DPH readies rules for new mobile integrated health care law

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The Department of Public Health is working on rules to implement a law creating a new system of community-based health services involving mobile municipal and other paramedic resources.
These new services would be coordinated with local hospitals and other health care organizations as a way to improve local health care delivery, avoid unnecessary hospital visits, and potentially reduce costs.
The new Mobile Integrated Health services statute (M.G.L. Ch. 111O), enacted as a section in the fiscal 2017 state budget act, creates a framework for local mobile medical service providers – such as private and municipal EMS services – to contract with health care providers to provide out-of-hospital services to patients. The services could include pre- and post-hospital care that fills critical gaps in health services and reduce costly hospital admissions and re-admissions.
In other parts of the country, MIH programs have been successful in reducing ambulance transports and hospital-based services.
The new law, and the draft DPH regulations, establish separate MIH and Community EMS programs. The Community EMS-based program would be run by the municipal board of health or health department in coordination with the local ambulance service, using local EMS personnel for outreach and assistance intended to prevent injuries and illness.
Under the draft regulations, the DPH would create a list of low-risk, high-value public health services that Community EMS programs could provide, mainly in the area of illness and injury prevention. This could include conducting health care screening programs, fall prevention and other “healthy living” training, and the delivery of vaccinations. A Community EMS-based program would be developed by the local ambulance service and require approval by the city or town.
The more comprehensive MIH programs would be approved by the DPH and include the use of mobile resources to deliver a variety of out-of-hospital care, including chronic disease management, behavioral health, post-hospital discharge visits, and other serious health issues that can be handled in an out-of-hospital environment.
In testimony provided at the DPH hearing on the draft regulations on Sept. 29, the MMA noted that participation by cities and towns and local agencies in any MIH or Community EMS program would impose a measure of service delivery and fiscal consequences that must be carefully considered by the municipality. The MMA recommended that the regulations be amended to include a clear local acceptance process that ensures an opportunity for local review of the responsibilities and risks associated with participation in the program.
Because the new law does not provide a specific system for funding new mobile services, the MMA also recommended that the DPH provide guidance on how to finance new programs.