Agenda 12/13/2016 Item #16E8 16.E.8
12/13/2016
EXECUTIVE SUMMARY
Recommendation to renew the Collier County Emergency Medical Services Certificate of Public
Convenience and Necessity for Advanced Life Support Transport for one year and authorize the
Chairman to execute the Permit and Certificate.
OBJECTIVE: To allow Emergency Medical Services to continue to provide Advanced Life Support
(ALS) services to the citizens and visitors of Collier County.
CONSIDERATIONS: Collier County Emergency Medical Services (EMS) is currently operating under
a COPCN for ALS transport. Section 10 of Collier County Ordinance No. 04-12, as amended, allows
renewal certificates to be approved routinely by the Board upon advice of the County Manager or
designee. The Director of the Bureau of Emergency Services is the County Manager's designee.
In addition, Section 10 provides that renewals be based on the same standards as the granting of the
original COPCN along with such other factors as may be relevant. The minimum requirements for an
application to be deemed complete are set forth in Collier County Ordinance No. 04-12, as amended,
Section 5.The application is back-up to this item.
In accordance with Section 10 of Ordinance No. 04-12, as amended, the Director of the Bureau of
Emergency Services recommends approval based on his finding that there is a public necessity for EMS
to provide the service and that all other requirements under Ordinance No. 04-12 have been met.
If this item is approved by the Board, the renewal COPCN and Permit will commence on January 1, 2017
and expire on December 31, 2017.
FISCAL IMPACT: There is no fiscal impact associated with this action.
GROWTH MANAGEMENT IMPACT: None
LEGAL CONSIDERATIONS: The Ordinance allows the renewal COPCN to be approved routinely by
the Board without a hearing. If a hearing is held, the standards set forth in Ordinance No. 04-12, Section
7 apply. Section 7 states:
"The Board of County Commissioners shall not grant a certificate unless it shall find, after public hearing
and based on competent evidence,that each of the following standards has been satisfied:
A. That there is a public necessity for the service. In making such determination, the Board of
County Commissioners shall consider, as a minimum,the following factors:
1. The extent to which the proposed service is needed to improve the overall emergency
medical services capabilities of the County.
2. The effect of the proposed service on existing services with respect to quality of service
and cost of service.
3. The effect of the proposed service on the overall cost of EMS service in the County.
4. The effect of the proposed service on existing hospitals and other health care facilities.
5. The effect of the proposed service on personnel of existing services and the availability
of sufficient qualified personnel in the local area to adequately staff all existing services.
(2) That the applicant has sufficient knowledge and experience to properly operate the proposed
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16.E.8
12/13/2016
service.
(3) That, if applicable,there is an adequate revenue base for the proposed service.
(4) That the proposed service will have sufficient personnel and equipment to adequately cover the
proposed service area."
Ordinance No. 04-12, Section 8 provides:
"In making the determinations provided for in Section 7 above, the Board may, in its sole discretion,
appoint a Hearing Officer to hold a public hearing and to make factual findings and conclusions as a
result of the hearing. Should a Hearing Officer be appointed, said Hearing Officer shall render a written
report to the Board within 30 days of the hearing, which report shall contain the officer's findings and
conclusions of fact, and a recommended order. The findings and conclusions of fact shall be binding
upon the Board, but the recommended order shall be advisory only."
This item is approved for form and legality and requires a majority vote for Board approval. -JAK
RECOMMENDATION: That the Board of County Commissioners accepts the Director of the
Bureau of Emergency Services' findings; and approves and authorizes the Chairman to execute a Permit
and renewal COPCN to Collier County Emergency Medical Services for ALS Transport.
Prepared by: Artie Bay, Supervisor-EMS Admin.
ATTACHMENT(S)
1.Memo from Chief Butcher to Manager Ochs for 2017 license (DOC)
2.Attach A-Vehicle List (PDF)
3.Attach B - Schedule of Fees (PDF)
4.Attach C -Memo Summers to Ochs_doc(DOC)
5. Permit -JAK signed (PDF)
6. Certificate-JAK signed(PDF)
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16.E.8
12/13/2016
COLLIER COUNTY
Board of County Commissioners
Item Number: 16.E.8
Item Summary: Recommendation to renew the Collier County Emergency Medical Services
Certificate of Public Convenience and Necessity for Advanced Life Support Transport for one year and
authorize the Chairman to execute the Permit and Certificate.
