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	Corporate Report
DEPARTMENT/	CAO's Office
DIVISION	Emergency Medical Services	REPORT NO.	2008.124
DATE PREPARED	May 23, 2008	FILE NO.
MEETING DATE	June 23, 2008
SUBJECT	EMS Cross Border Billing - Resolution

RECOMMENDATION

With respect to Report No. 2008.124 (Emergency Medical Services), we recommend that the City of Thunder Bay enter into agreements with the Kenora District Social Services Administration Board (DSSAB), Cochrane DSSAB and Rainy River DSSAB with respect to cross border billing;

AND THAT the Mayor and Clerk be authorized to execute any necessary documentation;

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

This report recommends approval of agreements between the City and its neighbouring EMS Designated Delivery Agents (DDAs) with respect to EMS cross border billing costs, and provides an overview of the terms of the various agreements. Cross border billing occurs when EMS paramedics respond to calls outside of their designated geographical boundary.

Since land ambulance service became a municipal responsibility in 2001, this issue has been outstanding. Resolving the matter has the additional benefit of more certainty for the budget process.

Cross border billing is necessary to reconcile costs incurred by DDAs when their paramedics respond to emergency calls outside of their service area. The actual impact to Superior North EMS is negligible, as this situation only occurs when Rainy River paramedics respond to calls in the Hwy. 11 corridor and along Lake Shebandowan in the District of Thunder Bay. Superior North EMS paramedics respond to neighbouring Districts on rare occasions, just as paramedics from Kenora, Cochrane, and Algoma rarely respond within our District.

In March 2007, Superior North EMS agreed with the Algoma DSSAB that since cross border calls are infrequent, that there would be no calculation for invoicing. This agreement expires December 31, 2008, at which time it will be open for renegotiation. The volume of cross border calls has not changed since 2007.

In April 2008, Superior North EMS reached agreement in principle (subject to approval of City Council) with neighbouring EMS DDAs as follows:

i) Kenora DSSAB – As cross border calls are considered infrequent, it was agreed that invoicing would not be necessary.

ii) Cochrane DSSAB – As cross border calls are considered infrequent, it was agreed that invoicing would not be necessary.

iii) Rainy River DSSAB – Based on calculations, the Rainy River DSSAB would be paid $48,355 with respect to cross border calls made since 2001. The cost per call of Rainy River paramedics attending to emergencies in the District of Thunder Bay has been agreed at $1,700 (2008 costs). Since 2001, the amount has been adjusted annually with inflation. Administration has determined that Rainy River paramedics respond to emergencies in the District of Thunder Bay an average of 5 times annually. Should our paramedic teams respond within the Rainy River District, the Rainy River DDA would be invoiced.

Administration recommends that City Council authorize Superior North EMS to enter into agreements with neighbouring Designated Delivery Agents formalizing the agreements.

The current balance in the Cross Border Billing Reserve Fund is approximately $1.7 million. Based on the proposed agreements with neighbouring DDAs, $48,355 is required to reconcile all cross border billing expenses since 2001, leaving approximately $1.65 million remaining in the Cross Border Billing Reserve Fund.

It is contemplated that the unallocated balance in the Cross Border Billing Reserve Fund will be a source of funding for EMS capital building projects. Future reports will address these needs and the ability and appropriateness of the use of this Reserve Fund to meet those needs.

In addition, EMS will no longer be required to budget an annual contribution of $150,000 to the Cross Border Billing Reserve. Based on the proposed agreements, EMS will budget $17,000 annually to cover expected cross border costs. This results in an additional annual savings of $133,000 in the annual operating budget starting in 2009.

It is concluded that City Council should approve the execution of cross border billing agreements with the Rainy River DSAAB, Kenora DSSAB and Cochrane DSSAB on the terms and conditions outlined in this report.

Under the principle of “seamlessness” citizen access to EMS, paramedic teams respond to emergency requests for service irrespective of administrative or political boundaries. The intent is to have the closest paramedic team respond to any given emergency at any given time. Political boundaries have no impact with respect to the dispatching of ambulances. Accordingly, paramedic teams from neighbouring Districts occasionally respond to emergencies within the boundaries of the District of Thunder Bay. Very rarely do Superior North EMS paramedic teams respond to emergencies outside the boundaries of the District of Thunder Bay.

Provisions have been made by the Province so that when cross border responses occur, municipalities may invoice a neighbouring municipality. (This is covered by a regulation under the Ambulance Services Act – O. Reg 129/99.) The regulation is meant to off-set the cost of providing a service outside of municipal or other boundaries. This is known as “Cross Border Billing”. In this respect, the Regulation provides municipalities with two options: either use a default Provincially-established formula, or negotiate a suitable alternative.

As no agreement had been reached with neighbouring EMS DDAs, and due to significant historical problems with Provincial call data, Superior North EMS established in 2006 a Cross Border Billing Reserve Fund. Funds allocated to this Reserve are intended to pay neighbouring DDAs when their paramedics attend to calls in the District of Thunder Bay. Superior North EMS disputed Provincial call data from 2001 through to 2006. In January 2006, the dispute was resolved and the Province transferred $1,041,592 to the City for the purposes of cross border billing costs incurred from 2001-2005. From 2005, it was estimated that $325,000 would be required annually in anticipation of an agreement with other DDAs. Superior North EMS has since contributed $325,000 (2006), $217,000 (2007), and $125,000 (2008) the Reserve.

As set out in this report, Superior North EMS and its neighbouring DDAs have now agreed upon the terms and conditions for compensation for cross border calls.

None.