HomeMy WebLinkAboutRes 2018-03 and C36670A and B Emergency Medical Services (EMS) Billing Pgrm 4 Cost Recovery STAFF REPORT CONTRACT NOS. C36670A&B
CITY OF PALM DESERT RESOLUTION NO. 2018-03
ADMINISTRATIVE SERVICE DEPARTMENT
MEETING DATE: January 11, 2018
REQUEST: Consideration of adoption of an Emergency Medical Services (EMS)
Billing Program for Cost Recovery.
Recommendation
1. Open the public hearing and accept testimony supporting or opposing the EMS
Billing Program for Cost Recovery in the City of Palm Desert; following public
testimony, close the public hearing.
2. By minute motion: a) Approve a Joint Powers Agreement with the Novato Fire
Protection District to provide emergency medical services billing services; b)
approve the Business Associate Agreement with the Novato Fire Protection District
to meet Health Insurance Portability and Accountability Act (HIPAA) requirements;
c) authorize the City Manager to execute said agreements subject to finalization and
any non-substantive modification by the City Attorney; d) budget estimated revenue
of $300,000 for April — June 2018 and appropriate $20,000 for administration fees in
Fund 230, Fire Tax Fund; and e) authorize the City Manager authority to take any
steps necessary to effectuate the actions approved herein.
3. Waive further reading and adopt Resolution No. 2018- 03 approving the
Emergency Medical Services Billing Program Fee Schedule and related Write-Off
Policy, and the Fee Development Analysis prepared December 2017.
Commission Action
City of Palm Desert Public Safety Commission
The Palm Desert Public Safety Commission reviewed this item on October 11, 2017, and
recommended that the City Council approve (by a 5-1-1 vote) an emergency medical services
billing program for cost recovery.
Cove Communities Services Commission
On October 17, 2017 the Cove Commission passed a resolution recommending that each
Cove City (Palm Desert, Rancho Mirage, and Indian Wells) adopt a resolution establishing that
each of these cities shall not balance bill residents of any Cove City for unpaid balance related
to emergency medical services. A resident is defined as a person residing within the
jurisdictional boundaries of Palm Desert, Rancho Mirage, and Indian Wells. The Cove
Commission does not intend that their recommendation or resolution be construed to impact a
City's ability to bill and/or collect from a resident's insurance provider for emergency medical
services rendered.
Strategic Plan & Citywide Goals
One of the identified 2017 Citywide Goals, under the financial performance section, is to
consider a program for cost recovery of EMS services provided to transport patients, similar to
that of neighboring cities. Priority 1 of the Public Safety & Emergency Services Chapter within
the Strategic Plan aims to enhance the delivery of public safety services. A cost recovery
January 11, 2018—Staff Report
Emergency Medical Services (EMS) Billing Program for Cost Recovery
Page 2 of 5
program will put the City in a better financial position to expand existing services provided by
the Fire Department and to address future growth and safety concerns.
Executive Summary
One of the identified 2017 Citywide Goals is to consider a cost recovery program, similar to
that of neighboring cities, for emergency medical services that provide emergency medical
care and transports for patients. A City sub-committee consisting of two councilmembers, a
public safety commissioner, Fire Department representatives, and staff met to discuss such a
program at length over several months. The committee recommends a program that mirrors
the neighboring Cove Cities of Indian Wells and Rancho Mirage, utilizing their service provider,
Novato Fire Protection District (NFPD). In order to efficiently implement this program, staff
recommends entering into a Joint Powers Agreement with the NFPD to provide emergency
medical services (EMS) billing services, including ambulance transports and related medical
care costs. This program enables the City to bill Medicare and other private health insurance
providers for EMS and ambulance transports for all insured patients, regardless of residency.
However, under this proposed plan, there will be no out of pocket costs for Palm Desert,
Rancho Mirage, or Indian Wells residents (Cove Communities). Adoption of this program
would result in a conservative estimate of approximately $2 million dollars in cost recovery at
the City's current patient calls for services and transport volume.
Background Analysis
On July 24, 1980, the Palm Desert City Council passed Ordinance No. 233, levying a special
tax for upgrading fire prevention and protection services. In 2009, this tax was increased to its
maximum levy of sixty dollars ($60.00), as permitted under the ordinance. Over the years,
emergency medical services have greatly increased and constitute 75% to 80% of the Fire
Department calls for service. Tax revenue collected has not covered the expenses and
requires an increased financial commitment from the general fund. In FY 2017/18 this amount
totaled approximately $3.7 million.
Historically, the Cove Communities of Palm Desert, Rancho Mirage, and Indian Wells have
not billed insurance or individuals for Emergency Medical Services (EMS). Last year these
three cities discussed exploring emergency medical services cost recovery methods that
would not increase resident taxes or create a new fee. This discussion identified the best
method as a program utilizing a third party to invoice insurance companies.
Staff met with the Cities of Rancho Mirage and Indian Wells to discuss implementation options
and informally interviewed two emergency medical services billing providers: Whittman
Enterprises, LLC and the Novato Fire Protection District (NFPD). Rancho Mirage and Indian
Wells subsequently entered into a joint powers agreement with NFPD, a public agency, to
implement EMS billing services on July 1, 2017.
There are currently four ambulances in service within the City of Palm Desert, seven days per
week, and twenty-four hours per day. As a matter of protecting the community's health and
safety the City maintains an additional three ambulances in reserve. The Fire Department
provided approximately 5,900 ambulance transports last fiscal year, a number which increases
annually and is expected to continue to do so as the City's population rises.
January 11, 2018—Staff Report
Emergency Medical Services (EMS) Billing Program for Cost Recovery
Page 3 of 5
Implementing the recommended EMS billing program allows Palm Desert to bill Medicare and
other private health insurance providers for EMS and ambulance transports, with the benefit of
no out of pocket costs for Palm Desert residents.
Staff recommends joining the other two Cove Communities in entering into a joint powers
agreement with the NFPD to provide EMS billing services. This non-profit public agency has a
nine year history of providing EMS billing services and currently provides billing services to
thirteen other California fire agencies. The District is familiar with reimbursement programs at
the State and Federal level that can benefit Palm Desert. Their staff is recognized as subject
matter experts of these types of reimbursement programs, Medicare/Medical billing, and
applies proven processes to maximize EMS cost recovery for public agencies.
Under this program, patients will see no change in emergency medical response. Emergency
medical personnel are currently collecting patient and insurance information. This data would
be provided to the NFPD who in turn will create the appropriate invoices and communications,
coordinate the collection of payments, and perform other administrative services as outlined in
the attached joint powers agreement. Procedures are included for the treatment of insured
non-residents and uninsured patients, as identified in the Write-Off Policy below.
Write-Off Policy
A Write-Off Policy is required and provides direction to the Novato Fire Protection District on
how the City will or will not pursue collections on amounts not paid by insurance. The goal of
this program is to collect payments from Medicare and other health insurance providers,
without out of pocket costs for Palm Desert and Cove Communities residents. The City
will collect only what Medicare or other health insurance providers will pay and the remainder
of the bill not paid by insurance (i.e. "the balance bill") will be waived. Under existing law, any
non-resident is required to be balance billed. Cove residents do not fall under this requirement
because of the current JPA that forms the Cove Communities Services Commission. In
keeping with the goal of residents not incurring costs and not having an adversarial collections
program, the Write-Off Policy will waive the full cost for any individual without insurance
coverage.
