Agenda Item 3.6
March 23, 2010
Introduction
MEMORANDUM
TO:
FROM:
County Council
~ichael
Faden, Senior Legislative Attorney
Minna Davidson, Legislative Analyst
Introduction:
Expedited Bill 13-10, Emergency Medical Services Transport Fee
- Established
SUBJECT:
Expedited Bill 13-10, Emergency Medical Services Transport Fee - Established,
sponsored by the Council President at the request of the County Executive, is scheduled to be
introduced on March 23, 2010. A public hearing is tentatively scheduled for April 13 at 7:30
p.m.
Bill 13-10 would authorize the County to impose and collect a fee to recover costs
generated by providing emergency medical service transports. This bill would also provide for a
schedule of emergency medical services, transport fees, fee waiver criteria, permitted uses of fee
revenues and other procedures to operate the emergency medical services fee program. Bill lS­
10 would prohibit a local Fire and Rescue Department from imposing a separate emergency
medical services transport fee. The Executive would be required to issue regulations to
implement the fee; draft regulations are attached on ©7-9.
This packet contains:
Expedited Bill 13-10
Legislative Request Report
Memo from County Executive
Draft regulation
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Expedited Bill No.
13-10
Concerning: Emergency Medical Services
Transport Fee - Established
Revised: 3-22-10
Draft No. _1_
Introduced:
March 23, 2010
Expires:
September 23, 2011
Enacted: _ _ _ _ _ _ _ _ __
Executive: _ _ _ _ _ _ _ _ __
Effective: _--::--:--_ _ _ _ _ __
Sunset Date: -'N"""o=n:'-=e'-:.--::--_ _ __
ChI _ _, Laws of Mont. Co. _ _ __
COUNTY COUNCIL
FOR MONTGOMERY COUNTY, MARYLAND
By: Council President at the Request of the County Executive
AN EXPEDITED ACT
to:
(l)
authorize the County to impose and collect a fee to recover costs generated by
providing emergency medical service transports;
(2) provide for a schedule of emergency medical services transport fees, fee waiver
criteria, permitted uses of fee revenues, and other procedures to operate the
emergency medical services fee program;
(3) prohibit a Local Fire and Rescue Department from imposing a separate emergency
medical services transport fee;
(4) require the Executive to issue certain regulations to implement an emergency
medical services transport fee;
(5) require a certain annual transfer
be
made as payment of residents' uninsured portion
of the emergency medical services transport fee; and
(6) generally amend County law regarding the provision of emergency medical services;
By adding
Montgomery County Code
Chapter 21, Fire and Rescue Services
Section
21-23A.
Emergency Medical Services Transport Fee
Boldface
Underlining
[Single boldface brackets]
Double underlining
[[Double boldface brackets]]
* * *
Heading or defined term.
Added to existing law by original bill.
Deletedfrom existing law by original bill.
Added by amendment.
Deletedfrom existing law or the bill by amendment.
Existing law unaffected by bill.
The County Council for Montgomery County, Maryland approves the following Act.'
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EXPEDITED BILL
No. 11-10
1
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Sec.
1.
Section 21-23A is added as follows:
21-23A.
Emergency Medical Services Transport Fee.
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4
W
Definitions.
In this Section the following tenns have the meanings indicated:
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ill
Emergency medical services transport
means transportation
Qy
the Fire and Rescue Service of an individual
Qy
ambulance or
other Fire and Rescue Service vehicle used for
purpose.
~
7
8
similar
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11
Emergency medical services transport
does not
include transportation of an individual under an agreement
between the County and
~
health care facility.
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ill
Federal poverty guidelines
means the applicable health care
poverty guidelines published in the Federal Register or
otherwise issued
Qy
the federal Department of Health and
Human Services.
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ill
{hl
Fire and Rescue Service
includes each local fire and rescue
department.
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Imposition gffee.
The County must impose
fee for any emergency
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medical services transport provided in the County and, unless
prohibited
Qy
other law, outside the County under
agreement.
(£)
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mutual aid
Liability fOr fee.
Subject to subsection (Q1 each individual who
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receives an emergency medical services transport is responsible for
paying the emergency medical services transport fee.
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Hardship waiver.
ill
The Fire Chief must WaIve the emergency medical servIces
transport fee for any individual whose household income is at or
27
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EXPEDITED BILL
No.
13-10
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below 300 percent of the federal poverty guidelines.
