Item C24BOARD OF COUNTY COMMISSIONERS
AGENDA ITEM SUMMARY
Meeting Date: _ _ July 15, 2015 Department: Emergency Services
Bulk Item: Yes X No Staff Contact /Phone #: Chief, James Callahan _
Deputy Chief Gary Boswell 289-6088
AGENDA ITEM WORDING. Approval of resolution revising Resolution 152-2009, dispensing
with the requirement that property owners produce a Monroe County driver's license in order to qualify
for a fee waiver for trauma scene and critical care interfacility flights; removing the reference to an
external billing company; removing the requirement to present the write-offs to the Board of County
Commissioners; setting an effective date; and directing the clerk to send a copy of the Resolution to the
Monroe County Sheriff.
ITEM BACKGROUND: On May 20, 2009, the Board of County Commissioners adopted Resolution
152-2009, which included a requirement that property owners show a current Monroe County driver's
license in order to qualify for the fee waiver, which many property owners who are seasonal or part-
time residents do not hold drivers' licenses issued by Monroe County. The revised resolution
dispenses with this requirement in order to extend the fee waiver program to those taxpaying property
owners; The revised resolution further reflects the fact that billing is now performed in-house by
Monroe County employees rather than by an external billing company; and lastly the revised resolution
dispenses with the requirement that air ambulance write-offs attributable to resident fee waivers be
presented to the BOCC for approval in the form of a resolution as currently set forth in Section 1 of
Resolution 152-2009.
PREVIOUS RELEVANT BOCC ACTION:
CONTRACT/AGREEMENT CHANGES:
STAFF RECOMMENDATIONS: Approval
TOTAL COST: TBD INDIRECT COST: TBD BUDGETED: Yes X No
DIFFERENTIAL OF LOCAL PREFERENCE: NIA
COST TO COUNTY: TBD SOURCE OF FUNDS: NIA
REVENUE PRODUCING: Yes No X AMOUNT PER MONTH Year
i
APPROVEDBY: CountyAttomeyCl' OMB/Purchasing6 Risk ManagementOL
DOCUMENTATION: Included Not Required
DISPOSITION: AGENDA ITEM #
Revised 6/15
RESOLUTION NO. - 2015
A RESOLUTION OF THE BOARD OF COUNTY COMMISSIONERS
OF MONROE COUNTY, FLORIDA, REVISING RESOLUTION NO.
152-2009; DISPENSING WITH THE REQUIREMENT THAT
PROPERTY OWNERS PRODUCE A MONROE COUNTY DRIVER'S
LICENSE IN ORDER TO QUALIFY FOR A FEE WAIVER FOR
TRAUMA SCENE AND CRITICAL CARE INTERFACILITY
FLIGHTS; REMOVING THE REFERENCE TO AN EXTERNAL
BILLING COMPANY; REMOVING THE REQUIREMENT TO
PRESENT THE WRITE-OFFS TO THE BOARD OF COUNTY
COMMISSIONERS; SETTING AN EFFECTIVE DATE; AND
DIRECTING THE CLERK TO SEND A COPY OF THE RESOLUTION
TO THE MONROE COUNTY SHERIFF.
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 above and beyond user service
fees is funded by ad valorem property taxes paid by Monroe County citizens; and
WHEREAS, on May 20, 2009, the Board of County Commissioners adopted Resolution
152-2009, creating a program whereby Monroe County property owners and their tenants
(collectively, "Residents") may qualify for a waiver of that portion of Trauma Star fees above
and beyond the amount of reimbursement obtained from third -party payors (including but not
limited to private insurance, Medicare and Medicaid) in return for the property taxes paid by the
property owners to support the Trauma Star program; and
WHEREAS, Resolution 152-2009 includes a requirement that property owners show a
current Monroe County driver's license in order to qualify for the fee waiver; and
WHEREAS, the Board of County Commissioners recognize that many property owners
who are seasonal or part-time residents do not hold drivers' licenses issued by Monroe County,
and the Commissioners now wish to dispense with this requirement in order to extend the fee
waiver program to those taxpaying property owners; and
WHEREAS, the Board of County Commissioners also wish to update Resolution 152-
2009 to reflect the fact that billing is now performed in-house by Monroe County employees
rather than by an external billing company; and
WHEREAS, the Board of County Commissioners also wish to update Resolution 152-
2009 to dispense with the requirement that air ambulance write-offs attributable to resident fee
waivers be presented to the BOCC for approval in the form of a resolution as currently set forth
in Section 1 of Resolution 152-2009.
