Item R15
BOARD OF COUNTY COMMISSIONERS
AGENDA ITEM SUMMARY
Meeting Date: February 17. 2010
Division: County Attorney
Bulk Item: Yes -X- No
Department: County Attorney
Staff Contact Person! Phone #: Suzarme Hutton #3473
AGENDA ITEM WORDING:
Approval to advertise a public hearing to consider adoption of an Ordinance requiring that notice be
given to patients that Trauma Star is an option for inter~facility & trauma scene air ambulance.
ITEM BACKGROUND:
Incident in which Trauma Star was not called even after the air ambulance company with which hospital
has contract to provide first right to provide service declined to send helicopter but was going to send a
Lear jet until patient's grandfather, Mario Di Gennaro, insisted that Trauma Star be called to ascertain
availability.
PREVIOUS RELEVANT BOCC ACTION:
Ordinance creating two MSTU's for ability to levy ad valorem tax in Upper Keys & remainder of
Monroe County. Due to lack of participation by municipalities and KLFREMSD, the taxies were not
levied. Adoption of Resolution 152-2009 providing for waivers of out-of-pocket costs of Trauma Star
in excess of third party payments.
CONTRACT/AGREEMENT CHANGES:
STAFF RECOMMENDATIONS:
Approval to advertise public hearing for March 17, 2010 at 3 :00 p.m. in Marathon
TOTAL COST: Adv. costs
INDIRECT COST: n!a
BUDGETED: Yes _No
DIFFERENTIAL OF LOCAL PREFERENCE: n!a
COST TO COUNTY: Adv. costs
SOURCE OF FUNDS:
REVENUE PRODUCING: Yes~ _ No -.X. AMOUNT PER MONTH_ Year
APPROVED BY: County Atty~ OMB/Purchasing _ Risk Management_
DOCUMENTATION: Included X Not Required_
DISPOSITION:
Revised 7/09
AGENDA ITEM #
Mario Di Gennaro
ORDINANCE -2010
AN ORDINANCE OF THE BOARD OF COUNTY COMMISSIONERS OF
MONROE COUNTY, FLORIDA, REQUIRING THAT PATIENTS REQUIRING
EMERGENCY AIR TRANSPORT SHALL BE GIVEN NOTICE OF THE
AVAILABILITY OF TRAUMA STAR; PROVIDING FOR SEVERABILITY;
PROVIDING FOR THE REPEAL OF ALL ORDINANCES INCONSISTENT
HEREWITH; PROVIDING FOR INCORPORATION INTO THE MONROE
COUNTY CODE OF ORDINANCES; AND PROVIDING AN EFFECTIVE DATE.
WHEREAS, the Monroe County Sheriff's Office operates Trauma Star, an air ambulance
service for trauma victims to be transported rapidly to trauma care facilities in Miami; and
WHEREAS, the courts have opined that a county can provide a method to subsidize
emergency medical services; and
WHEREAS, Section 395.1041, Florida Statutes, requires that hospitals providing
emergency services arrange for transfer to another hospital in certain circumstances; and
WHEREAS, due to the critical nature of a patient's condition and the distance to a
hospital with appropriate medical facilities, it is often necessary to arrange air ambulance
transport; and
WHEREAS, the Board of County Commissioners (BOCC) adopted Resolution No. 152-
2009, providing that waivers of out-of-pocket expenses in excess of insurance and other third
party payments may be waived for qualified patients transported by Trauma Star; and
WHEREAS, the BOCC finds it in the best interest of the residents of Monroe County to
be made aware that options for emergency air transport include Trauma Star; now therefore,
BE IT ORDAINED BY THE BOARD OF COUNTY COMMISSIONERS OF MONROE
COUNTY THAT:
Section 1. Section 11-179, Monroe County Code shall be created to read:
11-179. Notice of Availability of Trauma Star.
A patient for whom a medical decision has been made to transfer to another facility by air
ambulance for trauma scene flights or critical care inter-facility flights, or a person who is legally
responsible for the patient and acting on the patienfs behalf. shall be given notice that Trauma
Star provides a rapid-transport air ambulance with the potential for waivers of out-of-pocket
expenses in excess of insurance and other third party payments for qualified patients.
