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Item N07 BOARD OF COUNTY COMMISSIONERS AGENDA ITEM SUMMARY Meeting Date: 4/15/2009 (Key West) Division/ Dept. County Attorney Bulk Item: Yes No~ Staff Contact PersonlPhone #: Suzanne Hutton x3470 AGENDA ITEM WORDING: Approval one of two versions of Resolution Adopting a Fee waiver Policy for TraumaStar Billing. ITEM BACKGROUND: During budget hearings in the summer of 2008, it was proposed that there be an MSTU to cover the costs of TraumaStar which are in excess of the revenue generated by patient transports. A non-binding referendum was passed, by a vote of approximately 54.5% county-wide. The Key Largo FREMS District has declined to enter an interlocal agreement. The municipalities have not yet provided any ordinances allowing a special taxing district to be effective within their jurisdictions. There has been discussion re waiving the excess fees over: third-party payments for TraumaStar transport services. At the last BOCC meeting, it was indicated that the staff would bring forward a proposed billing policy. Due to the lack of BOCC direction heretofore regarding waivers for either trauma scene transports or inter-facility transports, two versions of the policy resolution are provided.' Version A provides administrative waivers for qualifying individuals for trauma scene transports and discretionary waivers for inter-facility transports. Version B provides administrative waivers for both trauma scene and inter-facility transports. PREVIOUS RELEVANT BOCC ACTION: Approval of Ordinance 30-2008, creating two MSTU's.. CONTRACT/AGREEMENT CHANGES: N/A STAFF RECOMMENDATIONS: Approval of either resolution. TOTAL COST: approx. $2 M BUDGETED: Yes No COST TO COUNTY: approx. $2 M SOURCE OF FUNDS: Ad Valorem REVENUE PRODUCING: Yes No --.X AMOUNT PER MONTH Year APPROVED BY: County Atty x9f OMBIPurchasing _ Risk Management_ DOCUMENTATION: Included X Not Required_ DISPOSITION: AGENDA ITEM # Revised 11/06 VERSION A RESOLUTION NO. 2009 RESOLUTION OF THE BOARD OF COUNTY COMMISSIONERS OF MONROE COUNTY, FLORIDA, ADOPTING A FEE WAIVER POLICY AND PROCESS FOR TRAUMA STAR BILLING. WHEREAS, the annual costs of operation of TraumaStar, the County's rapid-transport air ambulance, has been approximately $1,800,000 per year in excess of revenues collected from user service fees; and WHEREAS, 54.5% of the voters countywide approved a referendum on November 4, 2008, for the establishment of 2 taxing districts; and WHEREAS, the Board of County Commissioners for Monroe County, Florida, did, at a public hearing on December 8, 2008, adopt Ordinance No, 30-2008, creating two MSTU's, one for the area north of Mile Marker 95 Northern County Emergency Air Transport Municipal Service; and WHEREAS, s.171.203, F.S. requires an independent special district to consent by interlocal agreement to inclusion of the area within the district boundaries in the taxing unit established by the County; and WHEREAS, the Key Largo Fire Rescue & EMS District declined to enter into an interlocal agreement as co'mmemorated in their Resolution No. 2009-001; and WHEREAS, s.125.01(1)(q), F.S. requires a municipality to consent by ordinance either annually or for a term of years to inclusion of the area within the municipal boundaries in the taxing unit established by the County; and WHEREAS, the municipalities have not yet provided copies of ordinances regarding the inclusion of the areas within their boundaries in the MSTU; and WHEREAS, the Board of County Commissioners has determined that it is in the best interests of the public to establish a policy and set certain restrictions on billing for TraumaStar, particularly with respect to the potential for service fee waivers; now, therefore 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 TraumaStar: A. Fees for Services shall be waived administratively in the following cases: (1) Administrative waiver of fees in excess of third-party payments shall be limited to direct Trauma Star flights from emergency scenes to out-of-county hospitals; VERSION A (2) For emergency scene transfers, Trauma Star will continue to seek reimbursement from the residents' insurance, either liability insurance, automobile insuranee, health care insurance, Medicare/Medicaid, etc.; (3) The waiver process requires qualification as a resident and submission of documentation by the person seeking the waiver; (a) For qualifying individuals, the County commission shall eventually write off any and all balances remaining after receipt of third party payments. Qualifying individuals who do not have insurance shall be able to obtain a write-off of the balance after third-party payments through a waiver process. (b) A qualifying individual is a