Levy

LEVY SUMMARY:

Mon EMS is asking the voters of Monongalia County to support it's mission to ensure readiness and the provision of Emergency Medical Services (EMS) in Monongalia County.

WHAT ARE YOU ASKING FOR?

Mon EMS is asking the voters to approve a four (4) year EMS Levy that will provide approximately $4,470,399 per year to help support the provision of EMS services.

The total cost of the four (4) year levy is $17,881,598.

WHAT IS THE IMPACT TO YOU?

The levy is calculated on 60% of assessed value of your property. Assessed value is different than appraised value. If a property is appraised at $100,000, it is assessed at 60%. For every $100,000 of assessed value of your home, the impact would be $27.96. Commercial properties are appraised in a similar manner at a different rate.

Appraised Value Assessed Value Annual Cost to Taxpayers
$100,000 $60,000 $16.78
$166,667 $100,000 $27.96
$250,000 $150,000 $41.94
$333,334 $200,000 $55.92

 

WHY DOES MON EMS NEED THIS LEVY?

The cost to provide EMS is not covered by insurance reimbursement alone.

Every person that lives, works, and plays in Monongalia County deserves access to efficient, effective, high quality EMS care.

EMS is mainly reimbursed for the patients that are transported to the hospital.

No matter how efficient we get an EMS service, there will be a cost of readiness to ensure that an ambulance is ready for you in your time of need.

EMS (along with Police and Fire) are your safety nets. These services are here when all others cannot be.

Disaster response, specialty situations, and complex events are not typically reimbursable.

 


 

QUESTIONS

In an effort to promote transparency, Mon EMS will provide answers to frequently asked questions here. If you have other questions, please do not hesitate to contact Mon EMS at levy@monems.org 

Tell me a little about Mon EMS. 

The Mon EMS you know now was formed officially on July 1, 2019 from the previous agencies of Mon Health EMS (affiliated with Mon Health System) and the Morgantown operation of WVU HealthTeam (affiliated with WVU Medicine). Due to some issues identified in 2017 and 2018, the Monongalia County Commission worked with Mon Health and WVU Medicine worked to bring the two competing agencies with many duplicative services and inefficiencies together to solve the needs of Monongalia County.

What is Mon EMS corporate status?

Mon EMS is a 501(c)(3) Non Profit Corporation.

How is Mon EMS Governed?

Mon EMS is governed by a seven (7) member board of directors. That board consists of the following representatives:

  • County Representative
  • WVU Medicine Representative
  • WVU Medicine Physician
  • Mon Health Representative
  • Mon Health Physician
  • Community Representative
  • Community Representative

You can see a more in depth bio of Board Members at the link below. 

Mon EMS Board Members

Is Mon EMS Career (paid) or Volunteer?

Mon EMS is officially a combination department. We would love (and will still take) volunteers, however we have found that the nature of EMS in Monongalia County and the requirements of maintaining an EMS certification are difficult to obtain and maintain in the Morgantown area. For that reason, Mon EMS is primarily made up of career (paid) personnel. If anyone is interested in volunteering, please contact us!

Explain your Budget and how EMS is funded.

The Mon EMS budget is approved by the Board of Directors prior to the fiscal year. The budget for Mon EMS (total expenses) run between $12-14 million annually.

Right now, in order to meet those expenses, Mon EMS receives the following income:

~7 Million in Patient Revenue (When we bill a patient's insurance)

Remainder (~3-5 Million Mon Health & WVU Medicine)

In Fiscal Year (FY) 2023, Monongalia County Commission is giving $1 Million to help offset costs.

Can you help me to understand EMS Billing? What is this contractual allowance you always talk about? 

We are required by law to bill everyone under the same rate structure. So we put a sample bill through a few examples.

First, the red bar on the right are patients that do not have insurance, and are what we consider 'self pay'. When they are transported by EMS, they receive the same request for reimbursement as anyone else, but the number of folks that pay (or have the ability to) are very low.

Second, the third column (Commercial Insurance) is the insurance that you typically get from your employer like Blue Cross, Aetna, Highmark, etc. When we send them a bill, they typically pay most of it, and most people have some sort of co-pay (like when you go to your dentist or doctor's office). Please note that this is only 10% of our calls.

Lastly are the two columns on the far left, Medicare and Medicaid, which make up approximately 75% of the patients we transport. These payors have set amounts they will pay for each service as shown by the dark green section. In order to receive payment from these payors you must agree to write off the remaining portion of the bill, known as a contractual allowance This is shown as the yellow section.

Why do you just not raise your rates?

Mon EMS does re-evaluate it's charge rates on an annual basis just like any other business. Rates are usually adjusted up based on a realistic market percentage. We will further break down this question into two more parts:

Federal Payors (Medicare and Medicaid) - Unless the federal payors increase their reimbursement rates, raising rates does not impact federal reimbursement. Federal payors have a max amount they will reimburse, which is a set amount and not a percentage.