The proposed Write-Off Policy reads as follows:
Patients that reside within the jurisdictional boundaries of the Cities of Palm Desert,
Rancho Mirage, and Indian Wells (Cove Communities) shall not be balanced billed.
The City accepts insurance payments as payments in full. All patients will receive a
maximum of four(4) insurance information request notices, should insurance not be
provided at the time of service. For those patients that reside outside of the
jurisdictional boundaries of the Cities of Palm Desert, Rancho Mirage and Indian
Wells, the City's contracted EMS/ambulance billing company will send one balance
bill as required under law. Accounts that have had no activity for 90 days will be
deemed uncollectable at that time and will be written off as bad debt. Any patient
without insurance is deemed eligible for a financial hardship waiver; the City will
write the accounts off as bad debt. All other billing aspects shall comply with state
and federal law.
January 11, 2018—Staff Report
Emergency Medical Services (EMS) Billing Program for Cost Recovery
Page 4 of 5
Staff respectfully recommends approval of the agreement with the Novato Fire Protection
District to implement EMS billing services for the City of Palm Desert's emergency medical
services program. Should the Palm Desert City Council approve the JPA in January 2018,
patient billings would begin approximately May 2018. Staff plans to initiate a broad public
outreach campaign informing residents on this new billing program through a variety of means,
including the City's website and Brightside Newsletter, before the expected initiation date.
As noted, there was one dissenting vote for this program when the Public Safety Commission
reviewed this matter in October 2017. Commissioner Kramer cast the sole dissenting vote and
was concerned about how the City classified residents and non-residents and waiting 90 days
before waiving any uncollected debt.
When transporting a patient to the hospital, the Fire Department requests various health and
insurance questions, including asking for the patient's address. Staff recommends that a
patient's residency be based upon the response provided to the Fire Department. There may
be situations where the patient has two homes and does not provide their Palm Desert
address. In such cases, the patient can contact the billing vendor and request an update to
their records, whereby they would be classified as a resident under this program.
It is also important to note that if someone is insured; their health insurance company will be
billed regardless of residency status. However, in the case of a non-resident, once an
insurance payment is made any remaining unpaid amount will be submitted to them for
payment in the form of a "balance bill". Under existing law, any non-resident is required to be
balance billed. Staff recommends a 90 day waiting period to collect the debt and writing off any
amount not collected. This period of time is in line with industry standards. Staff also does not
recommend placing the City into an adversarial position to collect debt from economically
disadvantage individuals, who may also be suffering serious health issues.
Fee Schedule
The fee schedule below was developed in concert with the Fire Department and included an
analysis of actual costs and neighboring cities' fees. It represents the reasonable costs of
providing emergency medical services in Palm Desert. Typically, private and public insurance
companies pay a portion of these fees based on their own guidelines. This program will
provide partial cost recovery because public or private insurance payments would be
considered payment in full.
In addition to billing for emergency medical services, Medicare and other health insurance
providers allow for line item billing. In many cases, medical aid is provided both during
medical transports and also when no medical transport is provided.
The identified line item fees below will assist the City in cost recovery for different types of
medical aid provided by the Fire Department. Please note that Medicare and other health
insurance providers only pay a designated lower amount for such services. As with medical
transports, these fees will be charged to Medicare and other health insurance providers with
no out of pocket costs for Cove Communities residents. The fee schedule below will likely
be identical for all three Cove Cities and was derived from the cost study initiated by Indian
Wells and Rancho Mirage and in concert with the Fire Department. Such action is necessary
because based on the regional fire protection program, Cove residents can be served by
ambulances from all three communities, irrespective of geographic boundaries. A single fee
January 11, 2018-Staff Report
Emergency Medical Services (EMS) Billing Program for Cost Recovery
Page 5 of 5
structure will help eliminate any confusion and be more efficient. Staff reviewed the City's
actual expenditures to provide emergency medical services, based on an analysis of both
direct and indirect costs, and confirms that the fee schedule below is consistent with the City's
costs.
Fee Description Fee Amount
Ambulance Transportation $1.450.00
Ambulance Mileage Rate $29.00 p.%mile
Non-Transport Fee $425.00
Oxygen S132.00
Extra Attendant $155.00
Wait Time- per ' hour S82.20
First Responder/Pre-Stabilization $400.00
Basic Life Support (BLS) Disposable Supplies S303.75
Advanced Life Support (ALS) Disposable Supplies $382.00
Twelve (12) Lead EKG S285.00
Three (3) Lead EKG $156.48
Fiscal Analysis
Staff conservatively anticipates approximately $2 million in EMS cost recovery. Actual revenue
collections may be greater because many patients have Medicare supplemental insurance, or
private insurance, which includes higher coverage for ambulance transport.
The Novato Fire Protection District charges a flat rate of $18 per patient. Based on an
estimated 5,900 ambulance transports, annualized billing costs are anticipated to be
approximately $106,000. Billing related services and staff time will be included in the
assumption for future fiscal years as ongoing expenses.
Prepare by: tep en . Aryan, Risk Manager
LEGAL REVIEW DEPT. REVIEW FINANCIAL REVIEW CITY MANAGER
•
Robert W. Hargreaves Lori Care 'Jan t Moore Lauri Aylaian
City Attorney Director of Administrative 'rector of Finance City Manager
Service
ATTACHMENTS: 1.Joint Powers Agreement with Novato Fire Protection District
2. Business Associate Agreement (HIPAA)
3. Draft Resolution No. 2018-04
5. Cove Communities Services Commission Resolution No. 2017-01
6. Fee Development Analysis (December 2017)
District Doc#Iv[o I4-I201 I7 CONTRACT NO. C36670A
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JOINT POWERS AGREEMENT
FOR PARAMEDIC AMBULANCE BILLING SERVICES
This Agreement ("Agreement") is made and entered into as of the last date signed below
("Effective Date") by and between the NOVATO FIRE PROTECTION DISTRICT (hereinafter
"DISTRICT") and the CITY OF PALM DESERT (hereinafter "CITY") (each a "Party," and collectively
the "Parties").
RECITALS
WHEREAS, DISTRICT, a fire protection district, has established an Emergency Medical
Services Billing Division and has been billing for its own paramedic/ambulance services during the
past nine (9) years, as well as for other municipalities; has developed, and maintains the
expertise with respect to Medicare and Medicaid regulations and procedures necessary for the
processing of such billings; and has been licensed to use, and maintains technical software to
process such billings; and
WHEREAS, CITY has historically provided ambulance services in connection with its fire
paramedic program to the residents within its city serving an average of 4,600 patients each year;
and
WHEREAS, DISTRICT and CITY have the authority to enter into this Agreement for the
provision of ambulance billing services pursuant to Health & Safety Code Sections 13861, 13862,
13878, 13898, 13918, and 13916(a), Public Contract Code Section 20811, Government Code
Section 54981, and Government Code Section 6500 et seq.; and
WHEREAS, CITY and DISTRICT find it mutually beneficial to enter into this Agreement as
a joint powers agreement pursuant to Government Code Section 6502.
