Number
200605
Version
SUBSTITUTE 2
Reference
Sponsor
THE CHAIR
Title
A substitute ordinance relating to ambulance regulations and charges.
Section
75-15-2-a-6 am
75-15-4-c am
75-15-12-d am
75-15-14-a am
75-15-14-b am
75-15-14-c-0 am
75-15-14-c-1 am
75-15-14-c-2 am
75-15-14-c-3 am
75-15-15-a-1 am
75-15-15-a-2 am
75-15-15-a-3 am
75-15-15-a-4 am
75-15-15-a-5 am
75-15-15-a-6 am
75-15-15-a-7 cr
75-15-15-a-8 cr
75-15-15-a-9 cr
75-15-17-0 am
75-15-17-a-1 am
75-15-17-a-2 am
75-15-17-a-3 am
75-15-17-a-4 am
75-15-17-b-1 am
75-15-17-b-2 am
75-15-17-b-3 am
75-15-17-b-4 am
75-15-17-c-1 am
75-15-17-c-2 am
75-15-17-c-3 am
75-15-17-c-4 am
75-15-17-c-5 am
75-15-17-c-6 am
75-15-17-d-0 am
75-15-17-d-1 am
75-15-17-d-2 am
75-15-17-d-3 am
75-15-17-e-1 am
75-15-17-e-2 am
75-15-17-e-3 am
75-15-17-e-4 am
75-15-17-e-5 am
75-15-17-e-6 am
75-15-17-e-7 am
75-15-17-e-8 am
75-15-17-e-9 am
75-15-17-e-10 am
75-15-17-e-11 am
75-15-17-e-12 am
75-15-17-e-13 am
75-15-17-f rc
75-15-17-g am
75-15-17-h am
75-15-21 cr
75-15-22 cr
75-15-23 cr
Analysis
This ordinance updates various ambulance service rates, adds decontamination charges necessary during the COVID-19 pandemic and adds a new rate category to charge commercial facilities that request bariatric transports.
In addition, this ordinance codifies the fire department’s absorption of responsibilities from the health department for setting the rates and certifying ambulance companies annually, and creates a system of assigning patients with complex medical conditions or without insurance to appropriate programs to improve patient outcomes.
Body
The Mayor and Common Council of the City of Milwaukee do ordain as follows:
Part 1. Section 75-15-2-a-6 of the code is amended to read:
75-15. Ambulance Certification Regulations.
2. AMBULANCE SERVICE BOARD.
a-6. Representatives of the 5 hospital systems of >>Advocate<<Aurora, Ascension, Children’s Hospital, [[Froedert]] >>Froedtert and the Medical College of Wisconsin<<, and Veterans Health Administration. A hospital representative shall not be a current medical director of a provider.
Part 2. Section 75-15-4-c of the code is amended to read:
4. APPLICATION FOR CERTIFICATION AS CERTIFIED PROVIDER AND SERVICE AREA.
c. The [[commissioner of health]] >>fire department<< shall promulgate an appropriate initial or renewal application form to all providers by not later than September 1 of each year. All applications for initial or renewal certification shall be filed not later than September 30, to be eligible for certification for the next service period.
Part 3. Section 75-15-12-d of the code is amended to read:
12. REQUIREMENTS.
d. Charge fees for equipment and procedures other than the rates established under par. c. The fees shall be determined by the [[commissioner of health]] >>fire department<< and approved by the common council. The [[commissioner]] >>fire department<< shall review the fees on an annual basis, with any necessary adjustments being submitted to the common council for approval in conjunction with approval of the ambulance rate under par. c.
Part 4. Section 75-15-14-a to c-3 of the code is amended to read:
14. DETERMINING RATES BILLES BY PRIVATE SECTOR PROVIDERS. a. The [[commissioner of health]] >>fire department<< annually shall review and report to the common council by April 1 with respect to the ambulance conveyance rate established under par. c. and recommend, if appropriate, and adjustment in the conveyance rate.
b. Upon request, the legislative reference bureau shall provide the [[commissioner]] >>fire department<< with information from health-related cost indexes, including the medical care component of the [[Milwaukee]] >>Chicago-Naperville-Elgin, IL-IN-WI and the Minneapolis-St. Paul-Bloomington, MN-WI<< consumer price index issues by the U.S. bureau of labor statistics.
c. The rate charged for conveyance >>by private providers, or when the fire department provides BLS transports with an ALS apparatus due to turn-back or other extenuating circumstances,<< shall be as follows:
c-1. For patients who are residents of the city of Milwaukee, for basic life support, [[$708]] >>$740<< and, for basic life support-emergency, [[$708]] >>$740<< When patients require treatment without transport, a [[$227]] >>$237<< basic life support non-transport fee shall apply.
c-2. For patients who are not residents of the city of Milwaukee, for basic life support, [[$819]] >>$856<< and, for basic life support-emergency, [[$819]] >>$856<<. When patients require treatment without transport, a [[$326]] >>$341<< basic life support non-transport fee shall apply.
c-3. In addition to the charges provided in subds. c-1 and 2, a charge of [[$19.26]] >>$20.14<< per mile shall be assessed for mileage, mileage to be defined as the distance traveled with the patient in the ambulance from the point of patient origin to destination.
