Monday, January 31, 2022 - 9:00 am
Robin DeLoria - Chairman
Supervisor Merrihew called this EMS Subcommittee to order at 9:03 am with the following in attendance: Clayton Barber, Derek Doty, Roy Holzer, Noel Merrihew, James Monty, Ike Tyler, Davina Winemiller (9:18), Meg Wood, Mark Wright, Rob Wick, Dan Manning, Mike Mascarenas, Dan Palmer and Max Thwaits.
Also present: Dina Garvey, Bryse Taylor, Matt Watts and Darren Dickerson.
News Media present: Tim Rowland
MERRIHEW: Well, good morning everyone, I apologize for being a little bit late and Iíll call this meeting to order. The first one the agenda, weíll have Rob report, thank you.
WICK: Okay, so it seems to be kind of a habitual, starting these meetings, still waiting on DOS payments. Claim #2 is in, claim #3, we are still working on. Thatís going to be a tick over $1.1 million or so for the cost associated from 2021.
We do have two resolution requests that we put out last week, that I hope we can get moving today. One was for the used ambulance and the other was for the ALS monitors. So, both are covered in our budget, the used ambulance, as we mentioned before is going to be primality used for like training purposes and some backups when we have large scaled events, just to kind of be a relief value for some of the local agencies, so theyíre not having to pull from their day to day services for some of these bigger events and the ALS monitors. This is going to be supporting the local agencies, too. So, the money that we set aside in this yearís budget from this full scale grant to kind of provide some that critical equipment resource into the local agencies, this is what that is for. So, our intent is to procure a number of the refurbished ALS units, ALS monitors, so that way weíre able to get more of them, so we can put some newer ones in the hands of the agencies, as well as, get some for our medic cars, as well, too. So, hopefully we can kill two birds with one stone with that acquisition and we have some other items that weíll also be procuring through that same budget line item, here in the next several months for the agencies. Just trying to break some of those procurement stuff and like for like bunches.
For Medic Car 2, weíre still looking for a replacement for Jordan Favro. One item that we did want to discuss today is the Newcomb contract, so thatís in place and is going well, however we have one individual, I think this was brought up at the last committee meeting, Nathan, that is currently designated as the part time employee on that contract. He is willing to go full time and we have the ability to use his additional time in other places. So, we just kind of wanted to bring that up as a point of discussion that, you know, we have the opportunity to bring another full time person on board and plug him into other places, since we do have some shortfalls and kind of get some approval on that.
MERRIHEW: Does he have an indication of where he would be utilized the most? Would it be down in that neck of the woods?
TAYLOR: No, his additional hours would primarily be to staff one of our second medic cars, since weíre short right now and then he can also be floated for station coverage; which would help cover the gaps when employees take vacations or have sick time.
MASCARENAS: Do you have full time slots already available?
TAYLOR: So, we do right now, because weíre short staffed. If we filled all the medic car positions and then we would have to absorb the 32 hours in fringe at the County level. Right now we can roll it into one of the other contracts for the medic cars, because weíre not able to staff them currently.
MASCARENAS: In terms of budget, you have the positions physically in your budget or are you requesting that the Board have a full time?
WICK: So, right now, because we have a deficit we have it in the budget, yes and with the revenue that we get from the contracts, the additional labor hours and fringes should kind of pay for that, because at the beginning of this full scale phase, we elected to have sustainment of everything. We didnít know that we were going to have a couple additional positions that we were going to add on, like this shift from part time to full time and then also, weíll talk about it in a minute, Westportís request for another EMT. So, because weíre sustaining everything through the grant and then with the addition of the revenue, the short answerís, yes, we can cover the cost.
MASCARENAS: Okay, so how many full time positions do you have open, right now?
TAYLOR: We have three full time medic car positions that arenít currently filled. All of our contract agencies are currently staffed though.
MERRIHEW: Any further questions on that topic?
