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Home My WebLink About26-19 Amending Ordinance to Address Ambulance/Medical Fees ::-- p3TH, � r I222 S.MICHIGAN STREET 1 V d j PHONE 574' 23 5-925 5 SOUTH BEND,INDIANA 46601-2821 Fax 574 235-9305 41 1865 CITY OF SOUTH BEND PETE BUTTIGIEG,MAYOR SOUTH BEND FIRE DEPARTMENT STEPHEN F. Cox FIRE CHIEF Filed in Clerk's Office July 30, 2019 AUG 05 2019 President Tim Scott 1G REE,o,ql•f FOWLER South Bend Common Council CITY CLERK,SOUTH BEND, IN Suite 441 S County-City Building South bend,IN 46601 President Scott, I am respectfully requesting the South Bend Common Council consider my recommendation to increase the Ambulance User Fees charged by the South Bend Fire Department.As required by The South Bend Municipal Code, Chapter 9,Article 3, Section 9-18, I have provided the required 2019 Annual Review of User Fees with the recommendation for an increase that reflects the increase in reimbursement amounts allowed by Medicare.These amounts are current to this year.As I have stated in the past, Medicare typically adjusts this reimbursement allowance at least annually,which usually includes an increase in the rate of reimbursement. If adjustments are not made to our user fees periodically,we are unable to take advantage of Medicare's reimbursement increases. This ordinance also includes a provision for self-effectuating annual fee increases based on Medicare or similar federal or state annual rate adjustments. I recommend adoption of this self- effectuating provision because Medicare and similar rates provide a reliable,pre-approved standard for reasonableness and relationship of cost to service.Additionally,there is a provision to recover fees for services provided by a paramedic intercept vehicle.The SBFD recently put into service a paramedic intercept concept by which a lead paramedic is called to provide advanced life support services to the most critical patients. I appreciate your consideration in this matter. I look forward to presenting the ordinance to Council at your committee and regular meetings. Sincerely, St phe F. Cox Fire Chief UA MICHAEL J.DAMIANO TODD L.SKWARCAN ANDREW J.MYER JOHN COIYTHIER FEDERICO RODRIGUEZ,JR ASST.CHIEF OPERATIONS ASST.CHIEF SERVICES ASST.CHIEF EMS ASST.CHIEF TRAINING FIRE MARSHAL. Filed in Clerk's Office BILL NO. 26-19 AUG 05 2019 K ORDINANCE NO. ARE FOWLER CITY CLERK,SOUTH BEND,IN AN ORDINANCE OF THE COMMON COUNCIL OF THE CITY OF SOUTH BEND, INDIANA,AMENDING SECTION 9-16 OF CHAPTER 9,ARTICLE 3, OF THE SOUTH BEND MUNICIPAL CODE TO ADDRESS AMBULANCE/MEDICAL SERVICE FEES STATEMENT OF PURPOSE AND INTENT Since 1981,the City of South Bend, Indiana has codified the regulation of ambulance and medical user fees into the South Bend Municipal Code. South Bend's current ambulance and medical user fees took effect on June 27, 2016 (Ordinance No. 10444-16). The South Bend Fire Administration has regularly reported to the Common Council its ambulance service activity pursuant to Chapter 9, Section 9-18 of the South Bend Municipal Code, and has provided its recommendation regarding adjustment of user fees. The Fire Chief's most recent report was submitted to the South Bend Common Council on May 31, 2019. The City's ambulance and medical user fees have remained unchanged for over three years but based on its recent survey of these fees and charges, and due to increased costs to the City for personnel training and necessary medical supplies, it is recommended that ambulance and medical user fees be adjusted consistent with the 2019 Medicare Fee Schedule. To help recover the costs and expenses of the Fire Department paramedic branch in providing ambulance and emergency medical services, an adjustment is required of the current rates. It is also necessary to add and define a new category of ambulance and medical user fee for "paramedic intercept" services which are now reimbursed by Medicare. Such services are provided when paramedic support is rendered to an advanced life support non-paramedic ambulance in order to give a higher level of service to a patient in need of paramedic care. It is further recommended by the Fire Administration that hereafter the South Bend Fire Chief be authorized to adjust these user fees once annually and automatically by the same percentage rate as any adjustments made to the Medicare Fee Schedule rates, with notice to the City Clerk after which such new rates will take effect. These changes are reasonable, appropriate, based on the cost of service as reasonably determined by Medicare, and in the best interests of the City of South Bend. NOW,THEREFORE, BE IT ORDAINED by the Common Council of the City of South Bend, Indiana, as follows: Section I. Chapter 9, Article 3, Section 9-16 of the South Bend Municipal Code shall be amended to read in its entirety as follows: Sec. 9-16. Ambulance/medical user fee--Established. (a) The following user fee schedule shall be charged for all ambulance/medical services provided by the City through its