State study finds ND ambulance services underfunded; consultants propose delinquent-account grants and readiness funding
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Summary
A PWW Advisory study and DHHS presentations said North Dakota EMS agencies face a structural funding gap: fee-for-service revenues often do not cover readiness costs, unpaid/uncollectible claims were estimated at $2.7M among respondents and extrapolated to $5.8M statewide; options include delinquent-account reimbursement and enlarging REMSA readiness grants.
A consultant team from PWW Advisory and officials from the Department of Health and Human Services told the Emergency Response Services Committee that North Dakota ambulance agencies are operating with a chronic funding shortfall. "Across the respondents, the average fee for service revenue for a transport is just over $1,100," PWW's Matt Savatsky said, while "the expense per transport is $1,584," a gap that drives reliance on local tax subsidies and grants.
Chris Price, Director of the Emergency Medical Systems Unit at ND DHHS, summarized current grant programs and recent distribution challenges: the Rural EMS Assistance (REMSA) grant is now formula-based (HB1597) and awarded to political subdivisions rather than services; in the current fiscal year DHHS awarded $6,937,500 across 86 grants (average $80,669; awards capped at $225,000). Price said administrative transitions (OMB vendor registry and newly created ambulance districts) delayed some distributions this year but that the issues have been largely resolved.
PWW's statewide extrapolation estimated approximately $5.8 million in unpaid ambulance claims across North Dakota; within the project's survey sample respondents reported $2.7 million sent to collections and an average written-off claim around $1,062. The consultants cautioned that the survey covered 36 respondents and that their statewide extrapolation is an estimate, but they argued the data show a sector-wide structural gap that billing reforms alone cannot close.
Policy options presented included: (1) a delinquent-account stabilization grant to reimburse a portion of uncollectible claims; and (2) enlarging REMSA-style readiness grants to cover a higher share of the cost of readiness (not just reimbursements). The consultants also recommended state action to boost non-transport reimbursement (treatment-on-scene), promote telemedicine, and provide targeted help to prepare competitive federal grant applications.
Committee direction: members asked DHHS and legislative staff for more detailed fiscal scenarios and recommended that agencies improve billing and collection practices where possible. The committee accepted PWW's report for the record.