AGREEMENT
NOW, THEREFORE,the Parties hereby agree as follows:
1. PROJECT COORDINATION.
A. CITY. The CITY's Administrative Services Department shall be the representative
of the CITY for all purposes under this Agreement. The CITY's Director of Administrative Services
is hereby designated the PROJECT MANAGER for CITY and said PROJECT MANAGER shall
supervise all aspects of the progress and execution of this Agreement. Should circumstances or
conditions, subsequent to the execution of this Agreement, require a substitute PROJECT
MANAGER for any reason the CITY shall notify the DISTRICT within ten (10) business days of the
substitution.
B. DISTRICT. The Fire Chief of DISTRICT shall be the representative of the DISTRICT
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for all purposes under this Agreement. The Director of Emergency Medical Services for the
DISTRICT is hereby designated as the PROJECT MANAGER for DISTRICT, and said PROJECT
MANAGER shall supervise all aspects of the progress and execution of this Agreement. Should
circumstances or conditions, subsequent to the execution of this Agreement, require a
substitute PROJECT MANAGER for any reason the DISTRICT shall notify CITY within ten (10)
business days of the substitution.
2. DUTIES OF DISTRICT.
DISTRICT shall perform all services described in Exhibit "I" attached hereto and made a
part hereof, in accordance with the terms and conditions stated herein.
3. DUTIES OF CITY
CITY shall pay the compensation as provided in Paragraph 5, perform the duties specified
in Exhibit "I" and maintain a Lock Box with CITY's bank to receive and account for the collections
related to the billings provided hereunder.
4. ACCESS TO PATIENT MEDICAL RECORDS.
DISTRICT, as the authorized billing representative for CITY paramedic/ambulance
services, is authorized by CITY to access the CITY's Patient Care Records (each, a "PCR") and
other hospital records related to paramedic/ambulance services provided by CITY in order to
retrieve information needed to bill for such services, provided that DISTRICT shall maintain the
confidentiality of such medical records as required by the California Confidentiality of Medical
Information Act ("CMIA") (Civil Code Section 56 et seq.) and the Health Insurance Portability
and Accountability Act of 1996 ("HIPAA").
5. COMPENSATION.
For the full performance of the services described herein by DISTRICT, CITY shall pay
DISTRICT an amount equal to $18.00 per PCR received by DISTRICT from CITY. A check received
by CITY shall not be deemed a collection received if following deposit of the check with CITY's
bank, the DISTRICT or CITY receives a Return Item notice from the bank. CITY shall make
payment to DISTRICT in accordance with the provisions described in Exhibit "II," attached
herein and made a part hereof.
6. TERM OF AGREEMENT.
The term of this Agreement shall be for three (3) years commencing on December 1,
2017 and ending November 30, 2020. Upon written agreement of the CITY and DISTRICT, the
term of this Agreement may be extended for additional three (3) year periods, under the same
terms and conditions as provided herein.
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7. TERMINATION.
A. Discretionary. Either Party may terminate this Agreement without cause upon
sixty (60) days written notice mailed or personally delivered to the other Party. A written
notice shall be deemed served upon sending said notice in a postage paid envelope addressed
to the other Party to the Agreement and depositing the same with the United States Post Office
with postage paid.
B. Cause. Either Party may terminate this Agreement upon thirty (30) days
written notice to the other if the other Party has failed to fulfill its obligations under this
Agreement through no fault of the terminating Party.
C. Effect of Termination. Upon receipt of notice of termination, neither Party
shall incur additional obligations under any provision of this Agreement without the prior
written consent of the other, except that DISTRICT shall be entitled to compensation for
services performed hereunder, through and including the date of termination, but not to
exceed payment according to the rate specified in Paragraph 5 of this Agreement.
D. Return of Documents. Upon termination, any and all CITY documents or
materials provided to DISTRICT and any and all of DISTRICT'S documents and materials
prepared for, or relating to, the performance of its duties under this Agreement shall be
delivered to CITY as soon as possible, but not later than thirty (30) days after termination. This
does not include any documents relating to the software, equipment and software license that
DISTRICT owns and will utilize in connection with the paramedic/ambulance billing services to
be provided to CITY under this Agreement.
8. OWNERSHIP OF DOCUMENTS.
The written documents and materials prepared by the DISTRICT in connection with the
performance of its duties under this Agreement shall be the sole property of CITY. CITY may use
said property for any purpose, including projects not contemplated by this Agreement. This
does not include any documents relating to the software, equipment and software license that
DISTRICT owns and will utilize in connection with the paramedic/ambulance billing services to be
provided to CITY under this Agreement.
9. INSPECTION AND AUDIT.
Upon reasonable notice, DISTRICT shall make available to CITY or its agent, for
inspection and audit, all documents and materials maintained by DISTRICT in connection with its
performance of its duties under this Agreement. DISTRICT shall fully cooperate with CITY or its
agent in any such audit or inspection.
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10. ASSIGNABILITY.
The Parties agree that they shall not assign or transfer any interest in this Agreement nor
the performance of any of their respective obligations hereunder, without the prior written
consent of the other Party, and any attempt to so assign this Agreement or any rights, duties or
obligations arising hereunder shall be void and of no effect.
11. INSURANCE.
A. During the term of this Agreement, DISTRICT shall maintain, at its own cost and
expense, a General Liability insurance policy with a combined single limit of at least $1,000,000
for each occurrence or claim and a general aggregate limit of at least$ 2,000,000.
B. DISTRICT shall provide CITY with a Certificate of Insurance and policy
endorsement for the foregoing insurance policy as follows:
1. The CITY, its officers, employees, agents and volunteers shall be named as
additional insureds under the policy.
2. The CITY shall be given at least thirty (30) days written notice of any
cancellation,termination or material modification of the terms of the insurance policy.
3. The insurance policy shall be primary with respect to any insurance or
coverage maintained by CITY and shall not call upon CITY's insurance or coverage for any
contribution.
C. The insurance shall be written on an occurrence basis, and shall be provided by an
insured admitted to do business in California.
D. During the Term of this Agreement, District shall also maintain, at its own cost
and expense, Workers' Compensation Insurance (Statutory Limits) and Employer's Liability
Insurance (with limits of at least $1,000,000). DISTRICT shall submit to CITY, along with the
certificate of insurance, a Waiver of Subrogation endorsement in favor of the City of Palm
Desert, its officers, agents, employees and volunteers.
12. REPRESENTATION REGARDING PATENTS, COPYRIGHTS AND TRADE SECRETS.
DISTRICT hereby represents that it is the owner or licensee of any software, equipment
and documents that it will utilize in connection with the paramedic/ambulance billing services to
be provided to CITY under this Agreement, and agrees that at its own cost, risk and expense, shall
indemnify and hold harmless the CITY, its officers, employees, agents and volunteers ("CITY
PARTIES") and defend any claim on behalf of CITY PARTIES and satisfy any judgment rendered
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against any of them with respect to infringement of patents, copyrights, trade secrets in
connection with the paramedic/ambulance billing services provided by DISTRICT under this
Agreement.
13. INDEMNIFICATION.
A. DISTRICT shall indemnify, release, defend and hold harmless CITY PARTIES against any
claim, demand, suit, judgment, loss, liability or expense of any kind, including attorneys fees and
administrative costs, arising out of or resulting in any way, in whole or in part, from any acts or
omissions, intentional or negligent, of DISTRICT or DISTRICT's officers, agents and employees in
the performance of their duties and obligations under this Agreement.