Commercial Payors  - Are the ones that are truly impacted by any rate change. Because they usually pay a good portion of the bill, they are usually impacted. However, this is not guaranteed. Commercial payors get to choose how much they pay of the total bill, and many variables impact that.

Does this Levy fund WVU and other Special Events in the county?

No. The levy ask is strictly for 9-1-1 service to the citizens of our county. WVU pays their way when they request dedicated service for things like Football, Basketball, Baseball, Track and Field, Graduation, Fall Fest, etc. Other events (such as MoutainFest, Wine and Jazz, Balloon Festival, etc.) that request dedicated service, must pay or work out arrangements for that dedicated service.

Is Mon EMS facing some of the same staffing issues as elsewhere?

Yes. Like most other industries, EMS, not just in Mon County, but around the state and the nation is dealing with the staffing crunch. Mon EMS has been taking steps to increase wages and benefits, improving the culture, and working to make EMS an attractive career for those up and coming folks.

What would be some things you want people to take away knowing about the EMS levy?

We cannot give enough thanks to the Mon County Commission, Mon Health, and WVU Medicine for working to ensure that an amazing model for EMS delivery was developed for this county. Many counties do not have the resources we do and do not have one, let alone two health systems in their county that could help spearhead such an effort. The three entities working together to create a true public/private partnership and the health systems giving Mon EMS the runway to get it's foundational blocks down was a huge progressive step forward.

EMS is not something you think about, and we do not want you to have to. We want all citizens to have the peace of mind and comfort that in the event of an emergency that a professional, trained crew will be there in a timely manner in their time of need, no matter when that time of need is.

How did the Star City closure impact Mon EMS?

Mon EMS worked closely with Star City. They were not a competitor, but a symbiotic partner in this area. We were sad to see them close and have worked with Star City to ensure that their citizens are covered and that those folks that used to work at Star City had a good landing place (if desired)  to be able to continue to provide care to the citizens of Mon County.

Why don't the hospitals just fund it? They have for many years.

This is true, Mon Health and more recently Mon Health and WVU Medicine have funded EMS in Monongalia County since the early 80's. As the needs of the community keep rising, there is only so much the health systems can (and should) do to ensure 9-1-1 readiness. Ensuring that ambulances are available is not a hospital responsibility, according to WV code, it is a responsibility of the county. The Health Systems are not withholding support, and will still be a significant contributor to the system in general. They will take a lesser responsibility in providing county coverage for EMS services, but will still be over $1 Million each in FY 2024.

WV CODE §7-15-4. Duty of county commissions to provide emergency ambulance service; emergency ambulance service authorities authorized; authorities to be public corporations.

Except as hereinafter provided and in addition to all other duties imposed upon it by law, the county commission shall cause emergency ambulance service to be made available to all the residents of the county where such service is not otherwise available: Provided, however, That the duty imposed upon county commissions by this article shall not be construed in such manner as to impose a duty to cause such emergency ambulance service to be provided unless the commission shall make an affirmative determination that there are funds available therefor by the inclusion of a projected expenditure for such purpose in the current levy estimate, and in the event that such county commission shall make such determination the commission shall not be under a duty to cause such service to be provided beyond a level commensurate with the amount of funds actually available for such purpose.

The county commission may provide the service directly through its agents, servants and employees; or through private enterprise; or by its designees; or by contracting with individuals, groups, associations, corporations or otherwise; or it may cause such services to be provided by an authority, as provided for in this article; and any municipality or county, or both, or any two or more municipalities within any county or contiguous counties, or any two or more contiguous counties, or any combination thereof, may create an authority. Such authority shall be created upon the adoption, by the governing body of each participating government, acting individually, of an appropriate ordinance or order. Each authority shall constitute a public corporation, and as such, shall have perpetual existence. The authority shall be known by such name as may be established by the board.

What happens if the levy fails?

First, we hope that is not the case. However, Mon County and Mon EMS will have to have real conversations on the level of care they want for their citizens. This could include any number of options, and all potential options are on the table, however we hope that is not the outcome. That being said, just like now, if the voters vote this down then we will have an open, transparent conversation about the next steps for Mon County. 

Where does the money come from for EMS services?

Mon EMS makes up approximately 60% of it’s expenses from patient billing.

Right now, Mon Health and WVU Medicine currently offset the remaining expenses to ensure services in the county.

Next year, the county approved $1 million to Mon EMS to help offset the added cost of EMS services.

Do you think it is feasible to make EMS services a government (taxpayer) funded entity?

