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Agenda 11/13/2012 Item #16E 111/13/2012 Item 16.E.1. EXECUTIVE SUMMARY Recommendation to renew the Collier County Emergency Medical Services Department 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 receive approval from the Board of County Commissioners (Board) for the renewal of Collier County's Certificate of Public Convenience and Necessity ( "COPCN ") for Advanced Life Support ( "ALS ") transport and authorize the Chainnan to execute the permit and COPCN. 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 the 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, 2013 and expire on December 31, 2013. FISCAL IMPACT: There is no fiscal impact associated with this action. GROWTH MANAGEMENT IMPACT: There is no Growth Management Impact. 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 (EMS) capabilities of the County. Packet Page -2420- 11/13/2012 Item 16.E.1. 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 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 detenninations 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 has been reviewed by the County Attorney, is legally sufficient, and requires a majority vote for Board approval. - JAK RECOMMENDATION: That the Board of County Commissioners: 1. Accept the Director of the Bureau of Emergency Services' findings; 2. Approve and authorize 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. Packet Page -2421- COLLIER COUNTY Board of County Commissioners Item Number: 16.E.1. 11/13/2012 Item 16.E.1. Item Summary: Recommendation to renew the Collier County Emergency Medical Services Department 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: 11/13/2012 Prepared By Name: FrancoMaria Title: Administrative Assistant, EMS 10/11/2012 1:44:49 PM Submitted by Title: Administrative Assistant, EMS Name: FrancoMaria 10/11/2012 1:44:51 PM Approved By Name: BayArtie Title: Supervisor - Accounting,EMS Operations Date: 10 /11/2012 2:03:01 PM Name: pochopinpat Title: Administrative Assistant,Facilities Management Date: 10/15/2012 3:06:03 PM Name: KopkaWalter Date: 10/16/2012 12:25:28 PM Name: SummersDan Title: Director - Bureau of Emergency Services, Date: 10/16/2012 1:19:06 PM Name: KlatzkowJeff Packet Page -2422- Title: County Attorney Date: 10/25/2012 3:00:03 PM Name: PriceLen Title: Administrator, Administrative Services Date: 10/29/2012 10:19:00 AM Name: KlatzkowJeff Title: County Attorney Date: 10/29/2012 10:50:08 AM Name: KlatzkowJeff Title: County Attorney Date: 10/29/2012 11:30:35 AM Name: PryorCheryl Title: Management/ Budget Analyst, Senior,Office of Manag Date: 11/1/2012 10:28:20 AM Name: OchsLeo Title: County Manager Date: 11/4/2012 10:55:57 AM Packet Page -2423- 11/13/2012 Item 16.E.1. 11/13/2012 Item 16.E.1. Memorandum To: Leo Ochs, County Manager From: Walter Kopka, Chief Emergency Medical Services Department Date: October.5, 2012 Subject: Certificate of Convenience and Necessity for Collier County Emergency Medical Services Department Per Collier County Ordinance Number 04 -12, as amended, please accept the following information for renewal of this required certificate: 1. Collier County Emergency Medical Services Department is operated by the County's Board of County Commissioners located at: 3299 East Tamiami Trail Naples, Florida, 34112 The Board of County Commissioners is comprised of the following individuals: Donna Fiala, District 1 Georgia A. Hiller, District 2 Tom Henning, District 3 Fred W. Coyle, District 4 Jim Coletta, District 5 The age of each member may be located at the Board of County Commissioner's Office. 2. Collier County Emergency Medical Services Department will continue to provide service to the 2,032 square miles encompassing Collier County. 3. Collier County Emergency Medical Services Department has a total of forty -eight (48) State licensed vehicles. Thirty -five (35) of these are licensed ground transport ambulances and one (1) air ambulance (helicopter). There are also twelve (12) licensed ALS vehicles (non - transport). Of the above, twenty -three (23) licensed ground ambulances, and the air ambulance (helicopter) operate 24 hours and day, seven days a week. At least (1) additional around 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, eleven (11) licensed ALS ground transport ambulances are held in reserve. (Attachment A). Emergency Medical Services Packet Page -2424- 11/13/2012 Item 16.E.1. 4. Collier County Emergency Medical Services Department has one main office and twenty -one (21) 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 97726 1h Avenue Naples, Florida Station 10 14756 Immokalee Road Naples, Florida Station 21 11121 E. Tamiami Trail Naples, Florida Station 22 4375 Bayshore Drive Naples, Florida Station 23 7227 Isle of Capri Road Naples, Florida Station 24 2795 Airport Road North Naples, Florida Station 30 112 South I" Immokalee, Florida Station 32 4819 Ave Maria Blvd. Ave Maria, Florida Station 40 1411 Pine Ridge Rd. Naples, Florida Station 42 7010 Immokalee Road Naples, Florida Station 43 16325 Vanderbilt Drive Naples, Florida Station 44 766 Vanderbilt Beach Road Naples, Florida Station 46 3010 Pine Ridge Road Naples, Florida Medic Res 50 1280 San Marco Road. Marco Island, Florida Station 61 201 Buckner Avenue Everglades, Florida Station 70 4741 Golden Gate Parkway Naples, Florida Station 71 95 13th Street SW Naples, Florida Station 75 4590 Santa Barbara Blvd. Naples, Florida Medic Res 90 175 Isle of Capri Road Naples, Florida Med- Flightl 2375 Tower Drive Naples, Florida 5. Collier County Emergency Medical Services Department has been licensed and certified to provide Advanced Life Support ambulance service in Collier County since April 6, 1981. 