LEGISLATIVE FISCAL ESTIMATE

[Third Reprint]

ASSEMBLY, No. 4107

STATE OF NEW JERSEY

220th LEGISLATURE

 

DATED: OCTOBER 3, 2022

 

 

SUMMARY

 

Synopsis:

Makes various changes concerning regulation of emergency medical services; establishes mobile integrated health program and new State Emergency Medical Services Medical Director in DOH.

Type of Impact:

Increased annual State costs; Potential annual cost savings for certain hospitals.

Agencies Affected:

Department of Health; University Hospital and Bergen New Bridge Medical Center.

 

 

Office of Legislative Services Estimate

Fiscal Impact

Annual

 

State Cost Increase

Minimum of $200,000

 

Potential Cost Savings for University Hospital and Bergen New Bridge Medical Center

Indeterminate

 

 

 

 

·         The Office of Legislative Services (OLS) concludes that the Department of Health (DOH) will incur approximately $200,000 in annual salary and benefit costs for the State Emergency Medical Services Medical Director position to be established under the bill.  Additionally, indeterminate expenses will result due to the department’s responsibilities in establishing a mobile integrated health program, evaluating the criminal history background of applicants for licensure as mobile intensive care paramedics, and monitoring and approving protocols for emergency medical services (EMS). 

·         The bill authorizes the department, when deemed necessary, to place the responsibility for the cost of a criminal history background check, as required under the bill, on a mobile intensive care paramedic licensee applicant; however, it is unclear how the department will make this determination.  To the extent that the department absorbs these costs, department expenditures would increase by an indeterminate amount.

·         The effects of the various changes to the regulation of advanced life support EMS under the bill generally provide for flexibilities and streamlining in the provision of services.  Therefore, the OLS assumes that the bill will lead to certain cost savings for entities that operate EMS programs.

 

BILL DESCRIPTION

 

      Under the bill, the Commissioner of Health is to appoint a State Emergency Medical Services Medical Director to the Office of Emergency Medical Services.  The State Emergency Medical Services Medical Director is to be a licensed physician in this State and board certified in emergency medicine.  In selecting the State Emergency Medical Services Medical Director, the department is to give preference to a candidate who is board certified in emergency medical services.

      The DOH is also required to establish a mobile integrated health program.  In establishing the program, the department is to consider relevant standards and recommendations from interested stakeholders, and is to develop criteria by which an entity may apply for and receive authorization from the department to participate in the mobile integrated health program.  The bill defines "mobile integrated health" to mean health care services delivered with the approval of the department to patients outside of a hospital setting, using mobile resources, and employing team-based and patient-centered care.

      The bill provides that the existing Mobile Intensive Care Advisory Council is to:  (1) advise the DOH on all matters of advanced life support, (2) annually review advanced life support scope of practice; (3) directly provide recommendations to the department for clinical updates; (4) establish new by-laws; and (5) select a chair and vice-chair from among its members.  

      This bill also makes various changes to the regulation of advanced life support EMS.  The bill requires an applicant for licensure as a mobile intensive care paramedic to undergo a criminal history background check, as well as bear the cost of the background check when deemed necessary by the department.

 

 

FISCAL ANALYSIS

 

EXECUTIVE BRANCH

 

      None received.

 

OFFICE OF LEGISLATIVE SERVICES

 

The OLS concludes that the DOH will incur approximately $200,000 in annual salary and benefit costs for the State Emergency Medical Services Medical Director position to be established under the bill.  Additionally, indeterminate annual expenses will result due to the department’s regulatory responsibilities in establishing a mobile integrated health program, evaluating the criminal history background of applicants for licensure as mobile intensive care paramedics, and monitoring and approving protocols for emergency medical services.     

The bill authorizes the department, when deemed necessary, to place the responsibility for the cost of a criminal history background check, as required under the bill, on a mobile intensive care paramedic licensee applicant; however, it is unclear how the department will make this determination.  To the extent that the department absorbs these costs, department expenditures would increase by an indeterminate amount.  By way of comparison with other credentials issued by the DOH, New Jersey requires all new nurse aide candidates, new personal care assistant candidates, and nurse aides, and home health aides to undergo a criminal history background check; however, applicants are not charged for processing the application or fingerprint form.

The effects of the various changes to the regulation of advanced life support EMS under the bill generally provide for flexibilities and streamlining in the provision of services.  Therefore, the OLS assumes that the bill will lead to certain cost savings for entities that operate EMS programs, which include University Hospital, an independent non-profit legal entity that is an instrumentality of the State located in Newark, and Bergen New Bridge Medical Center (formerly the Bergen Regional Medical Center), a county-owned entity in Paramus.

      The OLS notes that the provisions of this bill only affect the second level of the State’s two-tiered EMS response system, usually provided by a paramedic, for critical or life-threatening emergencies, medication administration, and advanced care under the command of a physician.  This tier is mandated by State law to be provided by hospitals through a certificate of need.  The Department of Health is responsible for designating providers to serve a region, where they interface with the first level of the EMS response system, local agencies which provide basic life support services.  As such, the bill does not have an impact on local or county governments.

 

 

Section:

Human Services

Analyst:

Sarah Schmidt

Lead Research Analyst

Approved:

Thomas Koenig

Legislative Budget and Finance Officer

 

 

This legislative fiscal estimate has been produced by the Office of Legislative Services due to the failure of the Executive Branch to respond to our request for a fiscal note.

 

This fiscal estimate has been prepared pursuant to P.L.1980, c.67 (C.52:13B-6 et seq.).