Paramedics To Be Paid for Mental Health Transportation

A pilot program to bring people in mental health crisis straight to psychiatric services gets some traction.

By Rose Hoban

On Tuesday, mental health services in North Carolina hit a quiet milestone.

For the past few years, several counties have experimented with allowing emergency medical technicians and paramedics to transport people having mental health crises directly to psychiatric facilities – such as crisis urgent care centers – bypassing hospital emergency rooms where those patients might end up sitting for days.

Starting on Tuesday, EMS agencies in 12 counties now have the ability to bill directly to the state and state-run mental health management entities to get reimbursed for the service.

“Paramedics are pretty well trained,” said Crystal Farrow, manager for the Department of Health and Human Services’ Crisis Solutions Initiative. She said the only reason they hadn’t been taking people directly to psychiatric facilities was because they weren’t reimbursed for doing it.

State lawmakers were impressed with what they saw with a pilot program in Wake County and in this year’s budget allocated $225,000 for a yearlong pilot to gather data on the effectiveness and cost-efficiency of direct transport.

DHHS officials found an additional $264,000 from federal mental health and substance abuse block grants to match those funds.

“Any events that meet criteria for diversion from hospital can be billed starting [Tuesday],” Farrow said.

“We evaluate about 240 people a month,” said Benjamin Currie, district chief of the Advanced Practice Paramedic program in Wake County, who has been involved with a seven-year-long pilot program there.

Currie said there are 16 full-time paramedics in Wake County who have attended additional training and education and are among the most experienced employees. When a call comes into 911, dispatchers are trained to ask screening questions to determine if one of those professionals should go along on the ambulance run.

“Sometimes between a third and a quarter of those can be brought straight to a psychiatric facility,” Currie said. An example of someone who wouldn’t be diverted to a psychiatric facility is a person who drank too much and simply needs to sober up.

Farrow has been working with community partners in 13 counties, 12 of which were ready this week to go live with the statewide pilot. Other partners in the initiative are the state-funded mental health management entities and local crisis centers.

Many communities don’t have crisis centers, but Currie said there are times when Assertive Community Treatment teams can provide services in the home.

Starting Dec. 15, EMS agencies can bill back to the beginning of this fiscal year and bill DHHS until the money runs out.

Farrow said she expects that by the middle of next year there will be about a year’s worth of data.

“We’ll know about clients, about what percentage of the behavioral health population can go to non-emergency department crisis centers, what their insurance is and where to advocate for other payers,” she said.

Next fall, Farrow and other DHHS officials will return to the legislature to report on how the pilot ran.

“I look forward to presenting the results,” she said. “And I’m looking forward to getting some sustainability behind that program.”