Item K1BOARD OF COUNTY COMMISSIONERS
AGENDA ITEM SUMMARY
Meeting Date: Wed.
June 10,
2015
Division: BOCC
Bulk Item: Yes
No
XX
Department: Comm. David Rice
Staff Contact /Phone #: Tamara Lamarche, X6000
AGENDA ITEM WORDING: Discussion of Trauma Star Fee Waiver Program to consider
proposal to expand the waiver program to all Monroe County property owners.
ITEM BACKGROUND: May 20, 2009, the BOCC approved Resolution #152-2009, adopting a fee
waiver program for Monroe County residents, made retroactive to November 04, 2008 when the voter
referendum approving the Trauma Star taxation county -wide. Residency was defined as a minimum of
six months, thereby not including a significant number of winter residents who are property owners,
paying the Trauma Star support tax.
PREVIOUS RELEVANT BOCC ACTION: Resolution #152-2009, establishing the fee waiver
program for Monroe County residents.
CONTRACT/AGREEMENT CHANGES:
STAFF RECOMMENDATIONS:
TOTAL COST: INDIRECT COST: BUDGETED: Yes No
DIFFERENTIAL OF LOCAL PREFERENCE:
COST TO COUNTY: SOURCE OF FUNDS:
REVENUE PRODUCING: Yes No AMOUNT PER MONTH Year
APPROVED BY: County Atty OMB/Purchasing Risk Management
DOCUMENTATION: Included XX Not Required
DISPOSITION:
Revised 7/09
AGENDA ITEM #
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Monroe County Fire Rescue
Impact of Tourism - Ground and Air Ambulance Transports
CY 2014
CY 2013
CA 2012
CY 2011
CY 2010
CY 2009
CY 2008
Total EMS Responses
3,022
2,983
3,018�
2,6751
2,634
2,3021
2,212
Total Ground Transports
1,634.
1,647
1,760
1,5911�
1,590
1,4231
1,450
Tourists Ground
348'
335-
490
498
437
4001
395
Percentage
21%-
20%•
28%
31%
27%
28%
27%
Total Air Transports
303
3051
315
232
204
167.
158
Tourists Air
94
86.
74
75
58
451
50
Percentage
3 1%'
28%�
23%
32%'
28%
27%,�
32%
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 INTERFACILITV
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 Monroc
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 hospital's 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
WHERFAS, a referendum on November 4, 2008 far the establishment of two speciai
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 Comity make frequent use oft e Trauma Star program
but do not directly pay any portion oft e 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
artim
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 or third -party payers, including
but not limited to liability insurance, automobile insurance, health care insurance,
Medicare, and Medicaid, tooffset 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, `fhe waiver of out-of-pocket expenses is made effective retroactive to No, veniber 4.
14009, the date of passage of the voter referendum.
DWrite-offs of out-of-pocket expenses will be completed by annual resolution of the
Board of County Contunissioners.
Section 2. Administrative Waiver-Quqlitication, To be eligible for a waiver of service fees,
the qualifying individual and the it 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,
Ce individual transported must not have been injured while involved in the
commission of felony criminal activity.
Section 3. iZesideqLQA!;! Lificalion. 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:
I . Any property owner, or immediate member of his or her household, who
is current in paying property taxes in Monroe County, including the Trarma 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 Cotionty, 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) soil, 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.
Section 4 EXCILOCd.
k rhe fee waiver program is not applicable to any other transport provided by any
of helicopter provider, even in the eve ntTraurna 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 oft "s Resolution to the Monroe County
Sheriff.
Mayor George Neugent Ye
Mayor Pro Tem Sylvia Murphy No
Gennaro
ngton
BOARD OF COUNTY COMMISSIONE'RS
OF 4'OLJN I'Y. ELOR IDA
By,
Mayor
L
M QT76 a6m. MEMO M
•
.0 7
Trauma Star Discussion
Monroe County Board of County
Commissioners
June 10, 2015
Ma�a�,on
'Tuhe In. WlSM
Trauma Star Transports
4-0
Fiscal
19 a
�
w
w
o
�
z
Year
I o
~ m
r
°1
4-0
4-0
Ui
,
O
r
2010
197
54
99
29
14
1
2011
237
48
157
18
12
2-
2012
286
62
194
20
10
0
2013
326
63
234
17
12
0
2014
291
62
207
16
6
0
2015*
255
46
181
11
12
5
*First eight months, October 2014 — May 2015
400
350
300
250
200
150
100
50
0
Trauma Star
Transports
--Total Transports
2007 2008 2009 2010 2011 2012 2013 2014 2015*
* Projected
3
Trauma Star
FY 2015
Projected Total Transports
338
Projection based upon FY 2015 YTD transports +
FY 2014 (June — September) Transports
11
Trauma Star Charges and Collections
Fiscal
Year
Gross
Billings,
Collected
Percent
Collected
2010
$2,663,300
$854,145
32%
2011
31004,1140
114721669
49%
2012
4011561840
113701738
33%
2013
515391020
118471077
33%
2014'
316991132
119161666
52%
2015'
2116271060
111231225
43%
'Before refunds, adjustments, waivers.
3First six months
2Represents six months in-house billing.
$6,000,000.00
$5,000,000.00
$4, 000, 000.00
$3,000,000.00
$ 2, 000, 000.00
$1,000,000.00
$0.00
Trauma Star
Billings and Collections
Gross Billings
- Collections
2010 2011 2012 2013 2014 2015*
*First six months
0
Air Ambulance Rate Comparison
Service
. . ... .... ...... .....
Broward County
Base Rate
$ 4,500.00
6L, Air Mileage
$ 75.00
Collier County
$ 5,900.00
$110.00
LifeNet (Monroe)
$22,554.84
$333.65
Martin County
$ 9,000.00
$100.00
Palm Beach County
$16,524.00
$135.00
St. Lucie County (Air Methods)
$31,091.20
$373.69
Trauma Star
$ 5,500.00
$ 80.00
Air Ambulance Rate Comparison
• Over the past year (April 2014 -March 2015) 45
transports and 4366 air miles were paid at 100% by
commercial insurance companies.
• If our rates had been $12,000 for Base Rate & $100 per mile
Trauma Star would have potentially raised an additional
$380,000.
• Any rate increase will result in larger annual write-offs due to
resident waiver program.
Recommended BOCC Action
�tr10�'ti� Mo
• Adopt Trauma Star rate increase. ��- A Pr°� 'n�S"
• Consider extending Resident Waiver Program to
include non-resident property owners. M/R �r°�d s
p p y recoMmeo��°o �kdP
a
COU-n+� �G� d eAll-hDn ar
July BOCC Meeting ,,p-cpeclD 0wrn2rs'r
• Report on success of In-house Billing
• Resolution amending Financial Incentive Program for
contract billing employees to correct referenced date
range for performance comparison.
• Recommendation for ground ambulance rate
increase.
a