6. Three (3) Collier County residents to act as references: Dr. Douglas Lee 2614 Tamiami Trail, 9255 Naples, Florida 34110 Nancy Laschied 4500 Gulfshore Blvd. N. - #903 Naples, Florida 34103 Dr. James Hampton 823 Bentwood Drive Naples, Florida 34108 7. Collier County Emergency Medical Services Department schedules of service fees (Attachment B). 8. October 5, 2012 Memorandum from Dan Sununers, Director of Bureau of Emergency Services to County Manager Ochs stating no further information required. 9. 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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 valorem taxes and user ices; and WHEREAS, the Board of County Commissioners recently entered into an Agreement with Advanced Data Processing, Inc. (hereinafter referred to as to "Billing Consultant ") to provide collection services for ambulance services and associated fees; and WHEREAS, this Resolution Is intended to apply;rrespective of whether EMS billing staff, Advanced Data Processing, Inc., or any other billing consultant is responsible for the collection of 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'). NOW THEREFORE, BE IT RESOLVED BY THE BOARD OF COUNTY COMMISSIONERS OF COLLIER COUNTY, FLORIDA, that: §ECTION ONE: EMS USER FENS BASF, TES: SERVICE LEVELS CODES RASE CHAROES A. EMS — BLS NON - EMERGENCY A0428 $ 700.00 B. EMS — BLS EMERGENCY A0429 $ 700,00 C. EMS —ALS I NON - EMERGENCY A0426 S 700.00 D. EMS — ALS I EMERGENCY A0427 S 700.00 E. EMS —ALS 2 EMURGENCY A0433 $ 750.00 F. EMS -- SPECIALTY CARE A0434 S 800.00 G. EMS — TREATMENT IVIO TRANSPORT A0098 S 175.00 H. EMS — HELICOPTER A0431 S 5,900.00 MILEAGE MMES: 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 M15CELLANEQIJ TES: SERVICE LEVELS RATES A TWO (2) MEDICSJONI; ALS VEHICLE (PER HOUR) S 150.00 Packet Page - 2428 11/13/2012 Item 16.E.1. B. ONE (I) MEDIC/NO VEHICLE (PER HOUR) S 50.00 COPIES*; Subject to statutory exemptions, "public records" are required by Chapter 119, FS. to be open to inspection and copying. Consistent with Chapter 119, Resolution No. 07 -327 establishes copying fees as follows: CQPIES OF DO UMENPS RATES A. One -sided copy which is 14 inches by g' /, inches or less $ .15 B. Two -sided copy which is 14 inches by 8'/: inches or less S .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 § 119.07(1), FS. as "thc cost of the material and supplies used to duplicate the record," but does not include the labor cost and overhead cost associated with such duplication. •Copying fees are subject to change only to the extent that either Chapter 119, rS or Resolution No. 07 -327, or both, are amended, replaced, or superseded. PAST DUE ACCOUNTS INTEREST ON PAST DUE ACCOUNTS $ 1 % monthly SECTION TWO: BILLING COLLECTION PROCEDURE Tho following shall be the minimum guidelines for billing and collection procedures for ambulance service fees and charges: A. initial fees and charges for ambulance service(s) shall W assessed either prior to or following the provision of service, as service dynamics reasonably allow. Unpaid fees and charges, subsequent to time of service shall be reflected in an accounts receivable subsidiary ledger system to be maintained by the EMS Department. B. EMS Billing Staff will transmit all data necessary to Billing Consultant to process the claim. I. Billing Consultant will send an initial bill to the service recipient's or responsible 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 privacy practices shall be sent fourteen (14) or more days after the data is 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. Ill. For Medicaid accounts, if the claim 1s 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. Packet Page -2429- 11/13/2012 Item 16.E.1. 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 Ilia patient no later than every 60 days front 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 oil the account have been exhausted by the Billing Consultant. The County may direct the Billing Consultant to not send a patient to collections at any time. Billing Consultant may send a patient to collections prior to exhaustion of alt collection efforts when: 1. The patient account has art invalid address. 2. Billing Consultant is directed by County to send a patient to collections. D. Interest will be assessed at 1% per month on all accounts that are sent to the County's contracted collection agency. E. A reasonable and customary payment plan will be made available for all service recipients or responsible parties. Should the service recipient or responsible party at the time fail to meet the terms and conditions of the payment plant for a period of (60) sixty days, the unpaid balance shall reenter tha 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 shall make reasonable effort to ascertain the correct mailing address. If reasonable efforts to ascertain it correct address fail, the account(s) may be considered for other collection alternatives. G. Nothing contained in this Section shall preclude reasonable telephone or other appropriate 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 which are believed to be uneolleetible. 1. 