Meeting Date: 12/13/2016
Prepared by:
Title: Supervisor-Accounting—Administrative Services Department
Name: Artie Bay
11/01/2016 1:47 PM
Submitted by:
Title: Department Head-Administrative Svc—Administrative Services Department
Name: Len Price
11/01/2016 1:47 PM
Approved By:
Review:
Emergency Medical Services Tabatha Butcher Additional Reviewer Completed 11/07/2016 9:56 AM
Administrative Services Department Pat Pochopin Level 1 Division Reviewer Completed 11/08/2016 4:08 PM
Administrative Services Department Len Price Level 2 Division Administrator Review Completed 11/14/2016 2:02 PM
Office of Management and Budget Valerie Fleming Level 3 OMB Gatekeeper Review Completed 11/15/2016 8:25 AM
Office of Management and Budget Laura Wells Additional Reviewer Completed 11/15/2016 12:17 PM
County Attorneys Office Jeffrey A.Klatzkow Level 3 County Attorney's Office Review Completed 11/16/2016 3:11 PM
County Manager's Office Nick Casalanguida Level 4 County Manager Review Completed 12/06/2016 12:50 PM
Board of County Commissioners MaryJo Brock Meeting Pending 12/13/2016 9:00 AM
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16.E.8.a
Memorandum
To: Leo Ochs, County Manager
From: Tabatha Butcher, Chief
Emergency Medical Services Department
Date: November 3, 2016
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Subject: Certificate of Convenience and Necessity for Collier County o
Emergency Medical Services Department
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Per Collier County Ordinance Number 04-12, as amended, please accept the following information forcc
renewal of this required certificate:
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1. Collier County Emergency Medical Services Department is operated by the County's Board of N
County Commissioners located at:
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3299 East Tamiami Trail ti
Naples, Florida, 34112
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The Board of County Commissioners is comprised of the following individuals:
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Donna Fiala, District 1 a)
Georgia A. Hiller, District 2
Torn Henning, District 3
Penny Taylor, District 4
Tim Nance, District 5
The age of each member may be located at the Board of County Commissioner's Office. m
2. Collier County Emergency Medical Services Department will continue to provide service to the v
2,032 square miles encompassing Collier County. o
3. Collier County Emergency Medical Services Department has a total of fifty (50) State licensed
vehicles. Thirty-nine (39) of these are licensed ground transport ambulances and one (1) air
ambulance (helicopter). There are also ten (10) licensed ALS vehicles (non-transport). Of the
above, twenty-five (25) licensed ground ambulances, and the air ambulance (helicopter) operate
24 hours and day, seven days a week. At least(1) additional ground transport licensed ambulance
may operate 12 hours a day, seven days a week (as needed) during the seasonal months and is
taken out of the reserve ambulances. The remaining, thirteen (13) licensed ALS ground transport
ambulances are held in reserve. (Attachment A).
Emergency Medical Services
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I6.E.8.a
4. Collier County Emergency Medical Services Department has one main office and twenty-five
(25) substations located throughout Collier County at the following locations:
Headquarters 8075 Lely Cultural Pkwy. Naples, Florida
Station 1 835 8th Avenue South Naples, Florida
Station 2 977 26th Avenue Naples, Florida ti
Station 10 14756 Immokalee Road Naples, Florida N
Station 20 4798 Davis Blvd. Naples, Florida z
Station 21 11121 E. Tamiami Trail Naples, Florida a
Station 22 4375 Bayshore Drive Naples, Florida v0
Station 23 7227 Isle of Capri Road Naples, Florida U,
Station 24 2795 Airport Road North Naples, Florida w
Station 25 8320 Collier Blvd Naples, Florida
Station 30 112 South 1st Immokalee, Florida
Station 31 1107 Carson Road Immokalee, Florida
Station 32 4819 Ave Maria Blvd. Ave Maria, Florida o
Station 40 1411 Pine Ridge Rd. Naples, Florida N
Station 42 7010 Immokalee Road Naples, Florida a)
Station 43 16325 Vanderbilt Drive Naples, Florida m
Station 44 766 Vanderbilt Beach Road Naples, Florida —`-'
Station 46 3010 Pine Ridge Road Naples, Florida c
Station 48 16280 Livingston Road Naples, Florida L
—. Station 50 1280 San Marco Road. Marco Island, Florida °
Station 60 201 Buckner Avenue Everglades, Florida Nm
Station 70 4741 Golden Gate Parkway Naples, Florida 0
Station 71 95 13th Street SW Naples, Florida
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Station 75 4590 Santa Barbara Blvd. Naples, Florida
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Station 76 490 Logan Blvd Naples, Florida E
Station 90 175 Isle of Capri Road Naples, Florida
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Med-Flightl 2375 Tower Drive Naples, Florida
5. Collier County Emergency Medical Services Department has been licensed and certified to m
provide Advanced Life Support ambulance service in Collier County since April 6, 1981.
