NY Volunteer Fire Departments Can Now Charge for an Ambulance. That Could Save Rural EMS Services

In much of America, if you call an ambulance, you get a bill afterwards. 

But in rural New York state, where a lot of emergency services are bundled in with fire departments, that often doesn’t happen. Volunteer fire departments haven’t been allowed to charge for ambulance service. But that means they’ve had to eat the cost. 

A new bill, passed along with the NY State budget this summer, changes that. It's called the EMS Cost Recovery Act and was sponsored by Assemblyman Billy Jones. A version of this legislation has been in the works for decades, and many local fire departments are breathing a sigh of relief. 

Rural fire departments and ambulance service: a conundrum

In New York, fire departments provide EMS coverage to nearly half of the state.

You’ll find about 180 fire departments across the North Country. The vast majority of them are volunteer — people from the community get trained and fight fires in their community. Many of those fire districts also own an ambulance and run an ambulance service. 

The Altona fire district, in Clinton County, is one of them. But over the years, staffing their ambulance service with volunteers got more and more difficult, says Ryan Blondo, the chairman of the fire district’s board of commissioners.

"We were experiencing burnout. It was asking so much of them and their families. To get up in the middle of the night to respond or to be in the middle of your child's birthday party and have to leave to go, you know, take care of someone in need. It's a huge commitment."

They were missing calls and losing volunteers. That’s why, in 2014, the fire district decided to start paying ambulance staff. They still have volunteer EMTs, but they also have two employees on call in the fire station, 24/7.

"So the benefit to us is that right now we have a great reliable service when people are having a medical emergency. The downside of that is that it is very, very expensive."

Altona’s fire district is funded by property taxes. In 2021, they had a budget of about $724,000. They spent $500,000 of that on their ambulance service. That means less and less is leftover for firefighting, said Blondo. "What's been happening as we've incurred these expenses is we've had to ask the fire department the firefighting side, what do we really need, this is the amount of money we can we can use for that."

The reason this has been an issue is because of an old New York State rule, which says volunteer fire districts can’t bill for ambulance service. That means they have to provide it for free. Many manage this by using volunteer EMTs and paramedics, or by fundraising money from within their community. 

But in the last few decades, that’s left rural fire districts holding an increasingly large bill, and caused many to shut down their ambulance service altogether.

A bill to allow billing 

Scott Ewing knew this was a problem a long time ago. He's the deputy fire chief for the town of Plattsburgh District 3 fire department, and an emergency medical technician for the Morrisonville-Schuyler Falls ambulance service.

He’s also the first vice president of the NY State Association of Fire Chiefs.

In 2016, when Billy Jones was elected to the New York Assembly, Ewing convened the four big firefighting associations in NY to explain that fire districts needed to be able to charge for ambulance service.

"I called him and asked him if he would meet with us at the Morrisonville EMS station," Ewing said. "And we talked about this bill and how important it was to a lot of the rural areas."

The bill already existed in 2016. Some version of it has been bandied around the NY Assembly since the 1980s. But it never passed.

Billy Jones started sponsoring the bill, the EMS Cost Recovery Act, every year. Jones says it's a simple idea, "All it does is it gives the ability to for volunteer fire departments to bill for their ambulatory services. And that's important here, throughout the North Country, it's important throughout New York State."

He says it’s necessary to keep ambulance services alive in the North Country. "You know, in these rural communities where we have volunteer fire departments, they're losing personnel. There are not a lot of volunteers left. And in some areas, this is the only game in town." Jones said he never wants to see a situation where "a fire siren goes off, and people are expecting services to get there. And we never want to witness where that can't happen."

This summer the EMS Cost Recovery Act was passed as part of the NY State Budget. Volunteer fire districts can now bill for ambulance calls.

Not a band-aid, but a game changer for many rural departments 

First responders in New York still face many challenges. The EMS Cost Recovery Act doesn’t magically fix low wages for EMTS, and most fire districts still have to beg and borrow for their yearly budgets.

But in Altona, Ryan Blondo says it will make a big difference to departments like theirs. "We [volunteer fire departments] are now able to bill, Medicare, Medicaid, private insurances so that we can recoup some of those costs."

He says billing will allow departments to raise less of a budget each year, and allocate more of their budget to firefighting equipment needs. 

To address broader EMS issues across the state, New York state formed a ‘Rural Ambulance Services Task Force’ last year. The group is evaluating how EMS services are currently run and can be improved in rural areas, like the North Country. 

This story originally reported by Amy Feiereisel for North Country Public Radio