A Humboldt, South Dakota, ambulance in November 2022. (Photo by John Hult/South Dakota Searchlight)
A group of lawmakers voted Tuesday to back efforts to get ambulance services paid for helping low-income and elderly patients without taking them to a hospital.
The vote came during a meeting of the Legislature’s Emergency Medical Services Interim Committee at the Capitol in Pierre.
Ambulance services in South Dakota need to take patients to a hospital to get reimbursement for their work through Medicare or Medicaid.
That’s unfortunate in a lot of situations, according to Maynard Konechne, statewide advocacy director for the South Dakota Emergency Medical Services Association. It’s not uncommon for an EMT to arrive at the home of a diabetic patient who hasn’t been eating right, give that patient some food or a glucose pouch, and then hear the patient say they’re well and don’t want to go anywhere.
EMTs don’t force patients into the ambulance, said Konechne, of Kimball, but “if we don’t haul them to the hospital, we don’t get paid.”
Medicare, Medicaid tried reimbursements
Konechne told committee members that the federal Centers for Medicare and Medicaid could choose to reimburse ambulance services for the on-site care, called “treatment in place.”
The centers did that for a while a few years ago, but the practice didn’t last.
The Emergency Triage, Treatment and Transport (ET3) pilot program was meant to reimburse providers for that kind of care over a five-year period. It ended two years early, in 2023, “due to lower than expected participation and lower than projected interventions,” according to the centers.
Data released last year by the centers, however, showed an average cost savings to Medicare and Medicaid of $537 per patient for the ambulance services that participated. The National Association of Emergency Medical Technicians used that data as a selling point in its current push for the federal government to set rates for non-transport care.
State could make change
Rep. Eric Emery, D-Rosebud, moved that the interim committee draft a letter of its own to send to the federal government urging coverage for treatment in place. That passed unanimously.
South Dakota doesn’t need a policy change at the federal level to cover at least some of the costs of treatment without transport, though.
Lawmakers look for ways to deliver on support for ‘essential’ ambulance service
Emery, who’s the director of the Rosebud Ambulance Service, told the committee that North Dakota has reimbursed services for non-transport care since the mid-2010s, writing reimbursements for those costs into their state-level Medicaid pay schedules. As of 2025, ambulances are reimbursed $323 for a Medicare or Medicaid call without a transport.
Sen. Kevin Jensen, R-Canton, said he’d like to encourage the South Dakota Department of Social Services to change the rules in South Dakota to allow similar reimbursements.
“We can do that as a state,” Jensen said. “We don’t have to wait for the feds to do that.”
Reimbursements for trips to a patient’s home wouldn’t be as high as hospital transports, “but it would at least cover the expenses,” Jensen said, and would likely help save the state money by avoiding hospital bills for Medicare and Medicaid enrollees. The two programs are jointly funded by the federal government and states.
Other funding woes
The committee voted unanimously to support the “concept” of reimbursement changes at the state level, and to include that support in a report it will present to the legislature’s Executive Board next month. Sen. Tim Reed, R-Brookings, said it’s not clear at this point if legislation would be necessary to make the change.
The full Legislature ought to be made aware of the idea, Reed said, “because there could be enough savings to actually pay for treatment in place in our Medicaid system.”
New report recommends state efforts to sustain rural ambulance services
South Dakota Searchlight’s questions to the state Department of Social Services on reimbursement for non-transport ambulance services were not immediately answered Tuesday.
Such reimbursements would be welcome, said Scott Jongbloed, assistant chief for Watertown Fire Rescue, but they wouldn’t necessarily solve the larger financial woes of South Dakota’s emergency care providers.
Treatment-in-place calls represent only 20% of the Watertown agency’s call outs, Jongbloed told the committee.
But a combination of high call volume and low Medicaid reimbursement rates for hospital transports have put the service on such unsteady financial footing that break-even payouts for home visits wouldn’t be enough to fix the problem.
“We’re in a position now that our EMS is going to be $2 million, greater than $2 million, in the hole,” Jongbloed said.
‘Essential service’ issue remains
Tuesday was the committee’s last meeting before turning in its findings. The group opted against endorsing a bill that would designate EMS as an essential service, which typically means the government has to guarantee access by providing or funding it. Currently, a large share of EMS work in South Dakota is performed by volunteers.
Some committee members said there are too many questions about funding and too small an appetite for additional spending in Pierre to designate a new essential service.
“If you make it an essential service, that’s going to require a lot of money,” said Rep. Dave Kull, R-Brandon. “And you hate to hear the word ‘taxes,’ but that’s what pays for all of our essential services.”
Rep. Josephine Garcia, R-Watertown, said it’s a “disgrace” that EMS isn’t legally considered essential.
“It’s a necessity of life. It’s like a grocery store, it’s like gasoline,” Garcia said. “So I think it has to be an essential service. We will find the money.”
Reed, co-chairman of the committee, said the next step will be to convince more lawmakers to take the issue that seriously.
“We’ve got to have the conversation at the Legislature, and for the whole Legislature to have that fortitude,” Reed said.
Ultimately, the committee voted unanimously to include language in its final report “to encourage continued dialog concerning EMS as an essential service.”
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