[{"_1":2,"_100":-5,"_101":-5},"loaderData",{"_3":4,"_26":27},"root",{"_5":6,"_17":10,"_18":19,"_20":21,"_22":10,"_23":-5,"_24":-5,"_25":10},"user",{"_7":8,"_9":10,"_11":10,"_12":-5,"_13":-5,"_14":15,"_16":-5},"roles",[],"isAuthenticated",false,"isPremium","planName","subscriptionStatus","featureFlags",{},"insightsBudget","isDevelopmentHost","userPreferences",{},"recaptchaSiteKey","6LcvOJcUAAAAAHsB-gPGfGktcRlKpH7OTIU_dMTD","isImpersonating","impersonation","affiliateStatus","isFreedomPortal","routes/v2/article/layout",{"_28":29,"_30":31},"notFound",true,"relatedArticles",[32,76,88],{"_33":34,"_35":36,"_37":38,"_39":40,"_41":42,"_43":44,"_45":46,"_47":48,"_49":50,"_51":52,"_53":54,"_55":56,"_57":58,"_59":60,"_61":62,"_63":64,"_65":66,"_67":68,"_69":70,"_71":72,"_73":74,"_75":74},"mediaId",6135876,"mediaKeyId","5670505-5b67f07fead69b4d50cef5ed005a4150","parentId",5670505,"title","Rural providers, paramedics and county officials tell committee grants and staffing rules leave small ambulance services vulnerable","audioSeconds",1255,"startMs",6240000,"endMs",7495000,"viewUrl","/Search/View?dp=1&key=5670505-5b67f07fead69b4d50cef5ed005a4150&start=6240&end=7495","thumbnailUrl","https://assets.pipeline.soar.com/5670505-5b67f07fead69b4d50cef5ed005a4150/thumbnail_6240000.jpg","articleUrl","/articles/6135876/North-Dakota/Rural-providers-paramedics-and-county-officials-tell-committee-grants-and-staffing-rules-leave-small-ambulance-services-vulnerable","mediaUrl","https://secure.pipeline.soar.com/6135876-fc43700f54d1fee42b5e9530cb2e9f74/orig.mp4?Expires=1770974066&Signature=S7rc1k9klzoGm3kdVSFGht1vILLzolOtIP~u-4FFxWKxfZAyKbRC~JYCLLJ118ZmsEm1FTXPhCgbkudbtMOrHTNNTRmgAMM46gVTvBLkSP3cRCLRpiIloDDLxHh36OBzbU5A-s7hbJ0ULgzYEUsWAWREr~pBx3pPBquRQTdHTisd8qIl~uDPxjGCy0xy9~FUT~H~gnO9q5Xq4yBEflzHC3ZKVbKKf6W2lHbbaP3Kop~xYklgwJZ3MgpnXP8GC905KaEpl5DatdGSfypU8Yrg8-5wya4itdyT~W0wT3FNLZzHfgJbn-mxLttfHim6FQVV9yPxS6E54HZ4yeokLor3Ug__&Key-Pair-Id=KUT5TJCACFTXG","author","North Dakota Legislature","date","2025-08-20T00:00:00Z","article","Local providers, paramedics and elected officials urged the Emergency Response Services Committee to dig deeper into how state grants are awarded, how local taxing districts are used to support ambulances, and whether existing benefit programs provide adequate protection to volunteers. Testimony spanned the state and included examples from Oaks, L'Amour, Carrington, Bowman, and McVille.

Common themes: witnesses said state assistance grants and the formula used to distribute them are difficult for small services to navigate, that administrative requirements sometimes disadvantage small volunteer services, and that large hospital-owned or private services sometimes receive aid while smaller volunteer services do not. Several speakers asked the state to standardize and simplify grant application processes and to improve communication when applications are incomplete.

Local funding and tax districts: multiple witnesses said forming an ambulance tax district and levying a mill rate offered a reliable revenue source for some services, but many districts still lack the revenue needed to staff 24/7 coverage. Macville Ambulance Service Chairman Mark Reinhardt told the committee that his district adopted a tax levy this year and raised the rate after voters approved additional mills, but he said even with the levy the average cost per call in 2024 was about $2,582 while average reimbursements were about $854 — a shortfall he described as unsustainable. Several witnesses said county commissioners and local elected officials will need to weigh whether to increase tax support or pursue alternative models.

State assistance and grants: paramedic and small-service testimony said the legislation has not fixed longstanding administrative hurdles. Mike Sandy, a paramedic who manages Oaks Ambulance, and other small-service managers said applications can be held up by simple documentation requests, and that state staff sometimes struggle to reach local contact addresses. Sandy told the committee the state assistance grant has been helpful but that the application and allocation process has not reliably favored the smallest services.

Workforce and industry impacts: Dickey County Sheriff Chris Estes and others described how a major private construction presence (the applied-digital campus) has dramatically increased temporary workforce and housing demand in a small town, worsening housing and labor shortages for volunteer recruitment and for critical county jobs. Several witnesses said employers may be reluctant to release staff for training or response in some industries, and asked the committee to consider incentives for employers who allow employees to respond to emergencies.