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6. Three (3) Collier County residents to act as references:
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Nancy Laschied 4500 Gulfshore Blvd. N. - #903 Naples, Florida 34103
Dr. James Hampton 823 Bentwood Drive Naples, Florida 34108 i'
Michael Marcus, RN Lee Memorial Trauma Center Ft. Myers, Florida 33901 c
7. Collier County Emergency Medical Services Department schedules of service fees ra
(Attachment B). Q
8. November 3, 2016 Memorandum from Dan Summers, Director of Bureau of Emergency Services
, to County Manager Ochs stating no further information required.
Emergency Medical Services
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1 6E.8.a
9. Collier County Emergency Medical Services Department financial statement is available in
Collier County's Finance Department.
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Attachment B
RESOLUTION NO.08- 27
A RESOLUTION OF THE BOARD OF COUNTY COMMISSIONERS OF
COLLIER COUNTY,FLORIDA,PROVIDING FOR UP-DATED EMS USER
FEES FOR COLLIER COUNTY AMBULANCE SERVICES, UP-DATED
BILLING AND COLLECTION PROCEDURE, HOSPITAL TRANSPORT
BILLING AND FEES, ADJUSTMENTS OF EMS USER FEES PURSUANT
TO COLLIER COUNTY ORDINANCE NO.96-36,WAIVER OF EMS USER
FEES FOR SPECIAL EVENTS, AND AN UPDATED PROCEDURE FOR
APPROVING HARDSHIP CASES AND PAYMENT PLANS;SUPERSEDING
RESOLUTION NO.07-192;AND PROVIDING FOR AN EFFECTIVE DATE,
WHEREAS, Collier County Emergency Medical Services (hereinafter referred to as
"EMS")provides ambulance services to the residents and visitors of Collier County;and
WHEREAS, the Collier County EMS operating budget is funded exclusively through ad N
valorem taxes and user fees;and
WHEREAS,the Board of County Commissioners recently entered into an Agreement with d
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Advanced Data Processing, Inc. (hereinafter referred to as to "Billing Consultant") to provide
collection services for ambulance services and associated fees;and 2
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WHEREAS,this Resolution is Intended to apply irrespective of whether EMS billing staff,
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Advanced Data Processing,Inc.,or any other billing consultant is responsible for the collection of =
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fees for ambulance services;and
WHEREAS, Collier County Ordinance No. 96-36 § 5 provides that the user fees for
ambulance services may be established by Resolution of the Board of County Commissioners
(hereinafter referred to as to"the Board"),
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NOW THEREFORE, BE IT RESOLVED BY THE BOARD OF COUNTY :i
COMMISSIONERS OF COLLIER COUNTY,FLORIDA,that:
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SECTION ONE: EMS USER FEES
BASE RATES:
SERVICE LEVELS CODES rf)
BASE CHARGES
A. EMS—BLS NON-EMERGENCY A0428 $ 700.00
B, EMS—13LS EMERGENCY A0429 5 700,00
C, EMS—ALS 1 NON-EMERGENCY A0426 S 700.00
D. EMS—ALS 1 EMERGENCY A0427 $ 700.00
E. EMS—ALS 2 EMERGENCY A0433 $ 750,00rts
F, EMS—SPECIALTY CARE A0434 S 800.00 Q
G. EMS—TREATMENT W/G TRANSPORT A0098 $ 175.00
H. EMS—HELICOPTER A0431 S 5,900.00
MILEAGE RATES:
,SERVICE LEVELS CODES MILEAGE CHARGE
A, EMS—GROUND UNIT A0425 S 12.25 •
(Minimum Charge of I mile and no cap)
B. EMS—AIR UNIT A0436 $ 110.00
SPECIAL EVENTS AND MISCELLANEOUS RATES:
SERV 10E LEVELS RATES
A TWO(2)MEDICS/ONE ALS VEHICLE(PER HOUR) $ 150.00
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16E.8.c
B. ONE(I)MEDIC/NO VEHICLE(PER HOUR) S 50.00
COPIES+.