An
individual must request
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waiver on
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form approved
Qy
the Fire
Chief.
ill
The Fire Chief may deny
~
request for
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waiver if an individual
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who claims financial hardship under this Section does not
furnish all information required
Qy
the Fire Chief.
ill
Payment
Q[
Residents' Uninsured Portion
Q[
the Emergency Medical
Services Transport Fee.
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Tax revenues received
Qy
the County must be treated as
payment, on behalf of County residents, of the balance of each
resident's portion of the emergency medical services transport
fee that is not covered
Qy
the resident's insurance.
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ill
The County Council must annually transfer from the General
Fund to the Consolidated Fire Tax District Fund an amount that
the Council estimates will not be covered
Qy
residents'
insurance as payment of all residents' uninsured portion of the
emergency medical services transport fee.
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ill
Obligation to transport.
The Fire and Rescue Service must provide
emergency medical services transport in accordance with applicable
medical protocols to each individual without regard to the individual's
ability to
lli!Y:.
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(g)
Restriction on Local Fire and Rescue Departments.
A local fire and
rescue department must not impose g separate fee for an emergency
medical transport.
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{h}
Use
Q[
revenue.
Except for the transfer received from the General
Fund under subsection
ill
and in the first fiscal year this fee is
implemented, the revenues collected from the emergency medical
CD
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EXPEDITED BILL
No. 13-10
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servIces transport fee must be used to supplement. and must not
supplant, existing expenditures for emergency medical services and
other related fire and rescue services provided
Qy
the Fire and Rescue
Service.
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Regulations.. fee schedule.
regulation under method
The County Executive must adopt
ill
to implement the emergency medical
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services transport fee program. The regulation must establish
fee
schedule based on the cost of providing emergency medical services
transport.
The fee schedule may include an annual automatic
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adjustment based on inflation, as measured
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an index reasonably
related to the cost of providing emergency medical services transports.
The regulation may require each individual who receives an
emergency
medical
servIces
transport
to
provide
financial
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infonnation, including the individual's insurance coverage, and to
assign insurance benefits to the County.
Sec. 2. Expedited Effective Date.
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The Council declares that this legislation
IS
necessary for the immediate
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protection of the public interest. This Act takes effect on the date when
it
becomes
law.
Approved:
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Nancy Floreen, President, County Council
Date
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Approved:
Isiah Leggett, County Executive
Date
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LEGISLATIVE REQUEST REPORT
Expedited Bill 13-10
Emergency Medical Services Transport Fee - Established
DESCRIPTION:
This Bill would authorize the County to impose and collect a fee to
recover costs generated by providing emergency medical services
transports.
In order to meet current fiscal challenges facing the County, the County
must increase the amount of revenue available to maintain core
Government programs and services.
To enhance the amount of revenue available to support core government
programs and services.
PROBLEM:
GOALS AND
OBJECTIVES:
COORDINATION:
Office of Management and Budget; Department of Finance; Fire and
Rescue Service
FISCAL IMPACT:
To be requested.
ECONOMIC
IMPACT:
EVALUATION:
To be requested.
Subject to the general oversight of the County Executive and the County
Council.
Many jurisdictions in the regions have imposed an emergency
medical services transport fee.
Joseph Beach, Director of Management and Budget
Kathleen Boucher, Assistant Chief Administrative Officer
Richard Bowers, Chief, Fire
&
Rescue Service
Marc Hansen, Acting County Attorney
EXPERIENCE
ELSEWHERE:
SOURCES OF
INFORMATION:
APPLICATION
Yes.
WITHIN
MUNICIPALITIES:
PENALTIES:
To be researched.
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OFFICE OF THE COUNTY EXECUTIVE
ROCKViLLE. MARYLAND 20850
lsiab Leggett
C01m~v
Executive
MEMORANDUM
fL,
I"
1
":
March 18,2010
TO:
FROM:
SUBJECT:
Nancy Floreen, Council President
Isiah Leggett, County
Executive~~~
/'7
-- "1
FY 2011 Budget Reconciliation and Financing Act
I am attaching for Council's consideration a Budget Reconciliation and Financing
Act (BRFA) which makes changes to the County Code that are necessary to reconcile my
recommended FY 2011 operating budget with projected FY 2011 revenues. This bill will help
the County address its current fiscal challenges by increasing the amount of revenue available to
maintain and enhance core government programs and services. I am also attaching a Legislative
Request Report for the bill. A Fiscal Impact Statement will be transmitted to Council soon.