WICK: We donít have any courses planned, yet for í22, that I am aware of, at least none currently scheduled, so thatís kind of a placeholder, as soon as we have some of those scheduled, weíll keep everybody updated on that.
In the report at the back of the agenda from last year, we do have noted the different classes, from EMT and AEMT that were completed this year and the different skill sets that were associated. We had a number of new people and also just people going through getting through their CEUs. So, I have that detailed in that.
So, we are looking, again, trying to get the scheduling software. I was made aware as part of one of these Munis models, that thereís going to be some scheduling functionality in there, so hopefully we can make use of that if itís already something that the Countyís going to be purchasing, but if itís not going to offer the kind of flexibility for the EMS staff that we need, we were still trying to move ahead with trying to get our own scheduling software, because, I think as weíre all aware, weíve got through a lot of learning curves and frustrations with the Munis system in general, so itís kind of one of those that we canít afford it to have to be clunky and not effective and miss shifts and that sort of thing, so just a little bit of an FYI on that. Weíll bring that up, hopefully next committee meeting weíll have a little bit more information of how useful thatís going to be.
The CON is that?
TAYLOR, B: The CON is completely finished, I have a renewal file with the State and weíre set to go.
WICK: That is updated, as complete.
HOLZER: Just to back up to Number Two, so weíre kind of getting stuff done.
HOLZER: The used ambulance we approved last time, last year, correct?
WICK: Itís in the budget, yes.
HOLZER: It was in the budget?
HOLZER: Okay, so just to move this along, we need a resolution from this committee and then on the floor today?
WICK: Right and the only reason for that is because of the total cost, so that line item, the used ambulance, as well as the ambulance from Minerva, because we already went through the cost with the one from Minerva and theyíre on the same commodity line. So, we would have to have the resolution or go to bid for that.
HOLZER: Okay, so you need one out of this committee, first?
WICK: Ah, yes.
HOLZER: Iíll move that.
MERRIHEW: Okay, moved by Roy, seconded by Mr. Tyler.
RECOMMENDATION TO THE WAYS AND MEANS COMMITTEE TO AUTHORIZE THE PURCHASE OF A USED AMBULANCE FOR THE EMERGENCY SERVICES DEPARTMENT TO COME FROM BUDGETED FUNDS IN AN AMOUNT NOT TO EXCEED $10,000.00
Moved by Mr. Holzer, seconded by Mr. Tyler
MERRIHEW: Questions or comments?
MASCARENAS: Do you have a not to exceed cost on that, Rob?
MASCARENAS: Is it a bid or are you asking to award?
WICK: More or less itís going to be a quote base, because we have, one of the agencies has kind of offered up for our budgetary price that were asking. So, Iíll be working with Linda and Donna to make sure we get the procurement adequately done.
MONTY: What is the budgetary cost?
HOLZER: So, we moved that?
MERRIHEW: Further questions, comments? Being none, all those in favor? Opposed?
HOLZER: And you need a second one on the ALS, also?
WICK: Yes, the ALS monitors.
MERRIHEW: Youíll move that, also?
HOLZER: And what is the cost of that one?
WICK: I believe that one, our budget is $150,000.00.
HOLZER: And itís in the budget, already?
MERRIHEW: Second on the ALS?
RECOMMENDATION TO THE WAYS AND MEANS COMMITTEE TO AUTHORIZE THE PURCHASE OF ALS MONITORS IN THE EMERGENCY SERVICES DEPARMENT TO COME FROM BUDGETED FUNDS IN AN AMOUNT NOT TO EXCEED $150,000.00
Moved by Mr. Holzer, seconded by Mr. Tyler
MERRIHEW: Any questions, comments?
HOLZER: So, Rob are you going to have these two resolutions set for us to introduce at Ways and Means?
WICK: Yes, I sent them to Dan and the clerk, last week.
HOLZER: Thank you
MERRIHEW: All those in favor?
TYLER: Meg should be on this committee.
WICK: Yup, Iíll correct that.
