Monroe County's Billing Model...

Every citizen derives benefit from the availability of a helicopter ambulance. 

There has been plenty of press lately about patients struggling to pay balances due for transport by HEMS. Monroe County Florida elected to provide a benefit for tax-paying residents - no balance due beyond what a patient's insurance company pays. No insurance? No balance due.

This model could be adopted by other counties - even counties unable to create a HEMS service - through preferred-provider agreements. As HEMS companies do not pre-qualify patients for ability to pay, and stand ready to offer lifesaving services to anyone who needs it, it follows that all residents should help shoulder the financial costs of making such services available. Every citizen derives benefit from the availability of a helicopter ambulance - in the same way that every citizen derives benefit from law-enforcement and public-education. 

Indeed, anecdotal evidence indicates that rural counties are cutting back on money spent to provide ground ambulance services, because of the increase in number of HEMS services, thus shifting costs for a needed basic service (transport to definitive care) through extant HEMS operators to the relatively few patients who are flown...

This aircraft was purchased by Monroe County from Geisinger Life Flight. 

RESOLUTION NO. 1$2 2009 RESOLUTION OF THE BOARD OF COUNTY COMMISSIONERS OF MONROE COUNTY, FLORIDA, ADOFiTING A FEE WAIVER POLICY AND PROCESS FOR TRAUMA STAR BILLING FOR TRAUMA SCENE AND CRITICAL CARE INTERFACILITY FLIGHTS.

WHEREAS, Monroe County provides a rapid-transport air ambulance to provide air transportation of trauma, critically injured and ill patients, hereafter called "Trauma Star"; 

and WHEREAS, Trauma Star provides air transportation from emergency scenes in Monroe County to specialized hospitals and treatment centers out-of-county, and Trauma Star also provides air transportation from remote areas such as Fort Jefferson to Monroe County hospitals, hereinafter called "trauma scene flights"; and WHEREAS, Trauma Star provides air transportation from Monroe County hospitals to specialized hospitals and treatment centers out-of-county upon physician authorization, hereinafter called "critical care interfacility flights"; 

and WHEREAS, the annual cost of operation of Trauma Star has been approximately $1,800,000 per year in excess of' revenues collected from third party insurance through the billing of user service fees; and WHEREAS, a referendum on November 4, 2008 for the establishment of two special taxing districts for the operation of Trauma Star passed with 54.5 percent of the vote; 

and WHEREAS, the Board of County Commissioners has determined that it is in the best interests of its residents to support trauma scene flights and critical care interfacility flights for qualifying residents via a fee waiver program; and WHEREAS, the Board of County Commissioners have found that residents support the Trauma Star program through the payment of ad valorem property taxes; and WHEREAS, nonresidents of the County make frequent use of the Trauma Star program but do not directly pay any portion of the expenses through the County's real property taxes to pay for Trauma Star, including maintenance, operating costs, and the salaries of employees required to provide the Trauma Star program; 

and WHEREAS, the Board of County Commissioners has opted to establish a policy and set certain restrictions on billing for Trauma Star, particularly with respect to the potential for service fee waivers; now, therefore

Section I. The following policy is hereby established with respect to Trauma Star. A. The County will continue to seek reimbursement from third-party payers, including but not limited to liability insurance, automobile insurance, health care insurance, Medicare, and Medicaid, to offset a portion ofTrauma Star's operational costs. B. For qualifying individuals, the County Commission will eventually write off any and all balances remaining after receipt of third party payments, even in cases when the qualifying individual does not have any third party insurance. C. The waiver of out-of-pocket expenses is made effective retroactive to November 4, 2008, the date of passage of the voter referendum. D. Write-offs of out-of-pocket expenses will be completed by annual resolution of the Board of County Commissioners.

Section 2. Administrative Waiver Qualification. To be eligible for a waiver of service fees, the qualifying individual and the air ambulance transport must meet all of the following criteria: A. The waiver includes the cost of trauma scene flights and critical care interfacility flights. B. The patient must be a qualifying resident as defined in Section 3 below. C. The individual transported must not have been injured while involved in the commission of felony criminal activity. Section 3. Resident Qualification. The waiver process requires qualification as a resident and submission of documentation by the person seeking the waiver: A. 

A qualifying individual is a resident who defined as either of the following: I. Any property owner, or immediate member of his or her household, who is current in paying property taxes in Monroe County, including the Trauma Star tax. For the purposes of this paragraph, the term "property tax" includes the tax on real and personal property authorized by Monroe County Ordinance 030-2008. For the purposes of this paragraph,. The term "immediate member of his or her household" means (a) residing at the same address as the property owner, and (b) son, daughter, father, mother, brother, sister, mother-in-law, father-in-law, uncle, aunt, nephew, niece, brother-in-law, sister-in-law, stepfather, stepmother, stepdaughter, stepson, half brother, half sister, grandchild, or domestic partner. 

2. A resident of Monroe County, or immediate member of his or her household, who rents property subject to the Trauma Star tax. For the purpose of this paragraph, the term "immediate member of his or her household" means (a) residing at the same address as the property owner, and (b) son, daughter, father, mother, brother, sister, mother-in-law, father-in-law, uncle, aunt, nephew, niece, brother-in-law, sister-in-law, stepfather, stepmother, stepdaughter, stepson, half brother, half sister, grandchild, or domestic partner.

B. C. D. Section4. A. B. Section 5. A non-qualifying individual is any individual who does not contribute towards the financing of the Trauma Star service, such f!S visitors and part-time or seasonal residents, and all others who do not meet tl).e criteria in section 3 .A. The billing company will continue to proc~ss billing as in current practice, but will provide a waiver request form in the billing package. 

To be considered for the write-off or waiver of out-of-pocket expenses, the patient is required to show documentation to prove that the property oWner has paid all applicable property taxes, including any Trauma Star tax beginhing on November 1, 2009, and that the qualifying individual meets the other r11quirements as set forth in Section 3.A., above. The qualifying individual must submit proof of qualification to the billing company for review and validation. Documents to substantiate qualification must include a copy of the property tax bill showing that all taxes, including the Trauma Star tax, have been paid and are current. In addition, to qualify under Section 3.A.l., an individual must provide a copy of a current Monroe County driver's license showing residency at the address held by the property owner. 

To qualify under Section 3.A.2, an individual must provide a copy of a long-term lease and/or utility bills at the address held by the property owner. Residents who have met the waiver requirements, as documented by the billing company, will not be invoiced during the time that the billing company continues to seek third party payments and while pending the BOCC approval of the writeoff. Other Providers Excluded. The fee waiver program is not applicable to any other transport provided by any other helicopter provider, even in the event Trauma Star is out of service or unavailable. The County does not subsidize the operations of other providers, and the County is not responsible for any fees incurred by residents from other providers' services. The Clerk is directed to send a copy of this Resolution to the Monroe County Sheriff.