B. CITY shall indemnify, release, defend and hold harmless DISTRICT, its officers, agents,
employees, and volunteers, against any claim, demand, suit,judgment, loss, liability or expense of
any kind, including attorney's fees and administrative costs, arising out of or resulting in any way, in
whole or in part, from any acts or omissions, intentional or negligent, of CITY or CITY's officers,
agents and employees in the performance of their duties and obligations under this Agreement.
14. NONDISCRIMINATION.
DISTRICT shall not discriminate, in any way, against any person on the basis of age, sex,
race, color, religion, ancestry, national origin or disability in connection with or related to the
performance of its duties and obligations under this Agreement.
15. COMPLIANCE WITH ALL LAWS.
DISTRICT shall observe and comply with all applicable federal, state and local laws,
ordinances, codes and regulations, including but not limited to the CMIA and HIPAA, in the
performance of its duties and obligations under this Agreement. DISTRICT shall perform all
services under this Agreement in accordance with these laws, ordinances, codes and regulations.
DISTRICT shall release, defend, indemnify and hold harmless CITY PARTIES from any and all
damages, liabilities, penalties, fines and all other consequences from any noncompliance or
violation of any laws, ordinances, codes or regulations by the DISTRICT.
16. NO THIRD PARTY BENEFICIARIES.
CITY and DISTRICT do not intend, by any provision of this Agreement, to create in any
third Party, any benefit or right owed by one Party, under the terms and conditions of this
Agreement, to the other Party.
17. MISAPPROPRIATION OF COLLECTIONS.
DISTRICT shall regularly audit the reports received from CITY and the
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paramedic/ambulance billings provided by DISTRICT hereunder to assure that none of DISTRICT's
employees aids, abets or engages in the conversion of any collections that have been billed by
DISTRICT or should have been billed by DISTRICT for paramedic/ambulance services provided by
CITY. In the event of participation by DISTRICT's employees in any such conversion of collections
due to CITY, DISTRICT shall be liable to CITY for such converted collections, together with interest
thereon at the average rate of interest being earned by CITY on its investments during the quarter
in which the conversion occurred.
18. NOTICES.
All notices and other communications required or permitted to be given under this
Agreement, including any notice of change of address, shall be in writing and given by personal
delivery, or deposited with the United States Postal Service, postage prepaid, addressed to the
Parties intended to be notified. Notice shall be deemed given as of the date of personal delivery,
or if mailed, upon the date of deposit with the United States Postal Service.
Notice shall be given as follows:
TO CITY: Lori Carney, Director of Administrative Services
The City of Palm Desert
73-510 Fred Waring Drive
Palm Desert, CA 92260
TO DISTRICT: Fire Chief
Novato Fire Protection District
95 Rowland Way
Novato, CA 94945
19. MISCELLANEOUS.
A. The terms and conditions of this Agreement, all exhibits attached, and all
documents expressly incorporated by reference, represent the entire Agreement of the Parties
with respect to the subject matter of this Agreement.
B. This written Agreement shall supersede any and all prior agreements, oral or
written, regarding the subject matter between the DISTRICT and CITY.
C. No other agreement, promise or statement, written or oral, relating to the
subject matter of this Agreement, shall be valid or binding, except by way of a written
amendment to this Agreement.
D. The terms and conditions of this Agreement shall not be altered or modified
except by a written amendment to this Agreement signed by the DISTRICT and CITY.
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E. If any conflicts arise between the terms and conditions of this Agreement, and
the terms and conditions of the attached exhibits or the documents expressly incorporated by
reference, the terms and conditions of this Agreement shall control.
20. WAIVERS.
The waiver by either Party of any breach or violation of any term, covenant or condition of
this Agreement, or of any ordinance, law or regulation, shall not be deemed to be a waiver of
any other term, covenant, condition, ordinance, law or regulation, or of any subsequent breach
or violation of the same or other term, covenant, condition, ordinance, law or regulation. The
subsequent acceptance by either Party of any fee, performance, or other consideration which
may become due or owing under this Agreement, shall not be deemed to be a waiver of any
preceding breach or violation by the other Party of any teen, condition, covenant of this
Agreement or any applicable law, ordinance or regulation.
21. APPLICABLE LAW.
The laws of the State of California shall govern this Agreement.
22. VENUE.
All proceedings involving disputes over the terms, provisions, covenants or conditions
contained in this Agreement and all proceedings involving any enforcement action related to
this Agreement shall be initiated and conducted in the applicable court or forum in Marin
County, California.
(The remainder of this page has been intentionally left blank)
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IN WITNESS WHEREOF,the Parties have executed this Agreement as of the day, month and year
first above written.
THE CITY OF PALM DESERT NOVATO FIRE PROTECTION DISTRICT
Lauri Aylaian, City Manager Mark Heine, Fire Chief
Date: Date:
ATTEST:
Rachelle D. Klassen, City Clerk
APPROVED AS TO FORM:
Robert Hargreaves, City Attorney
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EXHIBIT I
SCOPE OF SERVICES
Statement of Work: This documents the mutual understanding of CITY and DISTRICT as to the
scope of services contemplated by the Parties hereto.
A. Obiective:
The objective of this project is to maximize the timely collection of revenue due from the
provision of emergency medical services provided by CITY. Further, it is to provide for
continuing review and improvement to the overall billing process.
It is the intent of CITY and DISTRICT that the Parties shall make all reasonable efforts to
collect for any emergency medical services provided by CITY to residents or nonresidents of
the City of PALM DESERT in the course of identifying payment sources and a patient's ability
to pay for CITY services. In doing so, DISTRICT shall approach patients in a courteous,
sensitive and professional manner. DISTRICT shall follow CITY's established policies /
practices regarding the direct billing of residents of the City of PALM DESERT.
B. Proiect organization:
The basic project organization shall be:
DISTRICT PROJECT MANAGER, in cooperation with CITY PROJECT MANAGER, shall provide
and oversee an integrated billing process for emergency medical services within the City of
PALM DESERT. Through the use of DISTRICT staff, DISTRICT shall process the patient care
report forms through a data processing system in order to produce invoicing and
corresponding reports. Through the use of DISTRICT staff, DISTRICT shall post all monies
received on behalf of CITY and produce the necessary balance billing, account registers and
accounting documents as outlined for CITY. CITY will identify and maintain the 'lock box
account' that the DISTRICT will post all monies to.
C. Project staffing:
Staffing for the project shall be the responsibility of DISTRICT. CITY shall provide sufficient
liaison personnel time to insure that report information is received by the DISTRICT on a
regular and timely basis.
D. Outline of authorized work:
DISTRICT shall produce invoicing (billing) for all qualified emergency medical responses
within the jurisdictional boundaries of the CITY, with corresponding completed report
forms. DISTRICT shall produce cumulative and detailed accounts receivable reports in
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generally accepted accounting format. Invoicing and/or reports shall be produced on a
monthly basis or in such other time frame as mutually agreed. DISTRICT shall provide all
necessary personnel, equipment and products necessary for producing said invoicing and
reports.
DISTRICT shall review and make recommendations, for change, if necessary, with respect to
current report forms content, data collection procedures therefor and billing amounts for
related services.
DISTRICT shall serve as the CITY representative in negotiation for payments with various
Health Maintenance Organizations, Preferred Provider Organizations, and Medicare/ Medi-
Cal.
DISTRICT shall provide on-site training for CITY personnel relating to proper billing
information procedures at CITY's request.
