Agenda Item 67

May 8, 2012

Public Hearing

MEMORANDUM

TO:

FROM:

County Council

~

Essie McGuire, Senior Legislative

Analys~

Public Hearing:

Expedited Bill 17-12, Fire and Rescue Service - Emergency

Medical Services - Reimbursement

Sf:

Michael Faden, Senior Legislative Attorney

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, was

introduced on April 24, 2012. A Public Safety Committee worksession is tentatively scheduled

for May 11 at 10:00 a.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:

Expedi ted Bill 17-12

Legislative Request Report

Memo from County Executive

F:\LAW\8 ILLS\ 1217 Fire And Rescue-EMS Reimbursement\PH Memo.Doc

Circle #

1

5

6



Expedited-Bill No.

..!..17!..--...!.:12~

_ _ _ __

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=.!n..:.>: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)

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 bracketsD

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:



EXPEDITED BILL NO. 17-12

1

Sec. 1.

Section 21-23A is added as follows:

2

3

21-23A.

ill)

Emergency Medical Services Transport Reimbursement Program.

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

4

5

6

7

lli!Y:.

(Q)

Definitions.

indicated:

In this Section the following terms have the meanings

8

9

10

11

12

13

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.

Emergency medical services transport

does not include

transportation of an individual under an agreement between the

County and

~

health care facility.

14

15

16

17

18

19

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.

ill

Fire and Rescue Service

means the Montgomery County Fire and

Rescue Service and includes each local fire and rescue

department.

W

Imposition

gf

reimbursement.

The

County

must

impose

~

22

23

24

25

26

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.

@

Liability {or Reimbursement.

Subject to paragraph

hl

each individual

who receives an emergency medical services transport is responsible for

paying the emergency medical services transport reimbursement.

27

o

f:\Iaw\bills\1217 fire and rescue-ems reimbursement\bilLdoc



EXPEDITED BILL NO. 17-12

28

29

ill

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

£!

waiver on

£!

form

30

31

32

33

34

approved

Qy

the Fire Chief.

ill

The Fire Chief may deny

£!

request for

£!

waiver if the individual

who claims financial hardship under this Section does not furnish

all information required

Qy

the Fire Chief.

35

36

37

38

39

40

ill

Payment

q[

Residents' Uninsured Portion

q[

the Emergency Medical

Services Transport Reimbursement.

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

41

42

43

44

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.

45

46

47

48

49

(g)

Restriction on Local Fire and Rescue Departments.

A local fire and

50

51

52

rescue department must not impose

£!

separate charge for an emergency

medical transport.

(h)

Use

q[

Revenue.

Except for the transfer received from the General Fund

53

54

under subsection

ffi

the revenues collected from the emergency

medical services transport reimbursement must be used to supplement,

0-

f:\Iaw\bills\1217 fire and rescue-ems reimbursement\bill.doc



EXPEDITED BILL NO. 17-12

55

56

57

58

59

60

61

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.

The County Executive must

adopt

£!

regulation under method

ill

to implement the emergency

medical service transport reimbursement program. The regulation must

establish

£!

reimbursement schedule based on the cost of providing

emergency medical services transport.

The reimbursement schedule

62

63

64

65

66

67

68

69

70

71

72

73

74

75

76

77

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 ofthe 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:

78

79

80

Roger Berliner, President, County Council

Date

f:\law\bHls\1217 fire and rescue-ems reimbursement\bill.doc



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 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, Director of Finance

Kathleen Boucher, Assistant Chief Administrative Officer

Richard Bowers, Chief, Fire

&

Rescue Service

Marc Hansen, County Attorney

APPLICATION

Yes.

WITHIN

MUNICIP ALITIES:

PENALTIES:

Not applicable.

F:\LA\V\BILLS\1217 Fire And Rescue-EMS Reimbursement\LRR.Doc



067785

OFFICE OF THE

Isiah Leggett

County Executive

COU~TY

EXECUTIVE

ROCKVILLE, MARYLAND 20850

MEMORANDUM

I, :)

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 BRF A (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

.

~'~ .~~

__

3·'·~

~"

montgomerycountymd.gov/311

•

~~~"~

'.~

240-773-3556 TTY



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 ofAssessments and Taxation ($5.3 million) and MCPSlMontgomery College

retirement administration ($2.9 million) which began in FYI2. All ofthese 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 FYI3. 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, FYII, 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

(j)



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

3~-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