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D.C. Municipal Regulations (Last Updated: September 13, 2017) |
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Title 29. PUBLIC WELFARE |
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Chapter 29-5. EMERGENCY MEDICAL SERVICES |
Section 29-567. EMERGENCY AMBULANCE FEES AND BILLING
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567.1 The following fees are hereby established for emergency ambulance life support service, and for the transportation of a person in a District of Columbia Fire and Emergency Medical Services Department (FEMSD) emergency ambulance vehicle:
(a) Basic Life Support (BLS) Unit Transportation Fee: A fee of four hundred twenty-eight dollars ($428) shall be charged for the transportation of each patient in an ambulance staffed by two (2) Emergency Medical Technicians, or an Emergency Medical Technician and an Emergency Medical Technician Intermediate or Paramedic when basic life support is administered to the patient or patients being transported;
(b) Advanced Life Support (ALS) Unit Transportation Fee: A fee of five hundred eight dollars ($508) shall be charged for the transportation of each patient in an ambulance staffed by an Emergency Medical Technician and an Emergency Medical Technician Intermediate or Paramedic when advanced life support is administered to the patient or patients being transported;
(c) Advanced Life Support-Level 2 (ALS2) Unit Transportation Fee: A fee of seven hundred thirty five dollars ($735) shall be charged for the transportation of each patient in an ambulance requiring the provision of medically necessary supplies and services including (1) at least three separate administrations of one or more medications by intravenous push/bolus or by continuous infusion (excluding crystalloid fluids) or (2) ground ambulance transport, medically necessary supplies and services, and the provision of at least one of the ALS2 procedures listed below:
(1) Manual defibrillation/cardioversion;
(2) Endotracheal intubation;
(3) Central venous line;
(4) Cardiac pacing;
(5) Chest decompression;
(6)Surgical airway; or
(7) Intraosseous line; and
(d) Total Mileage Transportation Fee: A fee of six dollars and fifty-five cents ($6.55) per mile traveled, or any fraction thereof, shall be charged to each patient transported in any of the methods listed in this subsection.
567.2The FEMSD may waive or reduce the charges imposed by this section for persons who demonstrate economic hardship.
567.3The FEMSD may waive or reduce charges for reasons other than economic hardship as necessary, where to do so is in the District’s best interest, as determined by the Chief of the Fire and Emergency Medical Services Department, or the Chief’s designee, in the exercise of his or her discretion.
567.4 Any person transported in a FEMSD ambulance, or that person's legal guardian or duly authorized representative (collectively referred to in this section as the "person"), shall be responsible for payment of ambulance charges in effect at the time of service except as follows:
(a) The FEMSD shall accept payment of Medicare, Medicaid, or D.C. Healthcare Alliance healthcare plan related benefits which may cover in whole or in part the costs of ambulance transportation, according to the rules of such plans;
(b) The FEMSD shall not bill, nor hold financially responsible, anyone enrolled in a D.C. Medicaid or other out-of-state Medicaid plan for the services provided by the Department;
(c) The FEMSD shall not bill, nor hold financially responsible, anyone enrolled in a D.C. Healthcare Alliance healthcare plan, unless such a plan requires a co-payment or deductible payment to be made by the patient as a requirement of the plan; and
(d)The FEMSD shall not bill, nor hold financially responsible, any District resident who is a Medicare beneficiary not covered by any other secondary health insurance program for any out of pocket expenses, including co-payments, deductibles and co-insurance.
567.5 Any person transported shall remain personally liable for any fee or portion of a fee not covered by an exception listed in § 567.2 through § 567.4.
567.6 In no event shall any person be denied emergency ambulance service because of inability to pay, nor shall any person be questioned about the ability to pay at the time service is requested.
567.7 The FEMSD, through its duly authorized representative, shall attempt to obtain from each person transported by a FEMSD ambulance sufficient information to enable FEMSD to submit a healthcare insurance claim or mail a bill of ambulance charges to the person for the transportation provided. This information may include, but shall not be limited to, the following:
(a) Full legal name;
(b) Residential address;
(c) Date of birth;
(d) Sex; and
(e) If applicable, healthcare or other insurance information.
567.8 FEMSD employees operating emergency ambulance vehicles shall not be permitted to accept payment of any fee, or any portion of any fee, from any person.
567.9 The FEMSD through its duly authorized representative, shall mail a billing and insurance information form to each person transported by FEMSD ambulance. The person who was transported shall complete the form and return it to the FEMSD in the envelope provided, together with full payment or insurance identification information.
