08-08-18 Personnel and Finance (#2)

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CITY OF SOUTH BEND I OFFICE OF THE CLERK ambulance services were being given additional appropriations based off the cost of delivering service,run volume,and other factors that formulated that reimbursement funding. Over the course of time, since 2015, because when we originally started this, we had some significant reimbursements from Medicaid, millions of dollars, that looked like we might be able to proactively fund that Fund using those Medicaid payments. He continued, Unfortunately, with the way things are going with Medicaid and the Federal Government's reimbursement schemes, it has been explained to us that each year, the funding for that program has decreased and we have seen those dollars going down every year. We've been told that by 2020 or 2021, we may not see much of anything with those reimbursements again. I've mentioned to Council numerous times in the past that, when we accept Medicaid assignment from patients, we basically have to write off any additional cost beyond what they reimburse us. Typically,the Federal Government will only reimburse us pennies on the dollar. If we have a$500 ambulance bill that goes out to Medicaid, typically we might see seventy dollars ($70) and are, in essence, writing the rest of it off. That is what this program was put in place for was to help make up some of that loss. Having said that, we are not one hundred percent (100%) sure what will be happening with the Federal Government as things move forward and with regards to the Medicaid reimbursement. We are actively attempting to get whatever we possibly can to get out of these programs. We continue to file for those Medicaid reimbursements but, unfortunately, they are typically two (2) years behind in reimbursement. So with this being 2018, we don't expect to get 2017 or 2018's money for another couple of years. We are looking, this year, at possibly finally getting 2016's money. There have been a couple different versions of the program. We have been in front of the Council asking for a lump sum payment to pay out to the State ahead of us getting the check which then the State reimburses us for. The first (P) time we did it, it felt shady quite frankly. It has been paid out each time,though, so we are pretty confident the State will not short- change us. He went on,The#288 Fund was then created as an Enterprise Fund to help fund our EMS service. A lot of things go into that Fund. All of our insurance, Medicare and Medicaid reimbursements that we receive for patient transports in our ambulance service, we budgeted this year for about $2.7 million in reimbursements gained through that. Councilmember Oliver Davis left the meeting at 5:52 p.m. Chief Cox continued,Approximately$1.7 million is money we receive from the County to be able to provide ambulance service for the unincorporated portions of the County. The County reimburses us for fifteen(15) FTEs associated with that program. That money comes into#288 as well. We also have an Interlocal Agreement with Notre Dame. We provide ambulance service for the athletic events and the other events that happen out on campus. Through the contract of the Interlocal agreement we have with the University, they reimburse us at a set rate based off of vehicle maintenance, fuel costs, salaries and benefits for the Fire Fighters that go out to provide those services for all of those events. Typically we will work on that agreement for anywhere between a three (3) or four(4)year, and I think we've even had a five(5) year agreement with the University. We base those increases of reimbursement rates off of contractual obligations we have. He continued, In #288 currently, we actually have forty-seven (47) Fire Fighters, including our Chief of EMS and four and a half(4.5) civilian positions. We have one (1) part-timer and those four and a half (4.5) civilian positions are EMS billers. Stephanie was talking earlier about EXCELLENCE I ACCOUNTABILITY I INNOVATION I INCLUSION I EMPOWERMENT 455 County-City Building 1 227 W.Jefferson Bvld I South Bend,Indiana 46601 I p 574.235.9221 l f574.235.9173 I TM 574.235.5567 wvvw.southbendin.gov 11