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HomeMy WebLinkAbout2017-11-16 Study Session - Ambulance Services Cost Recovery .... .. � 1..: CITY OF P DIM DESERT p 73-510 FRED WARING DRIVE n PALM DESERT, CALIFORNIA 92260-2578 --- 4! * TEL: 760 346-0611 Df% infoAcityofpalmdesert.org NOTICE OF STUDY SESSION OF THE PALM DESERT CITY COUNCIL NOTICE IS HEREBY GIVEN that the Palm Desert City Council will convene Thursday, November 16, 2017, at 2:00 p.m. in the Administrative Conference Room of the Palm Desert Civic Center, 73-510 Fred Waring Drive, Palm Desert, California 92260, for the purpose of conducting a Study Session. Said Study Session will be held in order to discuss Ambulance Services Cost Recovery. R HELLE D. KLASSE , CITY CLERK CITY OF PALM DESERT, CALIFORNIA November 9, 2017 NO ACTIONS WILL BE TAKEN AT THE STUDY SESSION. PURPOSE OF THE STUDY SESSION IS INFORMATION ONLY. 11/16/2017 FlRQ � PARAMEDtcs EMS COST RECOVERY November 16, 2017 City Council Study Session `�•`„r -)�F;mow rho-� is HISTORY Fire Prevention/Protection Tax AL , . (07/24/80) ! NRE Res u lilt FSFa FSFad A ED e F $60.00 levy - 2009 City Medic Program �■ EMS Cost Recovery Discussion SIR 201 7 City Manager Goals City Sub-Committee Only City in California with No Cost Recovery. 1 11/16/2017 FY 2017-- 1 B FIRE SERVICES BUDGET 1l Fire Fund ■General Fund Transfer k Fire Services Budget: 41 $ 12,875,300 0.28 > Fire Fund: $9,206,760 0J2 General Fund Transfer: $3,668,540 "GOALS OF EMS COST RECOVERY" Increase revenues without impacting 0 residents. Q No out of pocket costs for Palm �. Desert Residents. 2 11/16/2017 PROPOSED BILLING PROGRAM No change in emergency medical response. Collect patient data and insurance information. r Information provided to third party billing ' ' vendor. Vendor creates invoices, responsible for communication, and coordinates collection of _ payments. • �r Payments are sent to City's bank(lockbox). Estimated annual revenue($2 million)and cos ($108,000). • City has to establish fees and write off policy. WRITE-OFF POLICY City/Cove Residents no out-of- pocket costs ( ul. . . Residents and non-residents t . ►te insurance will be billed. meb Non-residents balanced billed. 90 Days Overdue Deemed state Uncollectable Non-Insured Patients Eligible for a Hardship Waiver. 3 11/16/2011 FEE SCHEDULE • Same for all Cove Cities-Regional Fire , Protection Program. • Eliminates Confusion • & More Efficient • Fee Analysis Medicare and Other Health Insurance Pay Lower Amounts FEE SCHEDULE FEE DESCRIPTION FEE AMOUNT Ambulance Transpodadon $1,450.00 Ambulance Mileage Rate $29.00 p/mile Non-Transport Fee $425.00 Oxygen $132.00 Extra Attendant $155.00 Wait time-per it 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 12 Lead EKG $285.00 3 Lead EKG $156.48 4 11/16/2017 NO VA TO F/RE PROTECTION DISTRICT *QVAr© Cove Cities Selected AlgreN Public Agency 10 Years Billing Nt....../ Experience / Other Fire Agencies Served 1(: tC ,. E0IS1/ Subject Matter Experts �.. PUBLIC SAFETY COMMISSION RECOMMENDATION • Recommends Approval (5-1-1 vote) • IMPORTANT-Insurance companies will be billed NIPIIIIP'' regardless of residency .,,,%9.1 , status ��4 Allirg • Determining residency 01101r1F1)),Idd (resident vs. non-resident) 90 Day Waiting Period- S . Industry standard No adversarial position Ilhhlh: oa... 11/16/201i •rtA0tilkiAle UtAeoS t J WtOS 6 STUDY SESSION REPORT CITY OF PALM DESERT PUBLIC SAFETY COMMISSION ADMINISTRATIVE SERVICE DEPARTMENT MEETING DATE: November 16, 2017 SUBJECT: Medical Insurance Billing Program for Ambulance Services. 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 One of the Public Safety & Emergency Services Chapter within the Strategic Plan aims to enhance the delivery of public safety services. In expanding the existing services provided by the Fire Department to address future growth and safety concerns, a cost recovery program will enable the City to be in a better financial position to do so. Executive Summary One of the identified 2017 Citywide Goals is to consider a program for cost recovery of EMS services provided to transport patients, similar to that of neighboring cities. 