Item C29
BOARD OF COUNTY COMMISSIONERS
AGENDA ITEM SUMMARY
Meeting Date: June 18.2008
Division: Emergency Services
Bulk Item: Yes ~ No
Department: Fire Rescue
Staff Contact Person: Camille Dubroff
AGENDA ITEM WORDING: Approval of Resolution of the Board of County Commissioners of
Monroe County, Florida superseding Resolution 245A-2006 and adopting an amended fee schedule for
use for providing Emergency Medical Air, Transport Service.
ITEM BACKGROUND: The current fee schedule is outdated as it has been two years since the initial
adoption of this fee schedule. In preparation of this rate increase, Advanced Data Processing Inc.
(ADPI) provided us with data that our current transport fees are lower than the Medicare
reimbursement standard and there is an anticipated reimbursement increase, which is set by Medicare
Ambulance Payment Extension Act. (See Attachment) Medicare reimbursements define the industries
standard for compensation for the different levels of service. After analyzing all of the data we have
based our recommendations for the proposed amended fee schedule upon knowledge of service type,
volume, current Medicare reimbursement fee revisions in progress, as well as Monroe County's
geographical isolation.
PREVIOUS RELEVANT BOCC ACTION: On November 17, 1987, the Board of County
Commissioners adopted Ordinance No. 050-1987 allowing the right to establish rates of user fees by
Resolution. On July 19, 2006 the Board approved a Resolution 245A-2006 ofthe Board of County
Commissioners of Monroe County, Florida to adopt a fee schedule for use for providing Emergency
Medical Air Transport Service.
CONTRACT/AGREEMENT CHANGES:
STAFF RECOMMENDATIONS: Approval as written.
TOTAL COST:
N/A
BUDGETED: Yes
No
COST TO COUNTY: N/A
SOURCE OF FUNDS:
N/A
REVENUE PRODUCING: Yes lL No AMOUNT PER MONTH Year X
~ ! Air Tr~ort ~eceivables (past ]2 months) - $45].335.98
APPROVED BY: County Arty ~ OMB/Purchasing~ Risk Managemen~nv
DOCUMENTATION: Included X Not Required_
DISPOSITION:
AGENDA ITEM #
Revised 11/06
Emergency Services
RESOLUTION NO. -2008
A RESOLUTION OF THE BOARD COUNTY
COMMISSIONERS OF MONROE COUNTY,
FLORIDA SUPERSEDING RESOLUTION NO.
245A-2006, AND ADOPTING AN AMENDED FEE
SCHEDULE FOR USE BY THE SPECIAL TAXING
DISTRICT FOR PROVIDING EMERGENCY MEDICAL
AIR TRANSPORT AMBULANCE SERVICES.
WHEREAS, Ordinance No. 050-1987 was passed and adopted by the Board of County
Commissioners of Monroe County, Florida on November 17, 1987;
WHEREAS, in accordance with Section 3 of said Ordinance No. 050-1987, the governing
bodies shall have the right to establish rates of user fees by Resolution; and
WHEREAS, the Board of County Commissioners of Monroe County, Florida previously
adopted Resolution 245A-2006, adopting a fee schedule for use for providing Emergency Medical Air
Transport Services in Monroe County;
WHEREAS, the Board desires to revise the fee schedule;
NOW THEREFORE, BE IT RESOLVED BY THE BOARD OF COUNTY
COMMISSIONERS OF MONROE COUNTY, FLORIDA, that,
1. Effective June 18, 2008, Resolution 245A-2006, adopted by the Board of County
Commissioners on July 19,2006, is hereby superseded by this Resolution; and
2. Effective June 18, 2008, the Board adopts the following Fee Schedule for use for providing
Emergency Medical Air Transport Ambulance Services.
Air Ambulance Transport Fee
Mileage
$5500.00
$ 80.00 per mile
PASSED AND ADOPTED by the Board of County Commissioners of Monroe County,
Florida, at a regular meeting of said Board held on the day of , 2008.
Mayor Mario Di Gennaro
Commissioner Dixie Spehar
Commissioner George Neugent
Commissioner Charles "Sonny" McCoy
Commissioner Sylvia Murphy
(SEAL)
BOARD OF COUNTY COMMISSIONERS
OF MONROE COUNTY, FLORIDA
Attest: DANNY L.KOLHAGE, Clerk
By:
Deputy Clerk
By
Emergency Services
RESOLUTION NO.245A -2006
A RESOLUTION OF THE BOARD COUNTY
COMMISSIONERS OF MONROE COUNTY,
FLORIDA ADOPTING A FEE SCHEDULE FOR
USE BY THE SPECIAL TAXING DISTRICT FOR
PROVIDING EMERGENCY MEDICAL AIR
TRANSPORT AM;BULANCE SERVICES.
WHEREAS, Ordinance No. 050-1987 was passed and adopted by the Board of County
Commissioners of Monroe County, Florida on November 17, 1987;
WHEREAS, in accordance with Section 3 of said Ordinance No. 050-1987, the governing
bodies shall have the right to establish rates of user fees by Resolution; and
WHEREAS, the Board of County Commissioners of Monroe County, Florida desires to adopt
the following fee schedule for providing air ambulance service;
NOW lHEREFORE, BE IT RESOLVED BY THE BOARD OF COUNTY
COMMISSIONERS OF MONROE COUNTY, FLORIDA, that the Board hereby adopts the following
Fee Schedule for use for providing Emergency Medical Air Transport Ambulance Services:
Air Ambulance Transport Fee
Mileage
$4500.00
$8Q..()O, p~r !llil~:,
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PASSED AND ADOPTED by the . Board... of County,.Commissioners of Monroe County,
Florida, at a regular meeting of said BI?~d;,~~t4~p~lln~ 'j,~'{i:;.&y:of' JULY ,2006.
