Loading...
HomeMy WebLinkAbout1995-02-08 Council Minutes - Special MeetingROMA 10ENAI CT'1'Y CO—UNCIL - SPECIAL MEETING FEBRUARY 9, -1995 . 71 B. M.- REmY CITY COW0116 CRNOUB i. Pledge of Allegiance 2. Roll Call 3. Agenda Approval H. $EMIG J SING 1. Proposed Rmbulance Fee Schodule a. Presentations b. Public Coment.. c. Council Discussion C; r� • r XZNAI CITY COUNCIL - SPECIAL MEETING FEBRUARY So 1995 7:00 P.M. RENAL CITY COUNCIL CxhM8bRa MAYOR JOHN.J. WILLIAMSiv PREAIDING Mayor Williams called the meeting to order at approximately 7:02 P.m. in the Council Chambers in the Kenai City Hall Building. A-1. ZE_DdM„QZ-AL82IANC8 Mayor Williams led those assembled in the Pledge of Allegiance. A-2 . Roll was taken by the City Clerk. Present were: Bookey, Swarner, Monfor, Measles, Bannock, Smalley and Williams. A-5. Mayor Williams requested the following changes to the agenda: ADD: ADDITIONAL INFORMATION - 2/5/95 Peter 0. Hansen, M.D. letter. ADDITIONAL INFORMATION - 2/7/95 D. Burnett memorandum regarding Estimated Revenues for Billing. MOTION: Councilman Smalley ROVED for approval of the amended agenda and requested UNANIMOUS CONSENT. There were no objections. so ORDERED. ITEM as PUBLIC HEARING 8-1. Proposed Ambulance Fee schedule B-sa. Presentations Mayor Williams reviewed the agenda with the Council and audience. Williams informed the audience that this is a special meeting of the Council. The Council felt it was the type of topic that needed public comment. Approximately 35 letters were mailed to members of the community with information about the ambulance fee proposal. The notice of the special meeting was advertised through the Peninsula Clarion, radio, and at the Chamber of Commerce luncheon. Williams: A presentation (with the use of graphs and overhead projector) was given by Williams for Council and the audience. - Williams discussed revenues, costs of operating the departments of SPECIAL KENAI CITY COUNCIL MEETING MINUTES FEBRUARY 8, 1995 PAGE 2 the City, mill rates, General Fund expenditures, etc. Williams added the Council wants to keep a stable economic base. Williams continued that there have been many of abuses to the ambulance system. The ambulance will have to be replaced soon. Cost for a new ambulance will be approximately $125,000. People use the ambulance for their own private taxicab service. The service cannot be refused to anyone when the service is offered for free. A great* percentage of the service is given to people from out of town. Also, the service transports patients from the hospital to the airport for air evacuation to Anchorage. Burnett: Fire Chief Burnett gave an informative slide presentation about the Kenai Fire Department, the equipment available, and the different expertise needed and used in the operation of the Kenai Fire Department. Williams explained the Fire Department is required by the FAA to respond to airport needs before other accidents, etc. if they happen at the same time. Williams added it troubles him that people use the service for non -emergency uses and it could open'the City to liabilities if the use keeps the Department from responding to someone who really needs the service. Williams opened the meeting to public comment. B-1b. Public Comment (Verbatim) Dwain Gibson: I'm Dwain Gibson. 710 Maple Street in Woodland. Thank the Mayor Williams for inviting him down to comment about our emergency service that we have and i would like to suggest that we, we do have a real fine service that's been given away for years. It's taken a lot of dedication and perseverance and monies to develop this organization. I'd like to say that I'm here to support it. You know, we have a, from my own opinion, we're proud of our city and the development that's come over the years. Some of us have, been here for a long time. We can, we can feel good about where the City has come to and of course, we want to see it continue. There are some areas of concern to me and to some others that have . commented to me. We do, we do have a very fine mi 1 rate. We would like to see that mil rate stay where it is and I. I'm sure that's. the goal of the mayor and the council to keep that mil rate -as E SPECIAL KENAI CITY COUNCIL MEETING MINUTES FEBRUARY 8, 1995 PAGE 3 competitive as possible. We want to see the City of Kenai grow and any, any advantage to an individual, or enticement I guess would be a another word, to get people to move to the City of Kenai and keep them here, the mil rate has a lot to do with it. Sales tax has a lot to do with it. But we can't continue to give this service away free. I'm surprised that we've waited this long to charge a fee for these services and I might say, at this point, that I have never had heard even, one complaint on the emergency service. As a matter of fact, on the flip side, it's always compliments about the service it's provided to Kenai for free. That doesn't mean that I want to see us charge an excessive rate. I would like to see it a rate charged, but I would like to suggest that the rates be reflected similar to the way our property tax, our mil rate reflects in comparison with other cities or municipalities. I would like to see a clarification, a real clarification on the resident and non-resident or people that have a mailing address for Kenai and maybe, maybe live part-time in Kenai and part-time elsewhere, but they still have a Kenai mailing address. In fact, they live elsewhere. Or they just work in Kenai and live someplace else. I think and I would trust that the City be very specific in those areas.... TAPE CHANGE... ...the non-residents, the way I understand it, had to be charged the same rate as the residents. I don't know if there can be any differentiation there. But at any rate, I think it's high time that we do charge for a service, as long as it's fair and equitable and if you have any questions, from an insurance standpoint, I'll be happy to try and answer them. WILLIAMS: Thank you very much Dwain. Do any of the members of the Council have questions of Mr. Gibson. Yes, Councilman Bookey first. BOOKEY: Thank you Mr. Mayor. schedule? GIBSON: Yes, I have. Dwain, have you seen the proposed BOOKEY: How do you feel on the numbers that are there now? Do you feel they are excessive or not enough? • SPECIAL RENAI CITY COUNCIL MEETING MINUTES FEBRUARY 8, 1998 PAGE 4 GIBBON: Ah, I would like to say that I want them, I would like to see them competitive or less so that it would encourage people, ..we can