H.B. 417 Patient Interfacility Transportation Requirements: transcript

All right. Well thank you for having me today, you guys. Um, I appreciate it and I will try to be fast. Um, HB four 17 creates a pathway for patients to transport themselves between medical facilities rather than having to rely on ambulances. This came about because I had a constituent who was dealing with depression. She checked into the, um, mental health receiving center and then was later transported to a hospital and, and got a big, big, big, big fat ambulance bill after the fact. So she was pretty frustrated by this sense. This wasn't as she saw it medically necessary. She wasn't bleeding out, she wasn't considered to be a danger to herself at the time. She could have phoned a friend, all sorts of things. So this is trying to save people some money. And so when we dug into it and what the issues are that are preventing people from doing this already, it turns out that because a patient would have to fully discharge, they're potentially giving up their bed that is being reserved from them at the hospital. And they're also gonna have to be reexamined again when they get in. So there a bed is a scarce supply often, and these reexamination fees are another, are another expense that is adding up. So what this does is it says that at the discretion of their medical team, a patient who is medically stable can transport themselves without needing to give up their bed and be reexamined as long as they arrive in a specified amount of time. It also has immunity for, um, the originating facility healthcare team, and that is the bill.

You know, I'm a little, I dunno if embarrassed is the right word to think that. I didn't ever think of this after seeing how often this actually impacts patient care and patient pocket books. Um, this is very appropriate and I think very wise. So just wanted to speak in support of the bill.

Thank you, Mr. Chair. Make a motion that we favorably recommend HB 14 to the Senate floor.

Um, thank you. I also think it's a great bill and like the Senate sponsor, so, oh, Wow.

I do, yes. Okay. All right. Am I on? Okay.

Fantastic. Thank you, Madam Chair, committee members for having me today. Um, so four 17 creates a path for patients who are medically stable, where it is not medically necessary that they be transported via emergency medical, um, providers to transport themselves between facilities. So this came up, I had a constituent who was dealing with depression, who Uintah the crisis center. And then they made the determination that she should be transferred to HMHI. So they transported her there, they transported her via ambulance. Um, and later she got a big bill for that. And she was concerned because she was stable at the time. She was dealing with depression, but she wasn't considered to be a danger to herself or others. She definitely wasn't bleeding out or anything like that. And so she felt like this was an unnecessary expense that she had had to incur by trying to get the treatment that she needed. So, um, we looked into this and it turns out that currently, um, that pathway does not exist. So right now, if a patient in her position wanted to move from one facility to the other, she would have to be discharged, go there. And the problem with that is she would have to potentially give up, um, her bed that she would have at the facility, as well as be reevaluated, which is an additional expense. So what this, um, bill does is it says that at the discretion of the patient's doctor, so this is only when it is strictly, um, approved by their medical team, um, that they can then have the option to transport themselves. They have to arrive within two hours. Um, so it takes away the, well, I'm feeling fine, let's just go home. Um, but they would still have that bed available for them if they arrive within the two hours. Um, and then if they, if it's not, um, seeming medically necessary to the staff for them to be reevaluated, they do not have to be reevaluated in order to be admitted to the new facility. So that is, that is the gist of what the bill does. Um, the goal of this is to have a narrow pathway so that in these unique circumstances, which are pretty rare, most of the time people are at hospitals because they need medical transportation, um, in those very unique circumstances, that they have options available for people so that they're not saddled, um, with these duplicative processes or, and incurring any additional expenses. So that's the gist of it. I would love any questions.

Yeah, thank you. Quick question on the, so on the two hour thing mm-hmm. I, my district is huge and I can't even get across my district in four hours. Um, is there room, I, I do understand the two hours because you do have to have a timeframe of, of like being reasonable. But for those that like distance itself will not allow two hours, is there room for an exception?

I would be open to working with you on that. We, we kinda struggled with that about how we balance the needs of hospitals. Who, I mean, these beds are in short supply sometimes, and we don't want to be holding a bed for a patient for half a day and not have them show up when it could be going to someone else versus the balance of your situation. Yeah. Where, where there is, there is that difficulty in getting one place to another. So we settled on the two hours. Like I said, I would be open to working on that.

