad and enabling Data requirement Reimbursement models Community needs assessment

Regulations Developed by the Division of Public and Behavioral Health. Researched other states and national standards for courses, testing, training and qualifications, continuing education, etc.  Worked with EMS agency leadership, EMS instructors, and Committee on EMS board members.  These representatives are from private EMS companies, county owned EMS agencies, volunteer based EMS agencies, and air- ambulance companies. Held public workshops and a public hearing for approval. Regulations went into place in January 2017

Medicaid Actions Create policy for: Establish Rates Enrollment Provider Qualifications Program Policy Establish Rates Submit State Plan Amendment Update the MMIS

Provider Qualifications Emergency Medical Technician (EMT) Advanced Emergency Medical Technician (AEMT) Paramedic Community Paramedic An endorsement for community paramedicine must have been obtained from the Nevada Division of Public and Behavioral Health, Office of Emergency Medical Services, or from the Southern Nevada Health District’s Board of Health Providers must be employed by a permitted Emergency Medical System (EMS) agency A scope of service agreement, based upon the individual’s skills, is required through the medical director of the EMS agency which they are employed Both the community paramedic and the medical director of the EMS agency providing community paramedicine services must be enrolled in Nevada Medicaid

Medicaid Covered Services Services do not require prior authorization Evaluation/health assessments Chronic disease prevention, monitoring, and education Medication compliance Immunizations and vaccinations Hospital discharge follow- up care Home assessments Minor medical procedures and treatments Telehealth originating site Point of care laboratory tests Laboratory specimen collection Services do not require prior authorization

Non-Covered Services Travel time Mileage Emergency response Duplicated services Personal care services Services related to a hospital-acquired condition or treatment

Implementation & Outreach Implemented July 1, 2016 Public Workshops Public Hearing for State Plan and Policy Updates Medicaid Provider Enrollment trainings Medicaid Billing Training

Nevada Program Outcomes Services: 3 services that have been utilized to date 99343 Home Visit New Patient Moderate to Hi Severity (45 min) 99348 Home Visit Established Patient Low-Moderate Severity (25 min) 99349 Home Visit Established Patient Moderate to High Severity (40 min) Expenditures: Minimal expenditures due to low utilization Next Steps: EMS organizations must move away from the “emergency only” mentality. Medicaid staff is working closely with Division of Public & Behavioral Health Emergency Management System staff to develop strategies to encourage increased enrollment and utilization.

Question & Contact Marta Jensen (775) 684-3677 Marta.Jensen@dhcfp.nv.gov

APPENDIX Assembly Bill 305 Nevada Revised Statute Medicaid Services Manual, Section 604