DISTRICT shall utilize TRITECH Software as a means to receive ambulance billing
information.
E. Deliverables:
DISTRICT shall produce and cause delivery of all invoices, statements and reports as
required. (See list of reports in Section F-4). In addition, DISTRICT shall provide CITY with a
report on its review of the report form, billing amounts and other items. This report shall be
provided to CITY no later than sixty (60) days after the commencement of this Agreement.
DISTRICT believes it will improve the billing process for service.
F. Work Plan:
To accomplish the objective, authorized work, and deliverables of this Scope of Services the
following is agreed upon as the necessary action steps:
1. Action Steps
The following is an outline of steps to be taken by DISTRICT and CITY:
a) On a minimum time frame of twice per week, CITY will provide to DISTRICT a report
of all calls that generated Ambulance Order numbers in the data system within CITY.
b) On a minimum time frame of twice per week, DISTRICT will receive and screen via
TRITECH the Patient Care report forms for ambulance billing information within
CITY's jurisdictional boundaries.
c) On a minimum time frame of twice per week, DISTRICT staff shall compare the
Ambulance Order report generated and provided by CITY with the information
received from TRITECH and report missing Patient Care Report information to CITY.
Page 10 of 13
Novato Fire Protection District Form042216
District Doc#h4014-120117 CONTRACT NO. C36670A
sow„-
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d) DISTRICT staff shall input all pertinent data to DISTRICT data processing system.
e) DISTRICT staff shall process the accounts and produce statements, invoices and
reports as required.
f) CITY shall receive all payments due and forward facsimiles (photocopies) of the
deposit information to DISTRICT staff on a routine basis.
g) DISTRICT shall post or credit the monies which CITY receives on accounts and shall
produce all corresponding reports and balance billing.
h) DISTRICT will meet at least monthly with CITY PROJECT MANAGER or designee to
discuss the project process and to review the projects reports.
2. Review Points
DISTRICT and CITY will review local demographic data and actual costs and DISTRICT will
make recommendations for change in billing procedures if necessary.
3. CITY Participation
CITY will provide a billing liaison person during normal business hours to DISTRICT.
4. Reports
Accounts Established Report: Commencing January 2, 2018, and thereafter by the 5th of
the month, CITY may request a report listing of all accounts established in the system for
the previous month or any specified period. This listing will include the following:
• Alphabetized order by Patient name
• Account Number
• Date of Service
• Total Charges
Charge Summary Report: Commencing January 2, 2018, and thereafter by the 5th of the
month a report listing of a summary of all charges by type of service for the previous
month.
Credit Summary Report: Commencing January 2, 2018, and thereafter by the 5th of the
month a report listing of a summary of all payments received by type of payer for the
previous month.
Charge Adjustments Report: Commencing January 2, 2018, and thereafter by the 5th of
the month a report listing of a summary of all charge adjustments made by type of
service for the previous month.
Credit Adjustments Report: Commencing January 2, 2018, and thereafter by the 5th of
the month a report listing of a summary of all payment adjustments made by type of
Page 11of13
Novato Fire Protection District Form042216
District Doc#MOI4-120I I7 CONTRACT NO. C36670A
trC"*°
`^
payer for the previous month.
Closing Balance Summary: Commencing January 2, 2018, and thereafter by the 5th of
the month a report listing the beginning balance, charges, credits, and adjustments, and
the ending balance for the previous month.
Payer Aging Report: Commencing January 2, 2018, and thereafter by the 5th of the
month a report listing each type of payer showing amounts owed by due date status.
The due dates should be in monthly increments for four months, followed by a two
month period, followed by accounts over 180 days. The line item reserved for patients
being billed should only include direct bill patients that are actually billed based on CITY
policies and practices.
Payer Summary Report: Commencing January 2, 2018, for the period of July through
September and thereafter by the 5th of the month following the end of a calendar
quarter a report summarizing the number of calls, charges, adjustments, and payments
by payer type.
Non Active Accounts: Commencing April 1, 2018 a report detailing accounts that have
had no activity or response for 120 days will be identified and delivered to CITY.
Page 12 of 13
Novato Fire Protection District Form0422I6
District Doc 4ti4014-1201►7 CONTRACT NO. C36670A
$orp4
(-4. 41
A.
EXHIBIT II
RENUMERATION PROVISIONS
A. DISTRICT: Commencing January 2, 2018, DISTRICT will invoice CITY on a monthly basis on
the 1st of the month for payment as described in the Agreement.
B. CITY: Commencing January 2, 2018, CITY will forward payments to DISTRICT no later than
thirty (30) days after receipt of invoices for services.
Page 13 of 13
Novato Fire Protection District Porm042216
1U0VA0
CONTRACT NO. C36670B -} ,
Business Associate Agreement
This Business Associate Agreement ("Agreement") between the Novato Fire Protection
District and the City of Palm Desert is executed to ensure that the Novato Fire Protection
District will appropriately safeguard protected health information ("PHI") that is created,
received, maintained, or transmitted on behalf of the City of Palm Desert in compliance with the
applicable provisions of Public Law 104-191 of August 21, 1996, known as the Health Insurance
Portability and Accountability Act of 1996, Subtitle F — Administrative Simplification, Sections
261, et seq., as amended ("HIPAA"), and with Public Law 111-5 of February 17, 2009, known as
the American Recovery and Reinvestment Act of 2009, Title XII, Subtitle D — Privacy, Sections
13400, et seq., the Health Information Technology and Clinical Health Act, as amended (the
"HITECH Act").
A. General Provisions
1. Meaning of Terms. The terms used in this Agreement shall have the same meaning
as those terms defined in HIPAA.
2. Regulatory References. Any reference in this Agreement to a regulatory section
means the section currently in effect or as amended.
3. Interpretation. Any ambiguity in this Agreement shall be interpreted to permit
compliance with HIPAA.
B. Obligations of Business Associate
Novato Fire Protection District agrees that it will:
1. Not use or further disclose PHI other than as permitted or required by this
Agreement or as required by law;
2. Use appropriate safeguards and comply, where applicable, with the HIPAA Security
Rule with respect to electronic protected health information ("e-PHI") and implement
appropriate physical, technical and administrative safeguards to prevent use or
disclosure of PHI other than as provided for by this Agreement;
3. Report to the City of Palm Desert any use or disclosure of PHI not provided for by
this Agreement of which it becomes aware, including any security incident (as
defined in the HIPAA Security Rule) and any breaches of unsecured PHI as required
by 45 CFR § 164.410. Breaches of unsecured PHI shall be reported to the City of
Palm Desert without unreasonable delay but in no case later than 60 days after
discovery of the breach;
4. In accordance with 45 CFR 164.502(e)(1)(ii) and 164.308(b)(2), ensure that any
subcontractors that create, receive, maintain, or transmit PHI on behalf of the Novato
Fire Protection District agree to the same restrictions, conditions, and requirements
that apply to Novato Fire Protection District with respect to such information;
5. Make PHI in a designated record set available to the City of Palm Desert and to an
individual who has a right of access in a manner that satisfies the City of Palm
Novato Fire Protection District
062216 Page 1 of 3
c6VAt.