I just, I don't want to accidentally put the facilities in a tough position to Yeah. Yeah. No, I wonder if there's a, a way to carve out maybe, um, classifications by county de depend.

I, I don't know. We could look at it. I'm happy to help out.

I would love that. Okay. Thank you.

Thank you. I just wondered, you said they can transport themselves, but it could be by any means. Mm-hmm. Like, could they, a family member, an Uber, whatever works for them.

Yes. Um, so we give examples in there, but this is essentially saying that you are, you are the master of your own tech, transportation destiny. So whether that is public transit, whether that's Uber, whether that's phone a friend, or grab your own keys.

Okay. Thanks. Thank you. Walk

Or whatever. Right.

Hi, I'm Dave Gsel, executive Vice President of the Utah Hospital Association. Uh, we appreciate the, uh, amendments that I think you're going to make. Uh, I don't if they were were adopted yet, but I just wanted to speak specifically for some of you who might not fully understand the MTA law. That's been a law for about 40 years of federal law, that essentially any person that comes on a hospital campus, including like the outside of it, if they're not medically stable, physically or mentally, we have to bring them in and we have to treat them regardless of pay, uh, until they're stable mentally or physically. And so, I'm sure there's some rare exemptions that she's talking about here, but at least from what I've heard of this particular thing, it strikes me that, that the medical team did not feel like this person was medically stable to go on their own. Because if that were true, she wouldn't have necessarily needed to be transferred or, uh, they could have left. We can't hold people, you know, in the hospital. Uh, but, but the reason why this is important is Impala is a big hammer on hospitals and doctors. If we don't do it right in a transfer, the average cost nationally fine from the federal government is $85,000 on mentally ill patients. And about 55,000 on, uh, uh, just phy physically, uh, challenge patients. And that might not seem like a lot of money, but this is one of the few other laws where they, if they don't like what the hospital is doing, they can kick them out of the Medicare and Medicaid program. So hospitals and physicians take this very seriously. I think there is a pathway, I'm not sure we're a hundred percent there right now, but I just wanted to let the sponsor and you know, that this is a really, uh, important area for the hospitals to comply with. So whatever we pass, we need to make sure that's okay. Um, it, it's difficult in individual circumstances, but again, we can't hold a patient unless they've a commitment or something like that, if they want to leave on their own. So I think, I think what you're covering here is pretty, uh, tight, I think because the vast majority of people, if they understand that, can, they can just leave, uh, as long, even if they're not medically stable, we probably have to have 'em sign something to try to protect us from the federal government on this. But anyway, uh, I appreciate this. Uh, this is something that, uh, I think we can find a pathway, but it's, uh, I don't know if we're quite there yet. And I apologize to the sponsor for that 'cause I can't give you additional amendments at the moment. But we might wanna be looking at that, uh, in as we go forward. Thank you.

Thank you, Madam Chair. I wondered if, um, either Mr. Gsel or Representative Hayes could draw a distinction for us. 'cause as, as Mr. Gsel said, Tala covers most patients, but I think the key there is the medically unstable piece. And I wonder if the sponsor could, or Mr. Geel could probably clarify where a patient who's protected under Tala is a different class of patient than the one that this sponsor is speaking to.

Yes. Thank you for the question. So any patient that is covered by Mt. Aala would not be touched by this bill. This isn't like, if these are Venn diagram, the circles aren't touching. They're in, they're in different hemispheres. This is only for medically stable patients. And there is a specific carve out right now in the bill, um, for Mt. Aala. And then the amendment that we're running makes that even more clear. So if a patient is being covered by alah, that means they are not currently stable. This is only for stable patients. So they shouldn't be touching,

My only comment would be if they're stable, they can leave on their own. And, uh, the other part you're trying to do is protect those beds, particularly in the mental health space. We have way too few beds in the state. Mm-hmm. You're wrestling that in other areas and appropriations. And, uh, I haven't heard feedback, but Representative Peterson, I know those as well. But to hold a bed for two or four hours, uh, when, when there's other people coming into those facilities, that is, that is not the norm right now. So anyway, that's, that would be a difference too. But thank you

Madam Chair. If I may follow up. Go ahead please. Thank you. Um, I, I, I'm pretty sure that the sponsor stated in her presentation that it's not a matter of just holding beds. It's a matter of the state law saying that if you, if you can, if you exercise your right to just walk away, then you've also exercised basic, you've also triggered a situation where that patient, once they arrived at the next facility, would have to undergo an entirely new intake process. And we're just trying to extend that intake process to not include an ambulance trip. And I'd be glad. I'm sorry. Thanks for the extra question. That's all I have for now.

