1. 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.

2. 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

3. 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.

4. 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

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

6. 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

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

8. 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

9. 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

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

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

12. 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.

13. Question & Contact Marta Jensen (775) 684-3677

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