WICK: Okay, letís skip to centralized billing, because Mr. Manning is here to talk about that and he just handed some stuff out. So, I did touch briefly that Westport was asking for another EMT, so that one would be like an additional ask, that wasnít in our budget in terms of how to incorporate that into the grant. So, the idea right now is that would be paid and invoiced for just the hourly rate, just like all the others, the County would pay all the fringes and whatnot. So, again, just like the part time and full time increase that the Newcomb individual, this one would be covered in our budget, as well, too. It just wasnít initially in there, so weíll do a budget mod and put that forward.
MERRIHEW: We donít need a resolution for that?
WICK: No, just keeping everybody updated. So, Dan is here to kind of give us a little bit more information. We spoke with EMR, our billing provider to get a little bit more information, a couple weeks ago, on like more of the details on some of the legal language that we would need to attack and just be aware of as weíre putting forward these lease agreements for the agencies, so that the folks that need to be able to bill that are not able to bill can be covered under our CON and some of the traps that we need to address for that.
MANNING: Thanks Rob.
MANNING: I initially had done a memo, we donít have a memo, you have the attachment, my secretary lost the memo on the computer, somehow, by the end of the meeting, maybe it will come down, but. So I guess I am going to concentrate on, itís my understanding that most of the agencies are billing or can bill, except for fire districts. In the packet is a copy of General Municipal Law 209B, which expresses, basically is the statute that allows for fire departments, I said districts, for fire departments to provide general ambulance services and at the very end of that statute, it is very clear that they cannot bill for that, Section 4 of Section 209B, no cost to the persons who have the service provided to them. I also gave you a couple of case law where that was determined by the State Comptrollerís office on two different occasions. So, the problem is fire departments cannot bill. So, they cannot bill and then I think you are looking to be able to establish a centralized billing mechanism for everybody and then authority for you to enter into any sorts of agreements and billing otherwise, provision of service, all those things, comes under Section 122B of General Municipal Law, that Section 122B, in 2019 we, it was amended a little bit, at our request. So, we could establish mechanisms with everybody through contractual means to provide general ambulance service, EMS service and bill. But, in 122B, because they recognize that in 209B fire departments could not bill, they said, hey, you can enter into all these contracts, County, City, Town and Village, anybody, even privates, but thereís a Section 122B that exempts fire departments, itís E, I have two stars next to that. So, not only is it not permitted under 208B, 122B prohibits, you can see that itís carrying it through. Thatís the legislative, the fire department not being able to bill. After that we have pending legislation, as you know, where weíre looking for the State of New York to allow us to, allow counties, towns and villages to create general ambulance districts, because that wasnít too clear the first time around. That same language is in that legislation, prohibiting any contract between counties, towns, villages with fire districts, fire departments, I keep goofing it up, with fire departments. So, basically the long and short of this is, fire departments canít bill and we canít bill for them, if they are fire departments. We canít enter into any sort of agreement, saying, hey fire department, Iíll bill for you, you give us the stuff, weíll reimburse you, weíll bill under our CON. Now, you can, with the other agencies, like towns, villages, you can contract with them and say, yeah, weíll be your centralized biller. Thereís no prohibition against it. Youíre going to want to make sure under your CON that thatís okay, but Iím pretty sure, I donít see any problem with that, because all these statutes, are you saying no, are you shaking your head?
TAYLOR: Thereís no issues with that.
MANNING: Okay, I didnít know. You know in reading all these statutes, I donít see a problem with everybody else being, doing centralized billing for everyone else. In a lot of occasions, if weíre providing manpower, in the case of a town, a lot of towns, forget that. So, I donít know what we can do with a fire department. The only other thing you could probably do, now there are a few things, we did speak with Peter Barry, is that the guyís name at the billing company?