say, "Hey, our services are a little less than someplace else.,, Okay? Now, what's excessive, the costs involved, I'm sure they've done some study on that and probably a major decision that is the proper, proper charge, but I want to stay with my point that 'l want to see the City have, provide the service, but I want to see it competitive. Very competitive. BOOKEY: Thank you. WILLIAMS: Councilman Smalley. SMALLEY: I've got a question for those folks that purchase insurance from you. By and large, are the coverages that they have for their ambulance service, is it 100%, 80%, varies? GIBBON: First of all, an auto policy. Let's take an auto policy. Not all auto policies have medical coverage on them. People can opt not to carry that. All of, a health plan from State Farm covers transportation to the hospital. SMALLEY: 800 100$? GIBBON: 100%. SMALLEY: Okay. Thank you. GIBBON: Thank you. WILLIAMS: Thank you. All right, is there anyone else that would like to address the council? Please feel free to just come forward and present your questions. I know there are questions out there. Please Loretta. BREEDEN: ...if no one alse...I will. BOOKEY: You've never been known to be bashful. BREEDEN: Loretta Breeden, Kenai resident some 36 years. And, ah,. I'm pretty well, in favor of the ambulance charges, but I do have. some questions and I' In not here to argue with you folks at all, but • what I would like to do, I'd like to go through this page by page and maybe if you'd make notes and answer my questions when I'm through. That way I won't get to argue with you. . SPECIAL KENAI CITY COUNCIL MEETING MINUTES FEBRUARY 8, 1995 PAGE 5 On page 1, the memorandum from Mr. Manninen, Ssaid the user fee, "may, be" used to contribute towards ambulance equipment replacement.' _ think it "should be" or "shall be" because he goes, somewhere else down the line further youlre talking about 20% going, towards equipment replacement. So, I, I, disagree with your "may bowa I don't know whether you need, this is generally speaking,I s don't know whether you need non-residents extra charges.I don't think they do down in Juneau. WILLIAMS: Loretta, maybe if we take them one at a time, and answer as we go and I think it would be a benefit.... BREEDEN: Well maybe, for people, promise to not let me argue with YOU* WILLIAMS: Okay. Let's start with the first one. We've had a lot of discussions about how to dedicate the revsu e. Ofthe laws of the State of Alaska,' dedicated revenueso are not generally acceptable and that generally relates to political subdivisions of the State as well. What we decided to do, without a lot of discussion yet with the Council, but what the Administration is proposing at this point is that we do not dedicate any of the ambulance fee as we had proposed in the memorandum, especially the 20%. We have, in fact, some time back instituted a quasi -dedicated fee in which we dedicate $300,000 a year to a $1 million capped fund for the replacement of equipment and we've been doing that on a consistent basis all the way along. From that $1 million -capped fund, we have purchased new fire truck, new graders, that's where we expect to purchase a new ambulance and I think it would probably behoove us to continue that policy insures that each and every budget period, if we put that $300,00to0 back in there with a maximum of $1 million it would save a lot of problems with the law regarding dedicated funds and also *the bookkeeping system and things like. So I think what we'll probably do is just continue to draw from the reserve and Purchase, now equipment as we go and just make sure the reserve is replenished each year. BREEDEN: Okay, on page 2 of the memorandum from Charlie Brown to Mr. Manninen...but before I hit on this, something you said John really kind of rang a bell. You said, "Well, because we are a free • SPECIAL KENAI CITY COUNCIL MTsBTING MINUTES FBBRUARY 8o 1995 PAGE 6 ambulance service, this would kind of change things. Before we couldn't refuse service to anyone." Are you saying now that if it's a paid service, you can refuse service? WILLIAMS: No. I didn't, I didn't mean to infer that we bnight refuse service. We will not refuse service and just to probably take it one step further. In our calculations of revenue, we've used the same approach the hospital does and that's that we fully expect to write off at least 20% of the revenues as uncollectible. The hospital follows that policy. I've discussed that with the hospital director and just as a matter of course, they write off 20% of everything because they can't collect it and they don't collect it. So, we'll probably wind up following the same policy. Also, with regard to your other question, and I know this was on Dwain's mind as well regarding non-residents. After long, lengthy discussion and re -writing of the program and everything, I think, with further discussion, the Council will probably agree that resident and non-resident status should not be an issue and that there will be one base fee .rather than resident, non-resident fee because many non-residents are, in fact, very close friends and neighbors and relations of ours who live right within the local area. So we don't feel it's justified to charge a non-resident more than the resident. They do, in fact, contribute to the well being of the City as well. BREEDEN: Okay, in Charlie's memorandum, you're going into ambulance billing here. That's the second page. And, throughout here, about most everything I see is Medicaid and Medicare. Medicaid and Medicare. Are you going, my question is, are you going to bill other insurance companies or are you going to leave that charge up to the person that you transport or the one that signs? What are you going to do about this other insurance? Are you going to charge it to them and wait for reimbursement? They should wait for reimbursement? WILLIAMS: I'll direct that question to the Administration, any one of you who, wants it. BROWN: In order to keep the administrative costs low enough in able to handle it without hiring people, we know we're going to have bill Medicare. and Medicaid directly because they insist on it. So, we'll handle that through a contractor and they'll only charge about, I think it's (seven or seven -fifty per bill. That's very reasonable. The rest of it, we're going to bill the individual • SPECIAL KENAI CITY COUAiCIL MEETING MINUTES PEHRUARY 8, 1995 PAGE 7 patient or somebody assigned as being responsible