Frequently Asked Questions - Español

What is the Emergency Medical Services Transport (EMST) Fee?

The EMST Fee will be charged electronically to heath insurance companies of County and non-County residents who are transported to County hospitals by the Montgomery County Fire & Rescue Service (MCFRS). The net proceeds of the EMST Fee will go entirely to strengthening and improving fire and emergency services in Montgomery County. The imposition of the fee will not affect access to the excellent services now provided by MCFRS – except insofar as it strengthens those services by directing more resources to those needs.

Will I see any difference in Montgomery County EMS service?

No. MCFRS will continue to provide the very best service to any individual in need regardless of ability to pay – just the way it’s always worked.

Who pays the fee?

The health insurance companies of County residents and non-County residents. County residents with health insurance will not be responsible for co-pays or deductibles. County residents without health insurance will not be charged. Non-County residents with health insurance may be responsible for co-pays and deductibles, depending on their policies. Non-County residents without health insurance will receive a bill, along with a request to waive the fees under hardship guidelines.

Why is the fee necessary?

The demand for EMS response has been growing significantly for the past several years as the County has grown, especially in the Upcounty area. To respond to these service demands, improve response time, and enhance firefighter/rescuer officer safety, several enhancements have been initiated within MCFRS and will require additional resources in the future including:

• Implementing four-person staffing.
• Opening four new stations in the Upcounty area.
• Implementing an Apparatus Management Plan that will replace, upgrade and modernize apparatus, and provide additional maintenance staff, supplies, and maintenance facilities.
• Implementing the State required Electronic Patient Care Reporting (e-PCR) System. On December 31, 2008, the Maryland Institute for Emergency Medical Services Systems will discontinue paper reporting. Currently MCFRS utilizes this method. MCFRS must quickly implement on a fast track, an e-PCR program in order to meet State of Maryland requirements as well as be fully capable of complete revenue recovery.
• Expanding the number of officers consistent with supervisory and work hour requirements which will result in a reduction to overtime.
• Supporting Local Fire and Rescue Departments (LFRDs) by funding on-going station maintenance and other needs.
• Maintaining high levels of service to all parts of the County.

Also a factor is the pressure on County government budgets caused by economic uncertainty, declining housing markets, the state of Maryland’s budget crisis, and other factors. This has caused program reductions and increased property taxes. Clearly, a new revenue source dedicated to MCFRS would help ensure that fire and rescue services are adequately funded in the future.

Where will the money raised by the EMST Fee go?

100 percent of the net proceeds of the EMST Fee will go to strengthen and enhance the MCFRS. By law, they will be dedicated to that purpose and cannot be used for anything else.

Will there be co-pays and deductibles?

No, not for County residents. Non-County residents may be responsible for co-pays and deductibles, depending on their policies.

Do other area governments have an EMST Fee?

Nearly all of our neighboring jurisdictions either have an EMST Fee or are moving to implement one. These jurisdictions include Fairfax County, Frederick County, Prince George’s County, the District of Columbia, Arlington County, and the city of Alexandria. Anne Arundel County is in the process of initializing fee.

How about local governments in other parts of the United States?

The 200 City Survey in the 2006 Journal of Emergency Medical Services (JEMS) reported that, across the U.S., an average of 61% of EMS system funding comes from user fees.

Will this fee deter people from calling 911 for ambulance service?

There is no evidence from jurisdictions that have successfully implemented this fee that it deters anyone from calling for needed emergency medical transport assistance.

Will this fee cause health insurance rates to increase?

There is no documented evidence that ambulance bills affect underwriting of risks for insurance premiums. Ambulance bills are in the “hundreds” of dollars, compared to hospital, physician, surgeon, rehab, device, and drug bills, which are typically in the “thousands and tens of thousands.” Ambulance expenditures account for less than 1% of insurance expenditures. Since most insurance companies determine rates on a regional basis – and most jurisdictions in the region bill insurance companies for this charge -- in most cases County residents may already be paying for ambulance service as a part of their premiums.

What charges will be billed to insurance companies?

Insurance carriers would be billed at the following rates, depending on the level of services necessary:

Basic Life Support – Non-emergency*	$300.00
Basic Life Support – Emergency*	$400.00
Advanced Life Support – Level 1 – Non-Emergency*	$350.00
Advanced Life Support – Level 1 – Emergency*	$500.00
Advance Life Support – Level 2*	$700.00
Specialty Care Transport*	$800.00
* The terms in the schedule are as defined in 42 CFR Parts 410 and 414.

In addition, insurance companies would be billed $7.50 per mile on emergency transports, a standard charge for most implementing jurisdictions.

If the EMS call does not result in transport to a hospital, the health insurance carrier or the non-County resident without insurance would not be billed for anything.

According to the 2006 JEMS “200 City Survey,” here are average charges in the 200 largest cities in the U.S.

What if my health insurance plan only pays a certain amount for ambulance services or refuses to pay? Will I have to pay the balance?

The County will accept whatever payment the insurance company has established as “payment in full.” County residents will not be responsible for any co-pays or deductibles. Non-County residents will be responsible for any applicable co-pays or deductibles.

The single biggest payor for these services is Medicare. If coverage requirements are met Medicare has no discretion to deny claims. Heath insurance companies are required by law to pay covered services, of which ambulance services is one. Any question about any Medicare or insurance company payment would be handled by the third-party vendor and would not involve the covered individual.

How will this fee affect Local Fire & Rescue Departments (“Volunteer Companies”)?

Local Fire & Rescue Departments would deliver services just as they do now, the only difference being the entry of a code into the electronic tracking system to enable the contracted billing agent to process insurance company payments or, in the case of non-County residents without insurance, to bill for the service, with accompanying information about hardship waivers.

The County has discussed with Local Fire & Rescue Departments possible revenue sharing, as well as potential opportunities to offset any unexpected reductions in their local fundraising that might conceivably result from the implementation of an EMST fee – although there is no evidence in other jurisdictions of a drop-off in donations owing to the implementation of an EMST Fee.

How will the billing to insurance companies work?

Data will be entered by EMS personnel in the Electronic Patient Reporting System, which will be required by the State – independent of any EMST Fee – starting December 31, 2008. Paper reporting, currently used by MCFRS, will no longer be accepted. That information will be examined by the third-party vendor responsible for billing health insurance companies and non-County residents without insurance.

What will be the start-up costs for this program? What will be the ongoing expenses?

The County is projecting about $700,000 in start-up costs for the first half year, half of which is the 5 percent of proceeds payment to the third-party billing vendor. Once the program is up and running, the overhead costs are estimated at 13-14 percent of total revenue – again, including the five percent going to the third-party billing vendor.

Will there be efforts to educate County residents about how the system works – and how no County residents will pay out-of-pocket?

While there is no evidence from any of these jurisdictions that adoption of an EMST fee has resulted in any diminution of calls for 911 emergency transport or any reluctance of residents to call for needed services due to a misunderstanding that they might incur a fee, a solid campaign of public outreach and education just makes good sense. Such a campaign would begin several months before the program actually began and extend several months afterward.

Revised June 21, 2008