DEPARTMENT: San Antonio Fire Department
DEPARTMENT HEAD: Charles N. Hood
COUNCIL DISTRICTS IMPACTED: City Wide
SUBJECT:
This ordinance adjusts the Fire Department Emergency Medical Services (EMS) fee structure by creating two additional fees. This adjustment will allow the department to charge the Medicare allowable fee for patients that utilize the telemedicine or treatment in place option of the ET3 program.
SUMMARY:
The San Antonio Fire Department (SAFD) will be implementing the ET3 program that has been offered by the Center for Medicare Services (CMS). In the program exists an optional program for patients to utilize the treatment in place alternative which will connect them to a physician from the SAFD Office of the Medical Director using telemedicine services. This fee has been approved for payment by CMS, so long as the patient meets the criteria set forth in the ET3 participant agreement. On December 10, 2020, City Council approved ordinance 2020-12-10-0876 which allows SAFD to participate in the ET3 program. This item for council approval will now establish a new “origination fee” that will allow us to bill for the telemedicine or treatment in place service.
BACKGROUND INFORMATION:
On February 27, 2020 the San Antonio Fire Department was selected, after participating in an extensive application process, to participate in the CMS ET3 program. The intent of the program is to offer Medicare Fee for Service (FFS) beneficiaries extended services in an effort to match the patient with the correct level of care. The ET3 model allows the Fire Department to transport less emergent patients to urgent care centers versus the hospital emergency department. It also allows for the Fire Department to originate a telemedicine visit for those patients that need medications or a higher level of medical advice, but do not necessitate treatment in a hospital. This program would allow the department to be compensated for these services.
The department has been working with urgent care partners, UT Health and STRAC to make the ET3 program possible for our senior population that are Medicare FFS beneficiaries. The change to the EMS fee structure is one necessary for the City to assist in funding this program.
These services will be available to all EMS patients, whom would be charged for services rendered as they would for any other EMS service received. The SAFD remains in communications with the Texas Association of Health Plans and the Texas Health and Human Services Commission through the Texas EMS Coalition for Innovation to expand the fee payment structure of ET3 to Medicaid and Private Insurance Companies.
ISSUE:
This action creates two fees for origination of telemedicine through the ET3 project. The two fees are Basic Life Support (BLS) origination fee of $370 and Advanced Life Support (ALS) origination fee of $450.
These rates were derived from the 2021 anticipated Medicare allowable rates for transport. These fees will allow a less expensive option to the user of EMS Services than the current transport fee of $1,000.
ALTERNATIVES:
The City has the option not to approve these fee structure additions, thus decreasing the possibility of funding reimbursement allowable from this program.
FISCAL IMPACT:
The revenue associated with these fees will be deposited in the General Fund. The total revenue to be collected is not known at this time, once the program is in place revenue projections will be included as part of the annual budget process.
RECOMMENDATION:
The Fire Department recommends approval of these additions to the EMS fee structure.