by the parent or guardian, we'll bill them. But it's up to them to,turn that bill in to their own insurance company. I don't intend to get involved in different insurance company plans. BREEDEN: Okay. I think, myself, I was just going to say, I think you're making a mistake by not having your gal upstairs or gentleman upstairs do the Medicaid/Medicare bill. I don't think it's all that hard and are you going to do then, sign off on the state and federal forms to Medicare that this is all true and correct and everything else when you're having someone else do it for you? BROWN: Well, I've already signed forms. BREEDEN: No, I mean the year-end report. BROWN: I, I can't answer that. I haven't had to file a year-end report. I don't know. BREEDEN: Well, okay. I, I feel a subcontractor is not a really a very good thing. Ah, are you going to bill a supplemental insurance company? BROWN: No. BREEDEN: Like, now, you see you're talking so much about Medicare and Medicaid and a lot of people I know around here have AARP Insurance, and you're talking about writing, in hare, you're talking about writing off what goes, what Medicare doesn't pay. Well, Medicare will only pay a certain amount or Medicaid. And then, past that, somebody on those, you know, on Medicare, can, the bill is usually sent to a supplemental, your supplemental insurance company. But, are you going to write that off, are you telling me? BROWN: No, we're not going to write that off. That information is supposed to be captured on the form'by the ambulance personnel, if there's secondary insurance and we'll try to collect that. But again, we're going to try to work with the individual and it's their responsibility to pay and if they have secondary insurance to Medicaid they should try to get it. Ah, I just can't,;I can't hire enough people to get involved in every specific insurance program that different people have. Ah, we will try to find out if people on Medicare have secondary insurance. We do not intend to write. off amounts that we think we can collect. • SPECIAL KENAI CITY COUNCIL MEETING MINUTES FEBRUARY 81 1995 PAGE 8 BREEDEN: Are you going to turn yorr collections over, much as the hospital does, to the bank for collection? I, I don't mean, I don't mean a loan collector, a bill collector, I mean where payments would be made into the bank on accounts? Or are you going to take care of that through City Hall? BROWN: I'm not sure I understand the question. BREEDEN: Okay. Let's just say you're going to bill somebody... BROWN: Okay. BREEDEN: ... and the accounts for a fee are turned over to the bank and the one who owes the bill goes into the bank to make their payments. And then if any problems crop up, these things would then be directed to a collection agency, • BROWN: No. BREEDEN: You're going to do that all in-house? BROWN: We're going to do it in-house and what we can't collect that we think should be collectable, we'll work with the attorney's office and see what , he can do. BREEDEN: Okay. What is the bottom line if somebody doesn't pay, Council, are you going to turn them into a collection agency? I've seen cases in my seven years on the Hospital Board where people were turned into collection agencies. I've seen people whose homes were on the line, whose vehicles, whose property were on the line. To what extent do you intend to go? WILLIAMS: I might just answer that briefly. It has ,not been the policy of the City of Kenai, for as long as I've been here, to use the services of a collection agency. Generally speaking, all outstanding debts to the City are collected by the City Attorney. I think that that policy could probably continue and the determination could be made by the City Attorney and the Administration as to whether a debt is uncollectible or not and the issue can stop at that point. I don't believe that we've ever, on a continuing basis of any sort,. used a collection agency. BROWN: No, no we haven't. Cary and I were discussing that today and we could think of really no instances where we'd probably want to use a collection agency in the State of Alaska. Now there, SPECIAL KENAI CITY COUNCIL MEETING MINUTES FEBRUARY 8, 1995 PAGE 9 we're going to have some very different kinds of collections here that we might be involved in where we may take actions that are slightly different if we're dealing with some out-of-state people. But, by and large, we have not, we do not intend to use collection agencies. BREEDEN: Okay. on Item 7 in Charlie's memorandum to the city manager, where the fire chief wants 20% of the collections to be designated for EMS equipment. Up to $250,000. Well, where were the rest, my questions are, where, where will the rest go? What is this user fee for? I sure don't like to see it going into that General Fund whatsoever. And looking at Charlie's, in the next paragraph, next page, where he said he's not enthused about another designation of fund balances for a single department use, but he admits there's no reasonable accounting or financial reason to objected, to object to it. So, I mean if you're going to charge this user fee, man, that better be what those funds are going for. Period. End of report. It's to that Fire Department and however it needs to be used, whether new equipment, or whatever, for training. I, I just really object to a user fee if you don't do that. MANNINEN: Well, well, the staff considered that also in the original proposal back last fall. We were talking about a dedicated user fee of up to 20% and maybe even having a dollar amount of $250,000. But as of today, we do not want to charge ah, any dedicated portion of the user fee for ah, automatically rolling it back to ah, purchasing equipment for the fire service, even though several months ago, that's where the recommendation was. But I don't know if it's Charlie's persuasiveness or the fact that that right and reason finally ruled the day and, but we changed our position 180 degrees and I think even the Fire Chief and the Fire Department agrees with it. Basically because they're such good lobbyists, they get more money than, than any fee is going to raise anyway from the Council. And, and, and this money going into the General Fund will be available to the Council on an annual basis to appropriate rather than to dedicate for Fire Department and then if Public Works happens to do a snow berm removal fee, to dedicate another pie to them, you know, that would basically take all the decision -making authority away from the Council on an annual budget basis. I don't think the Council wants to do that. I don't think the public wants that. And really, in the long run, I don't think any department wants that and, because you can win some years and then lose forever because of the way that's structured so, we ah, • SPECIAL KENAI CITY COUNCIL, MEETING MINUTES FEBRUARY 8, 1995 PAGE 10 we were where you're at six months ago, but we're not there right now and, and, ah,. we're not talking about dedicating any part of the user fee.... BREEDEN: Well, I.thought...my only argument here...