Panel considers program to assist ‘distressed’ rural ambulance services; fiscal note and FTE debate

Legislative staff and stakeholders presented a proposal to create a Distressed Ambulance Service Program within the Department of Health and Human Services to help rural ambulance services that are struggling with staffing, funding, or regulatory compliance.

Brady Larson of the Legislative Council’s Fiscal Services Division told the committee the interim health services committee drafted the bill to identify at‑risk EMS providers, require development of recovery plans with local stakeholders, and allow the department to contract with vendors to support restoration of service. The fiscal note attached to the draft estimated a little more than $200,000 and one FTE to administer the program.

Witnesses from the Department of Health and Human Services and the North Dakota EMS Association urged support but described practical limits. Tim Wiedrich (Health and Human Services) said the proposal intends to combine limited staff time with contractor capacity: department staff would help prepare requests for proposals and manage processes, and contractors would deliver intensive consultative assistance when a service reaches the “distressed” threshold. PJ (Patricia James) of the North Dakota EMS Association, a regional advisor, said the association supports the bill: “I do think there could be a place for both” an ongoing staff role and outside contractors, she said, adding contractors can step in for last‑ditch recovery work while staff handle ongoing monitoring.

Committee members pressed on two consistent issues: (1) whether the program should authorize a permanent FTE or require the department to procure contractor services; and (2) how the new program would be funded. Brady Larson and agency staff said the bill as drafted allows the department to either employ a staff position or contract out the work; Larson also said that if the committee chooses not to authorize an FTE, the department could still contract with vendors using operating funds. The fiscal note did not include an estimate for revenue to the proposed ambulance fund, and witnesses said revenue projections depend on variable factors such as contractor scope and the number of distressed services.

The hearing noted prior appropriations and supports for EMS: the committee discussed a prior biennial subsidy program that received $7 million in an earlier session and that program’s expansion. Multiple senators expressed concern about adding an ongoing FTE without first piloting a contractor approach; others suggested limited short‑term staffing will be needed to stand up contracts and rules.

No committee vote was recorded during the hearing; staff and witnesses said further drafting (including a clearer definition of “distressed” and revenue mechanisms) would be helpful before advancing the bill.