Subject to statutory exemptions, "public records"are required by Chapter 119,P.S. to be
open to inspection and copying. Consistent with Chapter 119,Resolution No. 07-327 establishes
copying fees as follows:
COPIES OF DOCUMENTS RATES
A. One-sided copy which is 14 inches by 8'V, inches or lass S .15
B. Two-sided copy which is 14 inches by 8%: inches or fess $ .20
COPY SERVICES
The actual cost of duplication for all other copies will be charged. The first hour of cost of
duplication will not be charged. "Actual cost of duplication"is defined in§ 1)9.07(1),FS. as"the
cost of the material and supplies used to duplicate the record,"but does not include the labor cost
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and overhead cost associated with such duplication. o
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'Copying fees arc subject to change only to the extent that either Chapter 119, ES. or
Resolution No.07-327,or both,are amended,replaced,or superseded.
PAST DUE ACCOUNTS
INTEREST ON PAST DUE ACCOUNTS S 1%monthly
SECTION TWO: BILLING COLLECTION PROCEDURE
The following shall be the minimum guidelines for billing and collection procedures for
ambulance service fees and charges: N
A. Initial fees and charges for ambulance service(s) shall be assessed either prior to or
following the provision of service,as service dynamics reasonably allow. Unpaid fees and t..
charges,subsequent to time of service shall be reflected in an accounts receivable subsidiary
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ledger system to be maintained by the EMS Department, 5
B. EMS Billing Staff will transmit all data necessary to Billing Consultant to process the claim.
1. Billing Consultant will send an initial bill to the service recipient's or responsible rn
party's Insurance carrier as soon as insurance information has been received,
validated,and entered by the Billing Consultant on the account.
2. When a valid patient address is present,the Billing Consultant will follow the patient
statement cycle outlined below,
i. An initial statement for ambulance services, including the HIPAA notice of as
privacy practices shall be sent fourteen (14) or more days after the data is
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entered by the Billing Consultant, but no later than 30 days after service has
been provided,
ii. If a non-Medicaid account remains unpaid, statements will be sent to the
patient no later than every 60 days from the last filed date. If a claim is denied,
a bill will be sent to the service recipient or responsible party.
For Medicaid accounts, if the claim is denied because of no coverage at the
time of service,or because it was determined to be not medically necessary to
be transported by ambulance, a bill will be sent to the service recipient or
responsibly party.
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16.E.8.c
iv. In the event the service recipient or responsible party does not have or does not
provide proof of insurance coverage,statements will be sent to the patient no
later than every 60 days from the last statement date.
C. The Billing Consultant will provide a file with patients to be sent to collections to the
County's contracted collection agency when all attempts to collect on the account have been
exhausted by the Billing Consultant, The County may direct the Bitting Consultant to not
send a patient to collections at any time. Billing Consultant may send a patient to
collections prior to exhaustion of all collection efforts when:
1. The patient account has an invalid address.
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2. Billing Consultant is directed by County to send a patient to collections,
17. Interest will be assessed at 1% per month on all accounts that are sent to the County's
contracted collection agency. Z
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E. A reasonable and customary payment plan will be made available for all service recipients n'
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or responsible parties. Should the service recipient or responsible party at the time fail to cn
meet the terms and conditions of the payment plan for a period of(60)sixty days,the unpaid
balance shall reenter the collections process set forth in Section C_above at the point in the
collections process at which it was taken out for a payment plan to be administered.
