No public entity wants to raise rates or fees for services, but those that fail to keep up with ever-increasing costs will find themselves falling behind and unable to catch back up. With both of Hardy County’s main ambulance agencies reporting over $100 or more lost “every time an ambulance leaves,” the Hardy County Commission and Hardy County Emergency Ambulance Authority have worked together to find a solution to the coming crisis.
That will likely come in an ambulance fee ordinance adaptation discussed by the HCEAA Board of Directors last week. Changes in the proposal have taken place since the original draft.
“We pray that You will be with us as we make decisions,” prayed Paul Lewis, 911 Director, during the customary invocation.
The fee is divided between residences and also businesses.
According to the latest draft, those who own “living units” will be liable to pay the fee. This category is “including, but not limited to residential homes, vacation and secondary homes, mobile homes, seasonal camps, hunting, fishing, and recreational camps, duplexes, Short Term Rental Units, condominiums, personal care facilities, and rental units.”
Apartment buildings and other such multi-unit buildings will have each “addressable unit . . . deemed to be a separate billable unit.” A living unit need not be hooked up to any utilities to be considered billable. The fee applies to living units, not occupied units, so property owners will still be liable for vacant units. Also the number of individuals taking residence in a living unit does not affect the fee, as the draft states “it is a flat charge per household or living unit property.”
Residential unit fees start at $120 in the first year, $135 for the second, $150 for the third, $165 for the fourth, and every year thereafter be subject to a consumer price index based escalator mechanism that uses the rate of inflation to help to determine an appropriate cost increase.
“Owners or operators of business establishments in Hardy County shall be liable for the ambulance fee on each ‘business unit’ they operate,” states the proposal. The business unit fee process has changed since the previous draft. The previous established tiers of cost based on number of businesses. Now the fee structure places the residential fee on those employing between one and seven. For each additional employee, the fee will charge an extra $25.
The ordinance establishes no difference between full and part time, nor does the number of hours worked per week enter into the formula. This excludes “any person employed through a school-based internship” or work “for educational purposes.”
“Each distinct business location in the County constitutes a separate business unit for fee purposes,” states the proposal. Businesses that have multiple locations will pay a fee for each “unless an exemption or special rule applies.” Nonprofits and other charitable organizations are considered businesses for fee purposes unless exempted.
Government agencies and fire and EMS facilities are exempt from the fee.
As Board member Roger Vanscoy explained, business can enter into a special payment arrangement or a rate that is “more reflective of the actual cost of medical services, but that requires a multi-step application process, approval by the Hardy County Commission, and would only remain in force for three years until either renewed or renegotiated.
Steven Schetrom, leading the meeting as Board president, stated that this comes into play when “an alternative rate better reflects actual costs and does not shift costs to other rate payers.”
Vancoy noted that the fee increase structure was intended to bring the cost of it into line with where the fee would be anyway had it adjusted along with the consumer price index all along.
Both HCEAA Inc and West Hardy EMS were asked to bring in detailed reports of their costs, revenues, and amount of money lost “per alert” among other information. The period of reporting was the current fiscal year to date. “Alerts” refer to any dispatch of an ambulance for any reason, not only those calls that result in transport.
HCEAA reported for both themselves and Wardensville Volunteer Rescue Service, which operates under the former organization. Combined, the two ambulance services received total revenues of $1,234, 982.49 and incurred costs of $1,328,982.49. That breaks down to a loss of $102.92 every time an ambulance gets dispatched.
Part of the problem lies in a 61.8 percent average in “billing recovery” for services rendered. “Government reimbursement limitations” from Medicare and Medicaid patient transport, as well as ambulance dispatches to scenes where patients refuse transport also add to the loss column.
West Hardy EMS reported that they had total revenue of $765,752.38 and total operating costs of $809,962.99. Despite employing a collection service, they took in only 56 percent of what they billed. Over 40 percent of billed revenue is lost to Medicare, Medicaid, and insurance payment limitations “before collection efforts are even considered.”
That agency loses $155.48 every time one of its ambulances rolls out to a call.
The fee was structured not only to reflect the consumer price index, but also to anticipate the budgetary needs of the service in the next three years.
Another issue raised lay in collection rates of the ambulance fee in place dating back to 2016. While those from 2016 to 2019 show over 90 percent collection, that for 2024 stands at approximately 83 percent. Many do pay late and that does come with an additional late fee.
One of the main topics of discussion lay in how to tabulate employees for the purpose of the business fee. While the honor system is in place now, the County does have the right to request evidence. Board members brought up that a business may have more or less employees over the course of the year. A “snapshot” date or period, similar to how the school system determines student populations, could be used.
The Board voted to approve the proposal “with recommendations” on details such as the employee county. The proposal next goes to the Hardy County Commission for final consideration.
