BACKGROUND: In 1995, the Village Council adopted an ambulance response fee which assessed a $300 fee for ambulance service for non-residents only.

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1 MANAGER S MEMO ITEM ITEM: Ambulance Response Fees WORKSHOP DATE: September 27,2005 PREPARED BY: Bob Tutko, Deputy Chief Fire Department PURPOSE: To recommend adoption of revised ambulance fees which will help off-set the costs of equipment required to provide an essential public safety service. BACKGROUND: In 1995, the Village Council adopted an ambulance response fee which assessed a $300 fee for ambulance service for non-residents only. In 2001, Council revised the ordinance to include a fee for residents. Residents paid $275 for basic life support (BLS), and $350 for advanced life support (ALS). Non-residents paid $350 for basic life support (BLS), and $425 for advanced life support (ALS). Both residents and nonresidents were charged additional fees for use of the cardiac monitor ($100), oxygen ($50), and mileage ($5/mile). Presently, under the ordinance adopted in 2001, a resident pays a little over $500 for an advanced life support transport (ALS). This amount includes the $350 base rate, plus $100 for the cardiac monitor, plus $50 for oxygen, plus the cost of $5 per mile to the hospital. These fees are covered by most insurance carriers as usual and customary. DISCUSSION OF ALTERNATIVES: In order to simplify the billing process for residents, Staff proposes that the additional fees for an ALS transport which includes use of a cardiac monitor, and oxygen be incorporated into the base rate (ALS I). In doing this, the ALS I transport cost remains at $500. For the ALS transport which includes, in addition to a cardiac monitor and oxygen, any two (2) additional paramedic procedures, Staff recommends the base rate of $550 (ALS II). The extra $50 is proposed to off-set the costs of some of the equipment necessary for the additional procedures. Finally for residents, Staff recommends that the BLS transport fee be increased from $275 to $350. Presently, Downers Grove rates are below surrounding community rates. An increase of $75 would make Downers Grove rates comparable to surrounding community rates. This increase would assist the Fire Department in off-setting the cost of equipment necessary for ambulance services. Mileage fees will remain at the rate of $5 per mile. As for non-residents, Staff proposes similar or slightly higher increases in the three categories of ambulance service. The reason for this is two-fold: (1) to simplify the billing process; and (2) to attempt to off-set some of the costs associated with providing emergency ambulance services. Initially for non-residents, Staff recommends that the BLS transport fee be increased from $350 to $450. This basic life support call does not provide for oxygen, cardiac monitor, medication, intubations or an intravenous line. This is a $100 increase. The current rate for a non-resident ALS transport is $575 which breaks down into transport ($425), oxygen ($50) and cardiac 1

2 monitor ($100). For this type of advanced life support transport (cardiac monitor and oxygen included), the base rate fee proposed is $650(ALS I). The extra $75 is proposed to off-set the costs of some of the equipment necessary for the service as well as to simplify billing with just one base rate. For the ALS transport which includes any two (2) additional paramedic procedures as well as the cardiac monitor and oxygen, Staff recommends the base rate of $700 (ALS II). This is a $125 increase from the present ALS fees which include $425 (transport) plus $50 (oxygen) plus $100 (cardiac monitor). Note that the present ordinance does not distinguish between ALS I and ALS II. Hopefully, by making this distinction, the Fire Department can recover some of the costs associated with a more intensive transport. Again, mileage fees will remain at $5 per mile. SURVEY OF OTHER COMMUNITIES: A poll of surrounding community ambulance response fees indicate that the current rates assessed by Downers Grove are low, and that the proposed fee structure is comparable to rates established by area communities as evidenced in the chart below. Effectually, ambulance service users are defraying the costs of this essential public safety service. The Downers Grove figures are based upon using the proposed resident fee schedule. Downers Grove: Area Department Comparables: ALS I - $500 Clarendon Hills: $525- ALS BLS- $350 ALS II - $550 Westmont: $500- ALS BLS- $350 BLS - $350 Darien-Woodridge: $500-ALS BLS- $400 ATTACHMENTS: Power point presentation An Ordinance Amending Fees for Emergency Response Services Pleasantview: $650- ALS BLS- $400 STAFF RECOMMENDATION: Staff recommends adoption of the proposed ordinance revisions at the October 4th Council Meeting. 2

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4 Downers Grove Fire Department Ambulance Fees and Billing Process Presentation September 27, 2005 By Deputy Chief Bob Tutko 1

