05-B Recognizing ALS-LevelAGENDA INFORMATION SHEET
PROJECT: Consider an ordinance recognizing the current level of ambulance service provided by the Paris
EMS System as the Advanced Life Support (ALS) level of service, and amending the Code of Ordinances of
the City of Paris to add a new Sec. 2-99 to require a continuation of Advanced Life Support (ALS) as the level
of service to be provided in the future by the Paris EMS System.
BACKGROUND: The Federal Balanced Budget Act of 1997 required a reduction in the amount of money
spent by the Medicare program (Center far Medicare/Medicaid Services (CMS)). The plan as to how
ambulance services will be paid was finalized and published in the Federal Register on February 27, 2002, with
the new reduced fee schedule becoming effective on April 1, 2002. CMS will phase in the new schedule at
twenty percent (20%) per year over five (5) years, and this phase-in period will use a blend of the current
payment policy with the new payment rules
DESCRIPTION: Paris EMS has provided ambulance service at the Advanced Life Support (ALS) to the
citizens ofParis and Lamar County since November 1982. Advanced Life Support (ALS) includes treatment
such as intravenous lines (IV), endotracheal intubation, medication administration, and cardiac pacing and
cardioversion. The City of Paris needs to recognize this long-standing level of inedical care provided in the
form of an ordinance in order to minimize the negative financial impact of the new Medicare fee schedule.
This ordinance will not modify or impact how medical care is delivered to patients, it will merely recognize
the level of care that has been delivered to the patients of Paris EMS since 1982 and require the continuation
of such level of care.
RECOMMENDED ACTION: Adoption of the proposed ordinance.
STAFF CONTACT: Kent Klinkerman, EMS Director, and Larry W. Schenk, City Attorney
COST: If the City does not adopt the proposed ordinance requiring ALS-level services to be provided,
Medicare will provide reimbursement to the City at the BLS-level, resulting in estimated losses of
approximately $50,000.00 annually, conservatively stated.
SCHEDULE: The rule is scheduled to become effective on April 1, 2002.
COUNCIL DATE: Consider for approval at City Council's March 11, 2002, regular Council meeting.
ADDITIONAL MATERIALS: See enclosed ordinance and other supporting documentation.
DRAFT
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March 6, 2002
ORDINANCE NO.
AN ORDINANCE OF THE CITY COUNCIL OF THE CITY OF PARIS,
PARIS, TEXAS, RECOGNIZING THE CURRENT LEVEL OF
AMBULANCE SERVICE PROVIDED BY THE PARIS EMS SYSTEM AS
THE ADVANCED LIFE SUPPORT (ALS) LEVEL OF SERVICE;
AMENDING THE CODE OF ORDINANCES, CITY OF PARIS, PARIS,
TEXAS, TO ADD A NEW SEC. 2-99 TO REQUIRE A CONTINUATION OF
ADVANCED LIFE SUPPORT (ALS) AS THE LEVEL OF SERVICE TO BE
PROVIDED IN THE FUTURE BY THE PARIS EMS SYSTEM; REPEALING
ALL ORDINANCES OR PARTS OF ORDINANCES IN CONFLICT
HEREWITH; MAHING OTHER FINDINGS AND PROVISIONS RELATED
TO THE SUBJECT; AND DECLARING AN EFFECTIVE DATE.
WHEREAS, the City Council of the City of Paris, Paris, Texas, finds and detertnines that the
City of Paris Emergency Medical Services System has provided ambulance service to the residents of
Paris and Lamar County at the Advanced Life Support (ALS) level since November 1982; and,
WHEREAS, the Departtnent of Health and Human Services, Centers far Medicare and Medicaid
Services, has established a new fee schedule far the payment of ambulance services under the Medicare
program that will provide Medicare reimbursements for ambulance services at the Basic Life Support
(BLS) level, regardless of whether an ALS-level unit responds to calls, unless by ordinance ALS is the
level of service required; and,
WHEREAS, in order to recognize and perpetuate ALS as the level of service to be provided by
the Paris EMS System, and to receive Medicare reimbursements appropriate to the level of service
provided, the City Council of the City of Paris desires to provide for continuation of and to mandate the
minimum level of service to be provided by the Paris EMS System to be at the Advanced Life Support
(ALS) level; NOW, THEREFORE,
BE IT ORDAINED BY THE CITY COUNCIL OF THE CITY OF PARIS, PARIS,
TEXAS:
Section 1. That the findings set out in the preamble to this ordinance are hereby in all things
approved.
Section 2. That the City Council hereby finds and detertnines that ambulance service to the
residents of the city of Paris and Lamar County has been provided at the Advanced Life Support (ALS)
level since November 1982.
Section 3. That in order to perpetuate the AdvancedLife Support (ALS) level of service provided
by the Paris Emergency Medical Services System, the Code of Ordinances of the City of Paris, Paris,
Texas, shall be, and the same is hereby, amended to add a new Sec. 2-99 thereto to read as follows:
"Sec. 2-99. Level of service.