Training, benefits and WSI: witnesses urged the committee to gather specific numbers on who is being covered for workers' compensation and death benefits, and to compare the cost of workforce-safety coverage with the state's current lump-sum death benefit. Representatives suggested the committee examine whether volunteers could buy into the public safety retirement plan or a length-of-service award program.

Why it matters: witnesses said the combined effect of low reimbursement, onerous administrative burdens on small services, and competition for labor threatens coverage in some rural areas. Several services said they had to rely on private staffing firms to cover shifts. Committee members directed staff to collect more granular financial data and deploy a provider survey to yield consistent statewide evidence for policy options.

Selected quotes: \"We must maintain local small-town ambulances because the people volunteering for these services are vested in these communities,\" paramedic Mike Sandy said. \"When you bring in a contract service, you lose a lot of that compassionate care.\"

Next steps: the committee approved a consultant-led survey and asked staff to collect data on grant allocations, mill levies, and service closures to inform the consultant's work.","mediaType","Video","parentTitle","Emergency Response Services Committee Aug 20, 2025","oneSentenceSummary","A line of paramedics, volunteer chiefs and county officials told lawmakers that small ambulance services face administrative barriers to state grants, rising operating costs and competition for labor that together threaten rural coverage.","taxTitle","Legislative, North Dakota","taxId",28306,"location","North Dakota","headline","","shortSummary",{"_33":77,"_35":36,"_37":38,"_39":78,"_41":79,"_43":80,"_45":81,"_47":82,"_49":83,"_51":84,"_53":85,"_55":56,"_57":58,"_59":86,"_61":62,"_63":64,"_65":87,"_67":68,"_69":70,"_71":72,"_73":74,"_75":74},6135881,"North Dakota EMS director warns of aging workforce, low reimbursements and training gaps",967,3323000,4290000,"/Search/View?dp=1&key=5670505-5b67f07fead69b4d50cef5ed005a4150&start=3323&end=4290","https://assets.pipeline.soar.com/5670505-5b67f07fead69b4d50cef5ed005a4150/thumbnail_3323000.jpg","/articles/6135881/North-Dakota/North-Dakota-EMS-director-warns-of-aging-workforce-low-reimbursements-and-training-gaps","https://secure.pipeline.soar.com/6135881-0b05101e7a6408b74eafcdbe79df9e7b/orig.mp4?Expires=1770974066&Signature=nIYZ1i8rSjca2EaBYysD2asIGMqk23IfC-KW6vRAhN741yBvWiyZMkypKuPMkkYMG~oicu3IxtV--CQ0LXR4p9-PP1AW2Tk7vtwVKCLF4MQLIR-whTXE2sEhgihyBQq8VM-d6mkx8lgI2trQxMJhF7yTetcLpSoarFcfoGt~~PkSWBdh838R2HtijudydfHVZm1AJArRs5ghnl3knjBSz6P62Goll8iIiHhVIZ~28gfxmpftQ5v7fkaE2xmCiCWp4cPbQR2dSmfQbNiwRX9NZpD5CIMHR06G3jtfirEN9woToNo3YTqk-3rXDheHv7fTB03v1tmlSZ8mcsaID2AiPA__&Key-Pair-Id=KUT5TJCACFTXG","The state's emergency medical services unit told the Emergency Response Services Committee that EMS staffing and finances are under strain and that rural services are particularly vulnerable. Chris Price, director of the Emergency Medical Systems unit at the North Dakota Department of Health and Human Services, said last year ground ambulance services in the state completed roughly 95,617 ambulance runs; only 56 percent of 9-1-1 responses resulted in transport to a hospital, leaving many calls non‑reimbursable under current payment rules.

Price said the workforce is aging: about 20 percent of licensed EMS providers are 55 or older; 12 percent are 60 or older. That demographic profile, combined with lower call volumes for many BLS services (78 percent of BLS services did fewer than 150 calls in 2024), means many rural services struggle to meet performance metrics such as the 10-minute dispatch-to-response standard. While all ALS services met the 10-minute dispatch standard, only about 62.5 percent of BLS services did.

The state helps through targeted grants. The EMS training grant subsidizes initial and continuing education and required field commitments; the rural EMS assistance grant paid about $10.7 million of $13.8 million in biennial EMS unit spending and is mostly used for personnel costs. Price said 33 paramedics and 143 new EMTs benefited from training grants in the last biennium, while the $10,000 stipend for paramedic initial training lags the actual cost of education (program costs cited in testimony were approximately $18,000). Price recommended regionalized training and more flexible delivery of paramedic and EMT training as possible responses.

Why it matters: Committee members heard that many rural ambulance services carry high fixed costs and low volume, and that fee-for-service reimbursement does not cover total cost in many areas. Lawmakers and witnesses repeatedly urged the committee to examine whether Medicaid and private-insurance reimbursement rates are adequate and to consider state policy moves that would either subsidize volunteers or reduce delivery costs.

