Albany – In some areas of the state, ambulance wait times are getting longer and longer, and a lack of volunteers and funding shortfalls have thrown our Emergency Medical Services (EMS) systems into crisis. In response, the New York State Association of Counties (NYSAC) and a coalition of state lawmakers and advocates have been working on a package of legislation to strengthen local EMS services.

Today, NYSAC was joined by county leaders, state legislators, and EMS professionals to discuss the proposals that will help support those efforts.

The legislative package, which NYSAC worked in close collaboration with state legislators and EMS providers to craft, is designed to provide local governments with the authority to create and fund countywide EMS services, provide financial incentives for EMS workers to enter and stay in the field, and update Medicaid reimbursement rates to reflect current needs and costs.

“All across the state, local EMS providers are in crisis due to rising costs and high demand for increasingly complex services,” said NYSAC President Daniel P. McCoy. “Counties are being asked to fill growing gaps in EMS services, but they lack the resources and authority to develop county-wide systems. We’ve heard our counties’ concerns loud and clear. Through close collaboration of our partners in the legislature and the industry, we’ve developed a package of reforms that provide counties with the flexibility they need to ensure that when one of our residents calls for help, they can count on faster, more reliable, lifesaving service.”

“With rural communities struggling to provide reliable access to emergency medical services, counties are stepping up to the plate,” said NYSAC Board Member and Otsego County Representative Meg Kennedy. “In response to overwhelming need, Otsego County launched its own county-wide service in 2021, but continuously rising costs threaten the program's sustainability. The ‘Rescue EMS’ package is critical to maintaining local EMS as it will drive down costs, provide county EMS with dedicated funding, and support both the professional and volunteer EMS workforce.”

The “Rescue EMS” package includes the following legislation:

• S.4020-B (Mayer) / A.3392-B (Otis) - This comprehensive legislative package allows special taxing districts to be created to fund EMS services. In addition, this legislation would recognize EMS as an essential service and provide reforms to the Emergency Medical Services Council. 
• S.5000 (May) / A.4077 (Lupardo) - This legislation would remove EMS services from the real property tax cap, which would allow local municipalities to expand and better support their local EMS services. This measure is needed in the short-term while other solutions are being discussed.
• Authorization of Reimbursement for Treatment in Place and Transportation to Alternative Destinations (Hinchey / Kelles to introduce) - Effectively immediately, NYS should establish a mechanism within the Medicaid Fee Schedule for Ground Ambulance Services to provide reimbursement to emergency medical service agencies for providing emergency medical care to Medicaid enrollees without transporting them from the location where medical care was administered to the beneficiary. Reimbursements shall be made when emergency medical care is provided to a Medicaid enrollee after a call, text, or other request for emergency medical care.
• S.6630 (Mannion) / A.6274 (Barrett) - This legislation allows volunteer firefighters and ambulance workers to claim both state income and local property tax credits.
• S.7286 (Martinez) / A.7524 (Thiele) - This legislation increases the volunteer firefighters’ and ambulance workers’ personal income tax credit from $200 to $800 for eligible individuals and from $400 to $1,600 for eligible married joint filers.
• A.231 of 2021 (Gottfried) – (MoA Hevesi to introduce) - This bill would create a methodology for ambulance reimbursement under Medicaid that more closely approximates the cost of providing the service. Ambulances are required by law to pick everyone up, including Medicaid patients.  It is unfair to require these ambulance companies to accept Medicaid patients and then not fairly reimburse them for the costs of providing services to these patients.

Assemblymember Andrew Hevesi said, “Right now, New York is asking EMS providers and counties to step up with resources they don’t have – to offer services they are not authorized to provide. The result of this is service gaps, an overextended workforce, and compounding healthcare inequities. With NYSAC’s advocacy – and this extensive coalition behind us – we’ve gotten that point across, and we should be able to move most, if not all of this legislation before session is out.”

Senator Shelley B. Mayer said, “I am very excited to join my friends at NYSAC, my colleagues, and leaders of the EMS community to advocate for the passage of legislation that will prioritize EMS workers and show them the respect they deserve. Along with Assemblyman Steve Otis, I have long advocated for and championed legislation that will ensure EMS personnel receive the recognition they deserve for their heroic work. We have made great strides forward, but we must do more. I thank Assemblyman Otis for championing this in the Assembly, to the NYSAC for their leadership, and to the EMS community for their dedication to serving others.”

Assemblymember Donna Lupardo said, “Many are surprised to learn that Emergency Medical Services are not considered “essential” under NYS law. As a result, there exists a patchwork approach to the delivery of these services that puts the entire system at risk. The “Rescue EMS” legislative package we are introducing today addresses many of the challenges our EMS providers are facing. I’d like to thank the Governor for including parts of this package in her proposed state budget and for signing the “Direct Pay” bill into law last year. These actions to strengthen local EMS services are necessary to protect public health and safety.”

