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Resolution 2006-222 RESOLUTION NO. 2006- 222 RESOLUTION OF THE BOARD OF COUNTY COMMISSIONERS OF COLLIER COUNTY, FLORIDA, TO APPROVE UP-DATED USER FEES FOR COLLIER COUNTY AMBULANCE SERVICES PURSUANT TO COLLIER COUNTY ORDINANCE NO. 96-36; ADOPTING BILLING AND COLLECTION PROCEDURE; PROVIDING CLARIFICATION ON ADJUSTMENTS AND WAIVERS; PROVIDING CLARIFICATION ON WAIVER OF SPECIAL EVENTS; AND PROVIDING A PROCEDURE FOR APPROVING HARDSHIP CASES AND PAYMENT PLANS; SUPERSEDING RESOLUTION NO. 05-224; AND PROVIDING FOR AND EFFECTIVE DATE. WHEREAS, Collier County Emergency Medical Services (hereinafter sometimes 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 fees; and WHEREAS, Collier County staff analysis of the cost for ambulance services requires an adjustment to the user fees to properly identify current costs of services to the residents and visitors of Collier County; and WHEREAS, Collier County Ordinance No. 96-36 provides that the user fees for ambulance services may be established by Resolution of the Board of County Commissioners (hereinafter sometimes referred to as "the Board"). NOW, THEREFORE, BE IT RESOLVED BY THE BOARD OF COUNTY COMMISSIONERS OF COLLIER COUNTY, FLORIDA, that: SECTION ONE: EMS USER FEES BASE RATES: SERVICE LEVELS CODES BASE CHARGE A. EMS - BLS NON-EMERGENCY A0428 $675.00 B. EMS - BLS EMERGENCY A0429 $675.00 C. EMS - ALS 1 NON-EMERGENCY A0426 $675.00 D. EMS - ALS 1 EMERGENCY A0427 $675.00 E. EMS - ALS 2 EMERGENCY A0433 $675.00 F. EMS - SPECIALTY CARE A0434 $675.00 G. EMS - HELICOPTER A0431 $5,900.00 MILEAGE RATES: SERVICE LEVELS CODES A. EMS - GROUND UNIT (Minimum charge of 1 mile and no cap) A0425 MILEAGE CHARGE $12.00 B. EMS - AIR UNIT (Minimum charge of 1 mile and no cap) A0436 $100.00 SPECIAL EVENTS AND MISCELANEOUS RATES: SERVICE LEVELS RATES A. TWO (2) MEDICS/ONE ALS VEHICLE (PER HOUR) B. ONE (1) MEDIC/NO VEHICLE (PER HOUR) COPIES: COPIES OF DOCUMENTS/PER PAGE (Excluding Governmental Agencies) $150.00 $50.00 $1.00 PAST DUE ACCOUNTS: INTEREST ON PAST DUE ACCOUNTS: 1 % monthly SECTION TWO: BILLING AND COLLECTION PROCEDURE The 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 be assessed either prior to or following the provision of service, as service dynamics reasonably permit. 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. An initial bill for ambulance services shall be processed in the following manner within thirty (30) days after service is provided. 1. The County will send an initial bill to the service recipient's or responsible party's insurance carrier provided that appropriate insurance information is made available to the EMS Billing Section. The EMS Billing Section will accept Medicare assignment, as a participating 2 provider, and will wait no less than 45 days for payment if Medicare or other insurance carrier's are billed. If the claim is denied, a bill will be sent to the service recipient or responsible party. 2. The County will also send a bill to Medicaid and accept assignment if appropriate insurance information is made available to the EMS Billing Section by the service recipient or responsible party. The EMS Billing Section will wait no less than 60 days for payment if Medicaid is billed. If the claim is denied because of no coverage at time of service, a bill will be sent to the service recipient or responsible party. If Medicaid denies because they felt it was not medically necessary to be transported by ambulance, then the account will be adjusted per the rules and regulations of Medicaid. 3. In the event the service recipient or responsible party does not have or does not provide proof of insurance coverage, the bill for ambulance service(s) shall be sent directly to the service recipient or responsible party for payment. The EMS Billing Section will wait no less than 30 days for payment. C. The following will occur if payment has not been received within above set guidelines: 1. A past due notice will be sent in accordance with the above provisions, (45 days after billing third party or Medicare, 60 days after billing Medicaid and 30 days after billing responsible party or service recipient). 2. Thirty (30) days after the first past due notice is sent, a second past due notice will be sent. 3. After a ten (10) day grace periOd following the second past due notice, the account will be sent to the County's contracted collection agency. D. Interest will be assessed at 1 % per month, on all accounts that are sent to the County's contracted collection agency, (excluding hardships as defined by County policy). 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 any time fail to meet the terms and conditions of the 3 payment plan, the unpaid balance shall be administered in accordance with Section C.3 above. F. When ambulance service bill(s), at any stage in this billing and collection procedure, are returned because the Postal Service cannot effectuate delivery, the EMS Billing Section shall make a reasonable effort to ascertain the correct mailing address. If reasonable efforts to ascertain a 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 uncollectible. I. 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 accordance with generally accepted accounting procedures and pursuant to law by Resolution. SECTION THREE: HOSPITAL OUT OF COUNTY TRANSPORTS Should a local hospital have a need for a patient to be transported to an out of County facility, the County shall, subject to equipment, manpower, availability and its sole discretion, utilize its resources to provide patient transport. The County shall invoice the hospital for all out of County transports that remain uncompensated after a period of ninety (90) days. SECTION FOUR: 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. 4 A. Medicare and Medicaid Adiustments. Contractual adjustments under Medicare and/or Medicaid assignment will be made in accordance with applicable Medicare and/or Medicaid rules and regulations. B. Victim's Compensation Contractual Adiustments. Contractual adjustments will be made in accordance with applicable state, federal and local rules and regulations. C. Worker's Compensation Contractual Adiustments. Contractual adjustments will be made in accordance with applicable state, federal and local rules and regulations. D. County Employee Adiustments. 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 may dispute his/her ambulance charge in accordance with procedures set forth in Ordinance No. 96-36. E. Champus/Tricare Adiustments. Contractual adjustments will be made in accordance with applicable Champus/Tricare rules and regulations. F. Railroad Retirement Adiustments. Contractual adjustments will be made in accordance with applicable state, federal and local rules and regulations pertaining to Railroad Retirement Adjustments. G. Social Services Adiustments. Contractual adjustments will 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 Pursuant to Ordinance No. 96-36, and from the effective date of this Resolution, user fees for EMS ambulance stand-by services may be waived if the Board finds that a valid public purpose has been established in recognition of their charitable contributions to the Community. 5 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 will 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 05-224 This Resolution shall supersede Resolution No. 05-224 SECTION EIGHT: EFFECTIVE DATE This Resolution shall become effective on October 1, 2006 PASSED AND DULY ADOPTED by the Board of County Commissioners of Collier County, Florida, this ~'A... day of S-t/k/;ll 6e I ../ ,2006. , ATTEST: DWIGHT t=, BROCK, Clerk BOARD OF COUNTY COMMISSIONERS, COLLIER COUNTY, FLORIDA BY: ~.'. .0,(" ~. CNt...... . . ,t.1.. BY: ~<=-~ Frank Halas, Chairman Approved as to form and legal sufficiency: frpf2~!rJ ~ . Colleen Greene Assistant County Attorney 6