F. When ambulance service bill(s),at the any stage in this billing and collection procedure,are
returned because the Postal Service cannot effectuate delivery, the EMS Billing Section
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shall make reasonable effort to ascertain the correct mailing address. If reasonable efforts to
ascertain a correct address fail, the aceount(s) may be considered for other collection d
alternatives. ti
G. Nothing contained in this Section shall preclude reasonable telephone or other appropriate
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contact for billing and collection purposes,in accordance with all applicable laws.
H. Throughout the fiscal year,the EMS Billing Section shall review all past due accounts and
report to the Board of County Commissioners on an annual basis,of all past due accounts to
which are believed to he uncollectible. m
The Board may, after reviewing these past due accounts and after finding that diligent
efforts at collection have proven unsuccessful,remove these past due accounts from active
accounts receivable in accordanee with generally accepted accounting procedures and c
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pursuant to law by Resolution. E
J. Probate Estate Cases', Should a decedent have an unpaid balance for ambulance services,
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the following shall occur:
1. The decedent's Personal Representative will notify EMS Billing Staff that a
probate estate has been filed with the Probate Court,
2. EMS Billing Staff'shall ensure that a Notice of a Claim is timely flied with the
Probate Court.
3. EMS Billing Staff shall ensure that the Office of the County Attorney is timely
notified of such claim and provided with: I)a copy of ambulance bill(s),2)all
correspondence between EMS Billing Staff/Billing Consultant) and Personal
Representative, 3)Notice of Claim filed with the Probate Estate, and any other
information necessary to pursue the claim.
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16.E8.c
4. The Office of the County Attorney shall take all reasonable actions that are
necessary to pursue such claim, including but not limited, to filing a lawsuit in
the County Court to pursue such claim,
5. If the estate has assets and$10,000 or less is owed for ambulance services,the
EMS Director and the County Attorney(or his designee)are authorized to take
reasonable actions to reach a settlement with the Personal Representative or his
attorney, Should a settlement be reached, the EMS Director and the County
Attorney(or his designee)are authorized to execute a satisfaction and/or release
on behalf of the County. lithe estate has assets and in excess of$10,000 is owed
for ambulance services,any negotiated settlement/compromise of the ambulance c
billing claim shall be approved by the Board of County Commissioners. If the `;r
estate has nominal assets or no assets,the County Manager may waive the rates,
fees, and charges as set forth in Ordinance No. 96-36, as it may be amended, n'
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replaced,or superseded.
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K. All accounts with a balance of$10 or less will be written off.
SECTION THREE: HOSPITAL TRANSPORT BILLING AND FEES
A. The fees set forth in Section One of this Resolution shall apply to ambulance transports that
occur between a hospital's facilities.
B. Should a hospital within the boundaries of Collier County have the need for a transport of a o
patient between hospital facilities located within the boundaries of Collier County, N
ambulance transport wilt be provided.
C. Should a hospital within the boundaries of Collier County have the need for a transport of a
patient to hospital facilities located outside the boundaries of Collier County, the County,
as
will subject to equipment and manpower availability, at its sole discretion, utilize its
resources to provide patient transport.
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D. Hospitals requesting ambulance transports shall be invoiced directly for ambulance transport
service on a monthly basis. p�
SECTION FOUR: ADJUSTMENT OF EMS USER FEES
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The following shall be minimum guidelines for adjustments to ambulance service fees. The
Board of County Commissioners,in accordance with criteria established by the enabling Ordinance,
may authorize other adjustments. c'
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A. Medicare and Medicaid Adjustments. Contractual adjustments under Medicare and/or E
Medicaid assignment will be made in accordance with applicable Medicare and/or
Medicaid rules and regulations.
B. Victim's Compensation Contractual Adjustments, Contractual adjustments will be
made in accordance with applicable state,federal and local rules and regulations.
C. Worker's Compensation Contractual Adjustments. Contractual adjustments will be
made in accordance with applicable state,federal and local rules and regulations.
D. County Employee A justments. Board of County Commissioners and Constitutional
Officers'employees that have Primary coverage under Collier County's insurance policy
will be responsible for any deductibles,co-payments or unpaid balances. An employee
Packet Pg.2084
16.E.8.c
may dispute his/her ambulance charge in accordance with procedures set forth in
Ordinance No.96-36.
E. Chamnpus/Frlcarc 8 justments. Contractual adjustments will be made In accordance
with applicable Champus/Tricare rules and regulations.