MANNING: And he mentioned, you know, in my opinion, it is very impractical, probably not cost effective, but, yes, you could do something with the fire department, if you took over their ambulances, youíd put placards on it that say it was our ambulances, you staffed it, you know, itís just all this stuff, which for the 100 or so runs that each of these fire departments are doing per year and less in some years, I donít know how cost effective all thatís going to be. The second way you might deal with fire districts, departmentsÖ
TYLER: Whatís the difference?
MANNING: A fire department is a private entity. Itís a non-for-profit, by law itís established and they do fire and they can do general ambulance, but itís private. A fire district is a district created in a town, in a village, in a county, whereby the town, the village or the county are going to provide ambulance service to the district. Now, it doesnít mean that the town has to have an ambulance service, they can contract out to provide that, they can have an ambulance service, there are a few other things that they can do.
TYLER: Thank you
MANNING: So, you know, with the fire departments, you can subsidize them, not based on the service they provide, and say weíre going to give you this money to participate. So, youíre not really paying them, the people arenít paying them, but the County would be paying them, so you would be out that money. I mean, if thatís something you wanted to do. You know, the only other thing you could do, is run this by the Department of Health on your CON and see if there are any exceptions. I donít see any, you know the lawís riddled, every law that deals with ambulance services is riddled with, forget the fire departments, youíre not; which I donít really, you know, they have to raise their own money.
TAYLOR: So, there is a practical solution.
TAYLOR: Basically, and Schroon Lake is one of the most recent people to do this, you can split your ambulance service off from the fire department.
TAYLOR: They become a LLC and then the LLC can contract with the town to provide ambulance services for whatever amount of money that the town is willing to pay and then they can bill for their services, because theyíre a private ambulance entity and theyíre not associated with the fire department. In practically and in Schroon Lake is a specific example, theyíre still in the fire department building, they still store the ambulances in the fire department, they split costs with the fire department for utilities and stuff, but they are still, legally a separate entity that allows them to bill.
MANNING: And you can do that.
HOLZER: When did they start that?
WOOD: A couple of years ago.
TAYLOR: They split three or four years ago, they just started billing less than six months ago, I believe.
WOOD: I donít know if they started yet.
MANNING: So, thatís another thing, itís a complete, itís not in the fire department, itís a completely different not-for-profit organization thatís doing that work and you certainly could do that, the fire department could say, weíre not doing it anymore, you can contact with somebody, so that was the third thing. Greene County did something like that. I spoke to their EMS Director, I canít remember his name, and he said that Greene County did something similar to that with a not-for-profit, but then again I donít know how your fire department is going to feel about that, but if they donít care then thatís what you do, you can do that. Itís easy to do, or not easy to do, but you know.
TAYLOR: Itís the most straightforward option.
MANNING: Or another thing is the fire department says weíre not providing any ambulance and then the town, is there a district in, was it Newcomb?
WOOD: Itís Schroon/North Hudson.
MANNING: Okay, is there a fire, no, thereís no ambulance district, probably, right? Is there an ambulance district established?
WATTS: I donít think so.
TAYLOR: I think Schroon Lake is just contracted to the Town without an actual ambulance district, because if they developed a district then theyíre tax funded and require a board of commissioners and all of the statutory stuff that goes along with that.†
MANNING: So, you can do that, too.
BARBER: So, how is that working for the Town of Chesterfield, with the fire district being in Clinton County Emergency, because I am getting questioned by my Fire Chief, Dave Winters and Linda Gillman?
TAYLOR: So, their fire department contracts with CVPH to provide ambulance services for the entirety of Keeseville, on both sides of the County. So, itís a Clinton County agency thatís contracted to the fire department that covers the entire fire departmentís district.
BARBER: Okay, so if an emergency car or the county ambulance happens to show up on a dropped call by them, how are they being billed?
TAYLOR: It would be billed through whatever entity took the call. So, if the County takes a backup call or Willsboro/Essex is their closest mutual aid, if Willsboro/Essex gets toned out for a call that CVPH has dropped, Willsboro/Essex bills for that under their CON in place of the mutual aid agreements that exists between the two agencies.
