COUNTY OF ALBEMARLE

 

EXECUTIVE SUMMARY

 

 

AGENDA TITLE:

EMS Cost Recovery

 

SUBJECT/PROPOSAL/REQUEST:

Resolution to establish fees for emergency ambulance transports

 

STAFF CONTACT(S):

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

 

LEGAL REVIEW:   Yes

 

AGENDA DATE:

December 2, 2009

 

ACTION:     X          INFORMATION:   

 

CONSENT AGENDA:

  ACTION:              INFORMATION:   

 

ATTACHMENTS:   Yes

 

REVIEWED BY:

 

 

BACKGROUND:

On September 9, 2009, the Board adopted an ordinance that authorized the Department of Fire and Rescue and any volunteer rescue squad that obtains a permit from the County to charge fees for emergency medical services (EMS) vehicle transports.  County Code §6-503 provides that the Board shall establish the schedule of fees by resolution.  It further provides that no person shall be denied transport for emergency medical services due to an inability to pay and directs the County Executive to establish policies and procedures to implement the fee system, including payment standards for persons demonstrating economic hardship.

 

STRATEGIC PLAN:

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

 

DISCUSSION:

EMS Cost Recovery Program fees are paid primarily by Medicaid, Medicare and private insurance companies.  The fees are a means for localities to recover system costs from those individuals who benefit directly from EMS delivery, including many non-County residents. In addition to fixed transport fees, Medicare and most commercial insurance companies allow for payment to ambulance providers for “loaded” ground transport miles (i.e., those miles for which the patient is on board the ambulance from the point of pick-up to the closest appropriate hospital).

 

The proposed rates for Albemarle County are as follows:

 

Basic Life Support                       BLS      $350

Advanced Life Support Level 1     ALS1    $450

Advanced Life Support Level 2     ALS2    $550

 

Ground Transport Miles                GTM     $8.50/mile

 

 

 

 

·         GTM is defined as the charge per patient transport mile.

 

While no legally required method for setting rates exists, most localities set the rates no lower than the usual and customary costs allowed by private insurers. The Virginia Office of Emergency Medical Services (OEMS) has issued a guidance document to localities and EMS agencies on ambulance billing that cautions against setting the fees too low. Medicare intentionally reimburses at one of the lowest rates among all billed entities.    Since most private insurance companies pay at a higher rate than Medicare, if the fees are established based on Medicare’s low rate, the insurance companies will pay less than their own allowable rates.  The Medicare allowable rate for our surrounding localities ranges from $300 - $450 per transport.  Albemarle County’s Medicare allowable rates will be determined by the Center for Medicare and Medicaid Services (CMS) after the County submits its application to CMS.  It is recommended that rates be  re-visited  on  a  regular  basis  in  order  to  stay within  the  industry  average and to keep pace with Medicare  and  Medicaid  rates, which typically increase annually.

 

Listed below are rates some surrounding counties are currently charging for EMS transports. The proposed rates for Albemarle are listed for comparison:

 

 

Locality

BLS

ALS1

ALS2

GTM

James City County

$375

$475

$575

$8.25

Spotsylvania

$350

$450

$550

$9.00

Orange

$350

$450

$575

$8.25

Albemarle (proposed)

$350

$450

$550

$8.50

Buckingham

$350

$450

$450

$8.50

Hanover *

$350

$400

$575

$7.00

Nelson

$320

$415

$530

$8.02

 

* Staff learned that for FY11, Hanover County will be raising its rates as Medicare is expected to raise its allowable rates.

 

A Resolution to Establish a Schedule for Fees for Emergency Medical Services Vehicle Transport Services at these proposed rates is attached (Attachment A). 

 

Staff is also providing the Board some additional background information on the Albemarle County EMS Cost Recovery Program (See Attachments B, C and D).  The County has entered into a contract with Diversified Ambulance Billing, LLC (“DAB”) to provide billing and collection services.  County staff and a representative of DAB have met with representatives of the volunteer rescue squads to review policy and procedure decisions and to receive their input.  The County Executive has authorized a compassionate billing policy that will not require any person to pay any portion of a bill that they determine they cannot afford.  In addition, the County Executive has determined that, at this time, it is not advantageous for the County to implement fee waiver procedures for co-pays and deductibles or to establish a service fee subscription plan.  (See Attachment B)  These ideas can be reconsidered at a later time if experience or circumstances suggest that they should be further considered.  The Program is scheduled to begin February 1, 2010.  (See Attachment C)  An important part of the implementation of the Program is a comprehensive public information plan. (Attachment D)

 

The Board of the Scottsville Volunteer Rescue Squad and its members have voted unanimously to join Albemarle County in starting the EMS Cost Recovery Program on February 1, 2010.  At this time, the Charlottesville-Albemarle Rescue Squad and Western Albemarle Rescue Squad continue to evaluate the Program and have not committed to participating in the Program.  County staff continues to work collaboratively with representatives of the rescue squads as the Program is designed and launched.

 

BUDGET IMPACT:

Based upon historical data on transports for Hollymead, Monticello and Scottsville Volunteer Rescue Squad, it is estimated that fees in the current fiscal year could total $75,000 assuming service commences on February 1, 2010.  For fiscal year 2011, it is projected that approximately $450,000 will be collected by these stations to partially offset the cost of EMS service provided in the County.

 

Funds received from this Program will be used to support and strengthen the County’s combination volunteer-career fire-rescue system and to offset the rising costs associated with providing emergency medical services.  The County provides financial support to local volunteer fire and rescue squads for basic operating costs; for capital funding for equipment and vehicles; by providing career staff in stations, when requested by the volunteers to provide coverage during daytime hours; and for training and volunteer incentives. 

 

RECOMMENDATIONS:

Staff recommends that the Board adopt the attached Resolution (Attachment A).

 

ATTACHMENTS

A – Resolution

B – EMS Cost Recovery Administrative Policy Decisions

C – Timeline

D – Public Information Plan

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