CONTRACT NO. C36670B s
111
Desert's obligations to provide access to PHI in accordance with 45 CFR §164.524
within 30 days of a request;
6. Make any amendment(s) to PHI in a designated record set as directed by the City of
Palm Desert, or take other measures necessary to satisfy the City of Palm Desert's
obligations under 45 CFR §164.526;
7. Maintain and make available information required to provide an accounting of
disclosures to the City of Palm Desert or an individual who has a right to an
accounting within 60 days and as necessary to satisfy the City of Palm Desert
obligations under 45 CFR §164.528;
8. To the extent that the Novato Fire Protection District is to carry out any of the City of
Palm Desert's obligations under the HIPAA Privacy Rule, the Novato Fire Protection
District shall comply with the requirements of the Privacy Rule that apply to the City
of Palm Desert when it carries out that obligation;
9. Make its internal practices, books, and records relating to the use and disclosure of
PHI received from, or created or received by the Novato Fire Protection District on
behalf of the City of Palm Desert, available to the Secretary of the Department of
Health and Human Services for purposes of determining the Novato Fire Protection
District and the City of Palm Desert's compliance with HIPAA and the HITECH Act;
10. Restrict the use or disclosure of PHI if the City of Palm Desert notifies the Novato
Fire Protection District of any restriction on the use or disclosure of PHI that the City
of Palm Desert has agreed to or is required to abide by under 45 CFR §164.522; and
11. If the City of Palm Desert is subject to the Red Flags Rule (found at 16 CFR §681.1
et seq.), the Novato Fire Protection District agrees to assist the City of Palm Desert
in complying with its Red Flags Rule obligations by: (a) implementing policies and
procedures to detect relevant Red Flags (as defined under 16 CFR §681.2); (b)
taking all steps necessary to comply with the policies and procedures of the City of
Palm Desert's Identity Theft Prevention Program; (c) ensuring that any agent or third
party who performs services on its behalf in connection with covered accounts of the
City of Palm Desert agrees to implement reasonable policies and procedures
designed to detect, prevent, and mitigate the risk of identity theft; and (d) alerting the
City of Palm Desert of any Red Flag incident (as defined by the Red Flag Rules) of
which it becomes aware, the steps it has taken to mitigate any potential harm t6hat
may have occurred, and provide a report to the City of Palm Desert of any threat of
identity theft as a result of the incident.
C. Permitted Uses and Disclosures by Business Associate
The specific uses and disclosures of PHI that may be made by the Novato Fire
Protection District on behalf of the City of Palm Desert include:
1. The preparation of invoices to patients, carriers, insurers and others responsible for
payment or reimbursement of the services provided by the City of Palm Desert to its
patients;
2. Preparation of reminder notices and documents pertaining to collections of overdue
accounts;
Novato Fire Protection District
062216 Page 2 of 3
owe
CONTRACT NO. C36670B 114
3. The submission of supporting documentation to carriers, insurers and other payers t❑
substantiate the healthcare services provided by the City of Palm ❑esert to its
patients or to appeal denials of payment for the same; and
4. Other uses or disclosures of PHI as permitted by HIPPA necessary to perform the
services that the Novato Fire Protection ❑istrict has been engaged to perform on
behalf of the City of Palm Desert.
❑. Termination
1. The City of Palm ❑esert may terminate this Agreement if the City of Palm Desert
determines that the Novato Fire Protection District has violated a material term of the
Agreement.
2. If either party knows of a pattern of activity or practice of the other party that
constitutes a material breach or violation of the other party's obligations under this
Agreement, that party shall take reasonable steps to cure the breach or end the
violation, as applicable, and, if such steps are unsuccessful, terminate the
Agreement if feasible.
3. Upon termination of this Agreement for any reasons, the Novato Fire Protection
❑istrict shall return to the City of Palm ❑esert or destroy all PHI received from the
City of Palm Desert, or created, maintained, or received by the Novato Fire
Protection District on behalf of the City of Palm Desert that the Novato Fire
Protection District still maintains in any form. The Novato Fire Protection District
shall retain no copies of the PHI. If return or destruction is infeasible, the protections
of this Agreement will extend to such PHI.
Agreed to this day of , 20
CITY OF PALM DESERT NOVATO FIRE PROTECTION
DISTRICT
Signature: _
Printed Name:
Title:
Date (mm/ddlyyyy):
Novato Fire Protection District
062216 Page3of3
WHEREAS, the Write-Off Policy will also waive the full bill for any individual
without insurance coverage as set forth under Section 3 of this Resolution; and
WHEREAS, on December 14, 2017, the City Council conducted a properly
noticed public hearing to consider approval of the Fee Schedule, at which testimony and
evidence, both written and oral, were presented to and considered by the City Council.
NOW THEREFORE, BE IT RESOLVED THAT THE CITY COUNCIL OF THE
CITY OF PALM DESERT HEREBY:
Section 1. Recitals
That the recitals set forth above are true and correct.
Section 2. Approval of the Fee Schedule
That the City Council hereby approves adoption of the Fee Schedule, as set forth
below:
Fee Schedule
Fee Description Fee Amount
Ambulance Transportation $1,450.00
Ambulance Mileage Rate $29.00 per mile
Non-Transport Fee $425.00
Oxygen $132.00
Extra Attendant $155.00
Wait Time — per hour $82.20
First Responder/Pre-Stabilization $400.00
Basic Life Support (BLS) Disposable Supplies $303.75
Advanced Life Support (ALS) Disposable Supplies $382.00
Twelve (12) Lead EKG $285.00
Three (3) Lead EKG $156.48
Section 3. Approval of the Write-Off Policy
That the City Council hereby approves adoption of the Write-Off Policy, as set
forth below:
Patients that reside within the jurisdictional boundaries of the Cities of Palm
Desert, Rancho Mirage, and Indian Wells (Cove Communities) shall not be
balanced billed. The City accepts insurance payments as payments in full. All
patients will receive a maximum of four(4) insurance information request notices,
should insurance not be provided at the time of service. For those patients that
reside outside of the jurisdictional boundaries of the Cities of Palm Desert,
Rancho Mirage and Indian Wells, the City's contracted EMS/ambulance billing
company will send one balance bill as required under law. Accounts that have
72500.0000I\30203277.I
DRAFT 10/4/17 2
had no activity for 90 days will be deemed uncollectable at that time and will be
written off as bad debt. Any patient without insurance is deemed eligible for a
financial hardship waiver; the City will write the accounts off as bad debt. All
other billing aspects shall comply with state and federal law.
Section 4. Severability
That the City Council declares that, should any provision, section, paragraph,
sentence or word of this Resolution be rendered or declared invalid by any final court
action in a court of competent jurisdiction or by reason of any preemptive legislation, the
remaining provisions, sections, paragraphs, sentences or words of this Resolution as
hereby adopted shall remain in full force and effect.
Section 5. Repeal of Conflicting Provisions
That all the provisions heretofore adopted by the City or the City Council that are
in conflict with the provisions of this Resolution are hereby repealed.
Section 6. Effective Date
That this Resolution shall take effect upon its adoption.
Section 7. Certification
That the City Clerk shall certify to the passage and adoption of this resolution and
enter it into the book of original resolutions.