Section 2. SEVERABILITY. Should any provision of this Ordinance be declared by a court of
competent jurisdiction to be invalid, the same shall not affect the validity of this Ordinance as
Notice to Patients re Trauma Star
1
Mario Di Gennaro
whole, or any part thereof, other than the part declared to be invalid. If this ordinance or any
provision thereof shall be held to be inapplicable to any person, property or circumstances, such
holding shall not affect its applicability to any other person, property or circumstances.
Section 3. REPEAL OF CONFLICTING PROVISIONS. All ordinances or parts of
ordinances in conflict with this Ordinance are hereby repealed to the extent of said conflict.
Section 4. INCLUSION IN THE CODE OF ORDINANCES. The provisions of this Ordinance
shall be included and incorporated in the Code of Ordinances of the County of Monroe, Florida,
as an addition or amendment thereto, and shall be appropriately renumbered to conform to the
uniform numbering system of the code.
Section 5. EFFECTIVE DATE. This Ordinance shall take effect upon filing with the
Department of State as provided in section 125.66(2), Florida Statutes.
PASSED AND ADOPTED by the Board of County Gommissioners of Monroe County, Florida,
at a regular meeting of said Board held on the day of ,2010.
Mayor Sylvia Murphy
Mayor Pro Tern Heather Carruthers
Commissioner Mario DiGennaro
Commissioner George Neugent
Commissioner Kim Wigington
(SEAL)
Attest: DANNY L. KOLHAGE, Clerk
BOARD OF COUNTY COMMISSIONERS
OF MONROE COUNTY, FLORIDA
By
By
Deputy Clerk
Mayor/Chairperson
Notice to Patients re Trauma Star
2
IERSION B
q2 2009
RESOLUTION OF THE BOARD OF COUNTY COMMISSIONERS OF
MONROE COUNTY, FLORIDA, ADO~TING A FEE WAIVER
POLICY AND PROCESS FOR TRAUMA STAR BILLING FOR
TRAUMA SCENE AND CRITICAL CARE INTERFACILITY
FLIGHTS.
RESOLUTION NO.
WHEREAS, Monroe County provides a rapid-transport air ambulance to provide air
transportation of trauma, critically injured and ill patients, hereafter called "Trauma Star"; and
WHEREAS, Trauma Star provides air transportation from emergency scenes in Monroe
County to specialized hospitals and treatment centers out-of-county, and Trauma Star also
provides air transportation from remote areas such as Fort Jefferson to Monroe County hospitals,
hereinafter called "trauma scene flights"; and
WHEREAS, Trauma Star provides air transportation from Monroe County hospitals to
specialized hospitals and treatment centers out-of-county upon physician authorization,
hereinafter called "critical care interfacility flights"; and
WHEREAS, the annual cost of operation of Trauma Star has been approximately
$1,800,000 per year in excess of revenues collected from third party insurance through the
billing of user service fees; and
WHEREAS, a referendum on November 4,2008 for the establishment of two special
taxing districts for the operation of Trauma Star passed with 54.5 percent of the vote; and
WHEREAS, the Board of County Commissioners has determined that it is in the best
interests of its residents to support trauma scene flights and critical care interfacility flights for
qualifying residents via a fee waiver program; and
WHEREAS, the Board of County Commissioners have found that residents support the
Trauma Star program through the payment of ad valorem property taxes; and
WHEREAS, nonresidents of the County make frequent use of the Trauma Star program
but do not directly pay any portion of the expenses through the County's real property taxes to
pay for Trauma Star, including maintenance, operating costs, and the salaries of employees
required to provide the Trauma Star program; and
WHEREAS, the Board of County Commissioners has opted to establish a policy and set
certain restrictions on billing for Trauma Star, particularly with respect to the potential for
service fee waivers; now, therefore
VERSION B
BE IT RESOLVED BY THE BOARD OF COUNTY COMMISSIONERS OF MONROE
COUNTY, FLORIDA THAT:
Section 1. The following policy is hereby established with respect to Trauma Star.
A. The County will continue to seek reimbursement from third-party payers, including
but not limited to liability insurance, automobile insurance, health care insurance,
Medicare, and Medicaid, to offset a portion of Trauma Star's operational costs.
B. For qualifying individuals, the County Commission will eventually write off any and
all balances remaining after receipt of third party payments, even in cases when the
qualifying individual does not have any third party insurance.
