COUNTY OF ALBEMARLE
Ordinance to amend Chapter 6, Fire Protection, of the County Code by adding Article V, Emergency Medical Services Cost Recovery
Public hearing on an ordinance that would authorize and establish a framework for fees for emergency ambulance transports.
Messrs. Tucker, Elliott, Davis and Eggleston; and Ms. Kim
LEGAL REVIEW: Yes
September 9, 2009
ACTION: X 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. Those jurisdictions include Nelson, Louisa, Orange, Fauquier, Roanoke, 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 program fees are primarily paid by Medicaid, Medicare and private insurance companies. The fees allow localities to recoup system costs from those individuals who benefit directly from EMS delivery, including many non-County residents. Programs assure that all emergency medical services are provided regardless of the patient’s ability to pay and apply compassionate billing policies. Fees for ambulance transports are typically set by the governing body of the locality authorizing the fees.
Goal #1: To enhance the quality of life in Albemarle County
The development of an EMS revenue recovery program requires the County to:
· Adopt an ordinance that authorizes and establishes a framework for EMS billing;
· Secure a billing contractor;
· Continue discussions with the volunteer rescue squads to determine if they will participate in EMS billing and establish EMS billing policies in collaboration with the volunteer rescue squads;
· Adopt transport fees by Board resolution; and
· Create and execute a comprehensive public information plan.
Adopt an ordinance that authorizes and establishes a framework for EMS billing:
Staff has prepared an ordinance (Attachment A) that would authorize the County to charge reasonable fees for transport services provided by emergency medical services vehicles and would establish the framework for an EMS revenue recovery billing process. If adopted, fees would be authorized for ambulance transports provided by the Department of Fire and Rescue. In addition, volunteer rescue squads may elect to participate in the EMS revenue recovery program by obtaining a permit from the County. The ordinance provides that the fee amounts shall be established by a resolution adopted by the Board. The ordinance specifically provides that no person shall be denied emergency medical services due to an inability to pay the fee and requires that policies and procedures implementing the revenue recovery program include payment standards for persons demonstrating economic hardship.
Secure a billing contractor:
If the ordinance is adopted, staff recommends that the County contract with an EMS billing company to assist in developing the EMS revenue recovery program. The EMS billing company would provide training on the legal mandates for billing systems, give advice concerning policies and fees, and administer the billing program.
Continue discussions with the volunteer rescue squads to determine if they will participate in EMS billing and establish EMS billing policies in collaboration with the volunteer rescue squads:
The proposed ordinance provides the legal framework for charging fees for transport services provided by emergency medical services vehicles operated by the Department of Fire and Rescue and by any volunteer rescue squad that applies for and has been issued a permit by the County to charge fees. Discussions between the County and the three volunteer rescue squads providing transport services in the County are continuing to determine if the volunteer rescue squads will participate in the EMS revenue recovery program and, if so, to establish a unified billing system. Participation by the volunteer rescue squads in the EMS revenue recovery program will be contingent upon the negotiation of an agreement between the County and the volunteers to establish a collaborative system that helps financially support the operations of the volunteer rescue squads.
Adopt transport fees by Board resolution:
As set forth in the ordinance, fees would be established by a resolution adopted by the Board and fees would be based upon the usual and customary cost of providing transport services. Policies would be developed to ensure that fees are assessed only if a patient is actually transported to the hospital. Billing information would be requested only when an 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. Most insurance policies, including Medicare and Medicaid, provide coverage for the cost of this service. No one will be denied treatment or emergency transport because of an inability to pay. A compassionate billing policy will be in place for those with financial hardship.
Create and execute a comprehensive public information plan
A successful implementation of a revenue recovery program will require extensive public information and education about the program. Staff is developing a Frequently Asked Questions sheet, a Program Overview and a Public Information Plan. The Public Information Plan will be coordinated to provide relevant information for the public hearing for the ordinance, after the ordinance is adopted, and at the commencement of billing.
Adoption of the attached ordinance would be just the first step in a process to establish fees to recover the cost for providing emergency transport services. Fees will not be charged until after policies and procedures have been established, the Board has adopted a resolution setting the amount of the fees, and the comprehensive information program has been initiated. If the ordinance is adopted, it is anticipated that EMS fees could begin being charged in calendar year 2010.
Preliminary estimates show revenue roughly equal to $200,000 per 1000 transports. Staff estimates that the Monticello and Hollymead Fire Stations will generate approximately 2000 transports/year. 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 providing emergency medical services. The County provides financial support to local volunteer fire and rescue squads for basic operating costs such as vehicle fuel, cars, utility vehicles, equipment and disposables; 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.
After the public hearing, staff recommends that the Board adopt the attached ordinance.
A – Draft Ordinance
Return to regular agenda