By Tess Kenny
Chicago Tribune
NAPERVILLE, Ill. — The Naperville Fire Department plans to hire six new employees to build out a program that allows emergency responders to help people with mental health, addiction or other issues that don’t require hospitalization.
Naperville City Council members unanimously authorized the new full-time positions at a meeting Tuesday night. The increased staffing will cost about $175,000 in 2023 and about $750,000 to the city’s 2024 budget, which starts Jan. 1.
But ultimately the new program won’t add to property owners’ tax bills because the cost will be covered by insurance billing.
“We anticipate that this will certainly be cost-neutral … (but) even if there wasn’t any reimbursement, I would still strive to provide this resource because it’s very important,” Naperville Fire Chief Mark Puknaitis said after the meeting.
The soon-to-be expanding initiative is called CART, or the Community Advocate Response Team program. At its core: reimagining emergency response.
Typically when someone calls 911, emergency responders either transport them to the hospital or deem them safe to go home, Puknaitis said. But calls don’t always lend themselves to just one option or the other, a gap CART aims to address.
“The difference is (an incident) might be a nonemergent type of thing, where we’re thinking, gosh, you don’t really need to go to the hospital but you do need certain types of therapy,” Puknaitis said.
Chemical addiction, mental health or other psychiatric calls are situations CART would cover, he said. In those instances, responders spend extra time working with individuals to address the underlying issues that prompted a call for help.
The eventual goal is to reduce the number of non-emergency calls made to 911 by directing residents to the resources that get at those not-so-apparent problems.
Puknaitis called the program a “paradigm shift” in fire service.
“The world has changed and in the situations that we respond to, we’ve noticed that we can do more,” he said. “So this is all about being more proactive as opposed to reactive.”
The fire department started piloting the program in January 2022 but on a limited, 40-hour-a-week basis. Action taken by the council Tuesday gives the program the staffing it needs to be a 24/7 operation.
“These calls don’t stop at 5 p.m. in the evening, they go on (into) the weekend, on holidays,” Puknaitis said. “These emergencies have no schedule, they have no timeline, they have no day of the week that’s a green light or a red light. ... We want to be able to say to this community that if you’ve got a situation, regardless of the time of day or year or month it is, we’re going to be there for you. Just like we do for every other emergency situation.”
With six more full-time personnel at its disposal, Naperville Fire will have one CART ambulance available at all times.
Building out the full-time operation will also require a heavier level of training across the department. CART’s nearly two-year pilot brought a handful of personnel into the fold, but a bigger team is needed to sustain the around-the-clock service Puknaitis imagines.
As an added resource, the chief said he plans to enlist graduate students working on master’s degrees in nursing at Naperville’s North Central College to ride along on the CART ambulance and help respond to calls.
Puknaitis said he is eager to see what impact a bolstered program can have on the community, especially after pilot results seen over the past two years.
According to the chief, of 119 calls made to 911 for health care needs in 2022, Naperville’s CART program was able to resolve 101.
“To me, you’ve done so well that we need to reinforce success, in my opinion,” Councilman Benny White told Puknaitis.
Mayor Scott Wehrli agreed.
“Chief and your staff, congratulations on launching this new program here in Naperville,” Wehrli said. “I think you are going to be a leader in the state, if not the nation and the world, in this endeavor.”
The program’s expected negligible cost also made for an easier sell.
Rachel Mayer, Naperville’s director of finance, said the city does not anticipate any fees or costs associated with the CART program that wouldn’t be covered by insurance billing.
“For 2023, for example, we estimate collecting $9.3 million in ambulance fees. This will be a component of that,” she said.
Ambulance fees incurred by residents, Mayer said, will be covered either through individual insurance carriers or the Centers for Medicare and Medicaid (CMS), the latter made possible by a recently developed federal program.
In 2021, CMS launched a new avenue for covering fees called the Emergency Triage, Treat, and Transport Model, or ET3. It allows reimbursement for services that don’t lead to hospital transport, such as those offered through the CART program.
Though sunsetting at the end of this year, ET3 defined the billing codes needed for Medicare beneficiaries to have nonemergency, non-transport calls covered going forward.
“The federal program basically created and defined those codes,” Mayer said. “Now those codes can be leveraged for (CART).”
As CART evolves from pilot program to permanent, the fire department will provide quarterly reports to keep the council and community updated.
“What kind of progress are we seeing?” Puknaitis said. “We’ll do follow-ups … on the overall effectiveness of the program that we’ve put together.”
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