Item G3
BOARD OF GOVERNORS
FIRE AND AMBULANCE DISTRICT 1
AGENDA ITEM SUMMARY
Meeting Date; September 17.2008 Division: Emergency Services
Bulk Item: Yes --2L No - Department: Fire Rescue
Staff Contact Person: Camille Dubroff
AGENDA ITEM WORDING: Approval of Resolution of the Board of Governors of Fire and
Ambulance District 1 of Monroe County, Florida superseding Resolution 263-2004 and adopting an
amended fee schedule for use by the special taxing district for providing ground ambulance services.
ITEM BACKGROUND: The current fee schedule is outdated as it has been four years since Monroe
County has increased ground ambulance billing rates. In preparation of this rate increase, we asked for
recommendations and information from our billing contractor, Advanced Data Processing Inc. (ADPI).
ADPI provided us a comparative fee schedule from similar clients plus the current and anticipated
reimbursement rates for Medicare, once the Medicare Ambulance Payment Extension Act goes into
effect. (Attachment A). Medicare reimbursements define the industries standards for compensation for
the different levels of service. In addition, a ground ambulance analysis was completed to show that the
budget and expenses for the service have increased yearly, yet the fees which result in biUing
receivables, have not been increased to aid in the cost for the service. (Attachment B). 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 BOG ACTION: On September 8, 1999, the Board of Governors adopted
Resolution 438-1999, establishing a fee schedule for use by Fire and Ambulance District 1 of Monroe
COlll1ty, Florida for providing ambulance service. On July 14, 2004 the Board of Governors approved
superseding Resolution 438-] 999 and adopting an amended fee schedule with Resolution 263-2004 for
use by the special taxing district for providing ground ambulance services.
OLD RATE NEW RATE
$500.00 $600.00
$500.00 $600.00
$600.00 $800.00
$200.00 $200.00
$9.00 er mile $12.00 er mile
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 X No _ ~fOUNT PER MONTH_ Year L
APPROVED BY: ~ ~ tl FY07R"~516
County Atty U /Purchasing _ Risk Management
DOCUMENTATION: Included X Not Required_
DISPOSITION: AGENDA ITEM #
Revised 08/06
I
i
Emergency Services
RESOLUTiON NO. -2008
A RESOLUTION OF THE BOARD OF GOVERNORS,
FiRE AND AMBULANCE DISTRICT 1 OF
MONROE COUNTY, FLORIDA~ SUPERSEDING
RESOLUTION NO. 263-2004, AND ADOPTING AN
AMENDED FEE SCHEDULE FOR USE BY THE SPECIAL
TAXING DISTRICT FOR PROVIDING GROUND ;
AMBULANCE SERVICES. l
[
WHEREAS, Ordinance No. 050-1987 was passed and adopted by the Board of County
Commissioners of Monroe County, Florida on November] 7, 1987;
WHEREAS, in accordance with Section 3 of said Ordinance No. 050-1987, the governing
bodies of the several special taxing districts shall have the right to establish rates of user fees by I
Resolution; and
WHEREAS, the Board of Govemors, Fire and Ambulance District I of Monroe County, I
Florida, previously adopted Resolution No. 263-2004, adopting a fee schedule for use by the speciaL !
i
taxing district that provides County operated ground ambulance services in Monroe County; and
WHEREAS, the Board desires to revise the fee schedule; now therefore,
BE IT RESOLVED BY THE BOARD OF GOVERNORS, FIRE AND AMBULANCE
DISTRICT 1 OF MONROE COUNTY, FLORIDA, that,
1. Effective September 17, 2008> Resolution No. 263-2004, adopted by the Board of
Governors on July 14, 2004, is hereby superseded by tIus Resolution; and
2. Effective September 17, 2008, the Board adopts the following Fee Schedule for use by the
special taxing disnict for providing ground ambulance services.
Transpolt Base Fee - Basic Life SUpport (BLS) $600.00
Transport Base Fee - Advanced Life Support (ALS I) $600.00
Transport Base Fee - Advanced Life Support (ALS2) $800.00
Standby (Special Events) $200.00
Mileage $12.00 per mile
PASSED AND ADOPTED by tile Board of Governors, Fire and Ambulance District 1 of
Monroe County, Florida, at a regular meeting of said Board held on the day of
,2008.