The BRF A consists of five primary components. First, it increases the energy tax
rates. Second, it temporarily redirects the portion of recordation tax revenues that are currently
reserved for County Government capital projects and rental assistance programs to the general
fund for general purposes. Third, it allows revenues generated by the Water Quality Protection
Charge to be used to pay debt service on bonds that fund stonnwater management infrastructure
projects. Fourth, it transfers responsibility for administering equal employment opportunity
programs from tlle Office of Human Resources to the Office of Human Rights. Fifth, it
authorizes the Fire and Rescue Service to impose an Emergency Medical Services (EMS)
Transport Fee.
As the Council knows, the County's energy tax is actually a tax on fuel oil,
natural gas, and electric utility providers which is passed on to all utility customers. Because the
energy
tax
is a broad-based tax, its impact on families is reduced by the fact that it is paid by
. businesses and households, and all levels of government, including federal agencies located in
the County (that currently do not pay any other major County tax). Additionally, the energy tax
is a consumption tax based on energy usage.
It
is not based on the overall size of the utility bill
or the cost per unit of energy used as billed to the consumer. Therefore, the amount of the tax
can be lessened by reduced energy usage. Based on existing usage patterns for the average
homeowner, my recommended FY 2011 budget assumes an average increase in the energy tax of
approximately $2.90 per month. I have also recommended additional funding in the Health and
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Nancy Floreen, Council President
March 18,2010
Page 2
Human Services budget for the County's Energy Assistance Program to minimize the impact to
low-income households.
My recommended FY1l budget contains several efforts to restructure County
Government to improve responsiveness and efficiency. One of these changes is the transfer of
the Equal Employment Opportunity program from the Office of Human Resources to the Office
of Human Rights. This shift takes advantage of existing staff resources to reduce costs and
leverage the efforts of County staff to produce better outcomes for the community. This bill
modifies the County code provisions relating to the responsibilities ofthe Office of Human
Resources and Office of Human Rights to reflect this change.
The EMS Transport Fee is needed to fund fire and rescue services in the County.
Without this fee, emergency response to residents will be impaired. EMS Transport Fees are
widely employed throughout the nation and by local governments throughout the Washington
region. These jurisdictions have not experienced any indication that people decline to use
emergency transports as a result of the imposition of an ambulance fee. By creating a prepaid
fund for uninsured County residents, the legislation that I am transmitting imposes a fee only on
County residents with health insurance which covers EMS Transports. This arrangement more
equitably distributes the economic burden of providing EMS transport services in the County
between residents and nonresidents. The legislation provides for a hardship waiver for
nonresidents who fall below 300 percent of federal poverty guidelines.
To provide the Council with a complete picture of the EMS Transport Fee
program created by this bill, I am attaching a copy of the proposed Executive Regulation to
implement the fee. This proposed regulation will be published in the April 2010 County Register
and submitted to Council after the 30-day public comment period ends on April 30.
Finally, I note that the BRFA is consistent with Bill 31-09, Consideration of
Bills - One Subject (enacted on September 29, 2009), which requires that a bill "contain only
one subj ect matter".· As noted in the Council staff packet for Bill 31-09, that bill was intended to
adopt the "one subject rule" of the Maryland Constitution, which requires all laws enacted by the
General Assembly to contain only one subject. The Maryland Attorney General has repeatedly
concluded that budget reconciliation and financing bills do not conflict with the one subject rule.
For example, in 2005, the Attorney General noted that "[f]or the past fourteen years, 15 budget
reconciliation, budget reconciliation and financing acts or variations thereof, have been used to
balance budgets, raise revenue, make fund transfers, redistribute funds, cut mandated
appropriations and authorize or mandate appropriations."j The Attorney General concluded that
all of those bills were consistent with the one subject rule because the provisions ofthe bills were
"clearly germane to the single subject of financing State and local government".
See Panitz v.
Comptroller ofthe Treasury,
247 Md. 501 (1967) (Omnibus supplemental appropriation bill
comprised a single subject for purposes of
§
29 of
Art
III of the State Constitution even though
I
See May 19, 2005 memorandum from Attorney General J. Joseph Curran, Jr. to Governor Robert Ehrlich regarding
House Bill 147 (2005).
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Nancy Floreen, Council President
March 18,2010
Page 3
the bill combined such diverse elements as police aid to local government; teacher salaries and
pensions; and general unrestricted grants to local government).
