Agenda Item 9
May 15,2012
Action
MEMORANDUM
TO:
FROM:
County Council
~
Michael Faden, Senior Legislative Attorney
Essie McGuire, Senior Legislative
Analyst~Lf?l~/
Action: Expedited Bill 17-12, Fire and Rescue Service
Services - Reimbursement
Emergency Medical
SUBJECT:
Public Safety Committee recommendation:
do not enact Bill 17-12 (2-1,
Councilmember Eirich dissenting).
If
the Bill is enacted, adopt Executive and Committee
amendments included in Committee redraft (3-0).
Expedited Bill 17-12, Fire and Rescue Service
Emergency Medical Services ­
Reimbursement, sponsored by the Council President at the request of the County Executive, was
introduced on April 24, 2012. A public hearing was held on May 8 and a Public Safety
Committee worksession was held on May 11.
Introduced Bill Expedited Bill 17-12 would authorize the County to impose and collect
a reimbursement to recover costs generated by providing emergency medical services transports.
This Bill is essentially identical in all material respects to Bill 13-10, which the Council enacted
on May 19, 2010, but the voters rejected in a referendum in November 2010 (see ballot and
petition language on ©55-56).
Executive amendments On May 8 the Executive submitted an amended Bill. (See the
Executive's explanatory memo on ©59-60.) The Executive's amendments clarify, but do not
substantially change, the central elements of the introduced Bill. They also add provisions that
would authorize the Executive to conduct an outreach and infonnation campaign to publicize the
reimbursement program, and would create a Patient Advocate position in the Office of Consumer
Protection.
Public hearing testimony Attached on © 18-54 are selected representative public
hearing testimony and related letters, including two from regional advisory boards which
endorsed this BilL Much of the testimony at the May 8 hearing repeated viewpoints about this
fee which the Council has heard many times before.
I
The most notable new testimony came
IMuch of the testimony from opponents of this Bill centered on the theme of "Respect the Voters", which would
treat as binding on the Council and Executive, for some unknown period of time, the 2010 voters' rejection of the
previous EMST fee law. In Council staff's view, this argument carries weight but should not be conclusive. There
is no legal bar to the Council enacting a similar, or even identical, law post-referendum. Presumably, no one would
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from fire chiefs in 3 nearby jurisdictions (Fairfax County, Anne Arundel County, and Prince
William County) which have adopted similar fees; in each case the Fire Chief reported that the
fees have been successfully implemented and have not resulted in negative consequences. See
Prince William County and Anne Arundel County testimony on ©35-46.
Committee worksession
At its May 11 worksession on this Bill, the Public Safety
Committee discussed and recommended adoption of the amendments submitted by the
Executive, with minor modifications, and other amendments before recommending (2-1,
Councilmember EIrich dissenting) that Bill 17-12 not be enacted. All Committee members
agreed that, if the Council enacts the Bill, it should be enacted with the Executive and other
Committee amendments shown on ©1-4B.
Committee members directed Council staff to work
with Executive branch staffto draft several amendments after the worksession; these are shown
on
©62-65,
and have not been approved by Committee members.
Budget Assumptions and Implications
The Executive submitted budget information and a proposed amendment to this Bill to
clarify the relationship of the EMST reimbursement revenue to the FY13 and future budgets.
The proposed amendment would specify that the "revenues collected from the emergency
medical services transport reimbursement must be used to supplement, and must not supplant,
Fiscal Year 2012 expenditures for emergency medical services and other related fire and rescue
services provided by the Fire and Rescue Service."
The Executive also submitted (see ©17) a spreadsheet detailing eligible FRS
expenditures in FY13-I8. For FY13, the spreadsheet lists the elements of the FY13
recommended budget increase for MCFRS, which totals $16.7 million. The net available
revenue from the reimbursement (less implementation costs) is projected to start at $8.6 million
in FYI3 and increase to $18.4 million in FYI8.
The Executive's approach to use of the EMST revenue would establish FY12 MCFRS
expenditures as the base that must not be supplanted. In FY13, the projected available EMST
reimbursement revenue of $8.6 million is less than the recommended MCFRS budget increase of
$16.7 million. The FY 13 budget increase does not reflect an increase in service capacity or
delivery. Rather, it more fully funds the currently approved level of service delivery by restoring
lapse and overtime reductions, among other personnel adjustments.
In future years, the MCFRS budget could be limited to only the amount of the available
EMST reimbursement revenue above the FY12 expenditure base and still meet the Bill's non­
supplantation requirement. While the Executive's spreadsheet on ©17 identifies other potential
eligible Fire and Rescue Service expenditures in FYI4-I8, such as apparatus and facilities, the
,
argue that the Council is forever bound not to do so, so the question is what period of time constitutes a "decent
interval" before the Council should revisit the issue. The Executive's view, emphasizing recent state and County
fiscal developments, is that now is not too soon. Just as a party in a court case can seek reconsideration of a
seemingly erroneous court decision, we think the Council, and potentially the voters, can fairly be asked to
reconsider their initial decision on this issue when circumstances warrant.
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Bill as amended would not require these expenses to be funded by EMST revenue. A $16-18
million increase above the FY12 MCFRS budget level could be met by continuing to fund the
ongoing FYI3 elements.
It
could also support future years' negotiated compensation
agreements, among other expenses.
The Executive's approach is the most fungible use of the EMST revenue; it offsets the
need to use general fund revenue to fund base expenditures in the MCFRS budget. However,
it
does not necessarily translate into increased Fire and Rescue services in FY13 or any future
year.
The Executive's March 15 budget submission funded the $16.7 million increase to
MCFRS within its balanced revenue assumptions. In his April 26 budget amendments, the
Executive added the projected $8.6 million revenue to his resource assumptions, but only
identified $954,450 in associated expenditures needed to implement the EMST reimbursement
program. As a result, the Executive's budget contains $7.6 million in unallocated revenue which
he currently carries as an FY 13 end of year fund balance in the Fire Fund.
Revenue use options/Committee recommendations
If the Council enacts an EMST reimbursement program, Councilmembers could select
any of the following
4 options
to use the resulting revenue.
1) Treat the funds as a fungible revenue source for any fire service expenditure
above the FY12 base budget level, as the Executive recommended.
This allows the most
flexible use and offset of the revenue.
It
primarily supports the FY13 recommended base budget
level and can allow, but does not necessarily result in, increased services in the future.
2) Keep the funds as a fungible resource for fire services, but require the Council to
specify
in
the operating budget appropriation resolution each year how the reimbursement
must be allocated.
This allows flexible use of the revenue but would provide increased
accountability regarding use of the funds and ensure that the revenue could only be used for
purposes agreed to by the Council. This would be a year-to-year approach, and would not let the
Council allocate the funds over any multi-year period.
3) Create a special dedicated fund or account to use the revenue.
This option would
assure that the revenue would fund specific fire and emergency service purposes, and would let
the revenue roll over from year to year. Council staff recommends that the fund, if it is created,
be dedicated to fire and rescue infrastructure, including equipment, apparatus, and facilities. The
fund could have an associated revenue and expenditure fiscal plan, which would let the Council
plan how to fund multi-year projects and needs.
4) Require the revenue to be used in the Capital Improvements Program (CIP).
In
addition to facility construction, many infrastructure items are or have been funded in the CIP,
such as apparatus purchases and the current Public Safety System Modernization project. This
option would let the Council support major capital investments with EMST reimbursement
revenue and also would facilitate multi-year planning.
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Council staff recommended either option
3
or 4, preferably option
3.
Both of these
options give the Council the most authority to direct the EMST reimbursement revenue and to
plan for multi-year infrastructure needs that otherwise could be difficult to fund in the future.
Both also closely correlate with the generally understood purpose of the reimbursement program:
to fund fire and rescue service needs. While they do not offer the immediate budget offset that
the Executive recommended, these options anticipate that the cost of eventual future
infrastructure investments could be addressed with this revenue stream rather than tax dollars.
Committee discussion During the Committee discussion, Executive branch staff
indicated general agreement with Council staffs recommended approach in Option 3 to create a
special fund or account for the EMS reimbursement revenue for dedicated fire and rescue
purposes. However, Executive staff agreed to amend this provision to make the FY13 Council
appropriation the base for non-supplantation going forward, rather than FYI2, and exclude from
this base the FYI3 EMST revenue.
For FY13 this approach does not provide additional revenue flexibility, nor does it create
a gap. The Council would fund the FY13 MCFRS budget as recommended by the Executive on
March 15 and endorsed preliminarily by the Council. The Council would then need to return to
appropriate any FY13 EMST revenue for fire and rescue services for purposes such as those
listed on ©61.
Committee members endorsed this option and directed Council staff to work with
Executive staff to refine parameters for use of this revenue. For this amendment, after
discussions with Executive staff, Council staff offers two options, which are discussed below.
Both options are shown in Amendment I on ©62. In deciding between these options, the
threshold question is whether the EMST revenue should be used for any personnel costs,
which are ongoing, or be used only for infrastructure expenditures. Committee members
did not agree on this question but emphasized their intent that the revenue supplement,
and not supplant, existing services.
• Option A: Allow EMST revenues to be used for personnel costs as well as other
purposes. This approach was recommended by the Executive and is reflected in the
list of potential FY13 items on ©61. As the Committee requested, appropriating
EMST funds for personnel costs in the form of new or restored services (opening new
Fire Station #32, restoring recently reduced services such as EMS units, or phasing in
4-person staffing) would not supplant the currently approved level of service.
It
would also allow the County to more quickly add or restore these items than might
otherwise be possible.
While this approach provides additional services in the near term, personnel costs will
then become an ongoing and growing expenditure for this revenue stream. For
example, if $1.3 million is used for personnel in FY13 (as sought on ©61 for service
restoration) then these personnel will require a growing share of County revenue in
future years.
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• Option B: Allow EMST revenues to be used for only fire and rescue
infrastructure, such as equipment, apparatus, facilities, or other "hard goods"
purchases (including associated future debt service). This would give the Council
the ability to plan for multi-year infrastructure needs that otherwise could be difficult
to fund in the future. This option anticipates that the cost of eventual future
investments could be addressed with this revenue rather than tax dollars.
• A third option C would be for the Council to set a cap on the level of EMST
revenue that can be used for personnel costs (for example, no more than 30%).
This would let the revenue support needed service priorities in the near term while
preserving future flexibility for one-time infrastructure investments.
Council staff continues to recommend option B, but would prefer option Cover
option A.
If the Council agrees to make FY13 the base year for non-supplantation and to dedicate
the revenue for fire and rescue services, Council staff recommends that the Council not assume
this revenue and not appropriate any associated expenditures until the outcome of a potential
referendum is clear. This would leave the EMST costs and revenues out of the FY 13 budget
approved this month, instead to be addressed in supplemental action this fall.
The Executive initially assumed that the EMST revenue will be available as general fund
revenue in FY13. The Council could decide not to restrict use of FY13 revenue but set funding
parameters and structure for future years. If the Council wants to take this approach as originally
proposed by the Executive, then the revenues would be assumed to fund part of the
recommended increase to the FYI3 base.
Under any scenario Council staff will work with OMB on the budget assumptions and
draft budget resolution language that reflects the Council's intent for FYI3 revenue.
Other issues/Committee recommendations
New patient advocate The Executive's amendments would create a patient advocate
position in the Office of Consumer Protection. However, this position is not reflected in the
implementation budget on ©17 or in any of the Executive's budget submissions. Since this
position would be offset by the anticipated revenue, if the Council enacts this Bill with this
position authorized, the Executive could submit the position as an additional budget amendment
and it could be included in the appropriate budget during reconciliation.
Reimbursement for volunteer activities This issue was raised at the public hearing by
Fire Chiefs from nearby jurisdictions and in Councilmembers' discussion with speakers. Since
volunteer corporations provide emergency medical transport services as part ofMCFRS, it seems
reasonable to discuss whether some of the EMST reimbursement revenue should support
volunteer services or resources. In contrast to many other jurisdictions, the County allocates
significant tax-supported funding for volunteer operations. The notable exception among local
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fire and rescue departments is the Bethesda-Chevy Chase Rescue Squad, which is self­
supporting. Council staff recommended that the Council examine options to allocate a share of
the reimbursement revenue to fund volunteer services, including training, gear, equipment, or
other resources.
The Committee recommended
allocating a share of the revenue to support volunteer
services and resources.
Council staff recommends
Amendment 2 on ©63 to accomplish this
goaL This amendment would let the Council annually dedicate a portion of the fund to replace
or augment core aspects of fire service delivery that volunteers provide. This approach would
reduce the pressures on LFRD funds by supporting expensive investments that are most difficult
for LFRD' s to fund, such as apparatus and gear.
Sunset
One option, as with any new program, is to include a sunset provision in the law,
under which the fee and program would expire on a certain date. This would allow the Council
to evaluate the effect of the EMST reimbursement program in, say, 3 years and decide whether to
continue or modify it. The Committee did not discuss this option.
Use
of public funds
Committee members directed Council staff to draft an amendment
that would prohibit the County and any recipient of County fire service funds from using public
funds, resources, or employees to influence the vote on any potential referendum on this Bill if it
becomes law. As discussions with the County Attorney and among Council legal staff
concluded, drafting an amendment that is both even-handed and effective, and that does not
impinge on private parties' First Amendment rights, is legally challenging. Amendment 3 on
©64-65 attempt to achieve those goals, but arguably may not do so. One factor that adds to the
difficulty is that, as of next fiscal year, ,County funds will not be directly appropriated to any
local fire and rescue department, although they will be appropriated to the County Volunteer Fire
and Rescue Association.