567.10 If the billing and insurance information form is not returned to the FEMSD or if the FEMSD, through its duly authorized representative, cannot identify patient insurance information or coverage to submit a claim for paying ambulance charges, FEMSD may use patient, hospital, District, FEMSD, and authorized third party records, including electronic records, to identify, confirm, or recover patient and insurance information for ambulance billing purposes. Techniques and practices shall include, but are not limited to:
(a)Recovery of personal identity information including full legal name, date of birth, sex, or other distinguishing characteristics to prevent fraudulent patient identification; and
(b)Recovery of the person’s billing information including District resident status, residential address, telephone number(s), health insurance information, auto insurance information, or other information to help identify insurance coverage status or file an insurance claim.
567.11 The FEMSD through its duly authorized representative, shall submit claims to insurance companies and other third parties identified as being responsible for payment of ambulance charges. The FEMSD through its duly authorized representative, shall pursue payment of ambulance charges considered due and owing from persons who were transported by a FEMSD ambulance for a period of at least twenty four (24) months after the date of transport by FEMSD ambulance.
567.12 Reasonable and acceptable methods to be utilized by the FEMSD through its duly authorized representative, for collection of payments may include but are not limited to, the following:
(a)Filed paper and electronic claims;
(b) Mailed invoices, letters, and other memoranda;
(c) Telephone calls to insurers, persons, or other responsible parties; and
(d) Other methods, including automated electronic notifications, that do not constitute “harassment or abuse,” “false or misleading representations,” or “unfair practices” as defined by the Fair Debt Collection Practices Act, 15 U.S.C. §§ 1692-1692p.
567.13 A health care facility shall reimburse the FEMSD for the cost of emergency ambulance services incurred by a patient resident of the health care facility if the health care facility requests ambulance transport services from the FEMSD and the patient’s healthcare insurance denies payment for the ambulance transport after a determination that the transportation did not meet the medical necessity standard as provided in Section 410.40(d) of Title 42 of the Code of Federal Regulations.
(a)“Health care facility” shall have the same meaning as provided in Section 2(5) of the Nurse Staffing Agency Act of 2003, effective March 10, 2004 (D.C. Law 15-74; D.C. Official Code § 44-1051.02(5) (2005 Repl.).
567.14The FEMSD may make a determination of “economic hardship” upon request by a District resident who is unable to pay ambulance charges because he or she:
(a) Has an annual income of less than one hundred fifty percent (150%) of poverty level for an individual or family or domestic partner arrangement as determined by “Poverty Guidelines for the 48 Contiguous States and the District of Columbia” published each year by the Federal Department of Health and Human Services;
(b) Is unemployed and receiving unemployment benefits; or
(c) Is considered “permanently disabled” for tax reporting purposes; and
(d) Is not and will not be eligible for Medicare, Medicaid or other public healthcare insurance coverage during a twelve (12) month period after the date of transport by FEMSD ambulance;
(e) Is not and will not be eligible for private healthcare insurance or other insurance coverage during a twelve (12) month period after the date of transport by FEMSD ambulance; and
(f) Is not eligible to receive any other recognized insurance or other third party payment that could pay due and owing ambulance charges during a twenty four (24) month period after the date of transport by FEMSD ambulance.
567.15Ambulances charges shall be paid by check or money order made payable to the order of the “D.C. Treasurer.”
567.16When the FEMSD, through its duly authorized representative, identifies that a person responsible for payment of ambulance charges received funds for payment of such charges from a third party entity and nonetheless failed to remit payment to the FEMSD not later than thirty (30) calendar days after having received such funds, the FEMSD shall, by request to the Office of the Attorney General, undertake legal proceedings to collect payment of such funds. Payments from third party entities shall include, but are not limited to:
(a) Workers’ compensation payments;
(b) Workers’ compensation insurance payments;
(c) Disability insurance payments;
(d) Employer third party payments;
(e) Civil settlements, awards, or claim payments;
(f) Third party settlements or payments; and
(g) Other recognized insurance program payments.
567.17 If the person responsible for payment of ambulance charges has not fulfilled his or her obligations as set forth in this section after receiving the initial billing and two (2) subsequent notices at least thirty (30) days apart, the Fire and EMS Chief, or his or her duly authorized representative, may, at his or her discretion, request the Office of the Attorney General to undertake legal proceedings to collect the unpaid portion of any fee.