Colorado lawmakers voted to advance a bill Wednesday that would shift emergency medical service licensing power away from counties to the state, starting in July 2024.
Currently, the state sets standards for EMS providers for personnel training and certification. But counties decide which ambulance services get a license to operate within their borders.
Senate Bill 225 would set a minimum standard for licensing and shift that oversight to the state while still letting counties have final decision-making power about local providers.
Advocates and the bill’s sponsors argue Colorado lags behind most other states by leaving ambulance licensing to counties. The bill also creates a statewide task force to evaluate existing emergency medical services.
“When I drive across the state, there are gigantic disparities between (EMS) systems that I'm going to travel through,” Scott Sholes, president of the Emergency Medical Services Association of Colorado (EMSAC), told KUNC. “And many of us in management around the state agree that we'd like to be able to find where those inequities are, find those disparities in access and in services, and find ways to help one another and develop a stronger statewide EMS system.”
Sholes, who is also Durango Fire Protection District’s EMS chief, testified on SB 225 in Wednesday’s Senate Health & Human Services Committee hearing. While he and EMSAC’s advocacy committee support the bill, the association overall has no official position on it yet.
Gini Pingenot, director of external affairs for Colorado Counties Inc., told KUNC the organization’s 61 member counties are split on the bill.
“Some counties may have struggled in the past to meet all the expectations of licensing ambulances locally,” Pingenot said, citing counties that lack the staff to address grievances residents may have with an EMS service as an example. “And so I think that there are some who may see this as helpful, that the state is stepping in that they would be setting minimum standards and then local governments can add a level of scrutiny if they so choose, but they don't have to.”
Other county officials, Pingenot said, worry it would become an “extra regulatory burden that is unnecessary and onerous for a provider.”
Friday afternooon, after a few senate finance committee amendments satisfied some counties' concerns, CCI officially decided to support the bill. There wasn't a full vote, just a consensus that none of the association's present members objected to.
No one testified in full opposition to the bill during its hearing Wednesday. However, its sponsor, Sen. Rachel Zenzinger (D), anticipated pushback about the bill “disrespecting” local control.
“Under this legislation, counties will still make decisions about what ambulance services would meet the needs of their communities. Counties will be in charge of selecting the ambulance provider that is right for them and will negotiate with those providers for specific contractual provisions that are important to their communities,” Zenzinger said. “This legislation simply ensures that these providers are appropriately licensed under a set of very transparent and consistent standards that address the health, welfare and safety concerns at a statewide level.”
The only committee member to vote against advancing the bill was Sen. Barbara Kirkmeyer (R), who said she needed to hear more from the state’s counties.
“The work that goes on day in and day out of the Capitol is trying to find the sweet spot, that midpoint where everybody can rally behind,” CCI’s Pingenot said when asked if there’s any way to balance the needs of counties that support this bill with those that don’t. “ At this point, I am in full exploration mode for what's at midpoint or compromise is.”
“I think that's one of the things that many of the county commissioners who are concerned about losing local control don't realize is there's an opportunity here, once the state understands what all the challenges are, to be able to offer assistance with those challenges,” EMSAC president Sholes said. “And so I guess one of the things that I'd like to see is to be able to shore those things up so the county retains control of who's operating and how they're operating and then whatever else the county wants to be involved in, we can develop.”
Why this bill exists
After the Aug. 2019 death of Elijah McClain in Aurora sparked protests and investigations into paramedics' use of ketamine to sedate people in police interactions, Sholes said “one of the main issues to be aired was the lack of oversight.”
“Although there's current oversight through various mechanisms under (the Colorado Department of Public Health and Environment), the ability to actually investigate and take action in accordance to what the public might expect really didn't exist,” he told KUNC. “It throws that back to the county level. And then even then the counties really only have legislative responsibility for the licensing of ambulances and ambulance services. So there was a gap there.”
Seeing the “writing on the wall” prompted Sholes and other stakeholders to begin having conversations with lawmakers last year about potential legislative action. The only thing they wanted originally was a task force to analyze the current state of emergency medical services in Colorado and provide recommendations to fix the “gaps” he and others saw in the system, ensuring long-term sustainability.
The current version of the bill would create an 18-member task force made up of state legislators, representatives of Colorado Counties Inc., EMS personnel and educators, fire chiefs and more. They’d begin work in August and then meet four times a year to gather input from stakeholders and oversee the collection and analysis of data on ambulance services.
“If you go to the emergency medical and trauma services branch at CDPHE, they can't even tell you how many ambulance agencies are operating in Colorado today,” Sholes said. “In fact, they don't know what services thrive and what services are teetering on the brink of failure.”
The committee would release a series of reports to guide state rulemaking (including on licensing) and funding allocations, with the first coming out in Sept. 2023 and the fifth, final report coming in 2027.
“To go ahead and have the licensing (shift to the state) in this bill wasn't our original intent,” he said. “We really wanted to investigate and look more thoroughly at it and then make decisions on how that might work.”
But after working with lawmakers on the licensing language in SB 223, Sholes said it “is one of the most exciting opportunities I experienced.”
“Despite the increased state oversight, I find this bill actually eases the county burden and in many cases eases the agency burdens while not interfering with county-level control,” he told senators during Wednesday's hearing.
Some local officials are concerned the state would place heavy fees on EMS providers in order to run the licensing and inspections. Sholes believes the shift will do “just the opposite,” though the details of how to avoid any new financial burdens would need to be “ironed out” by the task force.
Another concern has to do with the many volunteer EMS providers in the state’s rural areas. Would state regulation create extra responsibilities that make people less willing to volunteer?
“It's certainly a realistic fear that we overburden the volunteers any more than we already ask of them,” Sholes said. “So striking that balance, I think will come through the task force and the stakeholder process that comes later.”
The bill does specifically call for four EMS agency representatives to serve on the task force and suggests, but does not require, that the group includes people from rural and volunteer services.
SB 225 will be considered by the Senate finance committee on Friday.