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 front active accounts receivable in accordance with generally accepted accounting procedures and pursuant to law by Resolution. 1. Probate Estato Cases: Should a decedent have an unpaid balance for ambulance services, 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 filed with the Probate Court. 3. EMS Billing Staff shall ensure that the Office of the County Attorney is timely nodfled of such claim and provided with: 1) 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. Packet Page -2430- 11/13/2012 item 16.E.1. 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 designed) are authorized to execute a satisfaction and/or release on behalf of the County. If the estate has assets and in excess of S i 0,000 is owed for ambulance services, any negotiated settlement/compromise of the ambulance billing claim shall be approved by the Board of County Commissioners. If the 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, replaced, or superseded. K. All accounts with a balance of 510 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 patient between hospital facilities located 'Whin the boundaries of Collier County, ambulance transport will be provided. C. Should it 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, tho County, will subject to equipment and manpower availability, at its sole discretion, utilize its resources to provide patient transport. D. Hospitals requesting ambulance transports shall be invoiced directly for ambulance transport service on a monthly basis. t3EC ION FO R; ADJUSTMENT OF EMS USER FEES 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. A. 1!eare and Medicaid Adj�rs meats. Contractual adjustments under Medicare and/or Medicaid assignment will be made In accordance with applicable Medicare and/or Medicaid rules and regulations. B. Vim's Compensation Contractual Adjustments Contractual adjustments will be made in accordance with applicable state, federal and local rules and regulations. C. Wotkcr'a Compensation Contrac I Adi l! stmen s. Contractual adjustments will he made in accordance with applicable state, federal and local rules and regulations. D.ounty Employee Adjustments. 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 MM Packet Page -2431- 11/13/2012 Item 16.E.1. may dispute his/her ambulance charge in accordance with procedures set forth in Ordinance No. 96 -36. S. Ch diustmrnte. Contractual adjustments will be made In accordance with applicable Champusdfricare rules and regulations. F. Railroad RetlromQt Adjustments. Contractual adjustments wilt be made in accordance with applicable state, federal and local rules and regulations pertaining to Railroad Retirement Adjustments. O. Social Seryicos AdiUIl e ts, Contractual adjustments will be made in accordance with rules established by the County Manager and memorializod 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. Pursuant to Ordinance No, 96 -36, and from the effective date of this Resolution, user fees for EMS ambulance stand -by services may W waived if the Board finds that a valid public purpose 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 as hardship cases. Payment plans will be established pursuant to the minimum guidelines set forth in this Resolution. A. Hardship cases M11 be established in accordance with the Federal Poverty guidelines, as 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 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. SECTION SEVEN: SUPERCISION OF RESOLUTION 07 -192 This Resolution shall supersede Resolution No. 07 -192 SECTI N EIGHT: EfTECTIVE DA'T'E This Resolution shall become effective on January 29, 2008 PASSED AND DULY ADOPTED by the Board of County Commissioners of Collier County, Florida, this,? dayof T,'ii�r, t�z.t 2008. ATTEST!" DWIGHT E. BROCK; PLERK legal sufficiency; JenallWr A. Belped Assistant County Attorney BOARD OF COUNTY COMMISSIONERS COLLIER COUNTY, FLORIDA By' /24It 4 TOM NNIN , CI-IAIF Packet Page -2432- I 11/13/2012 Item 16.E.1. ATTACHMENT "C" MEMORANDUM TO: Leo Ochs, County Manager FROM: Dan Summers, Director Bureau of Emergency Services Division DATE: October 5, 2012 REF: Certificate of Convenience and Necessity for Collier County Emergency Medical Services Department After review of the application to renew this certificate for Collier County Emergency Medical Services Department, no further information is required at this time. The application is complete and sufficient. Packet Page -2433- Name of Service 11/13/2012 Item 16.E.1. COLLIER COUNTY FLORIDA Renewal of Class 1 COPCN This Permit Expires December 31, 2013 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 Coum Number of Ambulances on 24 hour duty: 23 ground units (ambulances) Number of Ambulances on 12 hour duty: I ground unit (as needed during season taken from reserve fleet Number of reserve Ambulances: I I Number of non - transport ALS vehicles 12 Number of Medivac helicopter: I 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 , 2012. ATTEST: Dwight E. Brock, CLERK Deputy Clerk Appr ey Ao form &gal sufficiency: Jeffrey County BOARD OF COUNTY COMMISSSIONERS COLLIER COUNTY, FLORIDA Fred W. Coyle, Chairman Packet Page -2434- n� 0 CD CD x � M G N• d � W d w A fb r C �+ CD w p w 0 w- d Co C ;I- d tz 03* 00 � On z� Or O z M W H c N a w Packet Page -2435- 0 0 m c� 0 C n O_ H' H ,7 fD O 11/13/2012 Item 16.E.1. a � � N 0 0 0 G O a, ) ~ w l J o o � r o z 0 m a z H `a G. 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