Capitol Update

by Senator Howard Marklein

August 18, 2023

Big Wins for Rural EMS


Over the last several years, I have been working on ways to support our rural EMS departments. They are struggling with recruitment, retention and funding while working very hard to provide necessary services to our rural communities. 
Recently, we had an extraordinary opportunity to make some significant changes to state law that will positively impact rural EMS. These changes were included in the 2023-2025 Wisconsin State Budget and the new Shared Revenue law, 2023 Wisconsin Act 12.
Many of these changes came directly from real people, on real volunteer departments, who attended summits I have held over the last several years. I was thrilled to have answers when I was asked if I had any ideas for ways to help rural EMS. Thanks to the many hours of meetings and work in our communities, we were able to make significant improvements for rural EMS. Thank you – to everyone – who has contributed an idea or input over the last several years.
The top issue I heard about at my summits was the difficulty of the National Registry of Emergency Medical Technicians (NREMT) exam, especially for Emergency Medical Responders (EMRs). I am proud to report that beginning on January 1, 2024, the NREMT exam will be optional for EMRs, at the discretion of the local EMS department. This change will significantly benefit our rural EMS departments and provide much needed regulatory relief.

Please note, this change will be entirely up to the local EMS department. They can decide whether they want EMRs to take this test – or not. EMRs will continue to be tested and trained in order to be certified, but a local department can waive the NREMT exam requirement. Departments that want to do this do not feel that this exam proves anything. They believe that the training and testing done in EMR coursework is more indicative of abilities. But, again, this is entirely optional and some departments may choose to continue requiring the NREMT exam.
The state budget made a significant investment in the Funding Assistance Program (FAP). Beginning on July 1, 2024, funding for the FAP is increased from $2.2 million annually to $25 million annually. The state budget also expanded FAP eligibility to include EMR Departments for the first time and will now allow a department to use 15% of its allocation to purchase single-use medical supplies and medications. These items were previously prohibited under the FAP. These expansions will have a positive impact on our rural EMS departments.
Other EMS provisions in the two acts include:

  • An ambulance engaged in a non-emergent inter-facility transport may be staffed with one EMT in the patient compartment during transport and one driver who is, at a minimum, CPR certified. Previous law required two EMTs. For example, if the ambulance is transporting a person from a nursing home to a doctor appointment, they can now do it with one EMT and a driver who is CPR certified.
  • When an ambulance service is operating under flexible staffing, the Department of Health Services (DHS) may not require an ambulance to be stocked at the highest level that someone on board may be able to perform. The way DHS interpreted previous law severely limited how flexible staffing could function.
  • A prohibition on “exclusive arrangements”. Previously, one department could prohibit its employees from volunteering with another department on nights and weekends. This change will allow more flexibility for individuals who would like to volunteer with their home-town department.

I am proud of these changes. While they are not the silver bullet to solve all of the staffing shortages and other challenges facing rural EMS departments, they are huge steps in the right direction.
I will continue to work on this issue and seek ways to help our rural EMS departments to provide the service and response that we need in our communities. I sincerely appreciate the time and effort of every volunteer who joined us for a summit and contributed ideas along the way. If you were unable to participate, but have ideas or concerns, please do not hesitate to connect with me to provide input, ideas or to seek assistance.  Send an email to sen.marklein@legis.wisconsin.gov or call 608-266-0703. I want to hear from you.