Potential Charter amendment
Councilmember Leventhal has proposed (see memo and
draft amendment, ©57-58), as an alternative to this Bill, an amendment to the County Charter
that would exempt from the Charter's current annual limit on property tax revenues any fire tax
used to fund County fire and rescue services. Besides the budget of the Fire and Rescue Service
per se, including funds that support local fire and rescue departments, this funding could include,
debt service for fire-related capital items. If the Council proposes and the voters approve this
amendment, the Council each year would decide how much of the Fire and Rescue Service
budget (not necessarily all) would be funded by the fire tax. If this approach is preferred to the
fee proposed by this Bill, rather than be applied in conjunction with the proposed EMST fee, the
effect would be to substitute County property tax for reimbursements from insurance, Medicare,
and Medicaid.
Charter amendment process
Although a public hearing is not required before the
Council puts a Charter amendment on the ballot, customarily the Council holds a hearing in June
of each even-numbered year on any Charter amendment proposed by the Charter Review
Commission and any other amendment proposed by a Councilmember or anyone else. This year
the Commission did not recommend any amendments. The Council could (and we think should)
schedule a hearing on this amendment. After the usual hearing is held, the Council schedules a
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worksession, normally in early or mid-July, to discuss any pending amendments. The Council
then decides, before taking its August recess, on which if any amendments to place on the
November ballot. That decision is required under state law by the second week of August.
This packet contains:
Expedited Bill 17-12 with Committee amendments
Legislative Request Report
Memo from County Executive
Fiscal Impact Statement
Economic impact statement
Budget information - memo from Executive
Selected public hearing testimony
Letters from Citizens Advisory Boards, Silver Spring VFD
2010 referendum ballot question
Charter amendment memo from Councilmember Leventhal
Executive's amendments -- memo
Fy13 proposed appropriations
Amendment 1 - use of EMST funds
Amendment 2 fund allocation to LFRD's
Amendment 3 use of public funds
Circle
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F:\LAW\BILLS\1217 Fire And Rescue-EMS Reimbursement\Action Memo.Doc
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Expedited-Bill No. . .!.17"--.. . :.1=2_ _----:-_ __
Concerning: Fire and Rescue Service ­
Emergency Medical Services ­
Insurance Reimbursement
Draft No. _3_
Revised:
5/11/12
Introduced:
April 24. 2012
Expires:
October 24.2013
Enacted: _ _ _ _ _ _ _ _ _ __
Executive: _ _ _ _ _ _ _ _ __
Effective: _ _ _ _ _ _ _ _ _ __
Sunset Date: -!...!N::::.,on:...:.:e=<-_ _ _ _ __
Ch, _ _• Laws of Mont. Co. _ _ __
COUNTY COUNCIL
FOR MONTGOMERY COUNTY, MARYLAND
By: Council President at the request of the County Executive
AN EXPEDITED ACT
to:
(1)
authorize the County to impose and collect a reimbursement to recover costs
generated by providing emergency medical services transports;
(2)
provide for a schedule of emergency medical services transport reimbursement
charges, waiver criteria, permitted uses of reimbursement revenues, and other
procedures to operate the emergency medical services reimbursement program;
(3)
prohibit a Local Fire and Rescue Department from imposing a separate emergency
medical services transport reimbursement;
(4)
require the Executive to issue certain regulations to implement an emergency
medical services transport reimbursement program;
(5)
require a certain annual transfer be made as payment of residents' uninsured portion
of the emergency medical services transport reimbursement; [[and]]
(6)
provide that County residents will pay no out-of-pocket expenses for an emergency
medical services transport:
prohibit Fire and Rescue personnel who respond to a request for an emergency
medical services transport from asking for any information relating to an
individual's insurance coverage:
establish a Patient Advocate in the Office of Consumer Protection:
require the Fire Chief to report semiannually to the County Executive and County
Council regarding implementation of this Act:
require the County to conduct a public outreach and education campaign: and
generally amend County law regarding the provision of emergency medical
services.
By adding
Montgomery County Code
Chapter 21, Fire and Rescue Service
Section 21-23A. Emergency Medical Services Reimbursement Program
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. 17-12
Sec. 1. Section 21-23A is added as follows:
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3
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21-23A.
Emergency Medical Services Transport Insurance Reimbursement
Program.
(a)
Obligation to Transport.
The Fire and Rescue Service must provide emergency medical
services transport under applicable medical protocols to each
individual without regard to the individual's ability to
lli!Y:.
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8
aJ
Any personnel of the Fire and Rescue Service who respond to a
request for an emergency medical services transport must not ask
for any information relating to an individual's insurance
coverage.
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10
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12
®
Definitions.
indicated:
In
this Section the following terms have the meanings
13
14
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
£!
similar purpose.
15
16
17
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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20
21
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
Fire and Rescue Service
means the Montgomery County Fire and
Rescue Service and includes each local fire and rescue
department
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Program
means the Emergency Medical Services Transport
Insurance Reimbursement Program.
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EXPEDITED BILL NO. 17-12
28
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(£}
Imposition
Qj
reimbursement.
The
County
must
Impose
a
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reimbursement charge for any emergency medical service transport
provided in the County, and, unless prohibited
Qy
other law, outside the
County under
~
mutual aid agreement.
@
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Liability/or Reimbursement.
Subject to paragraph (e), each individual
who receives an emergency medical services transport is responsible for
paying the emergency medical services transport reimbursement.
~
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Hardship Waiver.
ill
The Fire Chief must Waive the emergency medical servIces
transport reimbursement for any individual whose household
income is at or below 300 percent of the federal poverty
guidelines.
An individual must request
~
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waiver on
~
form
approved
Qy
the Fire Chief.
ill
The Fire Chief may deny
~
request for
~
waiver if the individual
43
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who claims financial hardship under this Section does not furnish
all information required
Qy
the Fire Chief.
ill
Countv Residents
-
Payment
Qj
[[Residents
']]
Uninsured Portion
Qj
the
Emergency Medical Services Transport Reimbursement.
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ill
County residents must not be required to pay any out-of-pocket
expense relating to any emergency medical services transport
because residents are deemed to have paid any co-payment
deductible. or uninsured portion of the cost of each emergency
medical services transport through taxes paid to the County.
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[[ill]]
ill
Tax revenues the County receives must be treated as
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payment, on behalf of County residents, of the balance of each
resident's portion of the emergency medical services transport
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EXPEDITED BILL NO. 17-12
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reimbursement charge that
msurance.
IS
not covered
Qy
the resident's
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[[ill]]
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 reimbursement charge.
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(g)
Restriction on Local
and Rescue Departments.
A local fire and
rescue department must not impose
f!
separate charge for an emergency
medical transport.
(h}
Use
gf
Revenue.
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ill
Except for the transfer received from the General Fund under
subsection
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.c.t1
the revenues collected from the emergency
medical services transport reimbursement must be used to
supplement, and must not supplant, [[existing)) Fiscal Year 2013
expenditures appropriated in the annual operating budget
resolution for emergency medical services and other related fire
and rescue services provided
Qy
the Fire and Rescue Service.
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ill
Regulations; Reimbursement Schedule.
adopt
f!
regulation under method
The County Executive must
to implement the emergency
ill
75
medical service transport reimbursement program. The regulation must
establish
f!
reimbursement schedule based on the cost of providing
emergency medical services transport.
The reimbursement schedule
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may include an annual automatic adjustment based on inflation, as
measured
Qy
an index reasonably related to the cost of providing
emergency medical services transports.
The regulation may require
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each individual who receives an emergency medical services transport
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EXPEDITED BILL NO. 17-12
82
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to provide financial infonnation, including the individual's insurance
coverage, and to assign insurance benefits to the County.
ill
The Fire Chief must submit a report to the County Executive and
County Council not later than January 1 and July 1 of each year
regarding implementation of the Program. The report should include:
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ill
the number of calls for emergency medical services during the
reporting period;
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W
ill
the number and type of emergency medical servIces provided
during the reporting period; and
any other infonnation relating to implementation of the Program
that the County Executive or County Council request.
!kl
Patient Advocate.
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The Office of Consumer Protection must employ a Patient Advocate to:
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ill
develop and implement a program for customer service as a part
of the Program;
98
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102
W
ill
develop and staff a help desk for questions regarding the
Program; and
serve as a liaison with any vendor retained by the County to
implement the Program to assure high quality customer service
and prompt resolution of questions and concerns.
103
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105
106
107
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Outreach and Education Campaign.
The County Executive must implement a public outreach and education
campaign before and during implementation of the Program.
campaign should include:
This
ill
infonnational mailers to County households;
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EXPEDITED BILL NO. 17-12
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al
distribution of infonnation through County internet and web-
based resources:
ill
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ill
(§J
radio and television public service announcements:
news releases and news events:
infonnation translated into Spanish. French. Chinese. Korean.
Vietnamese. and other languages. as needed:
extensive use of County Cable Montgomery and other Public.
EducationaL and Government channels funded by the County;
ill
posters and brochures made available at County events. on Ride­
On buses and through Regional Service Centers. libraries.
recreation facilities. senior centers. public schools. Montgomery
College. health care providers. hospitals. clinics. and other
venues: and
LID
special outreach to senior and "New American" communities.
Sec. 2. Expedited Effective Date.
The Council declares that this legislation is necessary for the immediate
protection of the public interest. This Act takes effect on January 1,2013.
Sec. 3. Implementation.
The County may collect the emergency medical servIces transport
reimbursement authorized by County Code Section 21-23A, enacted by Section 1 of
this Act, [[may be collected]] for any emergency medical services transport that
occurs on or after July 1,2012. [[Collection]] The reimbursement may [[occur]] be
collected retroactively to [[that]] July
1.
2012. or any later date during the first fiscal
year the emergency medical services transport [[fee]] reimbursement is implemented.
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LEGISLATIVE REQUEST REPORT
Expedited Bill 17-12
Fire and Rescue Service
-
Emergency Medical Services
-
Reimbursement
DESCRIPTION:
This Bill would authorize the County to impose and collect a
reimbursement to recover costs generated by providing emergency
medical services transports.
In order to meet current fiscal challenges facing the County, including the
shift of teacher pension costs to the County and substantial changes to the
County's obligation to fund public schools under the State maintenance of
effort law, the County must increase the amount of revenue available to
maintain core fire and rescue services.
To enhance the amount of revenue available to support core fire and
rescue 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 region have the authority to seek an emergency
medical service transport reimbursement.
EXPERIENCE
ELSEWHERE:
SOURCES OF
INFORMATION:
Joseph Beach, Director of Finance
Kathleen Boucher, Assistant Chief Administrative Officer
Richard Bowers, Chief, Fire
&
Rescue Service
Marc Hansen, County Attorney
APPLICATION
Yes.
WITHIN
MUNICIPALITIES:
PENALTIES:
Not applicable.
F:\LAW\BILLS\1217 Fire And Rescue-EMS Reimbursement\LRR.Doc
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067785
OFFICE OF THE COUNTY EXECUTIVE
ROCKVILLE, MARYLAND 20850
Isiah Leggett
County Executive
MEMORANDUM
April 12,2012
TO:
FROM:
SUBJECT:
Roger Berliner, Council President
Isiah Leggett, County Executive
--P~ ~
Expedited Legislation - Emergency Medical Services (EMS) Reimbursement Act
I am attaching for Council's consideration an expedited bill which creates an
Emergency Medical Services (EMS) Reimbursement Program under which the Fire and Rescue
Service is authorized to seek reimbursement for the cost of EMS transport services provided to
County residents from commercial insurers, Medicare, and Medicaid. Based on 2010
projections, EMS reimbursements are expected to generate $14 to $17 million annually. We are
in the process of updating these projections and will provide them to Council in the very near
future.
The bill is necessary to address unprecedented fiscal challenges facing the County
as a result of the General Assembly's 2012 Regular Session and the 2012 Special Session that
will inevitably be convened to complete work on the Budget Reconciliation and Financing Act
(BRF A) and other budget related items. We simply can no longer afford to let millions of dollars
go uncollected each year.
It
is fundamentally wrong for County taxpayers to foot the bill for
costs that are covered by insurers in most jurisdictions in Maryland, the Washington
Metropolitan area, and the nation.
If the State finalizes the budget "deal" reflected in the Conference Committee
Report for the BRFA (Senate Bill 152), the deal will result in a massive and immediate shift of
the State's teacher pension costs to counties that will cost Montgomery County $27 million in
FY13 (50% of normal cost) and significantly more in the following three fiscal years (65%,85%,
and 100% of normal costs, respectively) until the cost reaches $50 million in FYI6. Regrettably,
this unprecedented and troublesome cost shift does nothing to improve the sustainability of State
pension funding and bizarrely reallocates these costs away from the governmental entity which
has complete control over benefit levels and investment decisions (i.e., the State).
The State has already enacted legislation (Senate Bill 848) that imposes an
inflexible Maintenance of Effort (MOE) requirement that essentially places half the County
budget "off limits" for spending reductions, restricts flexibility in dealing with economic
montgomerycountymd.gov/311
.,
!ji'iIi!i!!1
240-773-3556 TTY
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Roger Berliner, Council President
April 12,2012
Page 2
downturns, and likely will require the County to put millions of dollars more into reserves to
preserve the County's Triple-A bond rating. The bill completely transforms MOE from a condition
that a County must meet to receive State funding to a complete State takeover of County budget
decision-making by making both the local share of foundation funding and each year's MOE target
as absolute requirements, and backing these mandates up with authority to raid County income taxes.
In addition to the State's seismic shift of teacher pension costs and inflexible
MOE mandate, the State has continued an additional $8.2 million cost shift relating to the State
Department of Assessments and Taxation ($5.3 million) and MCPSlMontgomery College
retirement administration ($2.9 million) which began in FYI2. All of these costs are paid by
County taxpayers.
The State has also reduced aid for community colleges, police, open space, health,
and library services by $9.4 million in FY13. Taken together, the State's FY13 cost shifts and
aid reductions for Montgomery County total $44.8 million. These FYl3 actions follow dramatic
reductions in State aid for community colleges, police, open space, health, libraries, and highway
user revenues in FYI 0, FYll, and FYI2.