NOW THEREFORE, BE IT RESOLVED BY THE BOARD OF COUNTY
COMMISSIONERS OF MONROE COUNTY, FLORIDA THAT:
Section 1, paragraph D (which currently reads "Write-offs of out-of-pocket expenses will
be completed by annual resolution of the Board of County Commissioners") is repealed
in its entirety and replaced with the following language:
D. Write-offs of out-of-pocket expenses attributable to fee waivers will be
reported to the Board of County Commissioners in the form of informal
monthly reports circulated by the Fire Chief.
2. Section 3, paragraphs C and D in Resolution 152-2009 are revised to read as follows:
C. Monroe County will continue to process 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
beginning on November 1, 2009, and that the qualifying individual meets the
other requirements as set forth in Section 3.A., above. The qualifying
individual must submit proof of qualification to the billing eampany 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 tinder- See4ieft
""Wunder 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.
D. Residents who have met the waiver requirements, as doetimeated by the
billing , will not be invoiced during the time that Monroe Countyt4+e
billing e continues to seek third party payments and while reading the
In all other respects, Resolution 152-2009 remains unchanged.
4. The effective date of this Resolution shall he July 15, 2015.
5. The Clerk is directed to send a copy of this Resolution to the Monroe County Sheriff.
PASSED AND ADOPTED by the Board of County Commissioners of Monroe County, Florida,
at a regular meeting of the Board held on the 15'h day of July, 2015.
Mayor Danny L. Kolhage
Mayor Pro Tem Heather Carruthers
Commissioner George Neugent
Commissioner David Rice
Commissioner Sylvia Murphy
Attest: AMY HEAVILIN, CLERK BOARD OF COUNTY COMMISSIONERS
OF MONROE COUNTY, FLORIDA
By: By:
Deputy Clerk
Mayor
MONROE COUNTY ATTORNEY
APPROVED AS��T/O�FORM
i4e� t.
Assistant County Attorney
VERSION B
RESOLUTION NO. 152 2009
RESOLUTION OF THE BOARD OF COUNTY COMMISSIONERS OF
MONROE COUNTY, FLORIDA, ADOPTING A FEE WAIVER
POLICY AND PROCESS FOR TRAUMA STAR BILLING FOR
TRAUMA SCENE AND CRITICAL CARE INTERFACILITY
FLIGHTS.
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 of this 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
B. A non -qualifying individual is any individual who does not contribute towards the
financing of the Trauma Star service, such as visitors and part-time or seasonal
residents, and all others who do not meet the criteria in section 3.A.
C. The billing company will continue to process 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 beginning on November 1, 2009, and that
the qualifying individual meets the other requirements as set forth in Section 3.A.,
above. The qualifying individual must submit proof of qualification to the billing
company for review and validation. Documents to substantiate qualification must
include a copy of the property tax bill shoving that all taxes, including the
Trauma Star tax, have been paid and are current. In addition, to qualify under
Section 3.A.1., 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.
D. 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.
Section 4. Other Providers Excluded.
A. 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.
B. 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.
Section 5. 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 Yes
Mayor Pro Tem Sylvia Murphy No
Commissioner Heather Carruthers Yes
commissioner Mario Di Gennaro Yes
mmissioner Kim Wigington Yes
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KOLHAGE, CLERK BOARD OF COUNTY COMMISSIONERS
OF MO ROE COUNTY, FLORIDA
By: 5
Mayor
MONROE COOUNTY ATTORNEY
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CYNTIA L. AL
ASSIS AN COUNTY AT ORNEY
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