Appomattox County, VA
 
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Table of Contents
Table of Contents
[Adopted 10-4-2010 (Ch. 21, Art. III, of the 1993 Code)]
A. 
In order to assure the adequate and continuing emergency services to the citizens of Appomattox County and to preserve, protect and promote the public health, safety, and general welfare, and in order to provide all emergency services personnel with the full benefit of privileges, rights and remedies available to them under law, the Board of Supervisors of Appomattox County hereby establishes a County EMS/Rescue Division in order to mitigate the effects of accidents, disasters and other medical and rescue-oriented emergency situations.
B. 
The following organizations are hereby officially recognized as entities of the Appomattox County Department of Public Safety, EMS/Rescue Division, and are hereby granted permits to operate emergency medical service vehicles in Appomattox County: Appomattox County Rescue Squad, Inc., Pamplin Volunteer Fire Department and EMS, Inc.,[1] Concord Volunteer Rescue Squad, and Gladstone Fire/EMS. Volunteer agencies identified in this subsection will maintain separate licensure with the Virginia Department of Health, Office of Emergency Medical Services, and maintain oversight of their respective volunteer agencies unless a separate agreement is entered into with Appomattox County as agreed to by both parties. Included in this provision is the responsibility to maintain mutual aid agreements with bordering agencies.[2]
[1]
Editor's Note: Throughout this article, references to "Pamplin Volunteer Fire and EMS, Inc." were amended to "Pamplin Volunteer Fire Department and EMS, Inc." at time of adoption of Code (see Ch. 1.1, General Provisions, Art. II).
[2]
Editor's Note: Amended at time of adoption of Code (see Ch. 1.1, General Provisions, Art. II).
C. 
The following organizations are hereby officially recognized as private commercial or not-for-profit entities that are authorized to provide EMS services within Appomattox County and are granted permits to operate emergency medical service vehicles, including but not limited to air medical evacuation (medevac) services utilizing helicopters equipped for such use, in Appomattox County and charge a fee for the service they provide to patients: any private service provider with which Appomattox County Rescue Squad, Inc., or Pamplin Volunteer Fire Department and EMS, Inc., contracts or Centra Health (helicopter and ground transport), University of Virginia (Pegasus helicopter and ground transport) and Carilion Health System (Lifeguard helicopter and ground transport), Davis Ambulance, Delta Response Team, Palidin Transport, and Virginia Ambulance. Furthermore, these private commercial or not-for-profit entities, except for Appomattox County Rescue Squad, Inc., and Pamplin Volunteer Fire Department and EMS, Inc., are exempt from the remainder of the provisions in this article. The Appomattox County Department of Public Safety may enter into contracts with any of these organizations to provide services on a routine basis as authorized by the Board of Supervisors. Additionally, the County may enter into mutual aid agreements with surrounding jurisdictions and agencies when it is deemed appropriate to do so by the County Board of Supervisors.[3]
[3]
Editor's Note: Amended at time of adoption of Code (see Ch. 1.1, General Provisions, Art. II).
D. 
Each of the organizations mentioned in Subsection B shall be assigned response areas that provide the best services to the citizens of the County. These response areas shall be maintained in writing by the Appomattox County Department of Public Safety, a copy of which will be posted in the communications center and available to the public. The Department of Public Safety may amend or change these boundaries from time to time in order to provide the best services available.
E. 
For purposes of this article, the following definitions shall apply, unless the context requires a different meaning:
EMERGENCY MEDICAL SERVICES PERSONNEL
Persons responsible for the direct provision of emergency medical or rescue services in a given medical emergency or emergency rescue, including all persons who could be described as attendants, attendants-in-charge, or operators.
EMERGENCY MEDICAL SERVICES VEHICLE
Any vehicle, vessel, aircraft or ambulance that holds a valid emergency medical services permit issued by the State Office of Emergency Medical Services that is equipped, maintained or operated to provide emergency medical care or transportation of patients who are sick, injured, wounded, or otherwise incapacitated or helpless.