PASSED, APPROVED, AND ADOPTED by the City Council of the City of Palm
Desert, California, on this 14th day of December, 2017, by the following vote, to wit:
AYES:
NOES:
ABSENT:
ABSTAIN:
JAN C. HARNIK, MAYOR
ATTEST:
RACHELLE D. KLASSEN, CITY CLERK
CITY OF PALM DESERT, CALIFORNIA
72500.00001\30203277.I
DRAFT 10/4/17 3
CITY OF R A NC • I ' IIRAce .ERKYSFFI OCE
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- DESERTT. c n
2811 DEC 19 PM 2: 33
LJ
December 14, 2017
N, (LP X
Jane Stanley, Secretary to the City Council 1.09e4(
City of Palm Desert P ��� f` Q. ,,JI
73510 Fred Waring Drive S ID
r
Palm Desert, CA 92260 ova
AAA-,5 ` ) and
.Re: Cove Communities Services Commission Resolution i�t 11/ 1�' {(�^
Dear Ms. an54-
Enclosed please find the fully executed Resolution No. 2017-01, A Resolution of the
Cove Communities Services Commission Recommending the Legislative Body of
Each Cove Communities Services Commission Member Agency Adopt a Resolution
Establishing that each member Agency shall not balance bill residents of any Cove
Communities Services Commission Member Agency in connection with their
respective billing program for Emergency Medical Services. This resolution was
adopted by the Cove Communities Services Commission on October 18, 2017.
Each of the Cove Communities Services Commission Member Agency has received
an original Resolution.
Should you have any questions regarding the enclosed, please feel free to contact
me.
Thank you.
Sincerely,
Joni Almy
'Executive Coordinator
'ON DCVCLOPMENT CCf<VICCC Hhgfn;.E: r
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RESOLUTION NO. 2017-01
A RESOLUTION OF THE COVE COMMUNITIES SERVICES COMMISSION
RECOMMENDING THE LEGISLATIVE BODY OF EACH COVE COMMUNITIES
SERVICES COMMISSION MEMBER AGENCY ADOPT A RESOLUTION
ESTABLISHING THAT EACH MEMBER AGENCY SHALL NOT BALANCE BILL
RESIDENTS OF ANY COVE COMMUNITIES SERVICES COMMISSION MEMBER
AGENCY IN CONNECTION WITH THEIR RESPECTIVE BILLING PROGRAM FOR
EMERGENCY MEDICAL SERVICES
WHEREAS, in 1981, the cities of Indian Wells, Palm Desert and Rancho Mirage
(hereinafter collectively referred to as the "Cities" and individually as "City") formed the
Cove Communities Fire Commission that subsequently became the Cove Communities
Services Commission ("Cove Commission"), pursuant to a Joint Powers Agreement, as
subsequently amended ("JPA"), that provided for joint police, fire and certain recreational
services to the Cities; and
WHEREAS, effective July 1, 2005, the Cities entered into that certain Joint Powers
Agreement Reforming the Cove Communities Services Commission, Contract No.
C23920 ("Reformed JPA"); and
WHEREAS, the Reformed JPA allowed each City to separately provide for the bulk
of its own police and fire services to its own residents; and
WHEREAS, the Reformed JPA also memorialized the Cities' desire to continue to
coordinate the provision of police, fire, emergency medical services and recreational
services and to jointly fund certain limited fire services, the Joslyn Cove Communities
Senior Center, Inc., and other recreational services; and
WHEREAS, the Cities desire to continue to coordinate emergency medical
services in accordance with the Reformed JPA; and
WHEREAS, each City has or is planning to adopt a billing program (each, a"Billing
Program") whereby each City contracts with a third party to provide services to maximize
the timely revenue collection from the provision of emergency medical services at no out-
of-pocket costs to their respective residents; and
WHEREAS, each City's Billing Program allows the respective City to bill Medicare
and other health insurance providers for emergency medical services as part of
individual's existing insurance coverage, as a way of partial cost recovery for that City;
and
WHEREAS, the law requires that non-residents be balanced billed for any
remaining balance for services rendered which were not wholly paid by their insurer; and
1
WHEREAS, each City's residents pay taxes to their respective City, which taxes
in part fund the emergency medical services; and
WHEREAS, non-residents do not pay the same level of taxes as residents; and
WHEREAS, as a result, it is appropriate that no City should balance bill any
resident of any of the Cities for any unpaid balance related to emergency medical
services.
NOW, THEREFORE, BE IT RESOLVED BY THE COVE COMMUNITIES
SERVICES COMMISSION AS FOLLOWS:
Section 1. Recitals.
That the foregoing Recitals are true and correct and are incorporated herein by
this reference.
Section 2. Recommendation that Cities Adopt Resolution.
That, for purposes of each City's Billing Program only, and in its capacity as an
advisory commission, the Cove Commission recommends that each City adopt a
resolution establishing that each City shall not balance bill any Cove Commission City for
any unpaid balance related to emergency medical services, and that to effectuate the
same, such resolution provide that for purposes of their Billing Program only, "resident"
shall mean a person residing within the jurisdictional boundaries of any City, including the
City of Indian Wells with zip code 92210, the City of Rancho Mirage with zip code 92270
and the City of Palm Desert with zip codes 92211, 92255, 92260 and 92261, as such
definition may be revised by each City. The Cove Commission does not intend this
recommendation, nor shall this Resolution be construed, to impact each respective City's
ability to bill and/or collect from a resident's insurance provider for emergency medical
services rendered.
Section 3. Severability.
That the Cove Commission declares that should any provision, section, paragraph,
sentence or word of this Resolution be rendered or declared invalid by any final court
action in a court of competent jurisdiction or by reason of any preemptive legislation, the
remaining provisions, sections, paragraphs, sentences or words of this Resolution as
hereby adopted shall remain in full force and effect.
Section 4. Repeal of Conflicting Provisions.
That all the provisions heretofore adopted by the Cove Commission that are in
conflict with the provisions of this Resolution are hereby repealed.
2
Section 5. Effective Date.
That this Resolution shall take effect upon its adoption.
Section 6. Certification.
That the Cove Commission Clerk shall certify to the passage of this Resolution and
enter it into the book of original resolutions.
[THE REMAINDER OF THIS PAGE INTENTIONALLY LEFT BLANK]
3
PASSED, APPROVED AND ADOPTED this 18th day of October, 2017.
(e(C4 f/d/--e/6
Ted Weill, Chair
G�✓L i��
icha d Balocco, Vice Chair
ATTEST:
Joni Almy, Commissionlerk
APPROVED AS TO FORM:
Cis-Steven B. Quintanilla
General Counsel
Colr., Dw'; Us. (/9c•.+rlLl.
lbe?-+y ,«.(
4
CERTIFICATION
STATE OF CALIFORNIA )
COUNTY OF RIVERSIDE )
CITY OF RANCHO MIRAGE )
I, Joni Almy, Commission Clerk of the Cove Communities Services Commission, hereby
certify that Resolution No. 2017-01 was duly adopted by the Cove Communities Services
Commission, at a regular meeting thereof held on the 18th day of October 2017, by the
following vote:
AYES: Balocco, Jonathan, Mertens, Smotrich, Weber, Weill.
NOES: None.
ABSENT: None.
ABSTAIN: None.
Joni Almy
Commission Clerk
5
Emergency Services Fee for Service
Fee Development Analysis Report
DIRECT COSTS(Most recent budget year-FY 17/18)
The direct cost of providing ambulance service consist of paramedic personnel,training,compliance reporting,and depreciation.
