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	Corporate Report
DEPARTMENT/	CAO's Office
DIVISION	Emergency Medical Services	REPORT NO.	2006.035
DATE PREPARED	January 30, 2006	FILE NO.
MEETING DATE	March 13, 2006
SUBJECT	Establishment of Reserve Fund for Cross Border Billing Purposes

RECOMMENDATION

THAT with respect to Report No. 2006.035 (Emergency Medical Services), we recommend that City Council establish a Cross Border Billing Reserve Fund to provide for payments to other Designated Delivery Agents when they provide services in the District of Thunder Bay;

AND THAT any necessary by-laws be presented to Council for ratification.

As reported in Corporate Report 2003.209 (Emergency Medical Services) and in the December 20th, 2004 memorandum to City Council titled EMS Funding Error Final Offer from MOH, a long standing dispute with the Ministry of Health and Long Term Care over funding levels has been resolved in our favour. There is a need to establish a reserve fund to transfer the initial Ministry of Health and Long Term Care amount of $1,041,592 and an annual amount to be determined based on calls performed by other delivery agents in the District of Thunder Bay each year. This fund would be identified as the ‘Cross Border Billing Reserve Fund’.

Since the transfer of land ambulance services to municipalities (referred to as Designated Delivery Agents) there has been an outstanding disagreement on how neighbouring Designated Delivery Agents would reimburse each other for calls provided outside their jurisdictions. Such calls arise, for example, when one Agent travels into another District to deliver emergency medical service. There has been limited progress on resolving the payment of the cross border bills across Ontario. A few municipalities have entered into agreements amongst themselves, but most are unable to invoice each other due to the inaccuracy of Provincial data, the lack of agreement as to what constitutes a call and the Province’s inability to resolve these issues. It is hoped the newly appointed committee reviewing land ambulance issues involving the Province and the Association of Municipalities of Ontario will be successful in addressing this matter in 2006.

The City of Thunder Bay should set aside appropriate funds in anticipation of an eventual solution to the cross border billing issue as we will likely be obliged to pay outstanding cross border costs occurring since 2001.

The one time payment of $1,041,592 was funded by the Ministry of Health and Long Term Care and is anticipated to cover the costs of cross border bills from 2001 to 2004. An estimate will be developed at the end of each year starting with 2005 as to the cost of cross border calls which may be due to other Designated Delivery Agents. Provincial and municipal funds to cover these costs should be deposited each year in the Cross Border Billing Reserve Fund for eventual pay out once a formula has been agreed upon by all municipalities. This will ensure that all municipalities in the District contribute their share to this reserve fund as per the weighted assessment formula.

It is concluded that a Cross Border Billing Reserve Fund should be established for the purpose of paying out Cross Border Bills to other Designated Delivery Agents. The initial amount received from the Province of $1,041,592 should be deposited into this reserve fund.

As indicated in report 2003.209 Provincial EMS Funding Error Update, an error was introduced in the grant provided to the City of Thunder Bay by the Ministry of Health (MOH) for the provision of land ambulance. This error of $298,356 per year was identified early in the process, but was denied by the province despite the presentation of irrefutable evidence in January of 2003. The amount in question should have been flowed to the City of Thunder Bay to be set aside to reimburse neighbouring ambulance service providers for calls they performed in our District. Instead, not only was it not flowed, but it was removed from our grant compounding the error further by another $298,356 for a total annual shortfall of $596,712.

Despite the new information, MOH did not accept the error until March 22, 2004. Administration then had to negotiate as to the final amount owed by the Province. In December of 2004 MOH agreed that they would repay their share of the funding error dating back to 2001 and would also increase the amount of the annual grant to reflect the correction beginning in 2005.

MOH also advised that since they had addressed all of the DSSAB Territories Without Municipal Organization (TWOMO) amounts, they wanted to resolve TWOMO for the City of Thunder Bay as well. After investigation by EMS, it was discovered that our TWOMO grant was more than it should have been and the First Nations funding was substantially less than it should have been. The Province insisted that any solution to our funding errors must include a reduction in our TWOMO to reflect the over payment they were making to the City of Thunder Bay. Because the Province had also launched a provincial review of First Nations funding, MOH felt it was a separate issue and refused to adjust this funding until a provincial solution is achieved.

After multiple meetings and proposed solutions, MOH forwarded a final offer on December 16th, 2004. Council approved it on December 20th, 2004. The Province provided the City of Thunder Bay with a retro adjustment of $1,041,592 to March 31st, 2005 and an annual base budget increase of $220,133.

The retroactive amount will need to be set up in a reserve fund for eventual settlement of the Cross Border Billing situation. Various solutions have been presented at Provincial levels to address the overall payment of cross border bills between municipalities. Should this issue be resolved, the Cross Border Billing reserve fund would be used to address any outstanding invoices for services provided to us by our neighbours since 2001.

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