"The level of service provided by the City of Paris Emergency Medical Services
System has been the Advanced Life Support (ALS) level, and all ambulances operated
by the City ofParis Emergency Medical Services System shall continue to be staffed
at the level necessary in accordance with established rules and regulations of the State
of Texas, the Federal government, and the Medicare program to provide emergency
medical services at the Advanced Life Support (ALS) level."
Section 4. That all ordinances or parts of ordinances in conflict herewith are expressly repealed
to the extent of such conflict only.
Section 5. That this ordinance shall become effective on March 11, 2002.
PASSED, APPROVED, AND ADOPTED this llth day of March, 2002.
Michael J. Pfiester, Mayor
ATTEST:
Thomas E. Haynes, Assistant City Clerk
APPROVED AS TO FORM:
Larry W. Schenk, City Attorney
Page, Woltberg & Wirth, LLC
Page 2 of 4
beneficiary is loaded onto the ambulance, NOT by the location of your ambulance service's station or the jurisdiction of the
Medicue carrier.
Once you determine your GPCI, your base rate under the new fee schedule is calculated by taking 70% of the appropria[e
unadjus[ed base ra[e (from one the 7 levels of service above), and multiplying that by the GPCI for your area. Then, add in
the remaining 30% of the unadjusted base rate to determine the base rate for your service.
Remember, as discussed below, between April I, 2002 and December 31, 2005, your actual payment amount will be
determined by "blending" your fee schedule paymen[ wi[h your existing paymen[ amount. The fee schedule payment amount
will be phased in in percentages over Ihis time period accotding to the phase-in schedule below. As of Ianuary 1, 2006, it's
100% fee schedule, ready or not!
An important note: if your actual charge, that is the amoun[ you actually bill Medicare for the service, is LESS than the fee
schedule payment, Medicare will pay the lesser of your actual chazge or the fee schedule amount. Providers should review
their charge sdvc[ures to ensure they aze billing at appropriate levels to ensure they receive the revenue to which they are
entitled.
PHASE IN PERIOD EXTENDED TO 5 YEARS: There is now a FIVE YEAR phase-in period instead of a four-year
phase in period as originally proposed. During the phase-in period, your paymen[s will be determined by blending a portion
of your existing payment rate with a portion of the fee schedule payment rate as calculated above. The phase-in schedule is
as follows: I
YEAR EXISTING PAYMENT FEE SCHEDUI.E PAYMENT %
2002--80%--20% (Note: this blend is in effect from April 1, 2002 - December 31, 2002)
2003--60%-40°h
2004--40°k--60%
2005--20%--80%
2006--100°lo fee schedule amount
MANDATORY ASSIGNMENT: Assignment is mandatory under the new fee schedule, but will NOT be phased in. That
means that EFFECTIVE APRIL 1, 2002 you must accept the Medicare amount as paymen[ in full and may only bill the
patient for unmet copayment and deductible amounts, NOT your full chazges. Mandatory assignment will NOT apply [o
non-covered services. So, for example, you would not be precluded from billing a Medicaze beneFiciary for non-covered
mileage if you hansport them to a facility that is not the closest appropriate faciliTy under Medicare guidelines. You can also
bill beneficiaries directly for your full chazges for other non-covered services like wheelchair vans or ambulance transports ro
docror's offices. In some instances, an advance bene£ciary notice (ABN) may be desirable, bu[ the ABN rules are not
changed at all by the fee schedule final rule.
MEDICAL NECESSITY: for payment [o be made, the pa[ienPs condition must meet medical necessity requirements for
ambulance transport a[ the level of service billed. For non-emergency hansports, the patient must be EITHER (1) bed
confined (under the current definition); OR (2) have a medical condition, "regazdless of bed confinement," such that
"transportation by ambulance is medically required." Therefore, bed confinemen[ is not the SOLE determinan[ of inedical
necessity for non-emergency transports.
MANDATORY ALS PROVIDERS: In some azeas, local law may require that the ambulance service provide all services
at the ALS leveL Medicare has recognized these local ordinances as binding and in the pas[ has paid such ambulance
services at the ALS rate even when the patient required only BLS. Once the fee schedule is fully implemented, payment at
the ALS rate can be made only when the 6eneficiary's condition requires an ALS intervention (or an ALS assessment, as
discussed below). However, Medicaze will phase in this policy by blending the ALS-level paymen[s with the new fee
schedule BLS rates underthe blending percentages discussed above.
PHYSiCIAN CERTIFICATION STATEMENTS: Medicare has changed the rules for physician certification statements
(PCS). Effective April 1, ambulance services must have a PCS form signed by the attending physician BEFORE rendering a
http://www.pwwemslaw.corrJPWWFeeSchedAnalysis 2/28/2002