Set public hearing date to allow EMS Revenue Recovery




Authorize public hearing to approve ordinance allowing service fees for emergency ambulance transport in Albemarle County.




Messrs. Tucker, Elliott, Davis, and Eggleston; and Ms. Kim







March 5, 2008


      ACTION:     X                     INFORMATION: 




      ACTION:                            INFORMATION: 











Virginia Code § 32.1-111.14 authorizes localities to charge reasonable fees for emergency medical services vehicle transports in order to assure the provision of adequate and continuing emergency medical services and to preserve, protect and promote the public health, safety and general welfare.  More than 40 jurisdictions in Virginia have enacted ordinances pursuant to this authority and are currently implementing Emergency Medical Services (“EMS”) revenue recovery programs.  These jurisdictions include Nelson, Louisa, Richmond, Chesterfield, Hanover, Petersburg, Colonial Heights, Hopewell, Stafford and Spotsylvania.  Many other Virginia localities are actively considering EMS revenue recovery programs.  Overall, nearly 80% of Virginia residents live in localities that bill for EMS transport; nationwide, that percentage approaches 85%.


EMS revenue recovery programs obtain the majority of their fees from Medicaid, Medicare and private insurance companies, rather than from individuals while at the same time allowing localities to recoup system costs from those individuals who benefit directly from EMS delivery, including many non-County residents. Programs generally apply compassionate billing policies and ensure that all emergency medical services are provided regardless of the patient’s ability to pay.  Fees for ambulance transports typically are set by the governing body by ordinance or resolution.


Requests for emergency medical assistance represents a large portion of the emergency service calls for the County.  As the need for emergency medical service continues to grow, the County, like many local governments, is seeking ways to fund these services without relying solely on real estate property taxes.   While patient transport is vital to ensuring effective care, it is equally important to recognize that first responders from the County’s volunteer as well as career fire/rescue station staff are critical as well to treating and stabilizing patients on the scene of an accident or other emergency medical scene.  Thus, the entire system of care from first responder to transport, if needed, should be factored into determining total costs of providing EMS in the County. Between fiscal years 2004-2007, the Board has appropriated approximately $12.9 million to fund volunteer operating and capital expenses as well as funding for daytime career staff for volunteer stations. Included in this figure is over $1.4 million in loans forgiven to the volunteer companies by the Board of Supervisors in fiscal year 2005. The source of funds for these expenditures is currently primarily real estate and personal property taxes. Accordingly, implementation of an EMS Revenue Recovery Program affords the County the opportunity to continue its strong level of funding support without relying entirely on general taxpayer revenues.


The Board of Supervisors initially contemplated establishing an EMS revenue recovery program during its FY06/07 budget deliberations.  This interest was reaffirmed by the Board during budget work sessions conducted for the FY07/08 Operating Budget and staff has included EMS revenue forecasts in both the County’s five year financial plan, which was accepted by the Board in January 2008, as well as the County Executive’s Recommended FY08/09 Operating Budget. 


Both staff and the Board of Supervisors have understood and acknowledged the critical role of extensive public information and education about EMS revenue recovery once the Board has given direction for the scheduling of a public hearing on this issue.   Work on that public education process has been underway, with the first informational items - a Frequently Asked Questions sheet and a Program Overview - attached to this Executive Summary for the Board's review.  Also attached is a public information plan that details activities in three distinct phases: prior to the public hearing; prior to adoption of an ordinance; and after ordinance implementation.  If the Board schedules a public hearing on EMS revenue recovery, this plan will move immediately into action with those activities outlined in Phase One.   




Goal #1: To enhance the quality of life in Albemarle County




Staff has prepared an ordinance that authorizes the Albemarle County Department of Fire and Rescue to charge reasonable fees for transport services provided by its emergency medical services vehicles.  Fees would be established by a separate Board resolution.  Volunteer rescue companies may elect to participate in revenue recovery by obtaining a permit from the County.


Notably, the ordinance provides that no person shall be denied transport for emergency medical services due to his or her inability to pay. The County Executive would be responsible for implementing additional compassionate billing policies and procedures.


If the ordinance is enacted, staff recommends that the County contract with an EMS billing company to provide advice concerning fees and to administer the billing program.  Policies would be developed to ensure that fees are assessed only if a patient is actually transported to the hospital; EMS calls not resulting in transport would not be billed.  Calls to 911 would not trigger any fees.  Billing would occur only after emergency medical transport has been provided.  Based on information from the patient, a claims form would be forwarded to the insurance provider, Medicare or Medicaid.  Patients, themselves, would not be billed until all insurance options were exhausted.  Depending on the provider, most insurance companies pay 80% of the charges for service.  In summary,


·      No one will be denied treatment or emergency transport regardless of their ability to pay

·      Most insurance policies, including Medicare and Medicaid, already allow for reimbursement of this service

·      A compassionate billing policy will be in place for those with financial hardship

·      If an individual calls 911 and receives treatment but is not transported, there is no charge




Preliminary estimates show revenue roughly equal to $200,000 per 1000 transports.  Albemarle County Fire and Rescue estimates that it will provide approximately 2000 transports/year from its Monticello and Hollymead Fire Stations.  Should the volunteer rescue squads also participate in revenue recovery, the revenue would likely approach $1.6 million/year.


Funds received from this program would be used to support and strengthen the County’s combination volunteer-career fire-rescue system and to offset the rising costs associated with this system.  The County provides financial support to local volunteer fire and rescue squads in a number of ways: annual funding for basic operating costs such as vehicle fuel, cars, utility vehicles, equipment and disposables; capital funding for equipment and vehicles; providing career staff in stations, when requested to provide coverage during daytime hours; and training and volunteer incentives.  Based on reports from other agencies, however, staff projects that volunteer squads will continue to need public support through donations to meet their financial obligations.




Staff recommends that the Board authorize the attached ordinance be advertised for a public hearing to be held on April 9, 2008.



A - EMS Revenue Recovery: FAQ’s

B - EMS Revenue Recovery: An Overview

C - EMS Revenue Recovery: Public Information Plan

D - Draft Ordinance

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