PIERRE, S.D. (KELO) — A new rule will let ambulance services in South Dakota seek hardship exemptions if they can’t get a physician to serve as medical director.
The Legislature’s Rules Review Committee gave official clearance to the final package on Tuesday.
However, several of the panel’s half-dozen members struggled with the question of whether the latest version of the new rule stretches beyond what state lawmakers had authorized last winter.
The review panel had previously allowed most of the new hardship-waiver language take effect after its August 20 meeting. But the panel blocked some parts of the original proposal as too vague on qualifications for the physician’s assistant or nurse practitioner who could be assigned as medical director instead.
The state Department of Health returned to the committee on Tuesday with a revised version. It now calls for a physician’s assistant or nurse practitioner to have at least two years of clinical experience and meet other requirements, including that the person has reviewed and understands the Rural EMS Healthcare Direction in South Dakota document on the department website.
The review panel found the revised qualification criteria acceptable but struggled over whether to accept the revised requirement that an ambulance service applying for a hardship waiver must show that no licensed physician could be found within 50 miles who was “available and willing to serve as the medical director of the ambulance service for a fee that is less than five percent of the ambulance service’s annual budget.”
Emily Kiel is director for the department’s healthcare access division. She showed the review panel results of a survey of 46 ambulance services that found 11 paid their medical directors, while 35 others had medical directors who worked without pay. Statewide there are 121 ground ambulance services, she said.
Marty Link is the department’s emergency medical services and trauma administrator. He acknowledged that the 5% threshold was considered by the department to be “a reasonable fee” but he acknowledged there wasn’t a “concrete” basis for it.
Republican Sen. Jean Hunhoff, who chairs the review panel, couldn’t decide whether to reject the proposed rule again or allow it. “We’re in this dilemma — we don’t have medical directors,” she said.
Republican Rep. Jon Hansen is the panel’s vice-chair and its only member who’s a lawyer. He first suggested rejecting the 5% portion of the rule because the new law doesn’t discuss financial criteria and letting the Legislature decide in 2025 whether the law needs to be better defined.
But reverting the 5% would have meant rejecting the qualifications criteria, too, because they were all contained in the same proposed section of rule.
Hansen then noted that the new law allowing hardship exemptions says an exemption will be granted if “the ambulance service demonstrates, to the satisfaction of the department, that no physician is available and willing to serve as the medical director.” He said that “implicitly” gave the department authority to set conditions such as the 5% and, under the circumstances, could go either way.
Republican Sen. Jim Mehlhaff at that point called for the rule to be allowed to go into effect.
Generally, rural ambulance services are volunteer organizations, Mehlhaff said, and it’s “more than reasonable” that it would be a hardship if an ambulance service couldn’t find a physician for less than 5% of the budget. He also acknowledged there’s ambiguity.
But, Mehlhaff concluded, “At this time, it’s the prudent thing to do.”
The vote was 5-0.
