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may discourage mutual aid agreements <br />between government- and non -government - <br />based ambulance service providers Finally, <br />unlimited liability exposure threatens the <br />existence of small, non -government -based <br />rural ambulance providers, which could <br />leave large geographic areas without any <br />ambulance service and undermine <br />emergency response to mass casualty <br />incidents. <br />In addition, the liability exposure of medical <br />directors associated with ambulance service <br />is a concern. While medical directors of <br />government -based ambulance services may <br />arguably be covered by public official <br />immunity, the law is unclear and should be <br />clarified. <br />Response: The League of Minnesota <br />Cities supports federal legislation that <br />would: <br />a) Require Medicare to set ambulance <br />payment rates at the "national <br />average cost" of providing service; <br />b) Require adequate reimbursement for <br />ambulance providers; <br />c) Establish a "prudent layperson" <br />standard for the payment of <br />emergency ambulance claims such <br />that if a reasonable person believed an <br />emergency medical problem existed <br />when the ambulance was requested, <br />Medicare would pay the claim; <br />d) Make it easier for providers to file <br />claims with Medicare by eliminating a <br />processing system that often leads to <br />the rejection of legitimate <br />reimbursement claims. <br />The League also urges the Legislature to <br />extend the protection of the state and <br />municipal Tort Claims Act to, at a <br />minimum, licensed third parties that <br />contract with a municipality to provide <br />ambulance services. The League also <br />supports extending the applicability of <br />public official immunity to medical <br />directors in the course of ambulance <br />service activities. <br />SD-13. Community EMTs <br />Issue: The primary role of fire departments <br />in cities throughout Minnesota has long been <br />that of a traditional fire fighting force. Over <br />time, the changing needs of communities <br />has necessitated that fire departments evolve <br />to meet these new needs, primarily by <br />providing emergency medical care as first <br />responders to emergency situations. As <br />known, trusted, and highly trained members <br />of their communities, firefighter/emergency <br />medical technicians (EMTs) are in a unique <br />position to participate in the continuum of <br />care and provide needed medical services to <br />residents, beyond solely responding to <br />emergencies. <br />The Patient Protection and Affordable Care <br />Act (ACA) of 2010 implemented the <br />Hospital Readmissions Reduction Program, <br />which creates economic incentives and <br />disincentives to hospitals and Accountable <br />Care Organizations to address inefficiencies <br />in our health care system. Under this <br />program, hospitals are penalized for patient <br />readmission within 30-days of discharge for <br />such illnesses as chronic obstructive <br />pulmonary disease (COPD), heart failure <br />and pneumonia. Hospitals with excessive <br />readmissions receive reduced <br />Medicaid/Medicare reimbursement from the <br />federal government. <br />The first three days following release from <br />hospital care is the time patients are at the <br />highest risk of readmission. By providing in - <br />home, post -release wellness checks within <br />this three-day timeframe, firefighters with <br />Community EMT certification help keep <br />patients from returning to the hospital for <br />the same issues within the 30-day period. <br />League of Minnesota Cities <br />2015 City Policies Page 8 <br />