resident, defined as any individual, or member of their household, who is current in paying property taxes in Monroe County (this would include both homestead and non-homestead property, and commercial property), that includes the Trauma Star tax. The waiver would not be extended to individuals who do not contribute towards the financing of the Trauma Star service, such as part-time residents who do not own property. Long term residents of Monroe County who rent property subject to the Trauma Star tax would qualify under this definition. (c) The billing company would continue to process billing as in current practice, but would provide a waiver request form in the billing package. To receive the write-off or waiver of out-of-pocket expenses, the patient would be required to show proof (attach a copy of their paid property tax bill, or the proof of prior residency in a tax-paid property through previously existing long-term lease and/or utility bills), indicating the individual or someone in their household has paid the Trauma Star tax and submit to the billing company for review and validation. (4) The waiver of out-of-pocket expenses does not apply to any other transport provided by any other helicopter provider, even in the event Trauma Star is out of service or unavailable (5) The waiver of out-of-pocket expenses would be effective on November 4,2008, the date of passage of the voter referendum and would not be retroactive to the date of Trauma Star inception. (6) The waiver of out-of-pocket expenses would not be applicable to individuals who are injured while involved in felony criminal activity. (7) Write-offs of out-of-pocket expenses would be completed by annual resolution of the Board of County Commissioners. Individuals who have met the waiver requirements-,- as documented by administrative staff or the billing company, will not be billed during the time that the billing company continues to seek third-party payments and pending the BOCC approval of the write-off. VERSION A B. Waiver of service fees may be approved by the Board of County Commissioners on a case by case basis for inter-facility transfers. (1) Inter-facility transfers from the three area hospitals (Lower Keys, Fisherman's, and Mariners) are contracted to other helicopter providers. Trauma Star only provides inter-facility transportation when requested and arranged by the respective hospital. Since the respective hospitals arrange the inter-facility transport, and the County does not subsidize operations of other providers, the County is not responsible for any excess of private provider fees over third-party payments. In the event other providers are no longer providing service in the Keys, the policy will be revisited. (2) The Board of County Commissioners shall consider the following criteria in determining whether to waive any portion of fees for inter-facility services: (a) Third Party coverage of the services; . (b) The timing of availability of other air-transport service at the time of the transfer; (c) Any medical opinion that ground ambulance transport was contra- indicated; (d) The financial ability of the recipient of the service to pay the fees within a two-year time period. Section 2. 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 15th day of April, 2009. Mayor George Neugent Mayor Pro Tem Sylvia Murphy Commisioner Heather Carruthers CommiSSioner Mario Di Gennaro Commissioner Kim Wigington Attest: DANNY L. KOLHAGE, CLERK By: BOARD OF COUNTY COMMISSIONERS OF MONROE COUNTY, FLORIDA By: Mayor Deputy Clerk VERSION B RESOLUTION NO. 2009 RESOLUTION OF THE BOARD OF COUNTY COMMISSIONERS OF MONROE COUNTY, FLORIDA, ADOPTING A FEE WAIVER POLICY AND PROCESS FOR TRAUMA STAR BILLING. WHEREAS, the annual costs of operation of TraumaStar, the County's rapid-transport air ambulance, has been approximately $1,800,000 per year in excess of revenues collected from user service fees; and WHEREAS, 54.5% of the voters countywide approved a referendum on November 4, 2008, for the establishment of 2 taxing districts; and WHEREAS, the Board of County Commissioners for Monroe County, Florida, did, at a public hearing on December 8, 2008, adopt Ordinance No. 30-2008, creating two MSTU's, one for the area north of Mile Marker 95 Northern County Emergency Air Transport Municipal Service; and WHEREAS, s.171.203, F.S. requires an independent special district to consent by interlocal agreement to inclusion of the area within the district boundaries in the taxing unit established by the County; and WHEREAS, the Key Largo Fire Rescue & EMS District declined to enter into an interlocal agreement as commemorated in their Resolution No. 2009-001; and WHEREAS, s.125.01(1)(q), F.S. requires a municipality