Mayor Norman Anderson
Chairman Clark Snow
Commissioner Sonny McCoy
Commissioner Dixie Spehar
Commissioner George Neugent
(SEAL) BOARD OF GOVERNORS, FIRE AND
AMBULANCE DISTRICT 1 OF MONROE
COUNTY, FLORIDA
Attest: DANNY L. KOLHAGE, Clerk By:
Mayor/Chairperson
MONROE COUNTY ATTORNEY
By A~~~:~;
Deputy Clerk
CYNTH IA L. HAlL
ASSI~ANT CO~Nb~ATTORNEY
Date ~ ~ - 0
Fire Rescue
RESOLUTION NO. 263 -2004
A RESOLUTION OF THE BOARD OF GOVERNORS,
FIRE AND AMBULANCE DISTRICT 1 OF
MONROE COUNTY, FLORIDA, SUPERSEDING
RESOLUTION NO. 438-1999, AND ADOPTING AN
AMENDED FEE SCHEDULE FOR USE BY THE SPECIAL
TAXING DISTRICT FOR PROVIDING 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 of the several special taxing districts shall have the right to establish rates of user fees by
Resolution; and
WHEREAS, the Board of Governors, Fire and Ambulance District I of Monroe County,
Florida, previously adopted Resolution No. 438-1999, adopting a fee schedule for use by the special
taxing district that provides County operated ambulance services in Monroe County; and
.
WHEREAS, the Board desires to revise the fee schedule; now therefore,
BE IT RESOLVED BY THE BOARD OF GOVERNORS, FIRE AND AMBULANCE
DISTRICT 1 OF MONROE COUNTY, FLORIDA, that,
1. Effective October 1,2004, Resolution No. 438-1999, adopted by the Board ofGov~mors
on September 8, 1999, is hereby superseded by this Resolution; and
2. Effective October 1, 2004, the Board adopts the attached Fee Schedule for use by the
special taxing district for providing. aplbulance .s>~rvic~s.
,,1\ J,.;.,.,....!./~.H ..'~;.. .~, '/",t...\.. ~
PASSED AND ADOPTED by t4e B9ard . of Gov~mOl:s, Fire and Ambulance District I of
Monroe County, Florida, at a .r~gUrar,'1iieeting of saicC130ard held on the~ 14th gday?cf
. c::; .r-
Julv ,2004. 0 1:' c- 1'"1
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Chairperson Kevin Madok yes ~,~ N d
Mayor Pro Tern David Rice yes g'~~ -:;0
Coyupissioner George Neugent ~?-.;.. "'0 :::0
.. yes 1'1
. 'CO~sioner Dixie Spehar . ',_4 -ieJ '._ :E
. . YPl': -<.,-1... ~
, \ , ':,C{)tJp.?t~ J ohn Cromarti~ . . j:-- r:'" .--
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yes "VI CI .. . J
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(SEAi-r\ .';,.:.i, BOARD OF GOVERNORS, FIRE AND
: . _~/t ~;: AMBULANCE DISTRICT 1 OF MONROE
" CO~RIDA
./
" '.4~.' ~~- ~-}1~
.. .
Attest: DANNY L. KOLHAGE, Clerk By:
B~~~ Mayor/Chairperson
../ ~Ji'~~; f ic t>:;.~t".J -f' Pi', . C -.