Uh, yes. Uh, I kind of want to wade into this question a little bit. It's, it's very nuanced. I wanna commend the sponsor for her work on this bill. I think she struck a, a good balance, um, to Mr. Uh, Gesell's comments. What frequently happens is somebody comes in and they determine you. They need to be transferred to a higher level of care, typically an inpatient facility. And a lot of times they, they don't want to have to go to the extra effort to then blue sheet them doing an emergency civil commitment, because that's a lot of paperwork, excuse me, extra cost and delay in, in, in care. So they'll recommend, yes, you need inpatient, you, you know, we're holding a bed there, so they're not civilly committed, but in the normal course of business, they're gonna put them in an ambulance. I'm just gonna give a a personal example here that it, I know that it's actually cheaper because of our extremely high ambulance rates in Utah. If somebody goes into a, a South Jordan facility, uh, the University of Utah, a lot of times it's cheaper to fly them to the main hospital than go in ambulance. And to literally transfer between the Hunts Mental Health Hospital and the main hospital, or vice versa, it's gonna be over a thousand dollars a mile for transport. So this bill will allow families to save significant expenses twice. I have been in this situation with a family member the first time I pled with him to let us take a taxi. It was that long ago when those maybe never heard of a taxi. But, um, um, luckily that we were able to do that the second time. There was no flexibility. And I felt completely comfortable transporting the family member, but then I had to pay a big ambulance bill. And frankly, it was a lot more traumatic for the family member to be strapped to a gurney and put into the back of an ambulance. And so I think this strikes the balance that if they want to go, they're kind of signing a waiver to say, I'm, we're, we understand there could be risks here, but we're in our judgment. We had the good judgment to bring 'em in. We think that we have the good judgment to be able to transport 'em. That's on the, the patient and their, their caregivers. But I think this is a way to save costs, allow patients to have a little bit more autonomy and their family members, and not put, uh, you know, patients that are at high risk, um, with enough autonomy that it could, you know, danger them or the facility. So hopefully that either confuses it more or shed some light on it. Thank you representative Les.

My name is Eric Isam. I'm here speaking on the Isam family behalf. Um, I wasn't planning on testifying on the Good Representative's Bill, but as I sat here and, uh, Representative Eliason already reinforced what I wanted to share, went through a personal experience with a family member who was going through a mental health crisis. We reached out, um, the family member was handcuffed, taken to the hospital. That wasn't our intent. That wasn't what we had planned on having happen. And then that individual, when they were transported from the hospital to an inpatient facility, um, we wanted to transport that individual. They wanted us to transport them. And it was not only for cost reasons, but it was for the trauma that was inflicted on the individual. And, uh, I would just encourage your support of Representative Hayes. Bill. Thank you.

Thank you, Madam Chair. Rep Representative Hayes, were you wanting to move amendment one?

I would love that. Thank you. I'll

motion to adopt amendment one for HB, uh, 4, 1 7.

All motion to that, we pass, uh, HPU 4 1 7 outta this committee, uh, as amended. Thank you. That motion is an order.

I've, I've seen this firsthand. Uh, I've, I've dealt personally with people who are bleeding from their head, their leg, their arm, and they're pleading with me as a first responder to not call an ambulance because they're worried about financial ruin. Um, so I understand that this is a real concern for patients. And if this, uh, this seems like a good, a good step, uh, in the right direction, and I'm happy to support, support the bill.

