REVISED 9/22/05 PROPOSED TRANSFER OF THE ACTION KENTUCKY BOARD OF EMERGENCY Agenda Item I-4 MEDICAL SERVICES TO KCTCS September 23, 2005 Recommendation That the KCTCS Board of Regents approve the transfer the Kentucky Board of Emergency Medical Services (KBEMS) from state government to KCTCS. Rationale KCTCS currently provides approximately 80 percent of the training that leads to the licensure and certification of individuals by the Kentucky Board of Emergency Medical Services. The transfer of the Kentucky Board of Emergency Medical Services to KCTCS would assist in creating a more effective and efficient training process for individuals seeking licensure or certification by the Kentucky Board of Emergency Medical Services. The Kentucky Board of Emergency Medical Services would complement the mission of KCTCS and the State Fire Commission as many of the professionals licensed or certified by both boards practice in fire protection and emergency medical services. KCTCS has a strong presence in statewide homeland security initiatives. Currently, KCTCS and the Kentucky Office of Homeland Security is developing an expanded joint training program for Kentucky s first responders, government officials, and volunteers. The transfer of KBEMS will facilitate a seamless delivery of educational preparation and homeland security training to Kentucky s first responders and emergency medical personnel. The Kentucky Board of Emergency Medical Services adopted a resolution on September 16, 2005, ratifying, resolving, and approving the proposed move and reorganization of KBEMS to the Kentucky Community and Technical College System (see Attachment A). Background The Kentucky Board of Emergency Medical Services was created during the 2000 Legislative session of the General Assembly as an independent agency to oversee and regulate pre-hospital emergency medicine pursuant to KRS 311A. The KBEMS Mission includes: licensing and certification of all first responders, emergency medical technicians, paramedics, instructors, and ambulance providers; oversight of the educational process of emergency medical professionals; and investigation and discipline of emergency medical professionals and entities that are subject to its jurisdiction. Attachment B provides additional information related to KBEMS and its proposed transfer to KCTCS. Revised 101-A
Revised 101-B Attachment A
Attachment B The Kentucky Board of Emergency Medical Services (KBEMS) I. OVERVIEW This paper reviews the history, governance, personnel, and funding of the Kentucky Board of Emergency Medical Services (KBEMS) to assist the Kentucky Community and Technical College System (KCTCS) Board of Regents in determining whether to seek executive and/or legislative approval to administratively transfer KBEMS to KCTCS. II. BACKGROUND KBEMS is an independent state agency that regulates pre-hospital emergency care, including the certification, licensing, and discipline of approximately 13,000 First Responders, Emergency Medical Technicians, Paramedics, and Kentucky s ambulance providers. Headquartered in Frankfort, Kentucky, KBEMS also oversees the educational and training requirements for emergency medical professionals and their instructors and evaluators. KBEMS consists of an 18-member board supported by its administrative staff. Board members are appointed by the Governor for two (2) year renewable terms, with recommendations from emergency medicinerelated organizations. The board is statutorily required to meet 6 times a year. III. BENEFITS OF TRANSFER The benefits of transferring KBEMS to KCTCS are numerous. KCTCS has a strong presence in statewide First Responder training and more recently, homeland security initiatives. Currently, KCTCS currently conducts approximately 80% of the training that leads to the licensure and certification of individuals by KBEMS. KCTCS and the Kentucky Office of Homeland Security are now in the process of developing an expanded joint training and certification program for Kentucky s first responders, government officials, and volunteers. The transfer of KBEMS will facilitate a seamless delivery of educational preparation and homeland security training to Kentucky s First Responders and emergency medical personnel. IV. HISTORY The Kentucky Board of Emergency Medical Services was established in 2000 (HB 405) as an independent agency of Kentucky state government to oversee all facets of pre-hospital emergency care pursuant to KRS 311A. Prior to its designation as an independent state agency, pre-hospital emergency care was regulated by the Kentucky Cabinet for Health and Family Services. Since its establishment, KBEMS has not been attached to any state entity for administrative or organizational purposes. Revised 101-C