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 medical insurance billing services for ambulance transports and related costs. This program enables the City to bill Medicare and other private health insurance providers for ambulance transportation services 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 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 November 16, 2017— Public Safety Commission Staff Report Medical Billing Program for Ambulance Services Page 2 of 5 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 ambulance services, 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 medical insurance 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 medical insurance 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 over 6,000 ambulance transports last year, a number which increases annually and is expected to continue to do so as the City's population rises. Implementing the recommended medical insurance billing program will allow Palm Desert to bill Medicare and other private health insurance providers for ambulance transportation services, 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 ambulance billing services. This non-profit public agency has a nine year history of providing ambulance 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 ambulance transport revenues 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. November 16, 2017— Public Safety Commission Staff Report Medical Billing Program for Ambulance Services Page 3 of 5 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 City 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 City limits and Cove Communities of Rancho Mirage and Indian Wells, the City's contracted 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. Staff respectfully recommends approval of the agreement with the Novato Fire Protection District to implement medical billing services for the City of Palm Desert's emergency medical services program. Should the Palm Desert City Council approve the JPA in December 2017, patient billings would initiate in approximately April 2018. 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 medical transports, 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. November 16, 2017— Public Safety Commission Staff Report Medical Billing Program for Ambulance Services Page 4 of 5 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 tentative fee schedule below will 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 structure will eliminate any confusion and be more efficient. Fee Description Fee Amount- Ambulance Transportation $1,450.00 Ambulance Mileage Rate $29.00 p/mile Non-Transport Fee $425.00 Oxygen $132.00 Extra Attendant $155.00 Wait time— per�/z 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 12 Lead EKG $285.00 3 Lead EKG T ._. .. $156.48 Commission Action 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) a medical insurance billing program for ambulance services. Commissioner Kramer cast the sole dissenting vote and was concerned about how the City clarified residents and non-residents and waiting 90 days before waiving any uncollected debt. When transporting a patient to the hospital, the Fire Department collects 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 November 16, 2017— Public Safety Commission Staff Report Medical Billing Program for Ambulance Services Page 5 of 5 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. Fiscal Analysis Staff conservatively anticipates approximately $2 million in ambulance transport 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 6,000 ambulance transports, annualized billing costs are anticipated to be $108,000. Billing related services and staff time will be included in the assumption for future fiscal years as ongoing enses. Prepare by: tephen . ryan, Risk Manager 111;. eviewed by: Lr r amey, Director of Administrative Services ATTACHMENTS: 1.Joint Powers Agreement with Novato Fire Protection District 2. Business Associate Agreement (HIPAA) 3. Draft Resolution No. 2017- 4. Memorandum dated June 22, 2017 — ■ 4.11 CT= 111+ • I I a. N Q# ■ ■ ■ —0 LA. ■ ■ ■ T ■ V I111■j II■■I N1 - 11 1 • . ■11}n 9 1111=11 I loft ■ mil rm./id ■ AM• 111I + T `Len • if *. 11rn` ■ ■I i III &.11 A —III jr la. witiAri ■ - - - - xa iil . • op ■11 `1 I■ 44 -I. - • 1 r - }�- II 1 III1101 i 116 11■ ' I M -1 : if:� 1 11 • I , 14. e1L�1111 .L 1 1 T tow T V F:M —,5 91111 11 ' id ■ II I m 11 1 1 4 1 u 11 - 9 ■ _ . 11 L - • • - MI • _ R ■ _ . I ■ — r A 1 I - ■! AV - - 1-U I 1 A 11P I I— - -1i1■ 11 —1 - 1 ■ • -AZ .',," 1 �: 1111 I: 1 Li 1 ■ - ■ 1 • T 1 TI 1 A i District Doc=M014-120117 +tt9a 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 4,000 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 Page 1 of 13 timato Hp:Protection District Ibrm042216 District Doc#4t014-120117r. *t3YAto 'LI 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. Page 2 of 13 Nolato Fir:Protection District I orm042216 District Doc g MIOI4-1201 17 ovAr. 