Senator Michelle Hinchey said, “EMS is the frontline of healthcare in rural and medically-underserved communities across New York State; however, we’ve seen firsthand how insufficient funding, along with workforce and geographic challenges, has pushed many providers to a breaking point. Two years ago, I sponsored legislation to create the Rural Ambulance Services Task Force, and I’m proud to champion a new bill based on its recommendations, which would create three new funding methods for EMS, covering Treatment-In-Place, Telemedicine, and Transport to Alternative Healthcare Settings, including mental health facilities. It is incumbent that we deliver real solutions to keep this lifesaving service available, and I thank all of our EMS professionals, NYSAC, and our coalition of partners in government for working with us to strengthen EMS in New York.”

Assemblymember Didi Barrett said, “Fire Departments and EMS providers across the state are facing significant hardship, with recruitment challenges, aging membership and insufficient financial support. In rural districts like mine, most of our heroic first responders are volunteers, who serve their communities with pride. NYSAC’s Rescue EMS campaign will provide direct support to our emergency services personnel, and I am proud that my legislation (A.6274) to allow volunteer firefighters and EMS workers to collect both the New York State Volunteer Firefighters' and Ambulance Workers' Income Tax Credit and a local property tax exemption is included in this legislative package. I thank NYSAC and my colleagues in the Legislature for their advocacy and look forward to passing these important bills this session.” 

Assemblymember Anna Kelles said, “Emergency Medical Services (EMS) are critical to saving lives and providing medical care to people across the state.  They provide direct care both in transit and on site.  This diversity of skills and services are especially critical in rural areas where access to hospitals and routine doctor’s visits may be hours away. The statewide EMS system is complex with some services being for-profit, some being community not-for-profit, some being municipal EMS departments and some being EMS services provided as part of a municipal Fire Department. Because the complex mechanism of funding is different for each system there is no one-size-fits-all solution to guarantee sustainable effective statewide EMS. We must include in the 2024-2025 budget a package of complementary solutions that address the lack of operational funding, insufficient wages, incomplete Medicaid coverage, inadequate Medicaid reimbursement rates, and antiquated restrictions that hamper all service systems. As one key example, this package must include provisions to ensure EMS providers are reimbursed for providing treatment on site, and that providers have the flexibility of transporting patients to non-emergency based settings so they can maximize their availability to all emergencies in their service area.” 

Assemblymember John T. McDonald III, RPh said: “The Rescue EMS package that we as upstate members are supporting seeks to address the growing gaps in care with EMS throughout the state.  Our approach of allowing for Treat in Place will not only provide more timely care to patients but also reduce the stress on our overburdened emergency rooms and hospitals. This will lead to reduced health care expenses for all payers including New York State.  Allowing local governments to work together in a shared effort is critical as the current laws of New York do not reflect EMS as an essential service and this lack of designation is a barrier to local entities providing a more effective response.  These are just two ideas in a robust package which is needed now more than ever.”

Senator Monica R. Martinez said, "EMS agencies throughout the state are nearing the need for life support due to ongoing budgetary, recruitment and retention issues. However, there are solutions identified in the 'Rescuing EMS' campaign that will prevent this crisis from further threatening to flat-line the entire system. As a sponsor of one of these essential initiatives, I know when we support our first responders, others who share the same passion and drive to help their neighbors are attracted to serve."

Steve Kroll, NYS Volunteer Ambulance and Rescue Association said, “We are grateful to all the Legislators here today to improve emergency medical services in New York State.  Long-term underfunding and a shortage of both volunteer and career EMS responders places communities at risk when ambulances are unavailable to respond when someone is seriously ill or injured.  This package of bills will take a major step in the right direction to ensure the health and safety of our communities, said Steven Kroll of the NYS Volunteer Ambulance and Rescue Association, which serves the community not-for-profit and volunteer EMS sector.

Alanna Badgley, Co-Founder of the EMS Sustainability Alliance said, “As a unified voice for EMS professionals looking to ensure a sustainable future for EMS for both patients and providers, the EMS Sustainability Alliance fully supports the passage of the following package of bills: S.4020-B/A.3392-B; S.5000/A.4077; S.6630/A.6274; S.7286/ A.7524; and A.231 of 2021.

We believe that each of these bills can effectively address a component of the EMS crisis and must be coupled with future legislation to create long-term sustainability for a functioning pre-hospital healthcare system. We are encouraged by the continued legislative energy of our leaders here in New York to build EMS as a viable career path for healthcare professionals within this field, not outside of it.”

Download NYSAC’s Rescuing EMS Factsheet.

Organized in 1925, NYSAC is the only statewide municipal association representing the interests of thousands of county leaders, including legislators, supervisors, county executives, administrators, commissioners, and other county officials from all 57 counties and the City of New York.

NYSAC is a bipartisan organization that represents counties before federal and state officials and works to inform county officials through conferences, workshops, reports, and extensive communication.