V. GOVERNANCE Pursuant to KRS 311 A, KBEMS has the authority to regulate pre-hospital emergency medicine services, issue licenses and certifications to pre-emergency medical professionals, establish educational standards for emergency medical personnel, establish the organizational structure, and oversee the operations of the board office, including the hiring of an executive director, deputy executive director, general counsel, medical advisor, and other personnel to carry out its statutory purposes. The board also has the statutory authority to enter into contracts and apply for grants and federal funds. A listing of current board members can be found in the appendix. The categories of board membership include the following: a) One (1) paramedic who works for a government agency but is not serving in an educational, management, or supervisory capacity; b) One (1) emergency medical technician-basic who works for a government agency but is not serving in an educational, management or supervisory capacity; c) One (1) first responder who is not serving in an educational, management, or supervisory capacity; d) One (1) physician licensed in Kentucky having a primary practice in the delivery of emergency medical care selected from a list of three (3) physicians submitted by the Kentucky Medical Association; e) One (1) physician licensed in Kentucky serving as medical director of an advanced life support ambulance service, selected from a list of three (3) physicians submitted by the Kentucky Medical Association; f) One (1) physician licensed in Kentucky who routinely is involved in the emergency care of ill and injured children selected from a list of three (3) physicians submitted by the Kentucky Medical Association; g) One (1) trauma surgeon licensed in Kentucky selected from a list of three (3) physicians submitted by the Kentucky Medical Association; h) One (1) citizen having no involvement in the delivery of medical or emergency services; i) One (1) emergency medical services educator from a Kentucky technical college, community college, college, or university that provides an emergency medical services educational program; j) One (1) mayor of a city that operates, either directly or through contract services, a licensed Class I ground ambulance service; k) One (1) county judge/executive from a county that operates, whether directly or through contract services, a licensed Class I ground ambulance service; l) One (1) volunteer-staffed, licensed Class I ground ambulance services administrator who is a certified emergency medical technician or a licensed paramedic; m) One (1) fire-service-based, licensed Class I ground ambulance service administrator who is a certified emergency medical technician or a licensed paramedic; n) One (1) licensed air ambulance service administrator or paramedic for a licensed air ambulance service headquartered in Kentucky. o) One (1) private licensed Class I ground ambulance service administrator who is a certified emergency medical technician or a licensed paramedic who is a resident of Kentucky; p) One (1) hospital administrator selected from a list of five (5) nominees submitted by the Kentucky Hospital Association q) One (1) basic life support, licensed Class I government-operated ground ambulance administrator who is a certified emergency medical technician or licensed paramedic; and r) One (1) advanced life support, government-operated ambulance service administrator who is a certified emergency medical technician or a licensed paramedic. Revised 101-D
VI. FUNDING STRUCTURE KBEMS receives state and federal government funding. KBEMS Fiscal Year 2005-06 budget is $2,999,800. Of this amount, $2,391,600 reflects the state general fund allocation which comprises items such as: staff salaries and benefits; equipment and maintenance; supplies; travel expenses; printing and postage; and includes approximately $1,229,000 for equipment grants to local ambulance providers pursuant to KRS 311A.155. The allocation for state restricted funds is $171,700 which includes: building lease payments; furniture and fixtures; and debt service payments. Federal government funds allocated to KBEMS are $436,500 and specifically designated for the Emergency Medical Services for Children program, the EMS Trauma Grant, the Automatic External Defibrillator (AED) Grant, and the Bioterrorism Grant. KBEMS generates revenues from the collection of licensure, certification and disciplinary fees which in FY 2004-05 was approximately $320,000. VII. PERSONNEL Currently, there are 17 full-time employees of KBEMS. The Executive Director and the General Counsel occupy non-merit positions and, therefore, serve at the pleasure of the board. There are 12 merit employees headquartered at the Frankfort office. Five other individuals are regionally located throughout the state working from their homes. The board also employs two part-time temporary clerical employees. VIII. ORGANIZATIONAL TRANSFER PROCESS Should the KCTCS Board of Regents determine that the transfer of KBEMS to KCTCS would be mutually beneficial, there are primarily two ways to proceed: 1) seek temporary reorganization by Governor s executive order this year and legislative approval in 2006, or perhaps, thereafter; or 2) seek legislative approval in the 2006 legislative session. A. Temporary Reorganization Plan To temporarily effect a transfer of KBEMS to KCTCS would require approval of a temporary reorganization plan via Executive Order by Governor. With the approval of KBEMS and the KCTCS Board of Regents, the Executive Director of KBEMS and the President of KCTCS would seek the Governor s approval of the temporary plan. Once executed by the Governor, the temporary reorganization plan would be filed with the Legislative Research Commission (LRC) and then reviewed within 60 days of receipt by the Interim Joint Committee on State Government. The temporary reorganization plan to transfer KBEMS would remain in effect until 90 days after adjournment of the next regular session of the legislature unless otherwise dictated by the General Assembly. Thereafter, a temporary reorganization plan would require legislative approval through the usual legislative process. Temporary reorganization plans are generally used when a state entity requires an expeditious reorganization for greater economy, efficiency and/or improved administration. Revised 101-E