5 Ambulance Billing Historical Perspective Began billing non residents : 1995 Established in Ordinance 3742 Adopted April 24,1995 Found in Section of the municipal code 2

6 Ambulance Billing Non-Residents Only Initiated in 1995 A. established $300 fee B. no fee if: 1. Village employee hurt at work 2. Patient died prior to hospital admission 3. Village Manager or designee may wave any or all portion of the fee 3

7 Resident Billing Initiated March 20,2001 Approved by Council, via ordinance Found in section of the Municipal Code Ordinance #4277 4

8 Ordinance 4277 Established (March 20,2001) Resident BLS Call: $275 ALS Call: $350 Oxygen: $50 Monitor: $100 Mileage: $5 Non-Resident BLS Call: $350 ALS Call: $425 Oxygen: $50 Monitor: $100 Mileage: $5 5

9 Insurance Assignments Downers Grove Residents are billed for Ambulance Service as an Insurance Assignment: Whatever the Insurance Company pays, we accept as full payment. If the Insurance Company pays $400 for a $500 Ambulance bill, the resident is not pursued for the remaining $100. 6

10 Insurance Coverage The figures in the following example are addressed by Humana Insurance. The cost figures represent the usual and customary fee payment schedule. 7

11 ALS Resident Insurance Payments Downers Grove Charges Insurance Payments $350 ALS $100 Cardiac Monitor $50 Oxygen $15 Mile $ $763 ALS Included above Included above $32.40 mi. (10.80) $ $ left on the table 8

12 Resident ALS II with Humana U&C Payment Resident Bill: ALS II..$550 Mileage.$15 $ Sent to Humana, no cost to resident. Humana Payment: ALS II.$550 Mileage $15 $ Entire bill would be covered by insurance 9

13 Ambulance Fee Survey Current Resident Rate Downers Grove $500 als - $275 bls Darien-Wood. $500 als - $400 bls Clarendon Hills $525 als - $350 bls Westmont $500 als - $350 bls Pleasantview FD $650 als - $400 bls 10

14 Ambulance Fee Survey Current Non Resident Rate Downers Grove $575 als - $350 bls Darien-Wood. $500 als - $400 bls Clarendon Hills $650 als - $650 bls Westmont $600 als - $450 bls Pleasantview $650 als - $400 bls 11

15 Proposed Changes to Resident Billing ALS I Fees Current: $350 - ALS $50 - Oxygen $100 - Monitor $ Proposed: ALS I $ This combines oxygen and cardiac monitor. This represents no increase in cost cost $

16 Proposed Change to Resident Billing ALS II Fees Current $350 ALS $50 - Oxygen $100 Monitor $ Proposed: ALS II $ This fee is the ALS I rate with the addition of $50 for any 2 additional paramedic procedures. $

17 Proposed Change to Resident Billing BLS fees Current: $275 BLS Routine ambulance call, no I.V., no medication, no cardiac monitor. The current fee is less than surrounding communities. Proposed: $350 BLS $75 increase to help off set cost of supplies This fee is in line with surrounding communities 14

18 Proposed Change to Non Resident billing ALS I Fees Current: $425 ALS base rate $50 - Oxygen $100 Monitor $ Proposed: $650 ALS I This fee incorporates all fees to the left and adds $75 to cover the cost of supplies. $

19 Proposed Change to Non Resident ALS Billing ALS II Fees Current: $425 ALS base rate $50 - Oxygen $100 Monitor $ Proposed: $700 ALS II This fee incorporates the fees to the left and any 2 additional paramedic procedures such as medication, intubation etc. $

20 Proposed Change to Non Resident BLS Billing BLS Fees Current: $350 Routine ambulance call, no I.V., no medication,no cardiac monitor. Proposed: $450 This fee is in line with surrounding communities 17

21 New rate VS. Old Rate Resident ALS I New Rate: $500 ALS I $15 Mileage (3/$5) Includes IV, Oxygen, and Cardiac Monitor Old Rate: $350 ALS $100 Monitor $50 - Oxygen $15 - Mileage (3/$5) $ $

22 New Rate VS Old Rate Resident ALS II New Rate: $ ALS II. $15.00 Mileage(3/$5) ALS treatment that includes all ALS I care plus 2 additional paramedic procedures $ Old Rate: $ ALS $ Monitor $50.00 Oxygen $15.0 Mileage (3/$5) $