Part 5. Section 75-15-15-a-1 to 6 of the code is amended to read:
15. BASIC LIFE SUPPORT ANCILLARY CHARGES BILLED BY PRIVATE SECTOR PROVIDERS.
a. Ancillary charges.
a-1. Airway >>supplies<<: [[$25.90]] >>$27.07<<.
a-2. Ventilation and CPR >>supplies<<: [[$379.60]] >>$396.68<<.
a-3. Bandaging and Trauma Treatment >>supplies<<: [[$22.06]] >>$23.05<<.
a-4. Personal Protection Equipment >>supplies<<: [[$28.23]] >>$35.00<<.
a-5. Obstetrics and Child Delivery >>supplies<<: [[$234.65]] >>$245.21<<.
a-6. Splinting and Immobilization >>supplies<<: [[$475.58]] >>$496.98<<
Part 6. Section 75-15-15-a-7 to 9 of the code is created to read:
a-7. Oxygen Therapy and supplies: $106.63.
a-8. BLS supplies (COVID decontamination or other routine supplies): $35.00.
a-9. CPAP Mask supplies: $56.85.
Part 7. Section 75-15-17-0 of the code is amended to read:
17. CHARGES FOR PATIENT SERVICES DELIVERED BY THE FIRE DEPARTMENT. The fire department shall bill for and collect all revenues generated from advanced life support conveyances and service provisions using fee schedules that have been adopted by the [[Milwaukee county association of fire chiefs and the intergovernmental cooperation council of Milwaukee county and the]] common council. The rate charged for conveyance and services delivered by fire department paramedic fleet shall be as follows:
Part 8. Section 75-15-17-a-1 to 4 of the code is amended to read:
a. For advanced life support for patients who are residents of Milwaukee county:
a-1. Paramedic non-invasive service or treatment without conveyance: [[$272]] >>$284.24<<.
a-2. Paramedic invasive service or treatment without conveyance: [[$284.24]] >>$284.24<<.
a-3. Paramedic service with transport Level ALS-1: [[$842]] >>$879.89<<.
a-4. Paramedic service with transport Level ALS-2: [[$926]] >>$967.67<<.
Part 9. Section 75-15-17-b-1 to 4 of the code is amended to read:
b. For advanced life support for patients who are not residents of Milwaukee county:
b-1. Paramedic non-invasive service or treatment without conveyance: [[$383]] >>$400.24<<.
b-2. Paramedic invasive service or treatment without conveyance: [[$383]] >>$400.24<<.
b-3. Paramedic service with transport Level ALS-1: [[$949]] >>$991.71<<.
b-4. Paramedic service with transport Level ALS-2: [[$1092]] >>$1141.14<<.
Part 10. Section 75-15-17-c-1 to 6 of the code is amended to read:
c. Advanced life support ancillary charges:
c-1. ALS supplies: [[$96.04]] >>$100.36<<.
c-2. Intubation >>supplies<<: [[$176.71]] >>$184.66<<.
c-3. I.V. and supplies: [[$72.62]] >>$75.89<<.
c-4. Defibrillation >supplies<<: [[$216.01]] >>$225.73<<.
c-5. EKG >>and supplies<<: [[$186.01]] >>$194.38<<.
c-6. Oxygen and supplies: [[$102.04]] >>$106.63<<.
Part 11. 75-15-17-d-0 to 3 of the code is amended to read:
d. Drugs included in the Milwaukee county >>office of emergency management, emergency<< medical services program adopted by the Milwaukee county association of fire chiefs and the intergovernmental cooperation council of Milwaukee county:
d-1. Items approved in Drugs, Group 1: Acetaminophen (1000 mg tablet & 160 mg/5 mL Liquid), Albuterol >>(2.5mg)/Ipratropium (0.5mg)/3 mL<< (.83%), Amioderone HCI [[(30 mg)]] >>(150mg)<< Aspirin (chewable 81 mg), Atropine Sulfate (0.3 mg), Calcium Gluconate (10 ml), Dextrose 10% (D10), Dextrose 5% (D5), Duoneb, IV-D5W, Glucose (oral gel 15 g), IV-Sodium Normal Saline (bags & capped), Ondansetron Tabs, Ondansetron IV/IO, shall be charged a rate of [[$39.02]] >>40.78<<.
d-2. Items approved in Drugs, Group 2: Diphenhydramine 50 mg, Dopamine, EPL 1 mg/10 mL IV, EPI 1 mg/cc IV, Lidocaine Drip 1 gm/25 mL, Lidocaine HCI (2%) 50 mg, Sodium Bicarbonate (50 CC), shall be charged a rate of [[$44.93]] >>$46.95<<.
d-3. Items approved in Drugs, Group 3: Fentanyl, Ketamine (Pediatric) Infusion, Ketorolac 30 mg/1 mL, Midazolam HCI 1 mg, Nitroglycerine Spray 0.4 mg IV, Norepinephrine 4 mg/4mL, shall be charged a rate of [[$57.94]] >>60.55<<.