In light of the historic - albeit lamentable -- realignment of State and County roles
and obligations reflected above and the resulting financial obligations for the County, there
should be no doubt whatsoever that the EMS reimbursement program is needed to fund fire and
rescue services in the County and that emergency response services to residents will be impaired
if the program is not established immediately.
EMS reimbursement programs are widely employed throughout the nation and by
local governments in Maryland and throughout the Washington region. The EMS
reimbursement program seeks no reimbursement from County residents themselves. When
County residents receive EMS services, the County will seek reimbursement only from
commercial insurers, Medicare, or Medicaid in the same way that a doctor's office seeks
reimbursement for the cost of health care services provided to a patient. However, unlike the
normal doctor's office situation, County residents will not pay any out of pocket expenses for co­
pays or deductibles.
Without the EMS reimbursement program, the County will face stark choices that
will result in: (1) significant and painful service reductions in the Fire and Rescue Service or
other vital programs; or (2) tax increases for County residents and businesses. Increasing taxes
further on top of the dramatic tax increases imposed by the State this year would further damage
the County's competitiveness in attracting and retaining business, as well as further burden
County households. Reducing Fire and Rescue Services or other vital County programs after
several years of programmatic reductions would seriously threaten the County's ability to meet
some basic needs.
To provide the Council with a complete picture of the EMS reimbursement
program created by this bill, I am attaching a copy of the proposed Executive Regulation to
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Roger Berliner, Council President
Apri112,2012
Page 3
implement the fee. This proposed regulation will be published in the May 2012 County Register
and submitted to Council after the 30-day public comment period ends on May 30.
On a related note, we are also in the process of preparing budget amendments to
reconcile assumptions reflected in my March 15 recommended budget with final State action on
the FYl3 budget.
Attachments (3)
cc:
Joseph Beach, Director, Finance Department
Timothy Firestine, CAO
Jennifer Hughes, Director, OMB
Kathleen Boucher, ACAO
Richard Bowers, Fire Chief, MCFRS
Marc Hansen, County Attorney
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ROCKVILLE, MARYLAND
MEMORANDUM
May 3,2012
TO;
FROM:
Roger Berliner, President, County Council
Jennifer A.
Hugiles;Dire~r,
Office of Management and Budget
Joseph F. Beach, Director, Department of Finance
Bil117-12E Emergency Medical Services Reimbursement Act
~/~
SUBJECT:
Attached please find the fiscal and economic impact statements for the above
referenced legislation.
I have also attached a copy ofthe April 26, 2012, EMS Transport Revenue
Projections report prepared by Page, Wolfberg,
&
Wirth.
JAH:aw
c: Kathleen Boucher, Assistant Chief Administrative Officer
Lisa Austin, Offices of the County Executive
Joy Nunni, Special Assistant to the County Executive
Joseph F. Beach, Director, Department of Finance
Marc Hansen, County Attorney
Richard Bowers, Chief, Department of Fire and Rescue Service
Scott Graham, Department of Fire and Rescue Service
Dominic Del Pozzo, Department of Fire and Rescue Service
Patrick Lacefield, Director, Office of Public Information
Naeem Mia, Office of Management and Budget
Alex Espinosa, Office of Management and Budget
Amy Wilson, Office of Management and Budget
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Fiscal Impact Statement
Council Bill17-12E - Emergency Medical Services (EMS) Reimbursement Act
1.
Legislative Summary.
This Bill would authorize the County to impose and collect a reimbursement to recover
costs generated by providing emergency medical services transports. This bill would also
provide for a schedule of emergency medical services transport reimbursement charges,
waiver criteria, permitted uses of reimbursement revenues, and other procedures to
operate the emergency medical services reimbursement program.
2.
An
estimate of changes in County revenues and expenditures regardless of whether
the revenues or expenditures are assumed in the recommended or approved budget.
Includes source of information, assumptions, and methodologies used.
Proj ected revenues are based on a mix of four payer types: Medicare, Medicaid,
CommerciallAuto Insurance and Self Pay and average revenue per transport rate of $265
in FY13 up to $291 in FY18 and a Montgomery County Fire and Rescue Service (FRS)
estimated transport volume of64,700 for
FY13
which is expected to increase to 68,000 in
FY18. Assuming implementation of the reimbursement charge January 1,2013, FY13
revenues are estimated to be $8,557,640.
Three additional full-time personnel are needed to implement the program: one Manager
of Billing Services to manage internal County billing issues; one Accountant/Auditor;
and one Administrative Specialist. The FY13 salary and benefits are estimated to be
$258,780.
Estimated operating expenses for FY13 total $695,670 and are comprised of
third
party
contract expenditures of $470,670 (5.5% of gross revenues collected); $200,000 for
community outreach activities in FY13, reduced to $25,000 in FY14-18; and $25,000 in
FY13 for training. Total annual operating expenses are dependent, in part, on the
negotiated fee for the third party contractor who will manage the billing program on
behalfof the County. Costs of community outreach
will
be reduced after the initial year
of implementation because the need for these outreach activities will not be as significant
when the program is fully operational.
3
.
evenue an
d
expend'ture es Imates covering at
I
eas
t
t
h
e next
6
fi
sca
I
.years .
R
1
I
i
: Revenue
i
Proiections
I
Implementation
, Costs
i
Available
, Revenue
FY13*
$8,557,640
$954,450
$7,603,190
FY14
$17,619,696
$1,252,860
$16,366,836
FY15
$18,100,911
: $1,279,330
i
FY16
$18,628,920
FYI7
$19,188,329
$1,339,140
FY18
19,759,903
$1,370,570
$18,389,333
!
TOTAL
$101,855,399
$7,504,720
$94,350,679
!
$1,308,370
$16,821,581 : $17,320,550
I
$17,849,189
*FY13 revenue estimate assumes implementation of the reimbursement charge on
January I, 2013. Third party contract billing expenses are pro-rated based on
implementation of the reimbursement charge, and all other expenditures are full-year
1
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costs in FY13. Net revenue available after implementation/administration costs will be
allocated to eligible expenditures.
4. An actuarial analysis through the entire amortization period for each bill that would
affect retiree pension or group insurance costs.
Not Applicable.
5. Later actions that may affect future revenue and expenditures if the bill authorizes
future spending.
Not 1\pplicable.
6. An estimate of the staff time needed to implement the bill.
It
is expected that three additional full-time persOlmel will be needed for implementation:
one Manager of Billing Services; one Accountant/Auditor; and one Administrative
Svecialist.
7.
An
explanation of how the addition of new staff responsibilities would affect other
duties.
The staff time required to implement the bill would be handled by the new positions
identified above and therefore would have no impact on other duties.
\
8.
An
estimate of costs when an additional appropriation is needed.
An
additional appropriation of $954,450 is needed in FY13 to implement the program.
9. A description of any variable that could affect revenue and cost estimates.
Variables that could affect the estimated revenues arid costs include fee rates charged,
documentation to support billing, changes in Medicare and Medicaid reimbursement rates
and regulations, changes in private insurance market rates, the number of transports
perfonned annually by the FRS, changes in local health care costs, and the negotiated fee
associated with third party billing.
10. Ranges of revenue or expenditures that are uncertain or difficult to project.
Not Applicable.
11.
If
a bill is likely to have no fiscal impact, why that is the case.
Not Applicable.
12. Other fiscal impacts or comments.
2
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While the proposed legislation pennits retroactive collection of transport reimbUrsements
to July 1,2012, the fiscal impact statement assumes collection would not actually begin
until January 1,2013.
13. The following contributed to and concurred with this analysis:
Scott Graham, Department of Fire and Rescue Service
Dominic Del Pozzo, Department of Fire and Rescue Service
Amy Wilson, Office of Management and Budget.
3
@
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Economic Impact Statement
Emergency Medical Services Transport Reimbursement Act
Council
Bill 17
-12E
1.
The sources of infonnation, assumptions, and methodologies used.
Bill
17-12E,
Emergency Medical Services Transport Reimbursement, would authorize
the County to impose and collect a reimbursement to recover costs. generated by
providing emergency medical service transports-. This bill_ would:also provide for a
schedule of emergency medical services, transport reimbursements, waivei'criteria,
permitted uses of the revenues collected and other procedures to operate the program.
According to the Fiscal Impact Statement prepared by the Office of Management and
Budget, it is estimated that the subject legislation would authorize collection of gross
revenue of over $17
mi11ion
annually (when fully operational) and nearly
$102
million
in
the FY
13-18
period. The revenue would largely be generated through payments made
from residents and visitors from Medicare and Medicaid, but also through private group
insurance and automobile insurance.
To develop this Economic Impact Statement we consulted with private consultants
pertaining to EMS reimbursement models and insurance industry trends and practices.
Based on our review of the legislation we do not believe the legislation will have a
quantifiable economic impact on the local economy including local insurance rates.
2. A description of any variable that could affect economic impact estimates.
While we do not consider that the legislation as proposed would have a measurable
economic impact, variables that could affect this conclusion include changes in Medicare
and Medicaid reimbursement rates and regulations, changes in private insurance market
rates, the number of transports perfonned annually by the Fire and Rescue Service (FRS),
and changes in local health care costs.
3. The bill's positive or negative effect, if any, on employment, spending, saving,
investment, incomes, and property values in the County.
The additional revenue generated through this legislation, while significant in the context
of the County's annual operating budget, is not large enough to generate a quantifiable
impact on employment; spending, savings or other relevant economic variables.
4. If a bill is likely to have no economic impact, why that is the case.
The bill will have an economic impact because of the additional revenue generated from
Medicare, Medicaid, and private insurance. However, as mentioned above, the economic
impact will be small in relation to the local economy that it will not have a quantifiable
impact.
@
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Economic Impact Statement
Emergency Medical Services Transport Reimbursement Act
Council BiII17-12E
5. The following contributed to and concuned with this analysis:
David Platt, Department of Finance, Michael Coveyou, Department of Finance, Terry
Fleming, Department of Finance
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OFFICE OF THE COUNTY EXECUTIVE
ROCKVILLE, MARYLAND 20850
Isiah Leggett
County Executive
MEMORANDUM
May 7, 2012
2:
TO:
FROM:
SUBJECT:
Roger Berliner, County Council President
IsiahLeggett, County Executive
c;:j;:o
.
°
3:
Expedited Bill 17-12, Fire and Rescue Service -
Emergenc;~cal
Services Reimbursement
.
:; .
-<
~
-'"
.
., ' ..
.£?-«
§€ftif21. ·
.
'23:0
nO'fTl
.
co
.I
This memorandum provides responses to Council Staff questions
regarding Expedited Bill 17-12, Fire and Rescue Service- Emergency Medical Services
Reimbursement.
Council Staff Question 1:
The CE's April 26 budget adjustment transmittal identifies $8.6 million as' a resource
amendment for FY13 based on enactment of the EMST reimbursement. What fire
rescue expenditures does the Executive intend this revenue to support? The
transmittal also references the fiscal impact statement for the legislation. \Vhen
will
the Council receive this fiscal impact statement?
Response:
The revenues collected will be used to cover the costs associated with implementation
ofthe bill ($954,450). Net revenues available after implementation costs, will be
allocated to eligible expenditures. The revenues collected from emergency medical
services transport (EMST) reimbursement will be used to supplement expendituresfor
emergency medical services and other related fire and rescue services in excess ofthe
FY12 appropriation for the Fire and Rescue Service (FRS). Based on my FY13
recommended budget, eligible expenditures total $16,730,424. See attached
spreadsheet for net EMST reimbursement revenues.
The fiscal and economic impact statements for Bill
17-12
were transmitted to Council
on May
7,
2012.
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Council Staff Question 2:
The bill's effective date is January 1,2013, how does this effective date affect FY13
expenditures given the bill's requirement to supplement and not supplant existing fire
rescue expenditures?
Response:
The FY12 approved budget/or the FRS ($179,769,870) establishes the base level
fimding/or this legislation. All expenditures above the base level are considered
eligible expenditures. Based on my FYI3 recommended budget, eligible
expenditures total $16,730,424. Due to mid-year implementation, FY13 revenues are
projected to be $8,557,640. Revenues net o/implementation costs are estimated to be
$7,603,190. There/ore, in FY13 $7,603,190 in revenues will be applied to eligible
expenditures.
The attached spreadsheet reflects eligible expenditures in my FY13
recommended budget as well as eligible expenditures in
FY14~
18 based on my
current assessment of resources needed to allow the FRS to continue to provide high
quality fire and rescue services in the coming years.
Please contact Office of Management and Budget Director Jennifer
Hughes
if
you need additional information relating to the fiscal impact of Bill 17-12.
IL:aw
c: Kathleen Boucher, Assistant Chief Administrative Officer
Joy Nurmi, Special Assistant to the County Executive
Jennifer Hughes, Director, Office of Management and Budget
Joseph F. Beach, Director, Department of Finance
Marc Hansen, County Attorney
Richard Bowers, Chief, Department of Fire and Rescue Service
Scott Graham, Department of Fire and Rescue Service
Dominic Del Pozzo, Department of Fire and Rescue Service
Patrick Lacefield, Director, Office of Public Information
Alex Espinosa, Office of Management and Budget
Amy Wilson, Office of Management and Budget
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.......
~
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(
Emergency Medical Services Reimbursement Legislation
BILL 17-12E
Testimony of Fire Chief Richard Bowers
Montgomery County Fire and Rescue Service
Public Hearing
May 8,2012
Good evening. I am Fire Chief Richard Bowers and I am here on behalf of
County Executive Leggett to speak in support of Bill 17-12E. I have served the
Montgomery County Fire and Rescue Service for over 34 years. I am here before you
now as the Fire Chief one of the Nation's most progressive combination fire and rescue
system that is at yet another critical point in these challenging times.
The proposed legislation, Bill 17-12E, is a viable solution to the resource
challenges presented to me as the Fire Chief. Bill 17-12E is different than previous EMS
Reimbursement legislation. Bill 17-12E revised provides revenue and will support the
fire and rescue service into the future. The EMS Reimbursement legislation is not a tax
or a fee, and no County resident will ever receive a bill for any EMS transport by fire and
rescue.