Yes. The path that Mon EMS, along with Mon Health, WVU Medicine, and Monongalia County is on is one of the great things when all parties joined forces in 2019. This means that patients that we transport will still fall in the normal insurance billing process. If the levy passes, the County can assist with readiness and infrastructure costs to ensure that the county has the resources it needs. The health systems partner to ensure that non-emergency transports are coordinated and efficiently completed. Everyone pays a little, and we get a really great system that is super cost effective for all involved.

Why is staffing down?

EMS is a very tough industry to get into. For years, we have been struggling to pay our folks the wages they deserve. We have made huge strides in that regard in the last year or so, but there is still work to do. EMS has become the ‘’tip of the spear” in the healthcare industry. Our professionals are the ones that usually make first contact, deal with folks in horrible situations in a variety of settings and weather. We expect them to know how to solve most problems no matter what we throw at them. In the last two years, these folks have lived in a COVID bubble where every patient was either positive or potentially infectious. This took a very difficult job and made it very difficult to recruit into.

Mon EMS is being proactive to solve it's staffing issues. We are leveraging monies available from the state, participating in or providing educational opportunities, creating workforce pathways for folks interested in EMS and working to create a culture of inclusion and excellence in all that we do. We are increasing our presence in schools, community groups, and other places to try and identify those that may be a great fit for Mon EMS now or in the future.

What is the Mon EMS Collegiate Link?

Mon EMS realized a couple opportunities a few years ago that were very frustrating to those coming to area (WVU, Fairmont State, Waynesburg, etc.) with valid EMS credentials.

The first thing that we realized was that the Universities and Colleges around Mon EMS (although mainly WVU)  have many 'hidden gems'. These are people that have either a National Certification and/or a State Certification/License from another state or territory. These folks volunteered or worked in their local EMS squads in their hometown across the country.

The second thing we realized is that the Certification process in WV is very long, cumbersome, and complicated. Mon EMS became an expert in navigating the WV OEMS process. Our goal was to know the certification process better than the state office so we could cut out as much of the time delays as possible. This allowed us to market specifically to students who were in town with valid EMS credentials, not just WV credentials.

We then combined a marketing campaign with our knowledge of the WV EMS process, and worked to get those folks involved with Mon EMS. Those folks provide 3-4 years of great employment, patient care experience, and then go on to their careers or continue in the field of medicine in another capacity. It is truly a win, win, win.

What can be done to make EMS services more stable again?

This levy is a first step to providing stability, but more work must be done.  There has to be continued focus on innovation (like what WVU Medicine, Mon Health, and Monongalia County did) with Mon EMS. However, that is just the beginning. We have to continue to look at ways to improve the delivery model. We have to raise reimbursement rates where we can, however that by itself will not solve the EMS problem. Forward thinking governmental bodies (like Mon County), health systems, communities, and the public have to realize there is a problem, and then come up a with a plan to address it, and then work to actually implement that plan. We are blessed to have a County Commission that cares enough about it’s constituents to work to get a plan in place. We have a shared vision to ensure that the safety net for the county is here if and when we need it.

We have to continue to evolve the profession of EMS, regardless if that is a career department or if you are still lucky enough to have a group of volunteers that provide that service.

The healthcare environment is not getting any easier, and people are not getting any healthier. We are doing our part to a very good safety net, but like any good net – we have to have a little bit of support.

How does the Monongalia Technical Education Center (MTEC) Program impact your staffing needs?

There are many programs that have been implemented by the legislature to improve access and reduce barriers to folks getting into and taking EMT courses. All of this is great news for Mon EMS.  We are working with MTEC and other educational institutions to ensure a seamless integration into Mon EMS for those that want to join our agency.

Q&A: How does Governor Justice’s announcement of raising Medicaid rates to 100% impact Mon EMS?

If you have not heard, on June 22, Governor Justice did authorize the WV Department of Health and Human Resources (DHHR), Bureau for Medical Services to raise the MediCAID ground ambulance medical transportation services to 100% of the MediCARE payment. The part that is a bit obscure is that the previous MediCAID payment was only raised 10% and already at 90% of the MediCARE rate. To further clarify, the 100% is not of what Mon EMS bills, but is 100% of what Medicare will pay.

What does this mean for Mon EMS?

First, we are super appreciative of Governor Justice making this move to assist EMS Services. It is definitely a step in the right direction. Raising rates will help in funding EMS Services, but it is not the only answer. That being said, let’s break this down.

Here is a sample call: (BLS EMERGENCY with a few miles)

  Previous Updated
Billed Amount $940.99 $940.99
Contractual Allowance $616.65 $584.09
Medicaid Reimbursement $324.34 $356.90
Net Impact   $32.56

 

We are super appreciative of this being an item that is being addressed in WV. This is one step in improving the EMS system in WV. The impacts to Mon EMS annually will be between $60,000-70,000 a year. A nice little bump, and is much appreciated, but will not solve the problem by itself. We thank Governor Justice and all of our elected officials for their efforts.