Part 12. 75-15-17-e-1 to 13 of the code is amended to read:
e. Other items shall be charged at the following rates:
e-1. Adenosine: [[$108.79]] >>$113.69<<.
e-2. Glucagon, up to 1 mg: [[$108.79]] <<$113.69<<.
e-3. Dexamethasone 20mg/5mL: [[$70.96]] >>$74.15<<.
e-4. E-Z IO: [[$145.46]] >>$152.01<<.
e-5. Patient ID & Tracking: [[$3.80]] >>$3.97<<.
e-6. Hydroxocobalmin (Cyano-kit): [[$1092.67]] >>$1141.84<<.
e-7. CPAP mask >>Supplies<<: [[$54.40]] >>$56.85<<.
e-8. Airway Supplies: [[$25.90]] >>$27.07<<.
e-9. Ventilation and CPR Supplies: [[$379.60]] >>$396.68<<.
e-10. Bandaging and Trauma Supplies: [[$22.06]] >>$23.05<<.
e-11. Personal Protective Supplies: [[$28.23]] >>$35.00<<.
e-12. Obstetrics and Child Delivery Supplies: [[$234.65]] >>$245.21<<.
e-13. Splinting and Immobilization Supplies: [[$475.58]] >>$496.98<<.
Part 13. Section 75-15-17-f of the code is repealed and recreated to read:
f. For lift assistance, access and conveyance of bariatric patients:
f-1. When the fire department provides basic life support transport, with an ALS apparatus, for a bariatric patient, the department is authorized to charge the rate specified in subd. a-3 or b-3 as appropriate.
f-2. When the fire department Heavy Urban Rescue Team is required to alter a structure, the department is authorized to charge a supplemental charge of $600 to cover the costs of supplemental materials and equipment.
f-3. When the licensed provider is dispatched to a commercial property or a skilled nursing facility to perform a lift assist for a patient not requiring transport, the department is authorized to charge the rate outlined in sub. 14-c-1 or 14-c-2 as appropriate to the facility.
Part 14. Section 75-15-17-g and h of the code is amended to read:
g. When the fire department provides advanced life support services to a cardiac arrest patient who is not resuscitated in the field, the department is authorized to charge the rate specified in [[sub. 14-c-1]] >>subd. a-4 or b-4, as appropriate<<.
h. In addition to the charges provided in pars. a to e, a [[charge of $19.26]] >>mileage charge indicated in sub. 14-c-3<< [[per mile]] shall be assessed for the distance traveled with the patient in the ambulance from the patient origin to destination.
Part 15. Section 75-15-21 to 75-15-23 of the code is created to read:
21. HIGH UTILIZERS. City of Milwaukee residents, identified through the quality control process of the fire department, private provider, or a healthcare partner, whose usage of the EMS system falls at or above the 95th percentile shall be enrolled in a program to assess the needs of the individual and identify ways to monitor and improve the individual’s personal health in an effort to reduce the individual’s utilization of the EMS system. Evaluation and intervention shall include members of medical direction, the applicable hospital systems represented in sub. 2-a-6, and the personal physician of the indicated patient, with discussions and plans to be held in private to protect the individual’s privacy. The fire department may utilize resources within its mobile integrated health system and the health department to facilitate positive outcomes for these patients.
22. COMMUNITY HEALTHCARE ACCESS PROGRAM (CHAP) REFERRAL. The fire department shall, upon identifying that a patient lacks health insurance, refer the patient to the health department’s CHAP administrator, transmitting the necessary information for the referral through a secure electronic medium, for the purpose of identifying an appropriate health insurance plan, and reducing the financial burden of the residents of the city of Milwaukee.
23. HEALTH INFORMATION EXCHANGE (HIE) CONTRIBUTION. The health department, in its operation of clinics, and the fire department, in its operation of an EMS system, shall contribute appropriate patient information to the state of Wisconsin health information exchange for the purpose enabling access to the patient’s longitudinal care record, promoting positive health outcomes through prevention, and providing patient records to supplemental clinicians, providers and healthcare systems in accordance with the centers for medicare and medicaid services (CMS) interoperability and patient access final rule (CMS-9115-F). Patients may opt out of contributing their information at the site of care in accordance with HIE policies.
LRB
APPROVED AS TO FORM
____________________________
Legislative Reference Bureau
Date: ______________________
Attorney
IT IS OUR OPINION THAT THE ORDINANCE
IS LEGAL AND ENFORCEABLE
____________________________
Office of the City Attorney
Date: ______________________
Requestor
Fire Department
Drafter
LRB176241-2
Luke Knapp
09/08/2020