County discusses expanding Rapid Medical Response: certificate of need, ALS capability and CGR study timing

County emergency services and administrators told the Public Safety Committee on Aug. 26 that they are prepared to seek a New York State certificate of need (CON) to permit billing and to enable at least one Rapid Medical Response (RMR) unit to operate at paramedic (ALS) level, pending policy decisions and CGR study recommendations.

County Emergency Response Director Joe (first name only) and Administrator Corsa explained that a CON would allow the county to bill for higher-level services and possibly create a revenue stream. "The first part of your question is yes, we would have to get a certificate of need," Corsa said. Emergency Response staff added that a CON application is largely prepared and medical director-signed; the county would submit it with legislative approval.

The CGR consultant team is still collecting data and interviewing stakeholders and is expected to deliver a full report at the Sept. 30 meeting, Corsa said. Committee members warned it may be impractical to implement major service expansions in the current tight budget year and stressed the need to identify sustainable funding sources. "It is essential that whichever direction we decide to move into, we identify... funding resources or revenue that can support the sustainability of any program," Corsa said.

Operational points: staff reported paramedics already work on RMR units but are often constrained to EMT-level interventions; converting a unit to ALS would require equipment such as cardiac monitors and pharmaceuticals but was described as a modest additional cost if done for a single unit. "For those people that are paramedics, we could allow them to step up their game and properly equip them to handle a call that required paramedic level," Emergency Response staff said.

Committee members described on-scene examples where ALS capability could have improved early care, including anaphylaxis and cardiac scenarios. Emergency Response said it is coordinating with transport providers and pointed to data showing RMR materially shortens response times in specific communities.

Funding and timing: Corsa and county staff cautioned that federal and state grant sources that previously supported RMR are not guaranteed, that insurance billing would cover only an estimated fraction of operating costs, and that most long-term funding would need to be local. Corsa said the county does not expect to add to its fund balance in 2025 and asked the committee to evaluate funding options critically.

Next steps: the committee will receive the CGR final report Sept. 30 and may consider partial or phased implementation, including piloting an ALS-equipped RMR unit. Staff said CON paperwork is ready to submit pending legislative authorization.