Montgomery County is growing exponentially and with that comes a greater need
for response and infrastructure resources. I am charged with being a good steward of
the recently procured fire apparatus valued at $32 million. The Apparatus Management
Plan which Council endorsed in 2004 is currently without funding. The EMST Insurance
Reimbursement can provide that funding through a planned, strategic approach,
preventing MCFRS from having to come back to the citizens again in 10 years to
replace an entire fleet once again.
Right now, we have limited options. First. which is not an option in my opinion. is
to ignore our financial challenges and hope they go away. Second, we can raise taxes
to provide the financial resources needed. This will place a financial burden on all
residents of Montgomery County whether they have the means to payor not. Lastly. we
can implement the EMS Reimbursement legislation. There will be no financial impact on
residents of Montgomery County, and it will produce the needed financial resources for
us to meet the challenges of our fire and rescue service. This is money that the
insurance companies have already allocated for this service which the County has
chosen not to collect.
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It is important to understand that County residents will be responsible for the
emergency service only to the extent of insurance coverage. Insured County residents
will not be responsible for co-pays or deductibles. Uninsured County residents will not
pay anything. No County resident will pay, period.
Many of our surrounding jurisdictions have already implemented an EMS
Reimbursement program, including Fairfax, Arlington, Prince George's, Anne Arundel,
Prince William and Frederick counties, the cities of Alexandria, Fairfax, and Baltimore,
and the District of Columbia. Each of these jurisdictions has collected millions of dollars
in revenues with their EMS Reimbursement programs. There have been no adverse
impacts on the residents of these counties and cities and there has been no reduction in
911 calls either.
The financial situation and landscape has significantly changed over the last two
years. Seven operational emergency response units in Fire and Rescue have been de­
staffed and no longer respond to emergency incidents. The EMS Reimbursement
legislation will enable fire and rescue to restore these units to service!
There can be no doubt that the burden of additional financial stresses associated
with either the doomsday budget or the financial shift of the teacher pensions and the
MOE are coming and will have a negative impact on the County and our residents in the
next decade and beyond.
The EMS Reimbursement Bill 17-12 does not place a fee or tax on any County
resident and no County resident will ever get a bill. Bill 17-12 does enable fire and
rescue to collect millions of dollars from the insurance companies, Medicare and
Medicaid to support the fire and rescue service.
I urge the County Council to pass Bill 17-12E.
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Montgomery County Volunteer
Fire*Rescue Association
P.o.
Box
1374
Rockville, MD 20849
301-424-1297
i
Marcine D. Goodloe, President
Eric N. Bernard, Executive Director
Testimony Before the County Council
of Marcine D. Goodloe, President
May 8,2012
Good evening. I am Marcine D. Goodloe, president of the MCVFRA and I am
here on behalf of the Association to speak in opposition to the proposed BILL 17-12 on
ambulance fees.
One of the foundations of our democracy is that those elected to office are to
respect the will of the people. Just 18 months ago the people of Montgomery County
elected you to this office. At the same time, they decisively rejected the County
charging ANYONE hefty ambulance fees of $300 - $800. If voters had upheld the
ambulance fee, we would have accepted the outcome, and not tried to get the Council
to override the voter's decisions.
There was high voter interest in the ambulance referendum. Nearly 95% of
voters who cast a vote in the governor's race also voted on Question A, which was at
the bottom of the ballot. In contrast, 100,000 fewer voters voted in the countywide
Board of Education elections then voted on the ambulance fee law.
.
Voters made a point to vote on Question
A
Voting yes meant keeping the law
and voting no meant repealing the bill passed by Council. By more than 20,000 votes,
voters voted "NO" and repealed the law. What does 20,000 votes look like? Picture the
Verizon center downtown with standing room only, and you have visual image of the
more than 20,000 vote margin by which voters repealed the ambulance fee law.
In the history of Montgomery County, this was the first and only time that County
voters repealed a County law. It was only the third referendum on a County law in the
past 25 years. Voters in each of the five County districts voted to repeal the ambulance
law.
At first, County Executive Leggett said that the voters had spoken and that he
would respect that vote But here we are again discussing the same bill that the voters
repealed. This SAME bill also has the SAME supporters from 2010, but has a VERY
different central issue. Because there was an ELECTION in-between the last
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Marcine D. Goodloe
Public Hearing Testimony
May 8,2012
Page 2
ambulance fees bill and this one. Now, the central issue is whether the County Council
will RESPECT the voters' decision or DISRESPECT the voters' decision.
Voting for this bill in the wake of the 2010 decision could erode voters TRUST in
county government, increase CYNICISM about elected officials and lead people to think
twice whether it is WORTH voting.
The push for this bill just 18 months later after it was repealed is an affront to the
voters of Montgomery County. Tonight you are hearing from 30 speakers, but
remember that you have already heard from 147,000 speakers - the same ones that
elected you to office and at the same time repealed the 2010 ambulance fee law by a
margin of more than 20,000 votes.
Thank you.
Marcine D. Goodloe
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Testimony of John T. Bentivogliol
Proposed Legislation to Impose Ambulance Fees in Montgomery County
May 8, 2012
Thank you for the opportunity to testify on the County Executive's proposed ambulance
fee legislation. While there are many compelling reasons for the Council to reject the County
Executive's attempt to impose ambulance fees, I would like to focus on three important policy
objections to such fees.
1.
Ambulance Fees May Deter Calls 'When Help is Needed Most
There is abundant evidence - rigorous scientific studies, professionally done population
surveys, and data analysis from Fairfax County and elsewhere that fees
do
create a barrier to
activation of the EMS system and pose a serious risk to public health and safety, especially
among poor and elderly populations
Take the example of Fairfax County. In a May 2010 analysis (attached), we documented
how EMS calls in Fairfax County increased steadily through 2004, decreased in 2005 -- the year
Fairfax County imposed an ambulance fee -- and have remained at pre-fee levels.
Peer-reviewed studies and professional surveys confirm the common sense notion'that
fees for emergency medical care pose a barrier to early activation of the emergency medical
system. This runs counter to decades of efforts to encourage early calls to
911
in cases of heart
attack, stroke, and other serious medical conditions.
There is plenty of anecdotal evidence that people in need of emergency transport take
transport costs into consideration when deciding whether to call for an ambulance. I have
attached several recent examples of such situations.
Finally, we are extremely concerned about the promise that County residents won't be
billed for service. Such an approach has not been tried -- all the surrounding jurisdictions cited
as models do bill residents for ambulance service and grant waivers only when residents go
through a lengthy and burdensome waiver application.
In
Fairfax, residents have to submit
employment information, tax filings or other similar documents for waiver requests.
Montgomery County is a dynamic community, with people moving into and out of the area with
I have been a Montgomery County resident and voter for the past 16 years and a volunteer firefighter
and EMT with the Bethesda-Chevy Chase Rescue Squad for more than 23 years. I was the lead
author of a report on the ambulance fee legislation entitled "Not Entitled to Their Own Facts: Data
Shows Ambulance Calls Will Deter Emergency Calls for Help" and served as counsel to the
MCVFRA in its efforts to put the ambulance fee on the November 2010 ballot. I am testifying today
in my individual capacity.
1
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some frequency. We are not confident that an out-sourced billing collection operation, relying
on often inaccurate hospital information, will not result in residents getting billed for EMS
transports.
2.
Ambulance Fees Will Drive Up Insurance Costs
The County Executive asserts that ambulance fees won't drive up health insurance costs.
He wants us to believe what parents have cautioned against for years there is no such thing as a
free lunch. Here's what the insurance companies said during the 2010 debate:
2
CareFirst BlueCross BlueShield, spokesman Michael Sullivan said a county ambulance
fee would drive up costs that might have to be passed on to customers. flMandates on
coverage, such as new ambulance fees, add to the cost of care and are directly reflected in
premium rates," he said. "New fees in Montgomery County would need to be accounted
for, but since ambulance fees represent just a small portion of overall care costs the effect
on premiums would, correspondingly, be limited."
America's Health Insurance Plans, a group representing the health care industry, agrees,
according to spokesman Robert Zirkelbach. "Anytime you add to the cost of providing
care, that has a direct effect on the cost of health care coverage," he said.
It's important to note that higher insurance premiums will fall most heavily on the self-employed,
small businesses, and families that are struggling to pay for health insurance.
3.
Ambulance Fees Aren't the Answer to the County's Budget Situation
The County Executive has cited potential ambulance fee revenues as the solution to
virtually every fiscal challenge we face. County leaders can and should be responsible in
meeting the County's needs, but the Executive's arguments are seriously flawed.
First, the County is in a far better fiscal situation than when voters rejected fees in
November 2010. Indeed, the Executive is proposing a 5% increase in his FY 2013 budget.
Second, under the proposed law, all ambulance fees revenue will be used solely for
fire/rescue needs and must supp'lement - not supplant - existing revenue.
If
that's true, no fee
revenue will be available for schools, police, libraries or other needs. Not one cent.
Finally, we have
s~rious
doubts about the amount of promised revenue. In just two years,
the projected fee revenue has jumped several million dollars when public and private
ambulance reimbursements are being scrutinized and, in some areas, reduced.
2
"Volunteer firefighters call on Leggett to stop spending tax dollars on campaigning," Montgomery
County Gazette, October 27, 2010.
2
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Conclusion
There are many other reasons to oppose ambulance fees, including objections to the fact
that such fees would often be charged when the services is provided for free by volunteer
personnel; County residents already pay for fire/rescue service through the County's Fire Tax;
and the County should not charge for such a core governmental function.
The voters clearly understood these issues when they went to the polls just 18 months ago.
They believed that such fees would discourage calls to 911, drive up insurance rates, and not
come anywhere close to delivering the promised benefits. Based on these facts, they rightly
rejected ambulance fees. The Council should respect voters and do the same.
Thank you.
3
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Testimony of Eileen Cahill on behalf of Holy Cross Hospital
before the Public Safety Committee of the Montgomery County Council
in support of Expedited Bill #17-12: Fire and Rescue Service - Emergency
Medical Services - Reimbursement
May
B,
2012
Good evening, Mr. Chairman and members of the Public Safety Committee. My name
is Eileen Cahill. I am the vice president of government and community relations at Holy
Cross Hospital, and I am here tonight on behalf of Holy Cross in support of Expedited
Bill #17-12.
But before I give the hospital's testimony I would like to make a personal comment, if I
may: I know one of the arguments against passing the proposed legislation is that the
voters decided against an EMS reimbursement program in 2010. I would argue that
that the 2010 ballot question posed to voters was poorly worded, and therefore difficult
to understand. As a voter myself and one who knew the issue reasonably well, I found
the ballot question confusing. In the face of potentially more cuts in county services
and/or increases in income or other taxes, one can only speculate how the voters would
respond today to a properly-worded ballot question on an EMS reimbursement program.
Holy Cross Hospital has been on the record in the past in support of similarly proposed
legislation. EMS reimbursement programs have been instituted in many of the
surrounding jurisdictions, and we have yet to hear a compelling reason why an EMS
reimbursement program should not be implemented in Montgomery County as well.
The main argument we have heard in opposition to an EMS reimbursement program is
that it might deter someone who is uninsured or living on a fixed income from calling 9­
1-1. If that were the case, the logic would follow that concerned residents would also
avoid hospitals because of their inability to pay for hospital services. At Holy Cross
Hospital, we have seen our charitable care program increase with each passing year.
Thus, it does not appear to us that a person's insurance or financial status would be a
deterrent to calling 9-1-1, when most times those calls result in a transport to a hospital
emergency department.
Holy Cross Hospital is supportive of this expedited legislation because EMS
reimbursement would only be sought from a patient's commercial insurance carrier, or
Medicaid or Medicare, and that no county resident would be denied ambulance service
because they lack insurance or the ability to pay for the service. Holy Cross would not
be supportive of any legislation or any county-sponsored program that would deny its
residents access to health care.
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Testimony of Eileen Cahill on Behalf of Holy Cross Hospital
May 8,2012
Page 2
Unfortunately, Montgomery County still struggles with the effects of a down-turned
economy, structural budget deficits, and, more recently, costs being shifted from the
state to the county. Leaving on the table potentially tens of millions of dollars in
reimbursable charges for ambulance services seems irresponsible when our county
continues to face difficult budget clloices.
Thank you for your time and attention.
###
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Fila, Rascua
Ii
EMS
Serving
Bethesda
Chevy Chase
NW Washington DC
5020 Battery Lane
Bethesda
Maryland 20814-2699
www.bccrs.org
Business: 3016520077
Fax: 301.656.6523
Voice Mail: 301.656.5423
Emergency MD: 911
Emergency DC: 301.652.1000
RESCUE SQUAD, INC
MONTGOMERY COUNTY COUNCIL PUBLIC HEARING
Expedited Bill 17-12: Emergency Medical Services - Reimbursement
Testimony of
Fire/Rescue Chief Edward G. Sherburne
May 8,2012
Good evening. I am Fire/Rescue Chief Edward G. Sherburne of the Bethesda­
Chevy Chase Rescue Squad (B-CCRS). I have helped residents, commuters and
visitors, for free, thousands of times, over my 33 years of service. I also have many
colleagues here tonight that work hard to be a part of an organization that funds its
emergency service without a County budget. Our publicly available, audited financial
statements, for FY 2011 document $5 million in contributed services and cash
expenditures that make Montgomery County a better place to live.
We are philosophically
opposed
to Bill 17-12 and the concept of an EMS transport
fee in any form because:
1. Patients, especially commuters and visitors, who will owe deductibles, and
be hard-billed, will be discouraged from using 911.
2. The concept of anyone charging for service we provide for free is at odds
with our community oriented, not-for-profit model.