Attachments (3)
cc:
Joseph Adler, Director, Office of Human Resources
Jennifer Barrett, Director, Finance Department
Joseph Beach, Director, OMB
Kathleen Boucher, ACAO
Richard Bowers, Fire Chief, MCFRS
Marc Hansen, Acting County Attorney
Robert Hoyt, Director, DEP
Richard
Y.
Nelson, Jr., Director, DHCA
James Stowe, Director, Office of Human Rights
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MONTGOMERY COUNTY
EXECUTIVE REGULATION
Offices of the County Executive • 101 Monroe Street • Rockville, Maryland 20850
Subject
Emergency Medical Service Transport Fees
Originating Department
Montgomery County Fire and Rescue Service
Number
Effective Date
Montgomery County Regulation on
EMERGENCY MEDICAL SERVICE TRANSPORT FEES
Issued by: County Executive
Regulation No. _ _ __
COMCOR: Chapter 21
Authority: Code Section 21-23A
Supersedes:
N/A
Council Review: Method (2) under Code Section 2A-15
Register Vol. __ No. __
Effective Date: Date Bill XX-I 0, "FY 2011 Budget Reconciliation and Financing Act"
becomes effective
Comment Deadline: April 16, 2010
Summary:
This Regulation establishes:
(1)
An emergency medical services transport fee schedule;
and (2) a requirement that an individual who receives an emergency medical services
transport provide certain information and execute an assignment of certain health
insurance benefits.
Scott Graham, Assistant Chief, Montgomery County Fire and Rescue Service
(240) 777-2493
Montgomery County Fire and Rescue Service
101 Monroe Street, 1
i
h
Floor
Rockville, Maryland 20850
Staff contact:
Address:
Page 1 of3
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MONTGOMERY COUNTY
EXECUTIVE REGULATION
Offices ofthe County Executive • 101 Monroe Street • Rockville, Maryland 20850
Subject
Emergency Medical Service Transport Fees
Originating Department
Montgomery County Fire and Rescue Service
Section
1.
Fee Schedule
Number
Effective Date
a.
In imposing and collecting the emergency medical services transport fee authorized under
Code Section 21-23A, the Fire Chief must comply with all applicable provisions of
42 CFR Parts 410 and 414,
Fee Schedule for payment ofAmbulance Services and
Revisions to the Physician Certification Requirements for Coverage ofNon-emergency
Ambulance Services.
The Fire Chief must impose the emergency medical services transport fee according to
the following schedule:
i.
11.
b.
$8.50 per mile, one way, from point of pick up to
the health care facility; plus
• Basic Life Support - Non-emergency*
• Basic Life Support Emergency *
• Advanced Life Support - Levell - Non-Emergency*
• Advanced Life Support Level 1 Emergency *
• Advance Life Support - Level 2*
• Specialty Care Transport*
$300.00
$400.00
$350.00
$500.00
$700.00
$800.00
* The terms in the schedule are as defined in 42 CFR Parts 410 and 414.
Section 2.
Required Information; Assignment of Benefits.
a.
An individual who receives an emergency medical services transport must furnish
to the County or the County's designated agent: (i) information pertaining to the
individual's health insurer (or other applicable insurer); and
(ii)
if applicable, financial
information that the Fire Chief determines is necessary for determining eligibility for a
waiver of the fee.
An insured individual who receives an emergency medical services transport must
execute an assignment of benefits necessary to permit the County to submit a claim for
the fee to the applicable third party payor.
The Fire Chief must increase the amount of the fees in the schedule annually by the
amount of the Ambulance Inflation Factor (AIF) as published by the Centers for
Medicare and Medicaid Services (CMS), United States Department of Health and Human
Page 2 of3
b.
c.
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MONTGOMERY COUNTY
EXECUTIVE REGULATION
Offices
of the
County Executive -101 Monroe Street - Rockville, Maryland 20850
Subject
Emergency Medical Service Transport Fees
Originating Department
Montgomery County Fire and Rescue Service
Services.
Number
Effective Date
Section 3.
Severability .
If a court of final appeal holds that any part of this regulation is invalid, that ruling does not
affect the validity of other parts of the regulation.
Section 4.
Effective Date.
This regulation is effective on the date that Bill XX-10, "FY
2011
Budget Reconciliation and
Financing Act" becomes effective.
Approved:
Isiah Leggett, County Executive
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