BARBER: Okay, so they turnaround and send the bill to?
WATTS: The patient.
TAYLOR: The patient, yeah. So, the chart gets submitted by the caregiver, that goes to the billing company, which is EMR for almost everybody in the county, because they have the best rate around and then EMR handles the coding and actual billing practices, including sending the bill to the patientís insurance to get their revenue recovery.
MASCARENAS: So, how many fire departments do we have left? Thereís Newcomb/MinervaÖ
TAYLOR: No, weíre not counting Minerva, because Minervaís contracting with Johnsburg and Johnsburgís billing for their services now.
WATTS: Newcomb, Westport and Keene Valley.
MASCARENAS: Newcomb, Westport and Keene Valley, is there any interest for those or is it too early to know on separating from fire?
TAYLOR: Keene Valley I will tell you, right now, is a hard no. Itís very integrated into the culture there and I would imagine that Westport has the same attitude. I will not speak for Newcomb, because I donít know for sure.
MASCARENAS: Itís also my understanding that those that are billing are happy with the way it works now?
MASCARENAS: And not interested anyhow. So, it would be a lot of chasing our tail for something that is not really needed or wanted or the other agencies in the county, but coming up, trying to figure out a mechanism for those individuals that canít currently bill, probably should be what weíre tasked with trying to help with.
TAYLOR: Itís unfortunatelyÖ
MASCARENAS: And if they donít want to, then thatís fine, too; right?
TAYLOR: And unfortunately, we just donít have enough calls in the entire county to have bargaining power, so even if we were able to bring all the billing power into one centralized mechanism, we donít have enough to leverage to lower rates or better reimbursement or fees or anything, so.
MASCARENAS: So, I guess, what are the next steps, I guess in terms of, is it meeting with those agencies, letting them know what their options are and kind of seeing if they want to go that route or not?
MASCARENAS: I mean, ultimatelyÖ
TAYLOR: And we could definitely offer some kind of support, maybe through Dan Manningís office of the process of establishing an LLC to contract, if theyíre interested, as like an outreach of the grant for agency support, but beyond that, thereís not really much that we, at the County level are able to do, because of the statuary restrictions.
HOLZER: It has nothing to do with this, but last year we approved the deliberators for some area departments, Wilmington being one of them. We received ours, do we just have them billed directly to the County? How do you want to do that?
WICK: Yeah, so, we got a similar issue with the Minerva ambulance, I just need to make sure how thatís invoiced. We might have to have the company modify the invoice directly to the County.
HOLZER: To Essex County? Okay
HOLZER: That would be the easiest cash flow-wise.
WICK: Yeah, otherwise we would have to set up another inter-municipal agreement, because I think the one that we had with Wilmington previously has expired.
WICK: So, I mean we got one for Minerva. So, that helps, so yeah, I think either modifying either who the invoice is addressed to and the County pays for it.
HOLZER: Weíll do that. Okay, thank you.
WICK: Does anybody have any other questions?
MERRIHEW: Dan, any other comments on?
MANNING: No, thatís basically it. I mean we canít do and unless the fire departments want to relinquish.
WICK: So, weíll reach out to those agencies and see what theyíll like to do, understanding the process and all things considered and see what we can go from there.
MERRIHEW: Right and as we established, I wouldnít reach out too hard. You know, theyíre independent, stand-alone, unless they come to us, weíve got other attentive matters that I think are higher priority.
TYLER: When you go to Westport, if I could be involved in that, I would like to be.
TYLER: Just to sit in on it.
MERRIHEW: Any further questions, comments, business to come before the Committee? Being none, thank you very much and you have those resolutions?
WICK: They should be, yes.
AS THERE WAS NO FURTHER BUSINESS TO COME BEFORE THIS TASK FORCE IT WAS ADJOURNED AT 9:28 AM.
Dina Garvey, Deputy Clerk
Board of Supervisors