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. Attest: I>ANNY L.KOLHAGE, Clerk
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MONROE COUNTY ATTORNEY
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About the Medicare Ambulance Payment Extension Act
The Medicare Ambulance Payment Extension Act was introduced on May 3 by
Senators Charles Schumer (D~NY) and Kent Conrad (D-ND) ill the Senate and
Representatives Mike McNulty (D-NY), Tom Reynolds (R-NY), Chip Pickering (R-
MS) and Tom Allen (D-ME) in the House. Representative Phil English (R-PA) also
signed on as an original cosponsor of the House bill. The legislation would provide
critical timely Medicare relief to all ambulance service providers.
The legislation would implementa Medicare increase of 5% to all ambulance
service providers regardless of th'e state or area in which the transport originated.
The two-year relief would apply to just the base rate and not mileage. The bill
language states the reUefwould commence on January 1, 2008 and expire on
December 31, 2009. Since we are past the commencement date, we will advocate
that it commence on .July 1,2008 and expire on .June 30, 2010.
The legislation is a different approach, supported by the findings of the May 2007
GAO ambulance cost report, to extending the expiring ambulance provisions of the
Medicare Modernization Act (MMA). The bills would not impact the relief
currently in place including the SO plus mileage bump, the regional fee schedule
adjustment or the super rural bonus payment. If enacted, S. 1310 and U.R. 2164
would result in an estimated $341 million in additional Medicare relicfto ambulance
service providers.
Attachment
200
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2008 Ambulance Fee Schedule
Section 1834(1) (3) (B) of the Social Security Act (the Act) provides the basis for updating payment limits that carriers, fiscal
intermediaries, and PartAJB Medicare administrative contractors use to determine how much to pay you for the claims that
you submit for ambulance services.
Specifically, this section of the Act provides for a 2008 payment update that is equal to the percentage increase in the urban
consumer price index (CPI-D), for the l2.month period ending with June of the previous year. The resulting percentage is
referred to as the ambulance inflation factor (AIF). CR 5801 furnished the calendar year 2008 AIF, which is 2.7 percent. The
revised fees are effective for dates of service JanuafY 1, 2008 and after.
Connecticut Fees Florida Fees
Code Fee Code Loc 99 Loc 03 Loc 04
A0425 6.42 A0425 6.42 6.42 6.42
A0426 285.36 A0426 229.04 240.27 249.50
A0427 451.82 A0427 362.64 380.44 395.04
A0428 237.80 A0428 190.86 200.23 207.92
A0429 380.48 A0429 305.38 320.37 332.67
A0430 2952.17 A0430 2,624.31 2,715.08 2,789.59
A0430 4428.26* A0430 3,936.46 4,072.62 4,184.39*
A0431 3432.33 A0431 3,051.13 3,156.67 3,243.31
A0431 5148.49* i\{)J;.j j 4,576.70 4,735.01 I ~l.7;t...'.'::;(, .ic
A0432 416.15 A0432 334.01 350.40 363.85
A0433 653.95 A0433 524.88 550.63 571.77
A0434 772.84 A0434 620.31 650.74 675.73
*""Rural Rate '" "" Rural Rate
Source: Publication 1 00-20, Change Request 5944
Revision to Certification for Hospital Services Covered by the Supplementary
Medical Insurance Program as it Pertains to Ambulance Services
CMS has issued the following MLN Matters article. Informationfor Medicare Fee-for.Service Health Care Professionals.
Provider Types Affected
Physicians, providers, and suppliers submitting claims to Medicare contractors (carriers, fiscal intermediaries [FIs], and/or
PartAIB Medicare administrative contractors [AJB MACs]) for ambulance services provided to Medicare beneficiaries.
Provider Action Needed
Change request (CR) 5833 rescinds and fully replaces CR 5684. This article is based on CR 5833, which updates the
section 20 of chapter 4 of the Medicare General Information, Eligibility, and Entitlement Manual as it pertains to physician
certification statement (PCS) requirements for all ambulance providers. CR 5833 deletes from that manual section the paragraph
that requires a physician certification of ambulance services provided by a hospital to transport a patient during an emergency
situation, such as transport from the scene of an accident.
Background
The Centers for Medicare & Medicaid Services (CMS) discovered there was a problem with a paragraph in the Medicare
General Information, Eligibility, and Entitlement Manual, chapter 4, section 20 regarding language not allowing the current
exception under PCS, i.e., that the PCS is not required during an emergency situation (such as the scene of an accident).
Therefore, CR 5833 deleted the following paragraph in chapter 4 (section 20) of the Medicare General Information,
Eligibility. and Entitlement Manual (Pub 100-01) that pertained to Physician Certification and Recertification of Services and
Ambulance Services because it conflicted with title 42 of the Code of Federal Regulations (CFR), sections 41OAO(d) (2) and (3);
Certification by a physician in connection with ambulance services furnished by a participating hospital is required.
In cases in which the hospital provides ambulance service to transport the patient from the scene of an accident and no
physician is involved until the patient reaches the hospital, any physician in the hospital who examines the patient or has
knowledge of the case may certify as to the medical needfor the ambulance service.
Deletion of this paragraph brings the manual into alignment with current regulations, which eliminate the pes requirement
in these emergency situations.
February 2008
The FCSO Medicare B Updatel
Attachment
30n
9