3. The philanthropic donor base harnessed to provide emergency service
above the tax-base will be negatively impacted. The outside volunteer
organizations quoted by the Executive are "apples to oranges" comparisons
and have no predictive value here. If billing is initiated, B-CCRS will be
unable to provide the same level of services we do today without County
assistance. The exact amount of degradation to capabilities is an open
question- but the financial risk to the County is real.
4. Many volunteer personnel see the County charging for services as just one
more example of a County administration that does not know how to
harness the value of a robust volunteer service in productive ways.
Volunteer, the experience of a lifetime!
@
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Montgomery County Council
Testimony of Chief Edward G. Sherburne
May 8, 2012
Page 2
5. There is no "free lunch:"
• Insurance companies have said they will raise rates to cover the cost
of new claims.
• The structure and level of reimbursements of Medicare is currently
under debate, as part of Federal budget discussions, and subject to
negative change.
• There is a risk in billing. In June 2011, the billing contractor for the
City of Dallas, Texas was found to be "up-coding" ambulance
transports in violation of Medicare regulations. Dallas agreed to pay
a $2.5 million settlement and entered a 3-year corporate integrity
agreement with the federal health care fraud regulators.
1
• And, finally, dependency on EMS fees subjects Montgomery County
to even more choking regulation and directive advice from outside
agencies in how we deliver EMS.
In looking to the future, we offer three suggestions:
1. Respect the will of the Montgomery County voters - it's an essential
element of citizen trust in government. The last minute modifications
proposed by the Executive don't alter this fundamental concept.
2. Advocate with our Congressional delegations for Medicare reimbursement
using population based formulas. These ideas are currently being debated
to reduce fraud, administrative costs, and to foster development of leading
edge health care delivery by EMS that do not require transport. Currently all
payments are based on transport and stifle innovation. A formula based
model would eliminate the need to require individual patient billing.
3. Restart discussions on legislation for a dedicated fire-tax to fund, with
appropriate safeguards on uncontrolled spending, future fire, rescue and
EMS needs without the need for user fees.
Thank you for your time. I remain available for questions, if needed.
I
Department of Health and Human Services and Department of Justice, Health Care Fraud and Abuse Program,
Annual Report for FY 2011, pg. 34.
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/0
Testimony of Erik S.
Gaull,
NREMT-P
before the Montgomery County Council
MayS / 2012
President Berliner and honorable Members of the Council, my name is Erik Gaul!.
I have been a volunteer paramedic/firefighter in the County since 1986. I have an
MBA and a Master of Public Policy from Georgetown University. I spent more
than eight years as a full-time consultant to fire and EMS agencies across the
United States and Canada, working on complex EMS management and finance
issues for jurisdictions including Chicago, Houston, Winnipeg, Wake County (NC),
Prince William County (VA), and Washington, DC. I was the primary author for the
EMS chapter of the first edition of the U.S. Fire Administration's manual,
Funding
Alternatives for Fire and EMS Departments.
I teach two resident courses at the
National Fire Academy -
EMS Management
and
Advanced Leadership Issues in
EMS.
I am on the Editorial Review Boards of
EMSWorld Magazine
and
Prehospital
and Disaster Medicine.
I have given more than 100 presentations at public safety
conferences throughout the United States, Europe, and the Middle East.
It is incomprehensible to me that Montgomery County does not have EMS cost
recovery in place. Plainly stated, by not having cost recovery, the County is
leaving millions of dollars in the pockets of big insurance companies.
People who argue that seeking cost recovery for EMS usage will result in higher
insurance premiums do not understand how insurance works. Insurance
companies do sophisticated actuarial calculations to determine the likelihood an
insured party will need an ambulance and what they will have to pay in
reimbursement for such use. For personal or work reasons, Montgomery County
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residents are regularly in nearby jurisdictions - almost all of which seek
reimbursement from insurance companies for ambulance service. Because
there's no way to know if someone will have a heart attack or car crash in say,
D.C., as opposed to Montgomery County, insurance companies set aside money in
anticipation of needing to reimburse for EMS usage. This means that the cost of
projected ambulance usage is already included in the premiums that County
residents pay. When reimbursement is not sought, insurance companies gladly
pocket as profit all money budgeted for EMS usage.
An argument has been advanced that implementation of EMS cost recovery will
result in people being unwilling to call 9-1-1 in a medical emergency. Simply put,
the empirical experience ofthe nation's largest and most geographically diverse
EMS billing firm clearly demonstrates that there is no drop-off in call volume
associated with the implementation of cost recovery programs. People call EMS
when they need an ambulance irrespective of whether their insurance company is
going to receive a request for reimbursement.
Finally, I know that some - but certainly not all- of my fellow volunteers object to
cost recovery because they worry that the public will being less willing to make
donations to their departments. While I understand this fear, experience from
across the nation does not support the concern.
At bottom, leaving millions of dollars on the table is - at the end of the day­
foolhardy. Big insurance companies already consider this money spent, and they
are only too happy to keep it when jurisdictions don't ask for it.
I urge the Council to do the intelligent thing by approving EMS cost recovery
legislation as soon as possible.
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Opposition to ambulance fees
Written testimony to Montgomery County Council, May 2012
by Darian Unger, Montgomery County resident and firefighter /EMT
DarianUnger@yahoo.com
\\
I wish we didn't have to be here. The residents of Montgomery County have already made the ethical
decision when they voted decisively against ambulance fees and I urge you to respect the people and
the democratic process.
19 months ago, the County Executive spent hundreds of thousands of dollars to try to convince people
to support these irresponsible ambulance fees. He convinced the same few groups to my left to speak
in favor of ambulance fees, and they are repeating what they said before. But ambulance fees were
not and are not acceptable to the citizens of the county, and election day told the story. You were all
elected. Ambulance fees were defeated.
Ambulance fees were voted down by the people in every district, despite the County Executive
plastering County buildings with political ads. Ambulance fees were decisively defeated despite the
County Executive ordering on-duty firefighters and their equipment to electioneer at the polls.
Despite those intimidating and highly inappropriate tactics unworthy of U.S. elections, the people
clearly said "No. We know there's a revenue problem. We don't want you to solve it this way."
To propose and support ambulance fees now is beyond disdainful, irresponsible, and arrogant.
It
is
antidemocratic and tells the educated voters of the County they don't matter
The people did not and do not believe these ridiculous claims that this is a "free lunch." We know
that fire/rescue services -like police protection should be freely and equally available to everyone.
That's not what this bill does. We know that ambulance fees have real consequences.
Think they don't matter? Think they don't hurt when they're imposed? Well, I'm a firefighter and
EMT by night, but my day job as a Howard University professor. Students at Howard are warned as
freshman by their own university that ambulance rides will cost them three hundred dollars. One of
my own students lost consciousness and fell, but wouldn't let an ambulance take her to the hospital
because she was afraid of the bill. Think they don't affect behavior here too? Tell that to the woman
who couldn't even walk, but tried to crawl out of my ambulance until I assured her that there was no
charge for my emergency assistance. She would have been charged by this proposed system.
My earlier testimony provided details and peer-reviewed research showing that the laws of supply
and demand hold true in EMS: increased fees reduce people's willingness to call 911. For all this talk
of "no resident getting billed," we know there will be real consequences to vulnerable people. Here's
a parallel for you. Nobody in this room believes Governor Scott Walker or the Wisconsin Republicans
who innocently claim that their new voter ID laws don't inhibit voting because it's just paperwork
that anyone can do. We know that's false, and that many poor people won't vote if barriers are
thrown in their way. Likewise, there should be no such financial and paperwork barriers to core,
public, life-saving emergency services.
My name is Darian Unger. I am a resident and a firefighter. I am one of many. We care too much for
our patients, for vulnerable people in distress, and for our community to allow the Executive to
override the express will of people on ambulance fees. I invite you to join us.
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{J;
THE LEAGUE OF WOMEN VOTERS
ofMontgomery County, MD, Inc.
Testimony to County Council on Expedited Bill 17-12, Fire and Rescue Service
Emergency"Medical Services - Reimbursement
May 8,2012
I am Barbara Hankins Co-President of the League of Women Voters of Montgomery
COlmty.
Leagues ofWomen Voters are able to take action on govenunental issues onlyafterits
members have studied and come to agreement. Eighteen months ago, LeagUe members
completed such a study and concluded that an emergency medical transport fee with
certain features would be one way to increase the revenues of the cOlmty at this time of
fiscal restraint. The conditions which we would attach to such a fee include an extensive
public education program; provisions for tracking and evaluating the program; a clear
description ofthe fee structure and distribution of monies; care and transport without
regard to income or insurance; and waivers for those unable to pay fees. Some of our
conditions are met in Expedited Bill
17-12
but, as the last time this issue was raised,
others should be fleshed out in the regulations implementing the bill.
The concept of such a transport fee is not unique to Montgomery County.
It
is estimated
that approximately 75% ofjurisdictions nationwide already charge fees. Of Maryland's
twenty four counties, only five including Montgomery, do not have transport fees of one
kind or another. Similarly, the District of Columbia and many counties in Northern
Virginia also collect such fees. Many of the departments who charge for ambulance
transport have, as does Montgomery County, significant numbers of volunteer firemen.
We do not believe that, given extensive educational programs, citizens
vvill
be deterred
from calling for ambulance services nor do we believe that there will be significant
increases in health insurance premiums ifUus bill passes. Most of our senior citizens are
covered by Medicare for which rates are set nationally. Many low income residents are
covered byivledicaid which is paid by the state and federal govenunents. The transfer of
funds from the general ftmd to the fire fund will cover the costs of the urllnsured allowing
us to meet federal requirements while still only directly charging fees for insured
individuals.
\Ve recognize, however, that in your consideration of this legislation, you
vvill
be
evaluating the likelihood of the bill's ability to S1.llV1Ve another petition drive and
referendum. If you conclude that it has a reasonable chance of doing so, and enact it, we
will work actively with other non-govenunental supporters to educate the voters about its
provisions, so that they can cast informed votes.
League of Women Voters of Montgomery County, Maryland, Inc., 12216 Parklawn Dr., Suite 101, Rockville, lVID 20852
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TESTIMONY BEFORE THE MONTGOMERY COUNTY COUNCIL RE PROPOSED
AMBULANCE TRANSPORT REIMBURSEMENT
GREATER OLNEY CIVIC ASSOCIATION
BY
ARNOLD B.GORDON,
MAY 8, 201
Ladies and Gentlemen of the Council:
The County Executive has again introduced the controversial ambulance fee, and for good and
sound reasons. The Greater Olney civic Association (GOCA) believes, as it did in 2008, that this
matter should not be the subject of political demagoguery. The facts are straight forward:
• This fee is found money; No taxpayer in our county will pay for this fee whether insured
or not;
• These fees are already calculated into all health insurance contracts in this general area;
• We are paying for this in our health insurance regardless of the vote;
• To refuse this fee is to leave $18 million in FY 2014 and up to $110,000,000 (94 million
after administrative costs) over the next 6 years on the table;
• If you have a heart attack on 270 north of the Frederick line you pay a fee; South of the
line no matter where you come from you don't pay a fee, ergo, a Frederick resident gets
a service from this county for free and a Montgomery resident in Frederick has to pay;
• Any co-payor deductible on this
will
NOT be collected by the county from a county
resident.
Now it has been argued by, among others, the Civic Federation, that there is language in the bill
that makes this an obligation of the service reCipient. This simply is not so since the language of
the bill clearly states that "Tax revenues received by the County must be treated as payment, on
behalf of County residents, of the balance of each resident's portion of the emergency medical
transport reimbursement charge that is not covered by the resident's insurance." If this was not
clear enough Amendment 3 to the bill as sent to you by the County Executive in a memo of May
ih,
clarifies that issue. No county resident
will
pay for the emergency transport.
It has also been argued that an amount equal to the portion of the fee not covered by insurance
reimbursements must be transferred from the General Fund to the to the Fire and
Rescue (FRS) budget; therefore the program will not generate added revenue to pay other
Bills; and, instead would decrease funds for other needed programs and services.
This too is false. 100 percent of this is dedicated funding for FRS and it supplements
existing FRS spending to fund critically needed apparatus, staffing, and training needs. Without
the $18 million, the County would need to shift money from other critical {non-fire} programs
which will be made very difficult in light of the recent shift of costs from the State to the
County, which I remind you will cost us at least $400 million over next ten years (and probably a
Good deal more). This charge this would offset $180 million plus of that cost shift. Further the
amendments just transmitted to you make that abundantly clear as well.
It has also been argued that our health insurance rates will rise. There is zero evidence of any
increase in insurance rates and that's because the costs of emergency services are already
included in the premiums charged by insurers and already paid by county residents. Those
premiums are already determined regionally or nationally and all other jurisdictions in our area
already charge for the service. Remember that emergency transport services are a mere
1/10th
of health care insurance costs. The county's actuaries calculate that there will be no difference in
rates that result.
The only possible opposition to this are the county's Fire Volunteer associations, who, without a
factual basis for such a belief, posit that they will collect less money for their contributions. That
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has not proven true in any of the surrounding jurisdictions. These jurisdictions have viable fire
volunteer associations that enjoy good financial health.
And here's the kicker: Ifthis is such a bad idea, where are the stories. where is the
adverse data, why aren't jurisdictions {locking to get rid oOt. Why are other volunteers
in jurisdictions that have it SUPPORTING it?
These facts are indisputable. Lets not pander to those who would frighten our taxpayers into
believing this is an additional exaction. It just plain isn't.
The fee has not deterred anyone from calling an ambulance in any of the surrounding
jurisdictions and if the politicos who pander on this will help edify their constituents properly, it will
not deter anyone from calling an ambulance here as well. This should not be made into a hot
political issue. We should approach this objectively and within the bounds of proper reasoning.
This money is needed and some county service will be lost or reduced, or additional tax will be
collected, if we don't collect the money that is already available to us.
As to the fact of the previous referendum results on this issue: The fiscal facts have changed
drastically and you are paid not only to follow the public's transitory will but to lead when
good sense dictates.
Thank you for your consideration.