= could argue that one...but, I mean, I think that the user fees that you said are necessary for.. the Fire Department, should go to the Fire Department. Period. Keep your mitts off of the rest of it. Now, back over to bill rates. The next page. Ah, what you're talking for transport, 100 bucks. What could that be? le that non -emergency transport? Could that perhaps be termed non - emergency transport? MANNINEN: First of all, I think you've got the old rate and maybe what I should do is just summarize where we're at because we have had a lot of changes... BREEDEN: Oh, thatts the one I got... MANNINEN: That rate is not what ' s being proposed now. In fact, we don't have f ive rates, we've got four and the f irst rate starts at $325... BREEDEN: Is that just for a plain transport? MANNINEN: That would include what you call a plain transport... BREEDEN: $325? MANNINEN: ...It would include, it would include what is in Level One and Level Two in what you have and then the ah new Level Two would be $550, Level Three $750 and Level Four $1500. Now, in Level One would be the basic transport. BREEDEN: (copy of new rate sheet passed to Breeden.) Oh...thank you. Oh, I see...ya. All I got was what I was mailed. FREAS: Up until today, I didn't have anything else... WILLIAMS: When -,- when we had the discussions regarding the resident, non-resident fee, doubling of the fee for non-residents, and so forth, that we decided that that probably would not be a good idea. We also discussed the Level One, $100 transport fee, in that that is the particular area that causes us a great deal of • • SPECIAL KENAI CITY COUNCIL MEETING MINUTES FEBRUARY Be 1995 PAGE 11 concern with the abuse of the system. It was felt that ah, if a person just needed to be taken to the hospital, and that's that's what the original basic transport fee was for, than more than likely that someone could take that person to the hospital and there wouldn't be a need to charge them $100 when a guy's just got to over there to get his medication checked, or get their pulse taken, or talk to the doctor because the doctor said "come see me on Tuesday." There's no reason for them to come to the fire station to begin with and get the ambulance ride over. That's where a lot of the abuse is coming from. it was also felt that at a hundred dollars, we still probably wouldn't solve the majority of abuse problems. People would still run over there and jump in the ambulance for a hundred bucks. So, we did away with that fee altogether. What we're trying to say is the basic life support system is there for the people that need it. It's not to be used for someone who needs to go and get their medication changed. It's not to be used because Johnny Junior stubbed his toe and itIs bleeding and we've got to get him to the hospital right away. Those are the things we're trying to BREEDEN: Okay... MANNINEN: Although, if somebody chooses to.... WILLIAMS: If they choose to do it, personal choice, and if they want to pay the $325 for it, that's again, their personal choice. BREEDEN: Well, I. I...one thing...okay, I'll go along with that, but I think it's quite high and your fifteen hundred one here but, ah, some of that stuff Is pretty technical. But what I don't see on here, on your rates, is, and I know, I mean, I know hospital personnel and I also know ambulance personnel, have gone to Anchorage on cases on air-evac cases and I know air-evac cases can run at the minimum of $20 500 up to nine or ten thousand and I don't see a charge on here of what you're going to charge for somebody going to, your personnel going to Anchorage. WILLIAMS: That's... BURNETT: Currently, in the transporting from the hospital, the, with an air transport. BREEDEN: Okay. last four, since we started we haven't sent any medics with • L] • SPECIAL KENAI CITY COUNCIL MEETING MINUTES FEBRUARY 8, 1995 PAGE 12 BURNETT: A stand-by fee hasn't really been addressed at this point, if we did. BREEDEN: Okay, down to Item 1. Medicare and Medicaid billings expected to filed electronically by a subcontractor. I want to knew who and I want to know why and I'm still wondering, as.a Medicare recipient, boy, oh boy, ch boy, you know, who is going...Say you guys take me in, �4ho in the world is going to file for my co-insurance, my AARP. Oh boy! You know. And I think you. need to do that in-house. So....and then you say, interest will not be charged. I want to know, why not? WILLIAMS: Well, we want to be a little benevolent here. BREEDEN: Okay. You say, Number 5, penalty of ten percent "may be" charged. Well, why not, "shall be" charged? WILLIAMS: I think that there needs to be a discretionary thing here. The Administration is willing, as is the hospital. and everybody else, to work with patients. If you put "may be" charged in there, if it's a blatant refusal to pay because of some philosophical difference with the City, or because they're running from the bill and have the ability to pay it, we have then the right to charge. But if it's a hardship case where it's quite obvious that nothing's going to be gained by either the City or the patient by fighting this thing, there's no sense in us, you know,. being hard-nosed and "shall" charge tho ten percent. It's a discretionary call thing, that's what it is. BREEDEN: Okay. In Number 6, I wonder why the Finance Director alone has the authorization to right off accounts deemed uncollectible. And here again you go into Medicare and Medicaid.. And what about your supplemental insurance and what about other insurance companies? Are you going to let that be written off too by him? WILLIAMS: Mr. Brown? BROWN: Well there, 1, I think there's too much emphasis on what other. insurance companies will pay. The patient owes the. money, if they have insurance or don't have insurance, or only have a policy that has a $2,000 deductible and they owe the money. It's up to thacn