B. Routine Legislative Approval In the second scenario, KBEMS and KCTCS would seek a legislator to sponsor legislation to approve the transfer during the 2006 Legislative Session. Generally, the Majority Floor Leader of the House or Senate sponsors state government reorganization bills which proceed through the typical legislative process. If the legislation is enacted, KBEMS would join KCTCS approximately 90 days from the end of the 2006 legislative session. IX. CONCLUSION KCTCS has determined that the proposed plan to transfer KBEMS is in the best interests of both entities. Upon approval of the boards of both entities, KCTCS staff will begin the process of seeking formal attachment of KBEMS to KCTCS. X. APPENDICES Appendix A: Profile of KBEMS Appendix B: KBEMS FY 04-05 and FY 05-06 Budget Appendix C: KBEMS Board Membership List Revised 101-F
Profile Kentucky Board of Emergency Medical Services (KBEMS) APPENDIX A Established in 2000 as an independent agency of Kentucky state government to oversee all facets of pre-hospital emergency care. (KRS 311A) Certifies First Responders and Emergency Medical Technicians (EMT s) and Instructors and Licenses Paramedics and state Ambulance providers Oversees education of emergency medicine professionals Investigates complaints and disciplines emergency medicine professionals when violations are substantiated Consists of 18 board members appointed by the Governor and includes 12 full-time Board staff located in Frankfort, including an Executive Director and General Counsel, 5 field staff, and 2 temporary clerical employees. Collects $320,000 from licensing, certification and disciplinary fees Received $1,416,500 in federal grants for FY 2004-05 for emergency medical services for children, trauma services, rural Automated External Defibrillator and a data collection grant The addition of KBEMS with KCTCS and the Fire Commission would be an effective and efficient use of resources as KCTCS conducts approximately 80% of the training that leads to KBEMS licensure or certification. Revised 101-G
APPENDIX B Final Commonwealth Budget 2005 Regular Session (House Bill 267) FY 04-05 and FY 05-06 22. EMERGENCY MEDICAL SERVICES 2004-05 2005-06 General Fund 2,391,600 2,391,600 Restricted Funds 171,700 171,700 Federal Funds 1,416,500 436,500 TOTAL 3,979,800 2,999,800 (1) Medicaid Supplement: Notwithstanding KRS 311A.145, a total of $300,000 in Restricted Funds from fiscal year 2004-2005 Emergency Medical Services Board collections shall be transferred to Medicaid Benefits in fiscal year 2005-2006 in order to increase the amount of Federal Funds able to be matched to increase Medicaid ambulance fees. Revised 101-H
APPENDIX C KBEMS Board Members Member Term Expiration Area of Representation Eric Bentley, M.D. September 19, 2005 Trauma Surgeons Christopher Lamont Graves September 19, 2005 Emergency Medical Technical-First Responder Rob Rothenburger, Chair September 19, 2005 County Judge/Executives operating licensed Class I ground ambulance services Mike Swift September 19, 2005 Volunteer-staffed, licensed Class I ground ambulance service administrator Vacancy May 31, 2006 Licensed air ambulance service administrators or paramedics for licensed air ambulance services in Kentucky Mary Fallat, M.D. September 19, 2006 Physicians routinely involved in the emergency care of ill and injured children Mary Guidugli September 19, 2006 Paramedics Sherman Hockenbury September 19, 2006 Private licensed Class I ambulance service administrators who is a certified emergency medical technician or licensed paramedic J. William Martin, Chief September 19, 2006 Fire-service based license Class I ground ambulance service administrator Vacancy September 19, 2006 Advanced Life Support, governmentoperated ambulance service administrators, certified emergency medical technician or licensed paramedic Vacancy September 19, 2007 Mayors operating a license Class I ground ambulance service Barry Brown September 19, 2007 Basic Life Support Provider Robert D. Knight, M.D. September 19, 2007 Physician having a primary practice in the delivery of emergency medical care Billy Miller September 19, 2007 Citizens at large Carl "Rudy" Garrett, II September 19, 2008 Emergency Medical Services Educator Michael Edward Gribbin September 19, 2008 Emergency Medical Technician Basic Gary M. Howerton, M.D. September 19, 2008 Physicians serving as a medical director of an advanced life support ambulance service Vacancy Hospital Administrators Revised 101-I