C. The waiver of out-of-pocket expenses is made effective retroactive to November 4,
2008, the date of passage of the voter referendum.
D. Write-offs of out-of-pocket expenses will be completed by annual resolution of the
Board of County Commissioners.
Section 2. Administrative Waiver Qualification. To be eligible for a waiver of service fees,
the qualifying individual and the air ambulance transport must meet all of the following criteria:
A. The waiver includes the cost of trauma scene flights and critical care interfacility
flights.
B. The patient must be a qualifying resident as defined in Section 3 below.
C. The individual transported must not have been injured while involved in the
commission of felony criminal activity.
Section 3. Resident Qualification. The waiver process requires qualification as a resident and
submission of documentation by the person seeking the waiver:
A. A qualifying individual is a resident who defined as either of the following:
1. Any property owner, or immediate member of his or her household, who
is current in paying property taxes in Monroe County, including the Trauma Star
tax. For the purposes ofthis paragraph, the term "property tax" includes the tax
on real and personal property authorized by Monroe County Ordinance 030-2008.
For the purposes of this paragraph,. The term "immediate member of his or her
household" means (a) residing at the same address as the property owner, and
(b) son, daughter, father, mother, brother, sister, mother-in-law, father-in-law,
uncle, aunt, nephew, niece, brother-in-law, sister-in-law, stepfather, stepmother,
stepdaughter, stepson, half brother, half sister, grandchild, or domestic partner.
2. A resident of Monroe Couonty, or immediate member of his or her
household, who rents property subject to the Trauma Star tax. For the purpose of
this paragraph, the term "immediate member of his or her household" means
(a) residing at the same address as the property owner, and (b) son, daughter,
father, mother, brother, sister, mother-in-law, father-in-law, uncle, aunt, nephew,
niece, brother-in-law, sister-in-law, stepfather, stepmother, stepdaughter, stepson,
half brother, half sister, grandchild, or domestic partner.
VERSION B
Section 4.
A.
Section 5.
B.
A non-qualifying individual is any individual who does not contribute towards the
financing of the Trauma Star service, such ~ visitors and part-time or seasonal
residents, and all others who do not meet t~e criteria in section 3.A.
The billing company will continue to proc~ss billing as in current practice, but
will provide a waiver request form in the billing package. To be considered for
the write-off or waiver of out-of-pocket expenses, the patient is required to show
documentation to prove that the property owner has paid all applicable property
taxes, including any Trauma Star tax beginlning on November 1,2009, and that
the qualifying individual meets the other r~quirements as set forth in Section 3.A.,
above. The qualifying individual must subimit proof of qualification to the billing
company for review and validation. Documents to substantiate qualification must
include a copy of the property tax bill showing that all taxes, including the
Trauma Star tax, have been paid and are current. In addition, to qualify under
Section 3 .A.I., an individual must provide a copy of a current Monroe County
driver's license showing residency at the address held by the property owner. To
qualify under Section 3.A.2, an individual must provide a copy of a long-term
lease and/or utility bills at the address held by the property owner.
Residents who have met the waiver requirements, as documented by the billing
company, will not be invoiced during the time that the billing company continues
to seek third party payments and while pending the BOCC approval of the write-
off.
C.
D.
B.
Other Providers Excluded.
The fee waiver program is not applicable to any other transport provided by any
other helicopter provider, even in the event Trauma Star is out of service or
unavailable.
The County does not subsidize the operations of other providers, and the County
is not responsible for any fees incurred by residents from other providers'
servIces.
The Clerk is directed to send a copy of this Resolution to the Monroe County
Sheriff.
VERSION B
PASSED AND ADOPTED by the Board of County Commissioners of Monroe County, Florida,
at a regular meeting of the Board held on the 20th day of May, 2009.
Mayor George Neugent ~
Mayor Pro Tem Sylvia Murphy ....!2.-
Commissioner Heather Carruthers~
ommissioner Mario Di Gennaro ~
mmissioner Kim Wigington ~
:. KOLHAGE, CLERK
i
BOARD OF COUNTY COMMISSIONERS
OF M<;fROE COUNTY, FLORIDA
BY:~""'~. n~,~
Mayor
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