County ambulance service could get state aid early

BY CHUCK VANDENBERG
PCC EDITOR

LEE COUNTY - A state program that helps prop up public ambulance services could potentially provide assistance the first year, if Lee County takes over the service.

According to Jim Steffen, an EMT instructor at Southeastern Community College, and head of the county's Ambulance Advisory board, a state program that typically requires a couple years of financial documents before pumping in subsidies, could be accessible July 1.

With the county still looking at taking over ambulance operations, the advisory board has been meeting weekly to review budgets and plan for the eventual transition.

According the Iowa Department of Human Services, the Ground Emergency Medical Transportation (GEMT) Program is a voluntary program that allows publicly owned or operated emergency ground ambulance transportation providers to receive supplemental payments that cover the difference between a provider’s actual costs per GEMT transport and the Medicaid base payment, mileage and other sources of reimbursement.

Providers receive cost-based, supplemental payments on a prospective basis for emergency ground ambulance transportation of Medicaid Fee-for-Service (FFS) and Medicaid managed care (MCO) members under Title XIX of the federal Social Security Act (SSA) and the Affordable Care Act (ACA) only.

Steffen said he had been under the assumption that the funding wouldn't be available until the service had established cost reports, but he said Thursday that may not be the case.

"We have some good news potentially. We don't have a final answer yet. With some hurdles, we could be eligible for funding the first year, fiscal year 2022," Steffen said.

"I have no idea how much and there are some hurdles. They wanted to look at it, and I think they wanted to see how it was service set up, so that it's not just a county service in name only."

The funding stream is only available to publicly owned ambulance services, a hitch that was part of the current Lee County EMS Ambulance revenue struggles. Private companies are only reimbursed Medicaid and Medicare established rates for services for those patients and the providers can't pursue the rest of the charges privately.

"Services that are public are eligible and those that are private are not," Steffen said. "That has contributed to the (Lee County EMS) issues, and this is the A-No. 1 reason that contributed to those issues."

Steffen also recommended that when the county takes over the service that they use the Burlington Fire Department for billing services.

The move would require a 28E agreement between the county and the BFD at rate of 6% of net revenues as a fee. There would also be some additional compensation for collections.

He said the BFD currently uses Financial Adjustment Bureau to collect outstanding balances and there would be 20% fee for those services and up to 50% could be charged for any claims taken to court under a proposed agreement.

Steffen said the agreement also requires county staff to deliver billing statements and other records manually to Burlington, but Steffen said he thinks they should be scanned and sent electronically, and delivered manually only when necessary.

Board member Dr. Philip Caropreso said Washington County has a .25/$1,000 levy tacked on to county residents tax bill each year.

County Budget Director Cindy Renstrom said to pay for the service, the county will have to surpass it's maximum levy, and that will require an additional public hearing and supermajority, with four of five Lee County Supervisors supporting the move.

The county board starts working on budgets at the start of the year, and Supervisor Rick Larkin, who sits on the advisory board, said things need to be in line by then.

The board has put together a $2.3 million operating budget, but with the GEMT funding that could bring provide additional revenues. The impact of that is still unknown, but Steffen said Burlington Fire Department's service receives about $600,000 annually.

Fort Madison Fire Chief Joey Herren said that budget number is close to the number he and Keokuk Fire Chief Gabe Rose, submitted to the county earlier in the year.

Herren said the two department's would need $1.8 million in a subsidy initially for capital outlay and start up costs, in addition to revenues for providing the service, to make it work. But Herren said he had to put those numbers together in 90 days to make a proposal to the county.

He also said that subsidy would shrink as GEMT funding came on board, and it could be smaller out of the gate, if the county bonded for some of the start up costs.

Steffen and board member Denise Fraise said they thought the $1.8 million was a request from each city, but Herren said that figure was combined. Herren said the subsidy combined with revenues received would put the city's proposal in line with what the county was considering.

"We said that subsidy would go down after GEMT money would come in," Herren said. "We were wanting that for five years because we didn't know what the first five years would be. But after the first year we believed it would come down."

Steffen said it's coming close to the time to negotiate a price to transition the service to the county. The board decided to reach out to Lee County Attorney Ross Braden regarding the negotiation. Steffen said he's hearing that Lee County EMS is asking the county to purchase accounts receivable, a move he didn't support.

"I don't see the benefit to Lee County to buy their books," Steffen said.

"It's an unknown asset and only way to put a value on that is to tell the owners that whatever we collect for previous calls they would get a percentage of that. The county gets a percentage because we have to deal with it."