Advancing Colorado Bill to Support EMS Funding and Healthcare Savings

Colorado legislators are advancing House Bill 26-1069, aiming to bolster funding for the state's emergency medical services (EMS) while potentially reducing healthcare expenditures. The proposed legislation seeks to expand the services that EMS agencies can bill to the Colorado Department of Health Care Policy and Financing, which manages Medicaid, and to private insurers.

A 2023 study highlighted that many EMS agencies in Colorado face financial strain, primarily due to reimbursement rates from both state and private insurers that fail to cover actual service costs. Representative Katie Stewart of Durango, who sponsors the bill and has EMT experience, expressed concerns over how funding shortages jeopardize EMS, especially in rural areas. She emphasized that current funding inadequacies are already affecting service availability.

Expanding Reimbursement Policies

Supported by Representatives Lisa Feret and Senator Kyle Mullica, the bill proposes that EMS agencies be eligible for reimbursement when treating patients on-site without necessarily transporting them to emergency rooms—a process known as "treatment in place." Current policies limit reimbursements to patient transport to emergency facilities, which EMS Chief Scott Sholes of Durango Fire & Rescue described as a costly approach. He stressed the need for expanded billing allowances for on-site treatment.

Although several states allow billing for non-transport services, Colorado's proposal also includes reimbursements for transporting patients to behavioral health clinics or using telehealth during emergencies—requiring only state payments, not those from private insurers. An initial draft featured private insurer reimbursements, later removed after discussions with stakeholders, including insurance companies, to address initial concerns.

Projected Healthcare Savings

Kevin McFatridge from the Colorado Association of Health Plans noted the bill's constructive changes, aimed at addressing operational and affordability challenges for carriers. Representative Stewart reassured that the legislation does not limit needed hospital transports but provides EMS and patients with more flexible care options.

The bill projects annual healthcare savings due to reduced emergency room visits, a crucial factor amidst the state's budget limitations primarily due to healthcare costs. Analysts estimate savings starting at $2.1 million in the fiscal year beginning July 2026, with further increases in subsequent years.

Parallel to this, House Bill 26-1238 aims to designate EMS as an essential service, which would enable access to state funds designated for public safety initiatives. Both legislative measures have cleared committee approvals and are poised for further review in the House.