Thank you. And I just, I wanna say I appreciate the discussion and the questions today. Um, Representative Monson, I'm happy to keep working with you on this. I just wanna make sure that our, our constituents are getting the care that they need and the way that works for them. And oftentimes, costs can be a deterrent to seeking care. And so I think this carves a narrow pathway. It's not gonna cover everyone. There's probably gonna people be people upset by that, but I want to get the ball rolling and making sure that we're taking care of people in the way that they need. So thank you.

Waive. Thank you.

The bill has been circled. Men reading Clerk House Bill four 17 patient in inter-facility transportation requirements by Representative Hayes. This bill was heard in Health and Human Services with a vote of 12 0 2.

Thank you, Mr. Speaker. I will not be motioning to circle. Um, this bill creates a pathway for patients to transport themselves between medical facilities when it is not medically necessary for them to take an ambulance. So this was brought to me. I have a, a constituent who's dealing with depression, who was transferred from the crisis receiving center to a hospital, and afterwards ended up with a very large medical bill, um, for that ambulance ride. And looking into it, she was really confused because she was dealing with depression, but she wasn't a danger to herself at the time. She wasn't bleeding out or anything like that. And so she was curious as to why she ended up with this ambulance ride that ended up costing so much. And we looked into it. And right now in code, it's not possible for a patient to transport themselves without discharging first. And by discharging, they would potentially lose out on their bed, on a hospital bed that's reserved for them, um, as well as have to have, uh, an, an examination again when they get in, which is again, an additional accrual of, of charges. So this bill carves a narrow pathway so that when a doctor approves, they can check themselves out and transport themselves to that hospital. Again, this is only when it is not medically necessary that they receive, um, medical transportation includes stipulations like that they arrive in a certain amount of time as well as, um, that they don't have to be reexamined unless it, it looks medically necessary that they do. Um, and then finally, it gives immunity for, um, the facility or healthcare provider from the originating, uh, facility. And that is the bill. I'm open to questions. Thank you.

Yeah, I'd like to make a motion to move amendment two in my name.

Yeah. So this amendment is just extending the time a little bit longer, up to four hours for, um, counties of the fourth, fifth, and sixth classes, just to, to make sure that we accommodate the more rural areas of the state.

Thank you, Mr. Speaker. This is a very friendly amendment. I'm very grateful to the sponsor from Blanding for working with me to make sure that we were more inclusive of our rural counties.

Uh, thank you, Mr. Speaker. I rise and supported this bill. I commend the sponsor for working with, uh, uh, numerous interested parties to craft something that is very practical and frankly very needed. Um, I've experienced this situation myself and wish this bill would've been in place, uh, many years ago. So I would, uh, advocate for its passage. Thank you.

Thank you. I I appreciate the, the friendly comments on this bill, and I would encourage your vote. So thank you.

HB 4 71 creates a pathway for patients to transport themselves between medical facilities when is not medically necessary to be transported via ambulance. I think many of you'll like this bill. This came about because a constituent who was dealing with depression checked into the mental health receiving center and was later transferred to the hospital. This patient was required to take an ambulance and required a large bill after the fact, despite the fact that she could have transported herself. Currently, if a patient were to transport themselves, they would have to discharge themselves from the hospital, meaning they would have to give up a hospital bed, be being held for them, and be reexamined again, costing more money and time upon reaching the facility. HP four 17 addresses these issues and concerns by allowing patients to transport themselves at the approval of their medical team if they arrive in a specific timeframe, which is two hours for urban and four hours for rural and in the same medical conditions when they left. It also provides immunity for the doctors at the originating facility. And that's the bill.

Call the question. And the question is, shall house Bill four 17 be read for a third time? Roll call vote.

Yes. Thank you. HP 4 71 again creates a pathway for patients to transport themselves between medical facilities when it's not medically necessary to be transported via ambulance. And that's the bill.

The question is, shall house bill four 17 pass Roll call vote. Senator Vickers. Baldry. Lewin Aye. Brammer. Us Cullimore Aye. Escamilla. Aye. Fillmore Grover. Aye. Harper Hankins. Good catch. Ipson Johnson. Juab McKay Mikel Milner Musselman Owens pitcher Plum Rebe Sandal Stevenson Stratton Aye. Vickers Weiler Wilson Winterton Musselman President Adams Aye. House Bill four 17,