to get it. What this discretionary right -off is that there are cases where it just simply not going to be worth the money.... • SPECIAL KENAI CITY CAUNCIL MEETING MINUTES FEBRUARY 8r 1995 PAGE 13 BREEDEN: Well, I guess probably one of the points I'm trying to get at around the corner .somewhere is, you're really not saying anything about other commercial insurances in here. Everything.... BROWN: Okay. The only, it's my point, I'm trying to make a point that Ila not dealing with the other insurance companies. I'm not ment ion ing them because I do not intend to send a bill to other insurance companies. BREEDEN: Okay. WILLIAMS: Ah, just a minute Loretta, Councilwoman Swarner has a comment... SWARNER: Okay, Loretta, I don't know if you are aware, but if you accept assignment under Medicare, you have to accept what they • pay... BREEDEN: Yes, I know, and it's very little. SWARNER: Right. And also, as a supplier of services, you have to right off what is called, I believe, billed and unfileable (sic), or some such thing. It's like a couple dollars. BREEDEN: Well, you know, like if you go down to the doctor's office, the doctor will bill Medicaid and he will .bill, your supplemental insurance. SWARNER: Right. BREEDEN:. or he will bill your commercial insurance. Some of them ask for money up front. SWARNER: But you don't have to. But anyway, you do, there are, somebody has to say,. okay you can right off these allowable charges under Medicare. So, that's what .... WILLIAMS: Councilman Bannock? BANNOCK: If I could ask a question to Councilwoman Swarner perhaps?. If you, ig you then agree to accept a Medicaid payment, and we'll just assign it a figure of $75 here for the argument. We'll call it $100. Yet the bill is $125, doers that mean that the Citycannot aces t from another source the other 225? p $ SPECIAL KENAI CITY COUNCIL MEETING MINUTES FEBRUARY Be 1995 PAGE 14 SWARNER: Okay, I just want to clarify something. Are, you said Medicaid. Do you mean Medicare or Medicaid? BANNOCK: Okay, not knowing the difference, I'll say either one of them. SWARNER: Okay. Medicare is for someone over 65 and disabled. BANNOCK: Okay. • SWARNER: And, if the bill is $350 and they will only pay $75, you write the rest off. BANNOCK: Okay, you cannot go back and ask them and say, "you're Medicare paid this much, so we still need 250 bucks?" SWARNER: When you have accepted assignment, that's all. Unless they have supplemental insurance. Then you can go after, then you know you can file that other one. But other than that, that's it. BANNOCK: That's the only, that's the only other way that we could, in that scenario collect the other two -hundred -and -some- odd dollars. SWARNER: And your chances of collecting the other $200 BANNOCK: But that's just for the , you can't get it from the individual. SWARNER: Not from Medicare. SMALLEY: Right, right. WILLIAMS: Unless they have supplemental, BANNOCK: Unless they have supplemental. So, that means, that the customer that's on Medicare and no supplemental, in this example, would get a 75 dollar bill. WILLIAMS: Whatever their rate is. BANNOCK: Whatever their rate is, yeah. Whatever they've agreed to pay. Regardless if the City of Kenai bills them for $325 or $1, 500. • SPECIAL KENAI CITY COUNCIL MEETING MINUTES FEBRUARY Be 1995 PAGE 15 BROWN: Yeah. I cannot go after that excess. What,I can do is,, after Medicare sends me a. statement, and I don't have. any experience in this, this is what i'm.reading in the book...After they send me a statement, they'll tell me if the patient had met their deductible for the year and what their co-insurance is and I, can bill the patient for the deductible co-insurance. But, it's. not much. BANNOCK: if there is co-insurance. BROWN: Well, there is a, I guess there is a co-insurance on that care. BANNOCK: Okay. Oh. All right. SWARNER: And yes, you did, I forgot about the deductibles. Because at the end of the year you have a certain amount of deductibles. BANNOCK: Thank you. BREEDEN: Well, just to give you folks an idea of ' what Medicare pays. All you gals know about mammograms and I'm sure you fellows know about your wives and I'm a new one on Medicare and I'm utterly amazed ah, actually, I, I, I couldn't believe it when I got back my notice of what the payment was to the hospital, Providence Hospital. A grand total of $19.16, Now, boy, you're really talking big money to contract this out. you know. Geez. But anyhow, I, I think that's a bad idea. That's probably one of the biggest reasons why you won't get even your monies' worth. I got some questions on your collection process for unpaid accounts. What you going to do, collection agencies? WILLIAMS: I think that we answered that. We said that... BREEDEN: Yeah. I wasn't real . sure. WILLIAMS: Right. We handle that in-house through the attorney. The. only time that a collection. agency, Mr. Brown stated, will. probably be used is in the case. of out -of --state situations where. you have to chase somebody down to collect the money. BREEDEN: Ufa hum. Well, knowing. a little bit about collections and collection law in the State of Alaska, you've got a patient in that SPECIAL KENAI CITY COUNCIL MEETING MINUTES FEBRUARY 8, 1995 PAGE 16 ambulance who's comatose or for whatever reason, he can't sign that responsibility for debt thing that you've got down here, right down at the bottom here. And, ah, hospitals sometimes, I call it trick, the spouse or the person that's with them or something, to sign and then they become responsible along with the patient. Ah, how are you going to decide if you have a comatose patient about whose responsibility is it for that debt? When does signing on occur? And, if the person's comatose, who is responsible? And boy, you better show a responsibility or you aren't going to collect that debt. WILLIAMS: Let me direct a question to Mr. Gibson. Mr. Gibson, in the insurance industry, if you have automobile insurance and you're involved in a collision and God forgive, but there is a death as a result of that collision, ah, the patient is transported to the hospital, how do you collect your money from the insurance company if the patient happens to be the primary recipient or the primary holder of that policy? Does the insurance company offer any type of resistance to paying the deceased patient's bills? GIBSON: Assuming there's a, assume that, you're talking about a two -car accident or one car? WILLIAMS: Either, it doesn't, one of the... GIBSON: Okay. A one -car accident, a person would have to have medical coverage first of all. And the transport, under the auto policy, it's reasonable with expenses for transport. Now whether the person is comatose or dead or whatever, that transportation fee, as I understand it, would be paid under the medical section to the hospital if they're transported to there... WILLIAMS: Or the ambulance billing... GIBSON: Or the ambulance. The , the City would present a bill and that would become part of the claim to be submitted to us in our case. WILLIAMS: So regardless if there was a signature or not, it would still be paid. GIBSON: Correct. WILLIAMS: Councilwoman Monfor? • 3PECIAL RENAI CITY COUNCIL 14EBTING MINUTES FF,BRUARY 6r 1995 PAGE 17 Mayor, I think Mrs. Breeden brought an einaway interesting MONFOR: Mr. May ► just g point and I really hadn't considered itsLet'sin cardiac arrest, hese routine runs and either (a) s if the sign anything, or (b) they're not going to caring Y which is ► accident. I can't imagine, first of all , thandton there is a major who was signing Department would have time to be worrying the service line, and secondly, I'm sure whosever needing whatcare that they have to sign on some line. Isn't that could give a in this. I mean, I don't ou just work out by being something Y te answer for everything yet because we haven't done think we have it. in the southeast BROWN: Nov Dave gave me a phone num in this. T eylve been doing that's about our size that's been doing and I asked his it in-house pretty much like we began we re ri t going to get their the same question. Because obviouslnot. They told me it's not a signature. A lot of times we may don't get this problem and they estimated about heal a the oblem with collections in • P doesn't seem to b p First, of signature and it general. It doesn't seem to be a problemwith d people • don't, the all, they're electronically filed he signature. Y It just doesn't government doesn't even really see the get the signature urn out to be a problem. W tog° rY when we can, but ites not theP priority. OR: How about saving the life is the top priority. MONF MY pardiif guess I've asked enough questions. BREEDEN: Well, I gu shots will bar user fees are for the Fire apartment don't o sign and your wife or husband gets in the hospital, responsibility sheet. WILLIAMS: Thank you. BREEDEN: Okay, thank you all. WILLIAMS: Yes, please..• just would like to make a comment if I may . On the GIBSON: I s from an penalty, ah, if the account is not paid i bi that should be at pe Y I would insurance standpoint, I would,penalty because there least 90 days before imposing are a ten not er paid cent until all the data is are many situations where claimswe're talking about a two -car is in and all the investigations ahation where a party, one party is accident. Especially in this situ SPECIAL KENAI CAS COUNCIL MEETING M114UT FEBRUARY Be 1995 PAGE IS is liable, therefore or they can't establish which Party for the bill and liable person is responsibleolice to g they don't know which the that takes quite a little Whiand establishing liability ot sometimes t the reports in their investigation o problem- is sometimes ion. A11 right* + e that into considerat WILLIAMS: okay. Weell take yes, Mr. Meeks- Ah a first Off, RogerMeeks• Post Office Box 424. Kenai. MEEKS: We didn't have any ambulancel it,ithe Itd like to go back to when of an old, what do you c About the time I came here hh rde r we g old blue ambulance • 11 WILLIAMS: It wasn't Air Force, it was ah..• MEEKS: Air Force ambulance. SWARNER: Civil Defense? fire truck,ire Jim and • Civil Defense and we had one he rack cny volunteer at MEEKS: you about that caul Doyle can tell y those. I don't know if he wfirenhall over ambulance when we had of the old that time, but he was at the time we 9 's still two of art gallery is now. He and T 1 the way through it that where the the old volunteer fireman that went al still live in town. as We grew, we then with volux:teers. Of course. were We got along I might add, -they is couldn't, couldn't depend on volunteers- h d •as the fire department ood for the equipment they and they saved a lot, a lot of just . g responded very quickly today. They houses• as on City Council and I don' ever remember Back in those days, I w thing that the Fire Departmentre running the of ever voting against any just couldn't bring myself to do it thehuiddle of the night i, I getting p the same days work Fire Departmentto workt e neXt day and doing t against Boma ing and then going It was kind of hard to but ahr that Y was doing re was times I did question the' Toe but �I didn't they wanted. There maybe they knew better than T. I just felt, agree with them all the time• • SPECIAL RENAI CITY COUNCIL MEETING MINUTES FEBRUARY 8, 1995 PAGE 19 Just like this thing, I don't, I don't liskeet to the rowne go in to the General Fund. Although, I can reasoning for it. After while, you can c a have it � to are on with separate accounts until you're going two treasurers to work at the city business. Ah, I don't think should get out of line too much with Othe facilities in charging, but sometimes it does seem quite, quite r lot of money to have to put out for and, of course, you won't get this type of money if you're dealing with Medicare. You neve will. So, and, and, to answer a question about Medicare. r dealt with Medicare and ah, I don't agree with Loretta on those forms are simple to fill out. if, if all you did was fill out that one form when you got the medical attention gtbackand to me, back ill and forth more, but brother, I've got them sent until I swear I think I filled out ten forms and there should have been one, ah but what you do, the Alaska hat iaccording to lawal Center does , they s the is lady that fills them out claimed to Medicaid. They do not have to have to fill those out, Medicare and fill out your supplemental. They did for a while and then they got away from that. The way our insurance works with our union is it is a $20,000 deductible on, on our supplemental insurance and ah, of course, like Linda says, when you accept assignment, isurance which our family service probably will, then the supplementalpays, then Medicare pays 80% of the assignment. The supplemental insurance pays 80$, or mine does, 80% of the other 20%. So, it doesn't leave the person receiving the service a whole lot to pay. And that's the way it works. I don't know how it does with other private