GREATER OLNEY CIVIC ASSOCIATION by
Arnold B. Gordon
301-570-0481
7 Minuteman Court
Rockville, MD 20853
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'1
go
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Thank you members of the Montgomery
County Council for the opportunity to provide
you testimony regarding EMS reimbursement
'}-,
ooAsider.i-ng,
Revised Bill 17==t2€.
.
.
I'm Kevin McGee, Chief of the Prince
Wiliiam'County Department of Fire and Rescue .
. Prince William County has over 800
operational volunteers and 535 career
personnel.
Our annual call volume is approximately
33,000 emergency incidents, over 75% of which
are medical emergencies.
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The growth in Prince William County has
placed greater service delivery demands on the
fire and rescue system ..
The economic reality most every jurisdiction
in the nation now find itself in necessitates
evaluation of the range of possible revenue
options, while balancing the financial imp;act on
our citizens.
\.,
Prince William County implemented an EMS
Billing Program as a new source,of revenue,
that doesn't have any additional financial impact
on our citizens.
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.
We began to capture EMS billing revenue in
ItJ
\At
~v
.
fiscal year 2011 and our curren"Nevenue
projection is 5 million dollars. Our
.
~(;AJ
v
reimbursement program is a soft billing
approach, as I see is in your proposed
leg islation.
EMS transport services are already included
in consumerinsurance premiums and by not
billing for these services, would have resulted in .
Prince William County losing legitimate
revenue. The same legitimate revenue that
Montgomery County Fire and Rescue is
currently not capturing.
®
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One EMS reimbursement misconception is
that citizens who need help won't call 911 for
concern about the cost.
This is simply unfounded and I can -tell you
that Prince William County has not experienced
any decline in EMS incidents.
In fact we're having an increase in EMS call
volume.
~~
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Critical to any EMS reimbursement
program's success is an outreach program to
provide accurate information to the citizens to
include your soft billing approach.
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Since the program's initiation, a small
number of citizen questions have been received
and have been easily satisfied with accurate
information.
FJtJ
tC!.-IIf·LLY
The EMS Billing Program has fiseaUy
supported critically needed enhancements to
Prince William County's fire and rescue system.
Our Fire and Rescue Association that
oversees the fire
,
and rescue system and
includes our el,even volunteer chiefs,
unanimously endorsed the initiation of our EMS'
billing program. This revenue has funded;
• systemwide needs such as the staffing
of additional EMS transport units,
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• the modernization of sophisticated
biomedical equipment and other EMS
equipment,
• and providing enhanced EMS training
so we can even better care for the
patients /we serve.
Our experience with the initiation of an EMS
reinlbursement program has had no downside
impact to service delivery, doesn't directly cost
our citizens anything and is directly responsible
for critical EMS system improvements.
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In review of the proposed amended:
legislation, your program is very Montgomery
County resident friendly. I believe you will
experience the positive impacts we have
experienced from our program.
I recognize you have an important policy
. issue before you. I hope I was able to provide
71ft!
Ptrlt
reassurance, based on
rllo/
experience, that a
. properly implemented EMS reimbursement
program can create a new and stable revenue
source for fire and rescue systemwide needs
that won't financially impact your citizens.
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having negative impacts on care or'
extending on-scene times.
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ARUNDEL
COllNTY
MARYLAND
John R. Leopold, County Executive
John Robert Ray, Fire Chief
ANNE
Fire Department
8501 Veterans Highway, Millersville, Maryland 21108
Phone41O-222-8200. Fax410-987-2904. TDD 410-222-8747
www.aacounty;org
Testimony of Fire Chief John Robert Ray, Anne Arundel County Fire Department
05/08/2012 before the Montgomery County (MD) County Council
11.r.
Chairman and members of the County Council, thank you for the opportunity to appear
before you this evening to speak about Anne Arundel County's EMS Fee for Service
program and urge your favorable consideration of your legislation.
My name is John
Robert Ray, and I am the Fire Chief of the Anne Arundel County Fire Department, serving
over 538 thousand Maryland residents. Although a smaller cousin to Montgomery County,
striking similarities between our combination career/volunteer Fire Departments and the
demographics of our populations lend .themselves as relevant to the issue under
consideration.
.~~--~----.
--"
~
....
Since 2008, our Country, State, and County have struggled under the crushing weight of a
prolonged recession that has had devastating effects on our collective ability to provide
essential services to our citizens> Although I cannot speak to the specific challenges you are
facing here, we share a common desire to ensure critical services, and I am confident you
are besieged with similarly difficult choices> On a smaller scale, we are likewise searching
"An All Hazards Response Organization, Committed to Your Safety"
@
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for innovative strategies to meet our mission without asking our citizens to contribute more
at a time when they are already struggling to survive.
To that end, we have located a new revenue stream that is forestalling even more painful
cuts to our budgets. In 2009, the County Council of Anne Arundel County implemented a
program to bill Insurance companies for EMS transport.
The program asks insurance
companies to pay their fair share of insurance premiums already charged to county
residents. Although there was tremendous trepidation prior to implementation and some
substantial emotional arguments promoted by a variety of constituencies, I am pleased to
report that the program has been an overwhelming success.
Please allow me to cite a few examples reflective of this success:
• The county has realized 17 Million dollars in new revenue since the inception
of the program, with an average annual income of $6 million dollars based on
40,000 patient care transports with an effective collection rate of 30%. All
funds collected are deposited into the General Fund pursuant to County Code.
• The new revenue stream has allowed us to provide critical system support,
our transports.
• There has been no reduction in call volume consistent with the introduction of
the
for Service program. In fact, our call volume continues to increase at
the steady rate of approximately 5% per year.
"An All Hazards Response Organization, Committed to Your Safety"
p.,.i'Hft:ld
((11
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• In the three years since the program started,
no County Resident has paid
any money out of pocket for an ambulance transport when transported by
a County ambulance.
• The county's bond rating agencies have specifically cited this program as a
positive attribute in helping to maintan our bond rating at AAA.
Additionally, our program provides the following:
• No case is ever referred to a collection agency
• A compassionate billing program provides a waiver for non-residents
experiencing [mancial hardship
• Out of County residents receive requests for payment consistent with the
demands placed on the system
One of our on-going challenges is the demand for services into surrounding jurisdictions.
Just as here, Anne Arundel County participates in automatic aid agreements with
surrounding partners in public safety. Of note, every time that a mutual aid ambulance
responds into our County and transports a patient, the county resident is subject to the EMS
transport fees imposed by that jurisdiction. At least three jurisdictions: Annapolis, Prince
Georges County and the City of Baltimore participate in a fee recovery program.
they are transporting approximately 3000 Anne Arundel County residents and the revenue
associated with the provision of that service is going directly to their jurisdiction. The
parallel for Montgomery County residents can
ambulance transports a county resident
drawn every time a District of Columbia
that county resident is subject to the
ENIS
fee
~
<:!:§J
"An All
Hazards ResDonse Orllanization, Committed to Your Sa
e "
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imposed by DC. Conversely, every time a Montgomery County EMS unit responds outside
the County and transports a patient, county taxpayers are paying for the provision of that
service at no cost to the user.
My goal here today is not to direct your decision. I would never presume to imply
that our experience is causally relevant to your experience should you choose to implement
this program.You must clearly act in the interest of the needs of your' citizens taking into
account all of the factors that are attached to this complex issue. I hope that in providing
information about Anne Arundel County's experience I have been able to successfully allay
commonly held myths and concerns relating to the deployment of a valuable new revenue
stream in these most challenging economic conditions.
I will be happy to answer any questions you may have about our program and I once
again thank you for your attention and invitation to speak this evening.
"An All Hazards Response Or anization Committed to Your Sa e "
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Testimony to the Montgomery County Council
Regarding Ambulance Fees by Johnie Roth, Jr.
May 8,2012
Mr. President and members ofthe County Council, my name is Johnie
Roth, Jr., and I'm here
t~is
evening wearing 2 hats, one as the
Volunteer President of the Sandy Spring Volunteer Fire Department
and the other as a resident and voter of Montgomery County.
I would like to say that I'm glad to be here with you this evening, but
I'd be lying. I would have preferred working on the problems dealt our
fire department by the county or a quiet evening with my family, but
instead, I'm here with you again in opposition to the Ambulance
Transport Fee. I must state from the start that I'm here tonight
speaking for myself, my family, and residents that couldn't be here this
evening.
A proposed form of the Ambulance Fee dates back to 2004 when
Montgomery County Executive Doug Duncan proposed it, and past
County Councils and citizens rejected the idea for numerous reasons.
Most recently even I applauded County Executive Leggett when he
declared after the last election that he would respect the voters decision
of "NO AMBULANCE FEES
IN
MONTGOMERY COUNTY" but
that was short lived and his words meant nothing. His recent disregard
of my vote is not just disturbing but wrong.
I was born and raised in this county some
63
years ago and I've served
proudly as a volunteer in the fire and rescue service in this county for
45
of those years, but I'm appalled and offended, that this County
Executive and some members of this County Council have continued to
blame and chastised the volunteers for defending the rights of their
families and the Montgomery County citizens we serve from paying an
Ambulance Transport Fees that technically they're already paying
in
their taxes already. In your own pamphlet entitled "Tax Facts" that the
citizens receive every year with their tax bills and is signed by both the
County Executive and the President of the County Council under
services provided
by
tax revenues it states that" There are additional
County taxes that are levied either Countywide or in specially defined
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areas ... The following taxes are Countywide (all taxpayers pay these
taxes) ... the Fire District Tax, which funds fire and rescue services ••.".
I feel that by enacting both, you're double dipping or pilling on to the
residents to solve financial problems created by the failure to live within
the budget you have established.
On a personal note, the claim that this is just free money waiting to
be
collected and that the insurance companies have a provision to cover
ambulance fees is just not true in all circumstances. Checking with my
own insurance company, (United Healthcare) I found out that we, in
fact, ARE NOT covered unless the annual deductible is met, and then,
we are covered at 80%, ONLY IF a ''medical'' procedure is performed
on the ambulance. Under our coverage, my family is not covered for a
basic ambulance transport
The Pros and Cons have been bantered back and forth and I won't bore
you with any more statistics or statements except to state it's all about
the money. It's not about the quality of life or the enhancement of
services provided to our residents that the County Executive is worrying
about; it's all about the money,
Finally, the proposed Ambulance Transport Fee is ethically wrong. It's
not an annual game .•• If you chose to support the County Executive
there will be NO WINNERS, but you will have lost the trust and the
faith of your constituents by overriding their votes
Please vote No
Thank you.
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The Real Cost of Charging for EMS services.
Leah N Gold Bates, EMT-B
Volunteer EMS provider, Montgomery County, Maryland
No one who hasn't been without insurance or ajob can really understand the anxiety of facing illness and facing medical
choices without the security of knowing that it will be paid for and that it won't break us or bankrupt us. No one but
someone who has to live on the financial brink on a daily basis can understand how little it can take to send you over the
edge.
Haven't we been here before? Did the people of Montgomery County not speak clearly enough the first time? The people of
Montgomery County do not want this usurious, immoral, dangerous fee to burden our weakest and sickest on their worst day.
The people of Montgomery County don't want to put people in the position of putting off calling for that extra half an hour
that just might be the difference between life, death or permanent, costly disability.
Before you tell me 'everyone else is doing it', let me remind you that everyone else was doing it with racism, sexism and
other injustices - that before Loving vs. Virginia, someone like me couldn't have married my husband, because he's white
and I'm black. It was the law. It was an immoral, reprehensible and unjust law.
It
discriminated and so does this. The only
difference is that this law targets the poor, the scared and those who lack the education or capacity to fight the powers that be.
Injustice has often been part of the law of the land; accepted, 'the way things are done'. The truth is laws are always made by
people more powerful than most of the people who have to deal with the consequences. One simply has to hope that our
representatives understand that they are here to represent, not to dictate to the voters. Your job is service with compassion,
not tyranny without heart.
The sad fact that other counties have made this mistake doesn't mean we should make it too. We shouldn't follow 'monkey
see- monkey do.' Instead, we should be an example, if necessary, the example. We should do the honorable thing. We
should do the right thing. We should do the good thing. This fee is the expedient, shortsighted, cold-hearted thing legislated
by those who apparently have no understanding of what it is to watch pennies. To not have pennies. To go without. To face
debt and even bankruptcy because of medical bills. The cost of health care as a commodity, when it should be a right.
If we want to be selfish and think about money, then we should at least do the thing that will promote our public health. We
shouldn't put people at risk of accidents because the heart attack victim is driving himselfto the hospital. We shouldn't
discourage the woman who might be patient zero of an infectious epidemic from calling an ambulance and instead taking the
bus and exposing many people to an infectious agent instead ofjust the two people who have been vaccinated and who are
taking proper protective precautions. Worse, they could wait to call us out of fear and never make it to the hospital at all­
and expose countless people to a dangerous disease before they finally die.
We don't charge for police calls because we want no hesitation when
it
comes to public safety. Yet this is also a public
safety issue and we don't seem to be able to get that. Is it really more important for someone whose stereo has been stolen to
be able to call for free than it is for a citizen having a stroke?
You say it won't fall on people; that their insurance will pay. Yet even people with insurance have copays or simply crappy
insurance. All insurance is not created equal. I've seen people fight with insurance companies to pay bills that the
companies should have paid without hesitation, but decided they could get away without paying, so they refused payment.
I've seen people who went to hospital thinking they were having a heart attack, when it turned out to be something lesser.
Then the insurance company told them that since
it
wasn't a 'real' emergency, they weren't covered. They were saddled with
many thousands of dollars for doctors, tests and yes, ambulance fees.
People don't know when they call an ambulance whether their insurance will consider it a 'real' emergency or tell them they
weren't 'pre-approved' for a 'non-emergency'.
