Colorado joins the national effort to promote mobile integrated health

EMS providers in Colorado will soon be reimbursed by the state’s Medicaid program for providing care that can bypass or eliminate a trip to the hospital. 

HB26-1069, recently signed into law by Governor Jared Polis, opens the door to mobile integrated health, community paramedicine, telehealth, and other programs that could reduce expensive ER visits and improve clinical outcomes. Prior to this bill, EMS providers could only be reimbursed if they transported a patient to a hospital. 

“This legislation fundamentally changes how Colorado views emergency medical services,” Tom Anderson, president of the Emergency medical Services Association of Colorado (EMSAC), said in a June 8 press release. “For decades, EMS agencies have been treated primarily as transportation services despite delivering increasingly sophisticated medical care. HB26-1069 recognizes EMS for what it truly is, a vital part of Colorado’s healthcare system. Patients will receive the right care, at the right time, in the right place, while EMS agencies gain a sustainable reimbursement pathway for services they are already providing every day.”  

“Whether it is a diabetic patient whose condition can be resolved on scene, a behavioral health patient who can be transported to a more appropriate destination, or a telemedicine consultation that prevents an unnecessary hospital visit, this law allows EMS clinicians to make patient-centered decisions without reimbursement barriers standing in the way,” he added. 

Colorado becomes at least the 14th state to allow Medicaid to reimburse EMS providers for treatment without transport (often billed using HCPCS Code A0998). Others include Minnesota and North Dakota, both of which are leaning into community paramedicine programs, New York, Indiana, Georgia, Idaho, Utah, Wyoming, South Dakota and Washington. 

What HB26-1069 entails

The new law, which goes into effect in 2027, defines first responders to include EMS providers, police and fire services (including volunteer firefighters) and mental health professionals who respond to medical emergencies. Reimbursement will be allowed for:  

• An ambulance service for ground transportation by an ambulance or other vehicle to a hospital or other destination as deemed appropriate by the ambulance service’s medical director; 

• An ambulance service for treatment on the scene of a medical emergency, which treatment does not result in ground transportation; and 

• A qualified provider, an ambulance service, or an agency for evaluation by telemedicine of a person being treated by an ambulance service or an agency for the purpose of preventing the need to transport the person to a hospital. 

The bill is the latest in a national effort to reduce costly and unnecessary ED visits and reduce the strain on hospitals, while supporting alternative care pathways that meet patients where they are. That could mean specially trained paramedics, ambulances equipped with telehealth and digital health tools and programs that deliver care in the home. 

Supporters say the change could save Colorado $5 million annually in unnecessary transports and treatments, not to mention the downhill benefits of improved health outcomes when a patient receives more timely and appropriate care.  

It could also empower EMS providers to embrace new technology like telehealth and digital health, and to forge partnerships with healthcare organizations to improve diagnoses and treatments at the scene and choose the right care pathway for patients. 

The new law applies only to patients on Medicaid, a population that traditionally faces barriers to accessing care and can sometimes rely on 911 and the hospital ED for their only source of care.  

Supporters say they will continue efforts to expand reimbursement to other payers, though the insurance industry successfully fought to amend this bill, which had originally included private payers.