insurance or not, but ah, I knowyou acan't collect thatrom rightoth in companies full amount because it states your policy when you start doing it. But, I would like to say that that the only objection I have with this and I'm all for it because I'd a whole lot rather see fPeople the that use that ambulance service, pay for it than later on don road, somebody's going to pay for it and I don't, sure don't want to see it tacked on to house insurance, ah, property insurance. Because that's who's going to pay. And that's why Anchorage is in trouble right now. They won't invoke a sales tax. But sales tart can only collect so much and then when all rie on the property, I don't like the idea of paying for somebody from • Florida, coming up here and using the ambulance service for free when I'm sitting here paying for it. SPECIAL RENAI CITY COUNCIL MEETING MINUTBS FEBRUARY S. 1945 PAGE 20 So, that's, that's really the only objection I have to it. Otherwise, I'm all for it. WILLIAMS: Thank you. Any questions? Councilman Bookey? BOOKEY: Roger, are you comfortable with the fees that are proposed? MEEKS: Ah, not really, but I, I look at it in another way. I know that, I hate to say this because I an a senior citizen, but you've got to make up somewhere where you lose on this assigned • assessment. And the assigned assessment, a lot of times, is a whole lot less than you charge and it gives you a chance... you're going to lose money from everybody on down the line, especially from tourists. Ali, there's some way you have to make it up. But you have to balance it. And I hate to see somebody have to pay $1,000 to go from here to Soldotna just to make up for what I don't pay when I collect on Medicare. But then, ah, of course, I may need the ambulance tomorrow, but in the forty years I've lived in Kenai, I've never had an ambulance and I hope to God I never have one. WILLIAMS: You're lucky. I've used it twice in the 25 or 30 years I've lived here and I'm glad it was here. MEEKS: When you need one, it's nice to know it's there. And, just to give you a little story, it's nice to know it's there. Jim will probably remember this. Back in the 60's, middle 60's, True McGrady, by name, could not hear the siren when it went off here in town. He was a volunteer fireman with the Department. So, he asked that one be installed closer to his house. So they got permission from Glen Kipp to put one on top of his motel. He did, and you should have heard the residents scream. They didn't want that there at all. So, I, you know, I had to come to their defense on that because my argument there was if I can lay in bed on a nice ice-cold night when it's 20 below and these guys get up and go out to a fire, I'll give them anything they want. WILLIAMS: All right. We still. have some time for more comments from the general public here. PORTER: Ah, my name is Pat Porter and I live at 116 Deepwood Court. I'm very much in favor of supporting an ambulance, a fee for ambulance services. Um. I don't have a problem with that at all. I would like to address something though. The Senior Center,. • r� • SPECIAL KENAI CITY COUNCIL MEETING MINUTES FEBRUARY 81 1995 PAGE 21 as I'm not only a resident, but I also am employed by the City of Kenai, is very happy to file for ,senior citizens, help them with their co-insurance. We do that on a regular basis all the time at. the Center and if they're having difficulty with that, we'd be happy to help them with it. And, actually follow it through.. If they have problems with insurance companies, we'll help them file appeals. So um, that should take care of dealing with older people, especially if they're having a problem taking care of the paperwork on that end of it after Charlie files with Medicare. We'd be happy to do that for them. And also, the idea of putting money, taking this money and putting it into a special fund. Even though it goes into the General Fund, um, I think we all need to remember that the salaries of all the Fire Department paramedics is all paid out of the General Fund. Is that correct? WILLIAMS: That's correct. PORTER: So even though it's going money is, in fact, going right back those are the comments I had, to the General Fund, ah, that into the Fire Department. So, WILLIAMS: Well, and as I mentioned earlier, and I would like to reiterate, we have set up a special, what we call the heavy Equipment Reserve Fund that we continually, every budget year, putting money into it specifically for the purpose of replacing equipment. The next ambulance that we buy, the newest ambulance - that we have is seven years old. Is it that old? It's hard to, believe that's seven years. The older ambulance is how old? BURNETT: Eleven years. WILLIAMS: Eleven years old. So the next ambulance we buy is going to cost 425,000. We can reach right into that reserve fund and pull that $125,000 out, whether we need to take out or pay for it. Because it's a strange thing that these companies that sell cities equipment. They expect us to pay for it right now. They don't want to wait around for the money. So, we have to reach right in there and grab the money and pay for it. So it's, it's going to come right out of that heavy equipment and we'll just keep funding that fund and buy what we have to . Okay, more comments Mr. Doyle? You were here a little late this evening. SPECIAL KENAI CITY COUNCIL MEETING MINUTES FEBRUARY 8, 1995 PAGE 22 DOYLE: Yes I was and I wish I hadn't been because I'd have liked to have presentation and to ah make a few comments on it. What I did hear, it sounds like I'm going to be kind of the only one that's ah, maybe not in favor of this. I'm not in favor of the charges on here. I don't ah, at this time anyway. Two reasons that I'm not ah, I think it should be left as it is. I think the benefits to the city, as far as the public relations, they're going to be a lot better the way it is than if you have a big bill out there that a lot of people can't pay. A lot of people won't pay. It's probably going to be worse than water and sewer assessment bills and things like that. We went through the billing on the Fire Department years ago. It didn't work then. Things, I sure, are a lot better now. I think that the ah, I think that the ah, feelings that is going to cause, with a big bill out there, when you're hurt and you're in the hospital and need a doctor, whatever the case is going to be, I think it's going to cause more damage than the few bucks that you