Municipal EMS takeover plan may face state review

Green Mountain Care Board regulators say they must rule whether they are required to approve the $1.37 million project

Health care regulators have told municipal officials here that a pending $1.37 million fire department takeover of emergency medical services may require state review and approval.

The Brattleboro Selectboard voted unanimously last fall for the town to drop its nearly 60-year contract with the private nonprofit Rescue Inc. - Windham County's largest and longest-serving EMS provider - and instead buy and operate its own ambulances starting July 1.

At the time, local leaders said the selectboard vote was the last step in their year-and-a-half-long effort to launch the plan. But after ordering three vehicles and hiring an EMS supervisor, they recently learned that a longtime Vermont law gives regulators from the Green Mountain Care Board the right to decide whether "a new health care project" must obtain a state certificate of need, or CON.

"The CON process," regulators note on their website, "is intended to prevent unnecessary duplication of health care facilities and services, guide their establishment in order to best serve public needs, promote cost containment, and ensure the provision and equitable allocation."

Under state statute, new projects require a certificate of need if the Green Mountain Care Board determines they exceed a series of thresholds involving costs and size of proposed changes.

Since the law's adoption in 1979, regulators have reviewed several transport applications submitted in the past to the Vermont Department of Health and then to the former Health Care Authority, the former Public Oversight Commission and now to the Green Mountain Care Board.

The state, for example, granted a certificate of need in 1996 to Dartmouth Hitchcock Medical Center's DHART helicopter and, most recently, one in 2021 for a Maryland company's $2.5 million acquisition of Franklin County's privately owned AmCare Ambulance Service.

Brattleboro leaders expect to outline their plans to the state "in the next week or so," Town Manager John Potter said. The Green Mountain Care Board then will decide within 30 days whether the project is within its jurisdiction and, if so, schedule a review that could take 90 days.

A state review would reopen a Brattleboro EMS debate that first sparked in April 2022, when the selectboard voted with little notice or public debate for a transition plan to study if the fire department should pick up ambulance coverage.

At the time, then-Town Manager Yoshi Manale claimed the proposal not only would cost less than Rescue's $285,600 annual fee but also collect "a $500,000 to $700,000 net gain in revenue."

Manale's assertions haven't proven true, and he abruptly resigned eight weeks later. But local leaders didn't give up on the proposal, even after a feasibility study found that a takeover would bolster the town's understaffed system of crisis response yet increase costs.

Just before approving the plan last September, the selectboard received a petition signed by more than 400 residents seeking a return to Rescue. Robert Oeser, a vocal takeover critic and one of nearly 90 people who wrote the town's public feedback page in support of the past ambulance provider, said this week that any new review would give people another chance to comment.

The Brattleboro news comes as the Vermont Legislature is set to consider a bill to create a task force to develop a more coordinated EMS system for a state where some communities are debating various options while others have few.

"We all expect an ambulance to come if we call 911 - it's a critical part of our health care delivery system," said the bill's lead sponsor, Rep. Katherine Sims, D-Craftsbury. "We need to ensure it's more coordinated, more efficient and more effective, as well as has adequate oversight and accountability."

In the same vein, Vermont's congressional delegation has introduced a bill in Washington to require the federal government to reimburse providers for all EMS services, and not just if a person needs an ambulance ride to a hospital.

"Rural communities depend on these critical services to close care gaps," U.S. Rep. Becca Balint, D-Vt., said in a statement. "This bill will mean common sense change to ensure EMS get properly reimbursed for their lifesaving work."

This News item by Kevin O'Connor originally appeared in VtDigger and was republished in The Commons with permission.

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