Agenda Item 6.1
April 24, 2012
Introduction
MEMORANDUM
TO:
FROM:
County Council
~~
Michael Faden, Senior Legislative Attorney
.
Essie McGuire, Senior Legislative
Analysf['PvliL~l,.,.
Introduction:
Expedited Bi1117-12, Fire and Rescue Service - Emergency
Medical Services - Reimbursement
SUBJECT:
Expedited Bill 17-12, Fire and Rescue Service
Emergency Medical Services ­
Reimbursement, sponsored by the Council President at the request of the County Executive, is
scheduled to be introduced on April 24, 2012. A public hearing is tentatively scheduled for May
8 at 7:30 p.m.
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.
This packet contains:
Expedited Bill 17-12
Legislative Request Report
Memo from County Executive
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Expedited-Bill No . . .:. 17:-.-. . :.1=.2_ _ _ _ __
Concerning: Fire and Rescue Service ­
Emergency Medical Services ­
Reimbursement
Revised:
4/19/2012
Draft No. 1
Introduced:
April 24. 2012
Expires:
October 24. 2013
Enacted: _ _ _ _ _ _ _ _ __
Executive: _ _ _ _ _ _ _ _ __
_
Effective: _ _ _ _ _ _" _ _ __
Sunset Date:
-.!..!N~o!.!.!ne::!._...
_ _ _ _ __
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) 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 unafficted 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:
2
21-23A.
Emergency Medical Services Transport Reimbursement Program.
Obligation to Transport.
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W
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
!mY:.
(hl
Definitions.
In this Section the following terms have the meanings
8
indicated:
9
10
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12
13
ill
Emergency medical services transport
means transportation
by
the Fire and Rescue Service of an individual
by
ambulance or
other Fire and Rescue Service vehicle used for
~
similar purpose.
include
Emergency medical services transport
does not
transportation of an individual under an agreement between the
County and
~
health care facility.
14
15
m
ill
Federal poverty guidelines
means the applicable health care
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poverty guidelines published in the Federal Register or otherwise
issued
by
the federal Department of Health and Human Services.
Fire and Rescue Service
means the Montgomery County Fire and
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21
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Rescue Service and includes each local fire and rescue
department.
if)
Imposition
Q[
reimbursement.
The
County must impose
~
reimbursement charge for any emergency medical service transport
provided in the County, and, unless prohibited
Qy
other law, outside
th~
County under
~
mutual aid agreement.
@
Liability fOr Reimbursement.
Subject to paragraph
hl
each individual
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who receives an emergency medical services transport is responsible for
paying the emergency medical services transport reimbursement.
(j)
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EXPEDITED BILL NO. 17-12
28
ill
Hardship Waiver.
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30
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.
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An
individual must request
f!
waiver on
f!
form
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approved
Qy
the Fire Chief
ill
The Fire Chief may deny
f!
request for
f!
waiver if the individual
who claims financial hardship under this Section does not furnish
all information required
Qy
the Fire Chief.
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ill
Payment
Q[
Residents' Uninsured Portion
Q[
the Emergency Medical
Services Transport Reimbursement.
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ill
Tax revenues the County receives must be treated as payment, on
behalf of County residents, of the balance of each resident's
portion
of
the
emergency
medical
servIces
transport
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reimbursement charge that is not covered
Qy
the resident's
Insurance.
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 Fire and Rescue Departments.
A local fire and
rescue department must not impose
f!
separate charge for an emergency
medical transport.
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ill
Use
Q[
Revenue.
Except for the transfer received from the General Fund
under subsection
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ti1
the revenues collected from the emergency
medical services transport reimbursement must be used to supplement,
0-
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EXPEDITED BILL NO. 17-12
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and must not supplant, existing expenditures for emergency medical
services and other related fire and rescue services provided
Qy
the Fire
and Rescue Service.
ill
Regulations; Reimbursement Schedule.
adopt
f!
regulation under method
The County Executive must
ill
to implement the emergency
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
each individual who receives an emergency medical services transport
to provide financial information, including the individual's insurance
coverage, and to assign insurance benefits to the County.
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 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 may occur retroactively to that date during the first fiscal year the
emergency medical services transport fee is implemented.
Approved:
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Roger Berliner, President, County Council
Date
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LEGIS LA TIVE 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 ofthe 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, Direetor 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.
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067785
OFFICE OF THE COUNTY EXECUTIVE
ROCKVILLE, MARYLAND 20350
Isiah Leggett
County Executive
MEMORANDUM
April 12, 2012
TO:
FROM:
SUBJECT:
Roger Berliner, Council President
Isiah Leggett, County Executive
--f/~ ~
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 FY16. 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 (Le., 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 "offlimits" for spending reductions, restricts flexibility in dealing with economic
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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 MCPS/Montgomery College
retirement administration ($2.9 million) which began in FY12. 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 FY13 actions follow dramatic
reductions in State aid for community colleges, police, open space, health, libraries, and highway
user revenues in FYI 0, FYIl, 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 ofthe proposed Executive Regulation to
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Roger Berliner, Council President
April 12,2012
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 FY13 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