Quotes from testimony: \"The state's EMS system has incurred 10 ground ambulance service closures over the past six biennia,\" Price said. \"There has not been an ambulance service closure in over 2-1/2 years, but staffing and sustainability remain a concern.\"

Next steps: Price told the committee the department will continue to provide data to legislative staff and to work with the committee on possible regional training and recruitment efforts. The committee voted to pursue a consultant-led survey of ambulance service providers that will give lawmakers more detailed, service-level data for policy options.","State Emergency Medical Systems director Chris Price told lawmakers that North Dakota's EMS workforce is aging, ambulance call volumes are rising, and many rural ambulance services have low call volumes and fail to meet response-time standards, leaving some services at financial risk.",{"_33":89,"_35":36,"_37":38,"_39":90,"_41":91,"_43":92,"_45":93,"_47":94,"_49":95,"_51":96,"_53":97,"_55":56,"_57":58,"_59":98,"_61":62,"_63":64,"_65":99,"_67":68,"_69":70,"_71":72,"_73":74,"_75":74},6135886,"Legislative committee approves consultant search for ambulance billing study; orders provider survey",527,8273000,8800000,"/Search/View?dp=1&key=5670505-5b67f07fead69b4d50cef5ed005a4150&start=8273&end=8800","https://assets.pipeline.soar.com/5670505-5b67f07fead69b4d50cef5ed005a4150/thumbnail_8273000.jpg","/articles/6135886/North-Dakota/Legislative-committee-approves-consultant-search-for-ambulance-billing-study-orders-provider-survey","https://secure.pipeline.soar.com/6135886-80efb5ca4623b627db228e8531791fa6/orig.mp4?Expires=1770974066&Signature=RqXhwfKBtkcOd2T30rVeusjqyRiPZwbGI1CA75k~w-ZkQ1En7YrlBxymj-4XXutZfTEWWBENyS3x5G1Fo9mA3TePwcwBydrMbG1zDDKm7oUNH4FFxKG5c8IG9of0nn73Hv8V8-9KcyZVyFoe3YHCBqckV6OjKmXOUxdcXZjrUaF1tN3atXM5Gcpl1-e6tItpPn6WblOSsCFY8xVfqqJDfeZcz2VMOQr7fiBQuS0I~7MGqL1r4gcWnBjxeaBt7oED3wMe2RXHoxvX0F-MSVhN3sdKAnfL3Rgvdtj7WUVzko1kST4vRzYGvoAKg2RxTFcPpuNQ3f-8gC9Uo1lxd3waAA__&Key-Pair-Id=KUT5TJCACFTXG","The Legislature's Emergency Response Services Committee voted to authorize a consultant-led study of ambulance billing and delinquent-payment reimbursement and directed staff to develop a public request for proposals to run a statewide survey of providers. The motion implements language in House Bill 1322, which appropriated $20,000 to the study. The committee also directed legislative staff to draft a second, broader study scope on evolving fire service organization and regional response (no consultant funds were attached to that second scope).

The committee majority framed the action as a practical next step after three hours of testimony and written reports describing recruitment and retention challenges for volunteer and paid emergency responders, uneven reporting of incidents, and inconsistent local funding streams. Committee staff told members the HB1322 appropriation can be used to hire a consultant to do the provider survey and stakeholder interviews required in the bill language.

Why it matters: testimony during the meeting emphasized that unpaid or unpaid-in-practice ambulance runs, low insurance reimbursement for many calls, and uneven access to training make it hard for small services to remain solvent and to recruit or keep staff. A consultant-driven survey is intended to collect standardized, statewide data from ambulance services and to interview people who left the field, giving the Legislature better evidence for policy changes.

What the committee approved: the motion authorizes legislative council staff to issue a request for proposals for a consultant to design and carry out the ambulance-service survey and related consulting work, including outreach to stakeholders and producing a final report with options for reimbursement and policy changes. Committee members asked that the consultant work explicitly include exit interviews with former EMS volunteers and staff, and that the survey capture small, volunteer, hybrid and career services.

Next steps: legislative staff will prepare the RFP and return a draft scope to the committee at the next meeting. Members also instructed staff to collect and share existing programmatic data (state reports, FCHIP and state grant distributions, county-level taxing data) to brief the consultant and to permit early analysis of trends across regions. The committee also voted to request a separate RFP-style scope to study regional fire-service organization, mutual-aid and statewide coordination; that study would require additional funding approval before contracting.

Votes and motions: the motion to authorize the ambulance-billing RFP passed on a recorded vote. A second motion to ask legislative staff to prepare an RFP scope for the broader fire-service study also passed. Both votes were recorded on the transcript and entered into the committee minutes.","The Emergency Response Services Committee approved a request-for-proposal process to hire a consultant to run a survey and study on ambulance billing and delinquent-payment reimbursement. The committee also asked staff to prepare a second, broader study on fire-service organization and response; both actions are steps in a multi-meeting interim.","actionData","errors"]

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Rural providers, paramedics and county officials tell committee grants and staffing rules leave small ambulance services vulnerable

North Dakota EMS director warns of aging workforce, low reimbursements and training gaps

Legislative committee approves consultant search for ambulance billing study; orders provider survey