to consent by ordinance either annually or for a term of years to inclusion of the area within the municipal boundaries in the taxing unit established by the County; and WHEREAS, the municipalities have not yet provided copies of ordinances regarding the inclusion of the areas within their boundaries in the MSTU; and WHEREAS, the Board of County Commissioners has determined that it is in the best interests of the public to establish a policy and set certain restrictions on billing for TraumaStar, particularly with respect to the potential for service fee waivers; now, therefore 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 TraumaStar: Fees for Services shall be waived administratively in the following cases: VERSION B (1) Administrative waiver of fees in excess of third-party payments shall be applicable to Trauma Star flights from both emergency scenes to out-of-county hospitals and inter- facility transfers; (2) For both emergency scene and inter-facility transfers, Trauma Star will continue to seek reimbursement from the residents' insurance, either liability insurance, automobile insurance, health care insurance, Medicare/Medicaid, etc.; (3) The waiver process requires qualification as a resident and submission of documentation by the person seeking the waiver; (a) For qualifying individuals, the County commission shall eventually write off any and all balances remaining after receipt of third party payments. Qualifying individuals who do not have insurance shall be able to obtain a write-off of the balance after third-party payments through a waiver process. (b) A qualifying individual is a resident, defined as any individual, or member of their household, who is current in paying property taxes in Monroe County (this would include both homestead and non-homestead property, and commercial property), that includes the Trauma Star tax. The waiver would not be extended to individuals who do not contribute towards the financing of the Trauma Star service, such as part-time residents who do not own property. Long term residents of Monroe County who rent property subject to the Trauma Star tax would qualify under this definition. (c) The billing company would continue to process billing as in current practice, but would provide a waiver request form in the billing package. To receive' the write-off or waiver of out-of-pocket expenses, the patient would be required to show proof (attach a copy of their paid property tax bill, or the proof of prior residency in a tax-paid property through previously existing long-term lease and/or utility bills), indicating the individual or someone in their household has paid the Trauma Star tax and submit to the billing company for review and validation. (4) The waiver of out-of-pocket expenses does not apply to any other transport provided by any other helicopter provider, even in the event Trauma Star is out of service or unavailable. (5) The waiver of out-of-pocket expenses would be effective on November 4, 2008, the date of passage of the voter referendum and would not be retroactive to the date of Trauma Star inception, (6) The waiver of out-of-pocket expenses would not be applicable to individuals who are injured while involved in felony criminal activity. (7) Write-offs of out-of-pocket expenses would be completed by annual resolution of the Board of County Commissioners. Individuals who have met the waiver requirements.. as documented by administrative staff or the billing company, will not be billed VERSION B during the time that the billing company continues to seek third-party payments and pending the BOCC approval of the write-off. (8) Inter-facility transfers from the three area hospitals (Lower Keys, Fisherman's, and Mariners) are contracted to other helicopter providers. Trauma Star only provides inter-facility transportation when requested and arranged by the respective hospitaL Since the respective hospitals arrange the inter-facility transport, and the County does not subsidize operations of other providers, the County is not responsible for any excess of private provider fees over third-party payments. In the event other providers are no longer providing service in the Keys, the policy will be revisited. Section 2. The Clerk is directed to send a copy of this Resolution to the MOlioe County Sheriff. PASSED AND ADOPTED by the Board of County Commissioners of MOlioe County, Florida, at a regular meeting of the Board held on the 15th day of April, 2009, Mayor George Neugent Mayor Pro Tern Sylvia Murphy Commisioner Heather Carruthers Commissioner Mario Oi Gennaro Commissioner Kim Wigington Attest: DANNY L. KOLHAGE, CLERK BOARD OF COUNTY COMMISSIONERS OF MONROE COUNTY, FLORIDA By: By: Deputy Clerk Mayor