EMS Cost Recovery is now part of the New York State 2023 budget and we thank everyone for their support in passing this critical legislation. But, what are the next steps? If you’ve got questions, FASNY has answers from the likes of Rich Brandt of the New York State Department of Health, EMS expert Scott Bowman, Ellen Nooney of the Albany County Sheriff’s Office and FASNY General Counsel Timothy Hannigan, Esq.
During this free virtual seminar the hosts answered questions addressed the real-life implications of EMS Cost Recovery for volunteer fire departments in New York State.
Watch the Seminar
On April 9, 2022, New York Governor Kathy Hochul signed the 2023 New York State budget. In that budget is the EMS Cost Recovery Act, which allows – for the first time – volunteer fire departments to recover costs associated with their ambulance services.
FASNY, along with other volunteer fire service organizations, has long fought for this legislation affecting EMS Cost Recovery. The legislation was led by sponsors New York State Senator John E. Brooks and Assemblyman D. Billy Jones. The act allows volunteer fire departments to recoup costs associated with equipment and training.
This seminar explains virtually everything volunteer fire departments need to know about EMS Cost Recovery, the timeline of the legislation to take effect and how this will affect ambulance services moving forward.
Frequently Asked Questions
Part KK of this legislation amended Section 209-b of the General Municipal Law to allow fire departments previously not permitted to bill for ambulance services to begin doing so for a four-year period, beginning July 8, 2022.
Chiefs and authorities having jurisdiction should read the full text of the new law, attached as an Appendix to this FAQ document. These FAQs are provided in an effort to clarify fire department requirements and responsibilities.
Q: Which fire departments are eligible to bill for ambulance services?
A: Any fire department, fire company, or fire district that holds a Certificate of Operating Authority from the New York State Department of Health issued prior to January 1, 2022, can bill for services provided on or after July 8, 2022.
Q: Why was this legislation important?
A: New York is the only state that prohibited fire department billing for ambulance services. This enabled direct payment of $750,000 each year by Medicare to ALS intercept services for rural ALS intercepts. The 465 fire departments prohibited from billing lost over $100 million annually in health insurance reimbursements. Until now, taxpayers had to fund those losses. Tax caps and hard financial times have forced many fire department ambulances to cease operations, primarily in rural and suburban communities.
Q: My fire department runs a BLS ambulance service. What does this law mean for us?
A: Fire Department BLS ambulance services that choose to bill must contract with an ALS service. The contract, at minimum, must establish fees for ALS services and detail how the ALS provider will be reimbursed. If the fire department chooses not to bill, and they are located in an area designated as a rural county or eligible census tracts in a metropolitan county (see www.hhs.gov/guidance/document/defining-rural-population), they must pay any ambulance service providing ALS intercepts a rural ALS intercept fee at rates negotiated between the fire department and the ALS service.
Q: If my fire department runs a BLS ambulance service and decides not to bill, are we still obligated to pay for ALS intercept charges?
A: Yes, if you are in a rural area (see www.hhs.gov/guidance/document/defining-rural- population). Under the new law, these charges are owed by the fire department that requests the ALS intercept.
Q: How easy is it to start billing for EMS service?
A: Billing is a complex process, usually exceeding the capabilities of a small fire department. Initially, it requires application for a national provider ID number as well as Medicare and Medicaid ID numbers. This takes some time (up to 3 months currently). There are several options available: use a billing service, have an ALS service do your billing for you, or, when ALS is provided by a County, have the County do your billing. If an ALS service or County does the billing for the Fire Deparment, they must bill under the Fire Department name, agency code, and provider number(s) for calls run by the Fire Department, and not under any agency code or number held by the ALS Service or County.
Q: If our fire department chooses to bill, can we bill only ALS patients?
A: Selective billing may run afoul of federal laws and regulations. A fire department that chooses to bill should bill for all transports they do. A competent billing service will work with the fire department to establish hardship procedures for patients who are unable to afford their bills. Part of the new law (General Municipal Law § 209-b  [e]) prohibits fire departments from directly issuing a bill to any uninsured recipient of services. Case specific questions and decisions like this should be made by a competent billing agent in conjunction with your competent local legal counsel.
Q: Are there any restrictions on the use of monies received from ambulance billing?
A: Yes. Monies received from billing must be used to offset the costs of providing ambulance services to the Authority Having Jurisdiction over the fire department or fire company. Often, they must offset other revenues, such as tax dollars.
Q: Is a separate account required for EMS Billing funds, or can the funds be placed in the general operating accounts maintained by the fire department?
A: The new law does not require that a separate account be formed. However, doing so may assist your fire department in clearly tracking monies recovered through EMS billing for purposes of assisting you in accomplishing the offset of tax dollars for such service explained in No. 7, above. In any event, it is critical that your agency be able to readily identify the dollar amount raised through EMS revenue recovery.
Q: Will billing for EMS calls result in my volunteer department causing financial hardship for our citizens?
A: No, billing for EMS transports relieves financial hardship by recovering health insurance monies that citizens already pay for. Fire departments that choose not to bill may be leaving dollars on the table and asking citizens to make up the difference through fire taxes or donations. Departments who choose to bill have full control over how they define inability to pay, and can establish rules with their provider and competent local legal counsel covering those situations where billing may cause an undue financial hardship to citizens
Q: What are the immediate steps every fire department ambulance service should undertake?
- If you are a BLS transport service, you must contract with an ALS service provider.
- Decide how you will pay for ALS services (fire department EMS billing or from thedepartment budget, if you choose not to bill).
- If you decide to bill for transport services, explore the best route to implement billing:
- Third party EMS billing company
- Contract with an ALS service to do your billing
- if your County Provides ALS intercept services, consider having them do your billing