paramedic branch of the Fire Department: Resident Non- Resident Non-Resident Resident • (1)Basic Life Support(BLS Non- 9 $128.51 $331.82 $470.74 Emergency) (2)Basic Life Support(BLS Emergency) 515.19 686760 530.91 753.18 (3)Advanced Life Support(ALS Non- 386.63 514.20 398.18 564.89 Emergency) (4)Advanced Life Support--Emergency 6 84-446 630.45 894.40 (ALS-1 Emergency) (5)Advanced Life Support(ALS-2 1,178.39 912.50 1,294.53 Emergency (6)Paramedic Intercept(PI) - - 580.68 823.79 (7)Mileage,Basic(Within City Limits) 12.66 12.66 12.66 12.66 (per patient miles,minimum one(1)mile) (8)Mileage,Rural(per patient miles, 19.16 19.16 19.16 19.16 minimum one(1)mile) (9)Non-Transport Medical Calls 150.00 200.00 200.00 200.00 (10) Specialized Care(AO 434) 1,047.09 1,392.63 1,078.41 1,529.90 (b) The above fees shall be charged per patient run occurrence; however, when ambulance/medical services are provided for a patient using a private ambulance, the mileage fee shall not be charged; and further provided that when more than two (2) members of an immediate family residing at the same address are transported per incident, the basic fee, mileage fee, and emergency fee shall only be billed for two(2)persons. (c) Non-resident: Is defined as a person whose primary residence at the time of the service is outside the corporate boundaries of the City of South Bend,Indiana. (d) Basic Life Support (BLS): Means transportation by ground ambulance vehicle and medically necessary supplies and services, plus the provision of BLS ambulance services. The ambulance must be staffed by an individual who is qualified in accordance with State and local laws as an Emergency Medical Technician(EMT)1. 1 ALS 1,ALS2 and BLS definitions track the language codified in Title 42 of the Code of Federal Regulations, Chapter IV, §414.605 entitled"Fee Schedule for Ambulance Services". (e) Advanced Life Support, Level 1 (ALS 1): Means transportation by ground ambulance vehicles, medically necessary supplies and services and either an ALS assessment by ALS personnel or the provision of at least one ALS intervention. (f) Advance Life Support, Level 2 (ALS2): Means either transportation by ground ambulance vehicle, medically necessary supplies and services, and the administration of at least three (3) medications by intravenous pus/bolus or by continuous infusion excluding crystalloid, hypotonic, isotonic, and hypertonic solutions (Dextrose, Normal Saline, Ringer's Lactate); or transportation, medically necessary supplies and services,and the provision of at least one(1)of the following: (1) Manual defibrillation/cardioversion (2) Endotracheal intubation (3) Central venous line (4) Cardiac pacing (5) Chest decompression (6) Surgical airway (7) Intraosseous line (g) Non-Transport Medical Calls: Means a response to a medical emergency call by ambulance vehicle and the administration of ALS skills upon or medication given to a patient who then refuses transport to the hospital. (h) Paramedic Intercept Services: Means the rendering of lead paramedic advanced life support (ALS) services, Level 1 or Level 2 during ambulance transport when the patient needs lead paramedic ALS service that the transporting ambulance is unable to provide. The lead paramedic is dispatched to meet the transport ambulance to provide the necessary lead paramedic-services. (h) f Mileage, Rural, shall apply to vehicle runs made to areas in zones or zip codes designated as rural by Medicare and the U.S.Department of Health and Human Services in its Medicare regulations. (j)The above fees shall take effect on August 1,2016 September 1,2019. (k) Hereafter, and in the event Medicare or other federal or State health care regulations require or allow an adjustment to ambulance/medical user fees, the South Bend Fire Chief is authorized to and may amend once annually the user fees set out in subpart (a) of this Section by the same percentage as the Medicare Fee Schedule rates for such services have been adjusted. This adjustment shall be effective on the calendar date immediately following the date on which written notice of said fee rate adjustment is filed in the office of the City Clerk. At the time such notice is filed,a copy of the new rates shall be made available in paper form for public viewing in the South Bend Central Fire Station, and such new rates shall also be published promptly on the City's web site. Section II. This ordinance shall be in full force and effect from and after its passage by the Common Council, approval by the Mayor, and any publication required by law, or by September 1, 2019, whichever is later. Tim Scott, Council President South Bend Common Council Attest: City Clerk Office of the City Clerk Presented by me, the undersigned Clerk of the City of South Bend, to the Mayor of the City of South Bend, Indiana on the day of , 2019, at o'clock . m. City Clerk Office of the City Clerk Approved and signed by me on the day of , 2019, at o'clock .m. Pete Buttigieg, Mayor City of South Bend, Indiana