DESCRIPTION ANNUAL AMOUNT
Paramedics' S5,252,022.00 Exhibit A(Top step/estimate)
Medic Program $250,424.00
Equipment Replacement" $200,000.00
Suplies and Equipment (Seven Ambulances) $140,000.00 estimated @ S20,000 per ambulance
Novato Admin Fees $97,100.00
City Staff"' $125,095.82
Depreciation"" $180,000.00
TOTAL $6,244,741.82
*Paramedic Training,certification,rose review and reporting compliance
**Ambulance replacement cost is$I80,000 per ambulance(remount)$210,000(new)with a 7-year useful life
""'Detail Included on separate worksheet
""Does not include durable medical equipment(gurneys,err.)that require replacement-This is a very conservative number
INDIRECT COSTS(Most recent budget Year-FY17f 10)
Cal-Fire Costs 82%number is based on the concept that 82%of all calls are medical
DESCRIPTION ANNUAL COST(75%) 100% 82%
Administration/Operational Support Services $676,543.50 $ 902,058.00 $ 739,687.56
Battalion Chief Support $142,299.00 S 189,732.00 S 155,580.24
Dispatch Services $215,995.50 $ 287,994.00 $ 236,155.08
Communication and IT Support 5346,465.50 $ 461,954.00 $ 378,802.28
Medic Fire Engine Direct Charge $56,994.75 $ 75,993.00 $ 62,314.26
Station Maintenance&Operations $142,500.00 $ 190,000.00 $ 155,800.00
TOTAL $1,580,798.25 $2,107,731.00 $1,728,339.42
Total Costs:(Direct +Indirect) $7,825,540.07 $8,352,472.82 $7,973,081.24
To calculate the transport fee,staff divided the total budget of direct and indirect costs,attributed to medical services,
(per CalFire 82%of all calls are medical)divided by the City's FY 15/15 Transport calls(the last year data was available
for)
Transports only-All calls(includes out of City responses) 5,859 $ 1,360.83
Palm Desert Only Calls 5,400 $ 1,476.50
Note:There is an opportunity cost to providing ambulance services:regardless of how many calls you go on.
Why is this less than neighbors?Because we have more calls.
'The ambulance transportation fee is established at: $1,450.00
In order to provide a consistent invoice amount and fee structure within the Cove Community Cities Joint Powers Authority the fee is
at$I,450. The fee will be reviewed annually during the budget prepreation process,and if appropriate adjustments will be
recommended for approval by the City Council.
OTHER FEES
Fee Description Fee Amount Comment
Ambulance mileage rate $29.00 p/mile
Oxygen $132.00
Extra Attendant $155.00
Wait time-per half hour $82.20
Nan-Transport fee $425.00
First responder/pre-stabilization $400.00
Basic life Support Disposable Supplies S303.75
Advanced Life Support Disposable Supplies $382.00
12 Lead EKG $285.00
3 Lead EKG $156.48
In addition to billing for medical transports,Medicare and other health insurance providers allow for line item billing.Medical aid is provided
during medical transports and during non-transport situations when a patient is treated and released at the scene.Staff developed a list of
other fees with the assistance of the Novato Fire Protection District.The fees were analyzed and approved by Riverside County Fire Department.
To ensure consistency with other local cities,the City of Indian Wells compared the fees with those charged by the Cities of Indio and
Cathedral City,both of whom have their own similar billing programs.tine item fees aid in cost recovery for different types of emergency medical
services provided by the City and are based on the cost of providing the services.These fees will be charged to Medicare and other health insurance
providers with no out of pocket costs for Palm Desert residents.
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STAFF REPORT? �,;.. ./. . ./7 ;�)0/ Y
CITY OF PALM DESEIRT✓ . C�;�*.
ADMINISTRATIVE SERVICE D PAk1MENT
MEETING DATE: December 14, 2017
.asi:�.:Ali...atw.aassu.l'-a:nA.egsayOSVI at,3a.3,.':-•• .. - .. .n.J.,......-..r..-.1..1
REQUEST: Consideration of adoption of a Medical Insurance Billing Program for
Emergency Medical Services (EMS) Cost Recovery.
Recommendation
By minute motion, recommend that the Palm Desert City Council continue
this matter until the January 11, 2018, City Council meeting.
Discussion
At the time of printing the City Council agenda for December 14, 2017, staff has not
yet finalized the fee study for the proposed Emergency Medical Services Cost
Recovery Program. Staff respectfully requests that the City Council continue this
matter until the January 11 , 2018, regularly scheduled City Council meeting. This
extension will grant staff enough time to prepare a more thorough analysis of the
costs associated with providing Emergency Medical Services to the public.
p
r
e
p by: ephen Y Aryan, Risk Manager
LEGAL REVIEW DEPT. REVIEW FINANCIAL REVIEW CITY MANAGER
S4'4— .56"(bk— do&.61.4.te
Robert W. Hargreaves Lori Carney Vet Moore Lauri Aylaian
City Attorney Director of Administrative lirector of Finance City Manager
Service
CITY COUNCILAITION
APPROVED ✓✓ DENTED)
Itf CE VED OTIi ER
MEETI}�G D
AYES:t►t�,'f� c/ 1 S P�� c a/2
NOES:
ABSENT:
ABSTAIN: P-
VERIFIED BY: jL-R Ica
Original on File with Citys Office
CITY OF PALM DESERT
NOTICE OF A PUBLIC HEARING
REGARDING THE ESTABLISHMENT OF CERTAIN EMERGENCY MEDICAL
SERVICES COST RECOVERY FEES
NOTICE IS HEREBY GIVEN that at 4:00 P.M. on December 14, 2017, or as soon
thereafter as possible, in the City Council Chambers of the City of Palm Desert, CA
located at 73-510 Fred Waring Drive, a public hearing pursuant to California Government
Code, Sections 66016 and 66018 will be held by the City of Palm Desert ("City") to
consider the City's establishment of an Emergency Medical Services (EMS) Cost
Recovery Fees ("Fees") and the approval of a resolution establishing such fees.
In connection with the establishment and increase of Fees, City staff have prepared
updates to reflect current costs of the City for providing the services for which such fees
are charged (collectively, "Fee Study"). The Fee Study contains a summary of the
proposed Fees, as well as (i) the purpose of the proposed Fees, (ii) the use to which the
Fees will be put, (iii) a reasonable relationship between the Fees' use and the types of
projects on which the Fees are imposed, and (iv) a reasonable relationship between the
amount of the Fees and the cost of the City's Services attributable to the applications on
which the Fees are imposed.
At the public hearing, the City shall consider all evidence and testimony for and against
the Fee Study and approval of the resolution establishing Fees. At any time prior to the
public hearing, any person may file in writing with the City a statement of his or her
objections to the Fee Study and/or approval of the resolution establishing Fees.
Persons who challenge the Fee Study and updates and/or approval of the resolution
establishing Fees in court may be limited to raising only those issues they or someone
else raised at the public hearing described in this Notice, or raised in written
correspondence delivered to the City at, or prior to, the public hearing.
A copy of the Fee Study and the proposed resolution are available for public inspection
at the Office of the City Clerk, located at 73-510 Fred Waring Drive, Palm Desert, CA,
during regular office hours, Monday through Friday, commencing December 4, 2017.
Any further information may be obtained by contacting Stephen Y. Aryan, Risk Manager,
or Lori Carney, Director of Administrative Services, for the City at (760) 346-0611.
DATE: November 27, 2017