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AMBULANCE FEE SCHEDULE
EFFECTIVE 10/1/2004
Transport Base Fee - Basic Life Support (BLS) $500.00
Transport Base Fee - Advanced Life Support 1 (ALSl) $500.00
Transport Base Fee - Advanced Life Support 2 (ALS2) $600.00
Stand By (Special Events) $200.00
Mileage $ 9.00 (per mile)
Comparitive Fee Schedule
City/County ALSi ALS2 SCT2 BLS 02 MILE
Pom pano Beach Broward County $ 750.00 $ 750.00 $ 750.00 $ 50.00 $ 10.00
Deerfield Beach Broward County $ 700.00 $ 750.00 $ 650.00 $ 12.00
Margate Broward County $ 700.00 $ 750.00 $ 700.00 $ 10.00
Miramar Broward County $ 700.00 $ 750,00 $ 700.00 $ 10.00
Boca Raton Palm Beach County $ 554.44 $ 715.42 $ 745.22 $ 554.44 $ 10.15
Hallandale Beach Broward County $ 500.00 $ 500.00 $ 500.00 $ 20.00 $ 7.50
Lighthouse Point Broward County $ 500.00 $ 600.00 $ 500.00 $ 9.00
Monroe Monroe County $ 500.00 $ 600.00 $ 500.00 $ 9.00
Lauderhill Broward County $ 475.00 $ 575.00 $ 450.00 $ 9.00
Broward Sheriff Broward County $ 460.00 $ 575.00 $ 450.00 $ 27.00 $ 8.00
Cooper City Broward County $ 460.00 $ 575.00 $ 450.00 $ 27.00 $ 8.00
Fort Lauderdale Broward County $ 452.00 $ 525.00 $ 425.00 $ 30.30 $ 8.50
Coral Sprinas Broward County $ 450.00 $ 575.00 $ 400.00 $ 7.00
DaniaBeach Broward County $ 450.00 $ 550.00 $ 450.00 $ 9.00
Hollywood Broward County $ 450.00 $ 550.00 $ 450.00 $ 9.00
North Lauderdale Broward County $ 450.00 $ 550.00 $ 425.00 $ 8,00
Riviera Beach Palm Beach County $ 450.00 $ 575.00 $ 450.00 $ 8.00
Davie Broward County $ 400.00 $ 530.00 $ 400.00 $ 30.00 $ 8.00
Tamarac Broward County $ 400.00 $ 500.00 $ 360.00 $ 7.25
Miami Dade Miami Dade County $ 380.00 $ 490.00 $ 330.00 $ 30.00 $ 7.50
Miami Beach Miami Dade County $ 380.00 $ 490.00 $ 330.00 $ 30.00 $ 7.50
Hialeah Miami Dade County $ 380.00 $ 490.00 $ 330.00 $ 30.00 $ 7.50
Plantation Broward County $ 360.00 $ 480.00 $ 330.00 $ 25.00 $ 7.00
Average $ 491.37 $ 584.58 $ 745.22 $ 473.24 $ 29.93 $ 8.56
Median $ 452.00 $ 575.00 $ 745.22 $ 450.00 $ 30.00 $ 8.00
'Most Counties in Florida are in the process of reviewing rates for increases.
Attachement A
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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) in the Senate and
Representatives Mike McNulty (D-NY), Tom Reynolds (R-NVj, Chip Pickering (R-
MS) and Tom Allen (D-ME) in the House. Representative Phil English (R-P A) also
signed on as an original cosponsor of the House bill. The legislation would provide
critical timely Medicare relief to aU ambulance service providers.
The legislation would implement a Medicare increase of 5% to all ambulance
service providers regardless of the 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 relief would commence on January 1,2008 and expire on
December 31,2009. Since we are past the commencement da,te, 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 50 plus mileage bump, the regional fee schedule
adjustment or the super rural bonus payment. If enacted, S. 1310 and H.R. 2164
would result in an estimated $341 million in additional Medicare relief to ambulance
service providers.
Attachment A
30f4
~~~"-~I:L1Ji!1l1~~
-
2008 Ambulance Fee Schedule
Section 1834(1) (3) (B) ofthe Social Security Act (the Act) provides the basis for updating payment limits that carriers, fiscal
intermediaries, and PartNB 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-U), for the 12-month period ending with June ofthe 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 January 1,2008 and after.
Connecticut Fees Florida Fees
Code Fee Code Loc99 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 3,243.3 I
A0431 5148.49* A043 I 4,576.70 4,735.01 4,864.96*
A0432 416.15 A0432 334.D1 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 100-20, 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-jor-Service Health Care Professionals.
Provider Types Affected
Physicians, providers, and suppliers submitting claims to Medicare contractors (carriers, fiscal intermediaries [FIs], and/or
PartAfB Medicare administrative contractors [AfB 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 siruation (such as the scene of an accident).
Therefore, CR 5833 deleted the following paragraph in chapter 4 (section 20) ofthe 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 ofthe Code of Federal Regulations (CFR), sections 41O.40(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 PCS requirement
in these emergency situations.
February 2008 The FCSO Medicare B Update! 9
Attachment A
40f4
Ground Ambulance Analysis
COST
of EMS Services. Ground Billing Recievables Percentage of
(13001 ) REVENUE REVENUE vs. COST
2004 $ 3,388,632 $ 345,770 10.20%
2005 $ 4,147,273 $ 426.495 10.28%
2006 $ 4,267,076 $ 378,037 8.86%
2007 $ 4,183,211 $ 393,517 9.41%
2008* $ 3,989,542 $ 298,352 7.48%
.2008 figures represent 10 months of the bUdget and recievables, from Oct through Jul 2008. The Tota! FY 2008 budget is $4,787,451.00
. .
Attachment B