You
may not charge people who can't pay, that doesn't mean they won't have
to pay. You may not intend for them not to call us, but that doesn't mean they won't hesitate to call. When you're poor and
every dollar matters, you make decisions that don't make sense to people who have money. You make decisions out of fear
and out of your experience of the world as a cruel place where bad stuff always happen, even when you do the right thing.
We should have universal health coverage and no one should ever have to worry about being bankrupted by illness. We're a
long way from that. This fee is going in the wrong direction. The law of the land should not be every man for himself
~
according to his ability to pay. That passes from immoral to amoral. Please don't take this step, this misstep.
r..:!.J;
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May 8, 2012. My name is Kim Bobola. I am a former chair of the East County Citizens
Volunteer
Advisory Board. Tonight I am speaking as an individual. Thank you for the opportunity to share my
thoughts on why I favor Bill 17-12 that establishes the ambulance reimbursement program.
Just last week, I attended the County's Volunteer Recognition Program for Volunteer Champions such
as the late Roscoe Nix, Chuck Lyons, Ambassador Connie Morella, and other outstanding volunteers in
Montgomery County. I left the ceremony in Bethesda and drove past the Bethesda-Chevy Chase
Volunteer Fire House where the electric sign in the front flashed the message "No Ambulance Fee."
In
response to seeing this message after just attending the County's gala, I made a wish for a better use of
our Volunteer Firefighters than campaigning against the passage of reimbursement legislation.
To the leadership of the county's Volunteer Firefighters' Organization, I say, as does a growing number
of people including our neighbors in Prince William and Anne Arundel Counties, it's time to tum off
that lighted sign, and tum your attention to being volunteers - for the good of the county budget, and in
helpful service toward maintaining Montgomery County as the great place it is.
Stop this nonsense that people won't call for an ambulance.
If
it's an emergency, of course they will
call, regardless of getting a bill. What it will prevent, however, is the abuse of our ambulance resources
for non-emergency use created by uninsured people who use our hospital emergency care as their
primary care provider when their only out-of-pocket cost is the tips they happily provide to the brave
volunteers who took such good care of them during their free ambulance ride.
We're at a critical point in Montgomery County's budget history, and now have an important job as
fellow volunteers in spreading the message on why the ambulance reimbursement program is a best
practice for county governments, including our own.
First, anyone who pays federal taxes, and most of us do, already pays for ambulance service for those
who receive Medicare and Medicaid. Most workers are discovering their health benefits also cover
ambulance service. So, why should Montgomery County taxpayers pay for this same ambulance service
when insurance companies, Medicare and Medicaid pay for ambulance service in other jurisdictions
around us? The County Executive's bill will stop this.
Second, the County Executive can't simply decide to do this. He needs the Council to enact a law.
Actually, such a law has passed twice, but was also overturned twice due primarily to the campaigning
efforts of Volunteer Firefighters - this last time by just 52% of the vote. The trend is that this bill will
ultimately pass, so why put off the inevitable and why not start reaping the benefits of reimbursement?
Third, this bill has adapted to incorporate concerns that have been expressed by Citizens Advisory
Boards around the County. Also, the County Executive's pending amendments make the bill more
compassionate towards those who suffer financial hardship.
Finally, let's keep things in perspective. Healthy people rarely need an ambulance, and many of us
won't ever use one over the course of our lifetime. For that reason, this reimbursement program is
inconsequential as part of the big picture. Conversely, if you add up the reimbursement dollars you'd
get by passing Bill 17-12, you'd find the reimbursement amount very consequential for a county
strapped for money.
On behalf of many fellow volunteers, thank you.
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Nonprofit
Montgcme~'Y
A NONPROFIT IilOUNDfAEll.E' A!"i".lIATt=
Good evening and thank you for the opportunity to speak. I am Luisa Montero, director of LAYC/Maryland
Multicultural Youth Center, tonight representing Nonprofit Montgomery.
During last month's public hearing on the FY
2013
budget, Nonprofit Montgomery stood along with our colleagues
from the Safety Net Coalition to urge you to make key investments in nonprofit service providers that will improve
our ability to continue delivering quality services to County residents. We requested a
2
percent inflationary
increase to all eligible base contracts for services provided by non profits to help them absorb the rising costs
of doing business in the County. We also requested a policy change to allow advance payments due under
contracts to prevent already strapped providers from having to deliver services up front and then wait a quarter to
be reimbursed.
We applaud the County for taking concrete positive steps on both requests. As you all know, since that hearing,
the Leggett administration announced a new pilot policy to provide advance payments on select contracts with
nonprofits up to
$25,999.
We also understand that, as part of your own deliberations of this budget, you are
looking at an inflationary increase for eligible contracts with nonprofits.
Tonight. we affirm our support for fair revenue-raising measures that allow the Countv to make sufficient
investments in community needs without harming those we aim to assist. We think the proposed ambulance fee
is just such a measure. and we support jts adoption in Montgomerv County.
We understand that this fee would pose no additional burden to Montgomery County residents regardless of their
insurance status, and that we are the only jurisdiction in the region that currently does not charge this fee. Most
importantly, we understand that this measure could raise as much as
$18
million per year in additional revenue.
No one would argue that this is revenue that could not be put to good use.
The recent economic downturn was a tough time for the entire County, and we know that safety net programs and
those vulnerable residents who benefit from them, were some of the hardest hit, enduring three successive years
of brutal cuts. At the same time, the need for assistance rose. We tightened our belts, however, and tried to
maintain services even as the downturn drove more and more people to our doors with requests for food, shelter,
health care and other basic needs. Demand is still high, as the recovery has yet to trickle down to our residents
who experience the most need.
Last month, we urged the County to begin reinvesting in its nonprofit partners who serve more than half of the
County's residents. This month, we want to support a reasonable revenue option that will help you to make that
investment.
The nonprofit community is committed as ever to partnering with the County. We support responsible options for
raising revenue that are fairly distributed, and help the County meet its obligations.
Thank you.
May
8,2012
www.nonprofitroundtable.org
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BAS"]' COUN1Y CITIZENS ADVISORY
BOARD
May 8, 2012
The Honorable Rogel' Berl iner
President
MontgomclY County Coullcil
100 Maryland Avenue
Rockville,
Maryland 20850
Dear Council President Berliner:
1 am writing to you on behalf of the East County Citizens Advisory Board (ECCAB) to express our
support for Expedited Bill
17~
12, Fire ami Rescue Service - Emergency Med ical Services ­
Reimbursement, which would authorize the Connty to seek reimbursement for EMS transport services
from insurance companies, Medicare and Medicaid.
On April 7, 2010, this Board submitted a letter in
SUppOit
of Bill 13-10, which was essentially
identical
to
the current bill and was ultimately passed by the Council. While the legislation was later
overturned by referendum, we believe t.hat the current fiscal circumstances, particularly as affected
by
state actions
including the
pending teacher pension shift
and
Maintenance
of
EffOit
legislation, wan'ant
passage of this bilL Bill 17-12 is transparent, serves the interests of the community and is a prudent
process for funding critical tire and rescue services, Many other jurisdictions nationwide and in the DC
metropolitan area, including the District of Columbia, have similar reimbursement programs. Moreover,
uncleI'
this legislation no Montgomery County resident would receive a bilI for emergency transport
services and low-income non-county residents would be eligible to apply
tor
a waiver of the fee.
We are pleased that the bill includes language that sets aside EMS reimbursement revenue for
supplementing fire and rescue services. However, we would appreciate ftuther clarification in the bill as
to how this revenue will be allocat.ed between County and volunteer fire and rescue services.
The EMS reimbursement program
will
provide Montgomery County Fire
&
Rescue Servi.ces with the
funds needed to maintain high levels of service to all parts of the Connty, and support our local volunteer
departments. We urge the Council to pass this legislation without delay,
Sincerely,
Ivlarva Deskins
Chair, .East County Citizens Advisory Board
cc: Hon. Isiah Leggett, Montgolnery County Executive
Chief Richard Bowers. Fire and Rescue Services
~- ~,
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3300 Briggs Chaney Road • Silver Spting, Ma.r:yland 20904 ..
240n77-8
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iOO, FA,X 240/777·8410
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UPCOUNTY CITIZENS ADVISORY BOARD
April 25, 2012
The Honorable Roger Berliner, President
Montgomery County Council
100 Maryland Avenue
Rockville, Maryland 20850
Dear Mr. Berliner:
The Up county Citizens Advisory Board (UCAB) held a joint Land Use and Quality of Life
committee meeting on April 23, 2012, during which a public discussion was held on the
proposed Emergency Medical Services Reimbursement Act. The advisory board members heard
from representatives both for and against the proposal. Both sides presented formidable
arguments. After deliberation, the UCAB voted 6 to 5, with 2 abstaining, in favor of supporting
the proposed Emergency Medical Services Reimbursement Act.
The majority cited the need to help raise revenue to offset potential shifting of teacher pension
responsibilities and the unfavorable effects of the Maryland legislature's "Doomsday" budget.
It
was acknowledged that most, if not all, of the surrounding jurisdictions also have similar
legislation in place and it would be a missed opportunity by 'leaving money on the table".
The minority cited the 2010 election in which the voters rejected the Ambulance Fee and the
divisive nature of the issue-one that cuts a deeper wedge between career fire fighters and the
volunteers.
We realize that this is difficult situation for both County Executive Leggett and the County
Council and we thank you for your continued support for Montgomery County and in particular
the residents of the Upcounty region.
Sincerely,
(
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Cardenas, Chair
Upcounty Citizens Advisory Board
cc: Isiah Leggett
12900 Middlebrook Road, Suite 1000 • Germantown, Maryland 20S74
240/777 -8000, TTY 2401777-S002. FAX 240/777-S00 I • www,montgomerycountymd,gov/upcounty
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Page 1 of 1
Marin. Sandra
.--... --.----.--.----.----.. ----.-------......---...---_..--...........-.--.- ..............-...-.---..--. .... -..--..--- ·-···---·----··..
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From:
Sent:
To:
Reindollar, Skip [wreindollar@mitre.org]
Tuesday, May 08, 2012 5:07 PM
Montgomery County Council
-
c.
MF
~~r:-
068299
Subject: Bill 17-12 Silver Spring Fire Department Neutral
Dear Council Members,
The Silver Spring Volunteer Fire Department (SSFD), as in
2010,
remains neutral on Bill
17-12.
SSFD does not support nor
is included in the Montgomery County Volunteer Fire Rescue Association as part of its efforts on Bill
17-12.
Any Silver
Spring member speaking at the hearing or providing written opinion does so as a private citizen.
SSFD continues to focus on serving the residents through the execution of its strategic plan shared with each of the
Council Members in September
2011.
SSFD intends to maintain and execute its mission through a cooperative fire
services delivery approach with the Montgomery County Fire Rescue Service.
Thank you,
Skip Reindollar
President
Silver Spring Volunteer Fire Department
Thank you,
Skip Reindollar
Homeland Security Systems Engineering and Development Institute
The MITRE Corporation
7515 Colshire Drive
McLean, VA 22102-7508
301-651-6060
US-VISIT Office 202-295-5409
wreindollar@mitre.org
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5/9/2012
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For the Constirutional Amendment
Against the Constitutional Amendment
For
BS 5
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REFERENOUM PETITION
CS)
We,
the
under!!ignetl
~r!lll.lred
wiers
of Montgcrnery
Coooty,
Maryland.
do
hemby
petition fof
iii
referendum
vote
on the Bill 13-10, entitled MAn Act to (1)
authorize
the
County
1.0
lIrIpoo&
and
oollect
a
fH
to
recover
costs
generated
b~
pro'Iiidlng emergenC)' medical MlMCle
'lran.sports;
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for a sche1:Iule of emergent::)' medical
services
!r.m!port
fees.
fee
waiver criteria,
poem1itt~
uses of
fee
revenues, and other procedures
to
operate
111&
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SMVI~s
fI!<!I
Pl'tlQram;
{3}
prohibit a
local F,re
lind
Rese:ue Depailmem
from lmposing
a separate emergeooy mediCal seMce$ tmnsJ)(lrl
fee;
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~·the
Eucutive
(0
luult
cartaln I'81JtIlatlona
to Imp1emen1 an
emergen<:y
~cal
!L'et"1.'lce!.
transport
tee;,
(5)
require
II
certain annual mm!lfer be
made
as payment of resklt!nt!.'
tmfmllmd
portion
of
tfle.
emetgftnCy medeal servJceos. transport fee; and (6}
~netatly
Ml'i!nd
ClJlmty
law I'l!9l'1rding
the
provision
<If
emelgency
medical
s.e~$"
enacted by Ihe
Catln\y
Courn:il for Montgomery
Ceunty, Maryland. at
It!;
Mtly
2010
r~islatNE!
~!fln.
(Mont
Co.
Corle 1005,
§
9-14;
19691.M,C.•
ch.
32,
§
2.)
.
If the full text of the IlHV{)rdlmmte
OT
part of tile bllVcrttfnante ref!!rrnd (the
·proPOS~I·}
does not appear on the back of this signature' page or as an attachment. a
rair
and
accurate
summary
of the
substilnttve
1)11'\11510115
of
the
proposal
must
I.'Ip~r
tM bad.or
be
a~ched,
and the
fult
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of
the
proposal must
be
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HII! Dl'!tffioD
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ballot
as a referendum
Question
at th@ ne)lt
to
thtt
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MONTGOMERY COUNTY COUNCIL
ROCKVILLE, MARYLAND
GEORGE LEVENTHAL
COUNCILMEMBER
AT-LARGE
MEMORANDUM
May 9,2012
TO:
FROM:
SUBJECT:
Couneilmembers
,
George
l.
Leventhal
Proposed Charter Amendment on Fire Tax
Dear Colleagues,
Attached are draft amendments to Sections 305 and 306 of the county Charter, which I
am proposing as an alternative to the ambulance fee.
The amendment to Charter §305 would remove the fire tax from the charter limit,
allowing the fire tax to become the dedicated source of funding for the Fire and Rescue
Service. Both the volunteer and career firefighters have expressed support for this
proposal.