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. Page 3 of 13 \mato Fire Protection District Form047716 District Doc MM014-120117 I €) 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 Page 4 of 13 Novato Fire Protection Disirict FormOd2216 District Doc FM01.4-120117 s9YAta 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 Page 5 of 13 No%ato Fire protection District Form0422I6 District Doc#Mfl14-120I 17 t41 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. Page 6 of 13 Novato Fire Protection District Form042216 District Doc FMO14-120117 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) Page 7 of 13 No\ato Fire Protection District FormO42216 • District Doc 4N10IJ-120117 t ' .1.411).,/ 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 Mark Heine, Fire Chief Date: Date: ATTEST: I City Clerk APPROVED AS TO FORM: City Attorney Page 8 of 13 Nevin)Fire Protection District Form0.12/16 District Doc='IO14-120117 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. Objective: 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. Project 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 Page 9 of 13 \o%ato I ire Protection District FormO422I6 District Doc#MI014-120117 te) 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 Ncstinto Fire Protection District Form042216 Distri t I)oc J101-1-I20I 17 OWIra 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 Adiustments 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 Pane 11ot13 `mato 1 ire Protection District I•orm0.122I6 District Doc i2M191-1-I201 17 Vittg ot 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. Paver 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. Paver 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 No%ato Fire Protection DiNtrict Form0422 i b • District Doc#N101,1-I20117 30VA70 tf211 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 Notiato I've Protection District I=ormO42216 woo 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 ovAro 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 3. The submission of supporting documentation to carriers, insurers and other payers to substantiate the healthcare services provided by the City of Palm Desert 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 District has been engaged to perform on behalf of the City of Palm Desert. D. Termination I. The City of Palm Desert 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 District shall return to the City of Palm Desert 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/ddiyyyy): Novato Fire Protection District 062216 Page 3 of 3 I i 1 • M1�k A F. b +Q RESOLUTION NO. 2017- A RESOLUTION OF THE CITY COUNCIL OF THE CITY OF PALM DESERT, CALIFORNIA, APPROVING THE EMERGENCY MEDICAL SERVICES BILLING PROGRAM FEE SCHEDULE AND RELATED WRITE-OFF POLICY WHEREAS, the City of Palm Desert ("City") incurs costs related to provision of emergency medical services to residents who both reside inside and outside City limits; and WHEREAS, in an effort to develop cost recovery processes related to such emergency medical services, the City Council will consider an Emergency Medical Services Billing Program ("Billing Program") to become effective December 1, 2017, which program will allow the City to bill Medicare and other health insurance providers for emergency medical services as part of individuals' existing insurance coverage with no out-of-pocket costs for Cove Communities residents; and WHEREAS, a Cove Communities resident is defined as an individual who resides within the Cities of Palm Desert, Rancho Mirage, and Indian Wells (Cove Communities); and WHEREAS, as part of the Billing Program, the City must establish a fee schedule ("Fee Schedule") that will establish the fees to be charged Medicare and other health insurance providers; and WHEREAS, the Fee Schedule was established based on the reasonable costs of providing emergency medical services; and WHEREAS, goal of the City's Billing Program is to only collect from Medicare and other health insurance providers as a means of achieving partial cost recovery for the City, as the City will collect only what Medicare or other health insurance providers will pay and the remainder of the bill will be waived under the write-off policy ('Write-Off Policy") set forth under Section 3 of this Resolution; and WHEREAS, the Write-Off Policy will also waive the full bill for any individual without insurance coverage; and WHEREAS, on November 16, 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. 2500.0000I\30203277 l DRA T 10:'4 17 1 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 per mile Non-Transport Fee $425.00 Oxygen $132.00 _ Extra Attendant $155.00 _ Wait time— per'/2 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 12 Lead EKG $285.00 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 City 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 City limits and Cove Communities of Rancho Mirage and Indian Wells, the City's contracted 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. 72500.00001.30203277.1 DRAFT I0/4/17 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 16th day of November, 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 1 rr-