F. Railroad Ret[r Ment Adjustments. Contractual adjustments will be made in accordance
with applicable state, federal and local rules and regulations pertaining to Railroad
Retirement Adjustments.
O. Social Services Adjustments. Contractual adjustments wilt be made in accordance with
rules established by the County Manager and memorialized by a memorandum of
understanding executed by the Social Services Director and the EMS Director.
SECTION FIVE: WAIVER OF EMS USER FEE FOR SPECIAL EVENTS, N
Pursuant to Ordinance No, 96-36,and from the effective date of this Resolution,user fees
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for EMS ambulance stand-by services may be waived if the Board finds that a valid public purpose
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has been established in recognition of their charitable contributions to the Community.
SECTION SIX: HARDSHIP CASES AND PAYMENT PLANS.
The Board recognizes that certain service recipients may need to be identified and processed
a)
as hardship eases. Payment plans will be established pursuant to the minimum guidelines set
a)
forth in this Resolution.
A. Hardship cases will be established in accordance with the Federal Poverty guidelines,asCsl
used by the Social Services Department of Collier County.
B. Payment plans for hardship cases will be set up on a monthly basis, with a minimum
payment of$10.00 per month. Hardship cases,placed on a payment plan will not accrue ti
interest or be placed into collection. Notwithstanding the foregoing, if a service
recipient has a payment plan and does not make the agreed scheduled payments for a
period longer than two (2) months, the account will be turned over to the County's
contracted collection agency and interest will begin to accrue. Cl
SECTION SEVEN: SUPERCISION OF RESOLUTION 07-192
This Resolution shall supersede Resolution No.07-192
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SECTION EIGHT: EFFECTIVE DATE
This Resolution shall become effective on January 29,2008
PASSED AND DULY ADOPTED by the Board of County Commissioners of Collier
County,Florida,this day of �t1r11xCt.b ,2008.
ATTEST; BOARD OF COUNTY COMMISSIONERS
DWIGHT E.BROCK;;CLERK COLLIER COUNTY,F ORIDA
By: Gr 1.446411116- t f29/Le
k:• i,t�..9''' TOM NNIN',CHA •
Yebvtliiktaforhi
legal sufficiency:
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Jennifer Belly- dib
Assistant County Attorney
�•. Packet Pg. 2085
16.E.8,d
ATTACHMENT C
MEMORANDUM
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TO: Leo Ochs, County Manager N
FROM: Dan Summers, Director Bureau of Emergency Services Division
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DATE: November 3, 2016 v,
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REF: Certificate of Convenience and Necessity for Collier County
Emergency Medical Services Department
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After review of the application to renew this certificate for Collier County -0
Emergency Medical Services Department, no further information is required at
this time. The application is complete and sufficient.
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COLLIER COUNTY FLORIDA
Renewal of Class 1 COPCN
This Permit Expires December 31, 2017
Name of Service: Collier County Emergency Medical Services
Name of Owner or Manager: Collier County Board of County Commissioners
Principal Address of Service: 8075 Lely Cultural Parkway,Naples,Florida 34113
Business Telephone: (239)252-3740
Emergency Telephone: 9-1-1
Description of Services Area: The 2,032 square miles encompassing Collier County
Number of Ambulances on 24 hour duty: 25 ground units(ambulances)
Number of Ambulances on 12 hour duty: 1 ground unit(as needed during season taken from reserve fleet).
Number of reserve Ambulances: 13
Number of non-transport ALS vehicles 10
Number of Medivac helicopter:
See attachment"A"for description of vehicles.
This permit, as provided in Ordinance 04-12, as amended, shall allow the above named Ambulance Service to
operate Emergency Medical Services for a fee or charge for the following area(s): Collier County until the
expiration date hereon, except that this permit may be revoked by the Board of County Commissioners of Collier
County at any time the service named herein shall fail to comply with any local, state or federal laws or regulation
applicable to the provision of Emergency Medical Services.
Issued and approved this day of ,2016.
ATTEST: BOARD OF COUNTY COMMISSSIONERS
Dwight E. Brock, CLERK COLLIER COUNTY,FLORIDA
, P-puty Clerk Donna Fiala, Chairman
Approved as • += •li •
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