23 New Rates VS Old Rates Non Residents New: ALS I $650 ALS II $700 BLS $450 Old: ALS $575 BLS $350 Non residents are assessed a higher rate than residents as is customary in surrounding communities 20

24 New ALS Resident Rate Comparison Downers Grove ALS I - $500 ALS II - $550 Clarendon Hills $525 Westmont $500 Darien Wood $500 Pleasantview $650 21

25 New BLS Resident Rate Comparison Downers Grove BLS - $350 Darien- Wood $400 Westmont $350 Clarendon Hills $350 Pleasantview $400 22

26 Summary Of Ambulance fees Fees will help off set additional costs of supplies, Equipment and un-recovered fees. No Change in Resident ALS I Billing. $50 increase in Resident ALS II Billing. $75 increase in Resident BLS Billing. 23

27 Summary Of Ambulance Fees Continued.. No change to mileage fee Streamlines the billing process. Ahead of the curve in Medicare Billing by eliminating itemized billing. Proposed Changes to Ambulance Billing Fees are in line with those of surrounding Communities. 24

28 EMT ORDINANCE NO. AN ORDINANCE AMENDING FEES FOR EMERGENCY RESPONSE SERVICES BE IT ORDAINED by the Village Council of the Village of Downers Grove in DuPage County, Illinois, as follows: (Additions are indicated by shading/underline; deletions by strikeout): Section 1. That Section is hereby amended to read as follows: Interference with inspections. No person shall in any manner interfere with the fire chief or his designee while he is engaged in the investigation, inspection or examination of any building in the Village, or, who shall prevent him from making such inspection, investigation or examination. (R.O. 1925, 172.) Section 2. That Section is hereby amended to read as follows: Emergency Medical Service and Transportation Fee. (a) The following fees shall be imposed upon each person who uses emergency medical service and/or transportation provided by the Downers Grove Fire Department: Residents Non-Residents Basic Life Support Calls $ $ Advanced Life Support I Calls $ $425$ Cardiac Monitor $100 $100 Oxygen $50.0 $50 Advanced Life Support II Calls $ $ Mileage-per loaded mile $5.00 $5.00 (b) No fee shall be charged to any person for emergency medical services provided under the following conditions: (1) The person is a Village employee and the emergency services and/or transportation provided are related to an injury or illness covered by the Village's worker's compensation or Village health insurance; (2) The person dies prior to being admitted to the hospital; or (3) The Village Manager or his designee may waive the fee, or a portion of the fee, if he determines that the person is incapable of paying the fee. Section 3. That Section is hereby amended to read as follows: Permit, Inspection, Training and OSHA Fees. No permit shall be issued or inspection conducted until all fees described in this Section and any outstanding fees have been paid in full. (a) Permit fees are as follows: Open Burning Permit (per occurrence) $40.00 Fireworks Permit (per occurrence) $50.00 Spray Booth Permit (annual) $50.00 Page 1 of 2

29 EMT Underground Petroleum Storage (annual) $ LPG Storage and Sales (annual) $35.00 Tar Kettle Permit (per occurrence) $50.00 (b) Inspection fees are as follows: Hydro Static Test $70.00 Fire Alarm Acceptance Test $70.00 Temporary Use Permit Inspections $40.00 Amusement Ride (per inspector) $50.00 Walk Through $25.00 Reinspections: Second reinspection $25.00 Subsequent reinspection(s) $50.00 (c) Fire Extinguisher Training Fire Watch Personnel Fire Watch Apparatus $ /hour $50.00 per person/per hour $ per hour Section 4. That Section is hereby amended to read as follows: Permit required; compliance with chapter. Any person desiring to plow, dig, scrape or in any way make or have made any hole, pit, ditch or excavation in or upon any street, alley, parkway or public land shall proceed with such work only after obtaining a permit therefor and in compliance with all regulations contained in or promulgated under this chapter including the Village of Downers Grove Standards for the Construction of Facilities on the Public Rights-of-Way (copies of which may be obtained at the Public Works Department and the Code Services Department. The Downers Grove Fire Department shall be notified of the issuance of such permit. (Ord. No. 843, 15.) Section 9. That all ordinances or parts of ordinances in conflict with the provisions of this ordinance are hereby repealed. Section 10. That this ordinance shall be in full force and effect from and after its passage and publication in the manner provided by law. Passed: Published: Attest: Village Clerk Mayor Page 2 of 2