EMS SQUAD or EMS DEPARTMENT
A volunteer emergency medical services (EMS) organization organized pursuant to § 27-8, Code of Virginia, in any town, city or county of the commonwealth, with the approval of the governing body thereof, consisting of emergency medical services personnel.
A. 
Each of the organizations and groups mentioned in § 15.2-6B and C shall coordinate their operations and activities with the Appomattox County Department of Public Safety and will carry out their assigned tasks to the best of their ability.
B. 
Each EMS/rescue organization mentioned in § 15.2-6B shall appoint a captain who shall be responsible for the overall direction and control of EMS/rescue service activities within his organization's respective primary response area. Additionally, the captain shall ensure that his organization complies with all of the provisions of applicable laws, ordinances, and standard operation procedures and shall coordinate his organization's operations and activities with the Director of Public Safety or his designee.
A. 
All officially recognized members of the organizations and groups mentioned above shall perform their respective duties, as outlined in standard operating procedures and applicable laws and ordinances, to the best of their ability.
B. 
All officially recognized members of the organizations and groups mentioned above will be subject to the procedures and practices established by the Appomattox County Board of Supervisors or its designee.
C. 
While performing in his official capacity, each of the members of the organizations and groups mentioned above shall have the authority to carry out his respective assignments as provided for in applicable laws, ordinances and standard operating procedures.
When providing services in their official capacity and acting within the guidelines of the Department of Public Safety, all officially recognized members of the organizations and groups mentioned above shall be afforded all of the privileges, rights and remedies available to them under law.
A. 
Service fee for emergency ambulance transport.
(1) 
Pursuant to § 32.1-111.14, Code of Virginia, as amended, it is hereby determined and declared that the exercise of the powers and duties set forth herein is necessary to assure the provision of adequate and continuing emergency services and to preserve, protect and promote the public health, safety and general welfare.
(2) 
Definitions. The following definitions shall apply to ambulance charges:
(a) 
Basic life support (BLS). Services shall be medical treatment or procedures provided to a patient as defined by the National Emergency Medical Services (EMS) Education and Practice Blueprint for the Emergency Medical Technician (EMT) - Basic.
(b) 
Advanced life support level 1 (ALS-1). Services shall be medical treatment or procedures provided to a patient beyond the scope of an EMT - Basic as defined by the National EMS Education and Practice Blueprint.
(c) 
Advanced life support level 2 (ALS-2). Services shall be defined as advanced life support (ALS) services provided to a patient including any of the following medical procedures:
[1] 
Manual defibrillation/cardio version;
[2] 
Endotrachael intubation;
[3] 
Central venous line;
[4] 
Cardiac pacing;
[5] 
Chest decompression;
[6] 
Surgical airway; or
[7] 
Intraosseous line and the administration of three or more medications.
(d) 
Ground transport mileage (GTM). Shall be assessed in actual road miles from the location of the incident scene, or center point of a rescue demand zone where an incident scene or address is located, to a hospital or other facility where a patient is transported.
(3) 
The schedule of rates for emergency ambulance transport services by Appomattox County Rescue Squad, Inc., and Pamplin Volunteer Fire Department and EMS, Inc., shall be based on a schedule as may be set by resolution by the membership of Appomattox County Rescue Squad, Inc., and the membership of Pamplin Volunteer Fire Department and EMS, Inc., from time to time.
(4) 
Appomattox County Rescue Squad, Inc., and Pamplin Volunteer Fire Department and EMS, Inc., shall adopt appropriate rules and policies for the administration of the charges imposed by this section, including and not limited to payment standards for those persons who demonstrate economic hardship, as established by this section.
B. 
Billing.