The proposed amendment to Charter §306 would make conforming changes to reflect
revisions in the name and structure of the Fire and Rescue Service, and particularly the
fact that the budgets ofthe former Fire and Rescue Commission (now called the Fire
and Emergency Services Commission) and the local fire and rescue departments are
. n ow subsumed in the budget ofthe overall Fire and Rescue Service. These changes to
§306 are not substantive and do not affect how any element of the Fire and Rescue
Service budget is reviewed and approved.
In order for the voters to consider this question in November, the Council must vote to
include it as a ballot question. I am in the process of consulting with the Council
President to determine the process we will follow for consideration of this potential
ballot question, given that the Charter Review Commission has not recommended any
other charter amendments this year.
I welcome your comments and suggestions.
STELLA 8. WERNER OFFICE BUILDING
100 MARYLAND AVENUE, 6TH FLOOR, ROCKVILLE, MARYLAND 20850
2401777-7811
OR
2.401777-7900, TTY2401777-7914,
FAX2.401777-7989
WWW.MONTGOMERYCOUNTYMD.GOV/COUNCIL
t.fi
PRINTED ON RECYCLED PAPER
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x
Fire Tax - Applicability of Property Tax Revenue Limit
The County Council proposes to amend'Sections
305
and
306
of the Charter of Montgomery
County as follows:
Sec. 305. Approval of the Budget; Tax Levies.
*
*
*
By June
30
each year, the Council shall make tax levies deer#ed necessary to finance the
budgets. Unless approved by an affirmative vote of
nineL"n6t~~Y~Il']
Councilmembers, the
Council shall not levy an ad valorem tax on real propertY,t9fin:ance the'QYRgets that will produce
total revenue that exceeds the total revenue produced
~y;tli:e
tax on real
pr9P~rty
in the preceding
fiscal year plus a percentage of the previous year's.:':!t!af property tax
reven.~~~~that
equals any
increase in the Consumer Price Index as comput,eq.ililder this section. This
ll~t;~qoes
not apply
to revenue from:
(1)
newly constructed propertYi':'(2) newly
r~.zgned
property, (3j:fi?'Joperty that,
because of a change in state law, is assessed diffetehtly
than:~:itWas
assessed in thtt previous tax
..'-
year, (4) property that has undergone a e:hange muse, [
an
'dl;(5)
any development distrIct tax used
to fund capital improvement projects,,:l.iliH'.(ill any fire tax%sed to fund County fire and rescue
services
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Sec. 306. Item Veto or Reduction.
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Upon approval of theb1idget, if:SAa:l1 be
deliY~f~d
within thIee days to the County
Executive~
who within ten
days!~~h~after maY~'4t$approve::6tTeduce
any item contained in it. If the County
Executive
disapprcjV~i~Qr
reduces
.'
:<
aliy..'itein in thti;bgdget, it shall be returned to the Council with
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the reasons for the disapproval
{)r;,ir~qg~t*~nlj!:l
writWg.
The Council may, not later than June
30
of that
year,,~r.e~pprove ahY'.~~eitW6vertli~7dl§,::<hrp~al
or reduction of the County Executive by
the
affirmaWY~~:'~FQi~J()f.
sixhlefupers, except thafthe affirmative vote of five members shall be
requi~~~~~fh:the cas~~8fJll~, budg~t:~;of
the Council, [the Fire and Rescue Commission,] the Fire
[Dep~entsJ
and
ResC~t'?, [Squa~rsl
Service, the Housing Opportunities Commission" and
MontgBm~w
College.
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Question
X
'Charter amendment by act of County Council
Fire Tax - Applicability of Property Tax Revenue Limit
Amend Sections
305
and
306
of the County Charter to exempt any fire tax used exclusively to
fund County fire and rescue services from the annual limit on property tax revenue, and update
related references.
FOR AGAINST
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'(y)F­
-----
CL
-..::tI5111?
,Lj­
V-r'lG
OFFICE OF THE COUNTY EXECUTIVE
ROCKVILLE, MARYLAND 20850
Isiah Leggett
County Executive
MEMORANDUM
May 7,2012
TO:
FROM:
SUBJECT:
/'2
Isiah Leggett, County Executive
~~
Roge,r Berliner, County Council President)
Fire and Rescue Service
Emergency Medical Services
co
I
In
response to concerns expressed by members of our community regarding
Expedited Bi1l17-12, Fire and Rescue Service - Emergency Medical Services - Reimbursement,
I am forwarding amendments which clarify the original intent of the bill, establish a Patient
. Advocate position in the Office of Consumer Protection, and add a monitoring and reporting
requirement. I am enclosing a revised draft of the bill that includes each of my requested
amendments, which are discussed in more detail below.
Amendment 1: Insurance Reimbursement Program
This amendment modifies the title of the bill to refer to "Fire and Rescue Service
- Emergency Medical Services - Insurance Reimbursement" (page 1) and adds language
referring to "Emergency Medical Services Insurance Reimbursement Program" (page 3, lines 26­
27). Both of these amendments clarify that the bill's primary purpose is to recover
reimbursement from commercial insurers, Medicare, and Medicaid.
Amendment 2: Fire and Rescue Personnel- No Insurance Inquiries
This amendment prohibits Fire and Rescue personnel who respond to a request for
emergency medical services transport from asking for any information relating to insurance
coverage (page 2, lines 8-10).
Amendment 3: County Residents - No Out-of-Pocket Expenses
This amendment clarifies that County residents will pay no out-of-pocket
expenses for an emergency medical services transport (page 3, lines 46-50).
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Roger Berliner, County Council President
May 7,2012
Page 2
,
.
Amendment 4: Non-supplantation
This amendment clarifies that the base year for the non-supplantation clause is
FY2012 (page 4, line 67).
Amendment 5: Reporting Requirement
This amendment requires the Fire Chief to report on a semiannual basis to the
County Executive and County Council regarding implementation ofthe bill (page 5, lines 82­
90).
Amendment 6: Patient Advocate
This amendment requires that the Office of Consumer Protection employ a Patient
Advocate to:
(1)
develop and implement a program for customer service as a part of the
Program; (2) develop and staff a help desk for questions regarding the Program; and (3) serve as
a liaison with any vendor retained by the County to implement the program to ensure high
quality customer service and prompt resolution of questions and concerns (page 5, lines 91-99).
Amendment 7: Outreach and Education
This amendment requires the implementation of a public outreach and education
campaign before and during implementation of the Program which includes:
Informational mailers to County households;
Distribution of information through County internet and web-based
resources;
Radio and television public service announcements;
News releases and news events;
Information translated into Spanish, French, Chinese, Korean, Vietnamese
and other languages, as needed;
Extensive use of County Cable Montgomery and other Public,
Educational, and Government channels funded by the County; ,
Posters and brochures made available at County events, on Ride One
buses and through Regional Service Centers, libraries, recreation facilities,
senior centers, Montgomery County Public Schools, Montgomery
College, health care providers, hospital;;, clinics, and other venues; and
Special outreach to senior and "New American" communities (page 6,
lines 100-118).
If you have any questions about any of these amendments, please contact
Assistant ChiefAdministrative Officer Kathleen Boucher at 240-777-2593.
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FY13 Fire and Rescue System Improvements and Enhancements
In FY13 the EMS Insurance Reimbursement legislation will provide for system
improvements with service restoration, apparatus replacement funding, facility
maintenance improvements, training and fire and rescue equipment funding.
Service Restoration ($1.3 million) - A ladder truck in the first battalion will be
placed in service with dedicated twenty four hour staffing. (NOTE: This ladder
truck was taken out of service because of recent fiscal challenges.)
Apparatus Replacement Funding ($3.1 million) - In FY13 funding will be
provided to purchase 1 tractor drawn ladder truck, 1 Engine Company, and 5
EMS units for system unit response improvements.
Facility Maintenance and Improvements ($2.3 million) - A strategic facility
assessment and subsequent plan for all LFRD and county owned fire and rescue
stations will be conducted in FY13 and initial maintenance and repairs to these
facilities Will commence in FY13 and carry through future fiscal years.
Training (250,000) - System training for career and volunteer personnel to
include core 'fire, rescue, EMS, technical rescue and driver training classes will
be conducted in FY13 and carry through future fiscal years.
Fire and Rescue Equipment ($350,000)- Beginning in FY13 and future fiscal
budget years funding to purchase personal protective equipment, portable fire,
rescue, technical rescue and EMS eqUipment for career and volunteer personnel,
the training academy and for operational units.
TOTAL
=
$7.300,000.00
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Amendment 1
Specify allowable uses of EMST funds
Insert
ill
on line 65 after
Revenue.
Insert after line 70:
al
The Fire Chief must create a dedicated fund for the revenues collected
from reimbursements under this Program. This fund must only be used
for:
Option
A
increased or enhanced fire and rescue services above the level
appropriated in FY13, including new field service positions related to
expansion of 4 person staffing or opening of new fire stations: increased
training classes or capacity; facilitv maintenance and repair: new or
replacement apparatus, gear, or equipment.
Option
Ai
(ADD:) Not more than 30% of this fund may be spent for
P¥l]onnel costs.
Option B
fire and rescue infrastructure, including equipment,
ill2llilratus, and facility constru9tion, renovati()n. maintenance, or re,paiL
This fund must not be used for personnel costs.
F:\LAW\BILLS\1217 Fire And Rescue-EMS Reirnburscrnent\Spending Amend.Doc
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Amendment 2
Allocate part of EMST funds to local fire and rescue departments
Insert after line 70 and Committee amendment on use of funds:
ill
A percentage
of
this fund, which the Council must specifY annually in
the operating budget resolutiofl. must be used to replace or augment
apparatus owned and staffed by local fire and rescue departments and
training, gear, and equipment for local fire and rescue departments. As
part of the Executive's operating budget submission, the Fire Chief
must transmit a plan for use of funds designated for local fire and rescue
departments. The plan the Chief transmits must specify:
CA)
the amount of the fund the Chief recommends to allocate to
replace apparatus that is owned and staffed by local fire and
rescue departments in the next fiscalyear; and
all
the amount of the fund to allocate to training, ge(lr. and
equipment for volunteers.
F:\LAW\BILLS\ 1217 Fire And Rescue-EMS Reimbursement\LFRD Funds Amend.Doc
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Amendment 3
Prohibit use of public funds to affect referendum
Insert after line 128:
Sec. 4. Use of County Resources.
W
Restriction.
The County, any officer or employee of the County. or any
recipient of County funds through the Fire and Rescue Service. must not
pay any County funds (including reimbursement program funds or grant
funds received from the County) or use any County employee,
contractor.
prop~rty,
equipment. communication medium, or other
County resource to support or oppose or otherwise influence voters to
approve or reject this Act at a referendum.
D2l
Exceptions.
ill
This Section does not prohibit spending public funds. to convey
information to the public about the potential effect of a
referendum on County law, policies. or services. if:
(A)
the information accurately, fairly, and impartially presents
relevant facts to assist voters
decision on the referendum;
(W
10
making an informed
the communication does not expressly or by implication
advocate a position on the referendum; and
aJ
the information isnQt presented at a polling place that is
open for voting.
ill
This Section does not prohibit a County officer or employee or a
recipient of County funds. acting within the scope of that
person's routine official duties. from publicly advocating the
approval or rejection of this Act at a referendum.
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ill
This Section does not prohibit a County officer or employee or a
recipient of County funds from taking any action to influence the
approval or rejectionofthis Act at areferendum if that person is:
(aJ
off duty;
not wearing a County uniform (including a uniform of any
element of the County Fire and Rescue Service); and
ill)
fk)
not otherwise identifiable as a County or Fire and Rescue
Service officer or employee.
F:\LAW\BfLLS\1217 Fire And Rescue-EMS Reimbursement\Referendum Amend.Doc
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Agenda Item 9
May 15,2012
Action
MEMORANDUM
TO:
FROM:
County Council
~
Michael Faden, Senior Legislative Attorney
Essie McGuire, Senior Legislative
Analyst~Lf?l~/
Action: Expedited Bill 17-12, Fire and Rescue Service
Services - Reimbursement
Emergency Medical
SUBJECT:
Public Safety Committee recommendation:
do not enact Bill 17-12 (2-1,
Councilmember Eirich dissenting).
If
the Bill is enacted, adopt Executive and Committee
amendments included in Committee redraft (3-0).
Expedited Bill 17-12, Fire and Rescue Service
Emergency Medical Services ­
Reimbursement, sponsored by the Council President at the request of the County Executive, was
introduced on April 24, 2012. A public hearing was held on May 8 and a Public Safety
Committee worksession was held on May 11.
Introduced Bill Expedited Bill 17-12 would authorize the County to impose and collect
a reimbursement to recover costs generated by providing emergency medical services transports.
This Bill is essentially identical in all material respects to Bill 13-10, which the Council enacted
on May 19, 2010, but the voters rejected in a referendum in November 2010 (see ballot and
petition language on ©55-56).
Executive amendments On May 8 the Executive submitted an amended Bill. (See the
Executive's explanatory memo on ©59-60.) The Executive's amendments clarify, but do not
substantially change, the central elements of the introduced Bill. They also add provisions that
would authorize the Executive to conduct an outreach and infonnation campaign to publicize the
reimbursement program, and would create a Patient Advocate position in the Office of Consumer
Protection.
Public hearing testimony Attached on © 18-54 are selected representative public
hearing testimony and related letters, including two from regional advisory boards which
endorsed this BilL Much of the testimony at the May 8 hearing repeated viewpoints about this
fee which the Council has heard many times before.
I
The most notable new testimony came
IMuch of the testimony from opponents of this Bill centered on the theme of "Respect the Voters", which would
treat as binding on the Council and Executive, for some unknown period of time, the 2010 voters' rejection of the
previous EMST fee law. In Council staff's view, this argument carries weight but should not be conclusive. There
is no legal bar to the Council enacting a similar, or even identical, law post-referendum. Presumably, no one would
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