(1) 
Appomattox County Rescue Squad, Inc., and Pamplin Volunteer Fire Department and EMS, Inc., or its agent shall generate a bill for ambulance transports whose point of origin is within the boundaries of Appomattox County performed by all ambulances operated by an agency licensed and chartered in Appomattox County by the Commonwealth of Virginia and mentioned in § 15.2-6B above. Organizations are required to submit information required for the volunteers or their agents to generate a bill for such services. Appomattox County Rescue Squad, Inc., and Pamplin Volunteer Fire Department and EMS, Inc., will not generate a bill for ambulance transport by organizations mentioned in § 15.2-6B above that would be considered humanitarian assistance (meaning activities not undertaken as a result of a call for emergency assistance to the Appomattox County Public Safety Communications Center). Due to the fact that patient care information is highly confidential under several state and federal laws, call sheets/patient care reports will remain the responsibility of the agency responding to individual calls. Information shared under this subsection shall be that information reasonably necessary to accomplish the billing process or other arrangement as mutually agreed to by the providing agency and Appomattox County.
(2) 
Appomattox County Rescue Squad, Inc., and Pamplin Volunteer Fire Department and EMS, Inc., may generate a bill for ambulance service in the primary response area of organizations mentioned in § 15.2-6B above in adjoining localities by separate agreement between Appomattox County, the adjoining locality, and the organization.
(3) 
No organization mentioned in § 15.2-6B above that is licensed and chartered in Appomattox County by the Commonwealth of Virginia may bill for services without the prior consent of the Appomattox County Board of Supervisors.
(4) 
Fees and responsibility for payment. Payment of all charges for ambulance services, including evaluation, treatment or ambulance transport, shall be the responsibility of the patient or the parent, guardian, or other legally responsible party in the case of a minor or an individual deemed incompetent.
C. 
Billing process. Patients will fall into one of the following categories for billing purposes:
(1) 
Insured through third-party health insurance company, Medicare, or Medicaid and is a resident of or employed in Appomattox County. The appropriate health insurance carrier will be billed. A resident of Appomattox County or persons employed in Appomattox County will not be responsible (invoiced) for co-payments, co-insurance, deductibles, or other similar payments.
(2) 
Insured through third-party health insurance company, Medicare, or Medicaid and is not a resident of or employed in Appomattox County. The appropriate health insurance carrier will be billed. Any applicable co-payments, co-insurance, deductibles, or other similar payments may be billed to the patient.
(3) 
No insurance and is a resident of or employed in Appomattox County. The patient will be billed for services with no further action for collection.
(4) 
No insurance and is not a resident of or employed in Appomattox County. A bill may be sent to the patient transported. If the individual has the financial ability to pay, then payment of the outstanding charges is required. If the patient can demonstrate a financial hardship and qualifies for reduced payments pursuant to Subsection E, then the patient shall be eligible for a reduction of the amount of the charges due.
D. 
Billing contractor. Appomattox County Rescue Squad, Inc., and Pamplin Volunteer Fire Department and EMS, Inc., may contract with a third party for billing and related services.
E. 
Ability to pay program.
(1) 
This program establishes an equitable fee setting policy for those situations where the patient is unable to meet the ambulance transport charge because of demonstrated financial hardship.
(2) 
Appomattox County Rescue Squad, Inc., and Pamplin Volunteer Fire Department and EMS, Inc., shall establish an "ability to pay" scale and eligibility criteria for individuals who can demonstrate financial hardship and receive a reduction in the charges owed.
(3) 
When a patient is billed for a transport and because of limited financial resources or assets is unable to pay, a procedure is hereby established for such patients to apply for a reduction in the charges due.[1]
[1]
Editor's Note: Amended at time of adoption of Code (see Ch. 1.1, General Provisions, Art. II).
(4) 
A patient representing that there exists a financial hardship will submit information sufficient to determine such hardship. If it is determined that payment of the emergency ambulance transport charges creates a financial hardship, charges due may be reduced or waived according to the scale as may be established by Appomattox County Rescue Squad, Inc., or Pamplin Volunteer Fire Department and EMS, Inc.
F. 
Collections. Billing subscription services and collection policies and services will be established by Appomattox County Rescue Squad, Inc., and Pamplin Volunteer Fire Department and EMS, Inc.