can draw in on the, on the • ambulance fee. As far as the cost of the ambulance, that's what that money's in there for, Mr. Mayor. The ah, part of it anyway. The taxes have been paying this ambulance fee for, since we quit being a, a volunteer fire department. I also know that the fire ratings have come way down since it first started. When I first went on there it was a ten. And it's way down now. So anytime it comes down by, I don't what it comes down by, but I assume it comes down about ten percent, your fire insurance. Another part of the ah, all part of it as far as I'm concerned, the extra time, the expense for the Fire Department when they are out there on an ambulance call and I know it takes time when you get people in a car accident, or whatever the case may be, ah, injured people don't have the facilities sometime to know what's going on and give you the right information. If the wife happens to be there, or whoever it is, if your husband's been in an automobile accident, you sure don't want these guys trying to get information out of you. You're more worried about your husband, wife, whoever it might be. There are two or three other things. I kind of jumped around a little bit, but ah, you also know that the ah, expense on these ambulance and whatever is going up, is included in the tax base of 18 the City of Kenai for the last ten years. It's went way up. It all goes to pay it and this is all has been paid out of taxes all - these years, why, why has it got to be different now? Unless there's some reason for it if we're going backwards, well then . SPECIAL KENAI CITY COUNCIL MEETING MINUTES FEBRUARY 8, 1995 PAGE 23 that's something else to think about. But again, I wasn't here to hear the presentations so I don't know all those things. A couple of other things that I might throw in. If you do go ahead.... (TAPE CHANGE) ... one reason I think it would be better, put a flat rate in there of $150, maybe 200 bucks, something like that a flat call. At the same time, put an ad in the paper. Self, rescue cards to the people and anybody that wants to buy it for 50 • bucks. Sell 2,000 of them, you've got $100, 000 there. Believe me, you'll sell them. The first new ambulance the City of Kenai had was a 167 Cadillac. The volunteers bought it. We bought it selling rescue cards for five bucks a, five bucks per family. I know you could sell them for 50 bucks. There isn't anybody here, probably, that wouldn't pay 50 bucks for a rescue card for the, to cover the whole family. It would raise a bunch of money. It's just kind of a suggestion of one way of doing it and ah, I don't think the ah, the rates should be anywhere near as high as what they are. I don't deny it doesn't cost that much, but this is new, there's new money coming in. We're still being covered by the, by the tax base out there. Another thing that I am against, and that's making two different costs. A cost for the tourist and a cost for the local people. I don't agree, I don't agree with that at all. We want these tourists up here. That's what, that's what we've been trying_to draw, the City of Kenai's been trying to draw tourists for years. Why penalize them for being a tourist to come in or whatever the case may be. And probably, chances are it's going to be harder to collect from them anyway. I believe that probably covers it. I an against it. I would like to see it stay as it is. I wish I hadn't missed the presentation, but anyway, why, if there's any questions, I'll be glad answer. WILLIAMS: Thank you very much. Questions of Mr. Doyle. Thank you Jim. All right. Anyone else? Mrs. Waters, WATERS: I'm Barbara Waters. I reside at 311 Kulila in Kenai. Been here, since somebody said they've been here 30 years, I'll say I've been here '78, however that many might be now. Um, I'd like to thank Mr. Doyle for having the courage to say he'a not in favor. My husband I s not in favor and you' 11 notice he's not here with me tonight and that's because he said he'd rather not • SPECIAL KENAI CITY COUNCIL MEETING MINUTES FSHRUARY 81 1995 PAGE 24 risk the high blood pressure and stay home with our grandchildren. So that's where he is. So count him down as one opposed at least. Um. I have some comments on some of the comments that have been made and I hope you'll take them to heart and listen with ah, the same respect that I'm giving them as well. I appreciated what Mr. Gibson had to say about the 90 days for insurance and Medicaid/Medicare billing. I would request that if you do consider, and that is in regards to the ten percent penalty, if you do consider that 90 days for those who are insured, however they might be insured, I wish that you would give that same degree to those of us who are not insured for whatever reason. There are plenty of us out there who are not insured and that was discovered when the Borough started going through all of this a few years ago and ah, went through the health care forum, went through their ambulance fee forums. There are a number of people. It's not just those of us who are self-employed, but for whatever reason, there are a number of people and I forget the percentage, but it was quite high as I recall. About the people who reside within this Borough and this City who are under -insured or uninsured. I'm one of them for various reasons. I wish you would listen very carefully. There have been a lot of concerns about putting the funds into the General Fund. There should be some red flags here people. With all due respect, why are we concerned that the money should be put, should not be put into the General Fund. So, I think, that if the money is, and I think it probably will be put into the General Fund, that you would be very careful upon using that money as I'm sure you are with all of our funds that are put into the General Fund. But there is a lot of concern out here. It's coming from somewhere. So you tell me. I have no idea. But why is that, that most of the comments we heard tonight said, "I don't think it should be into the General Fund. I think it should be put into a special fund for the Fire Department or whatever." Ah, one thing that I was concerned about, and I wrote it down at. the time, someone said, and I believe, forgive me if I'm wrong, but it was the Chief who said the ambulance personnel will capture the info on insurance. Ah. I don't recall who said that, but you did say that there will be three paramedics with ah, a patient on transport. One driving, two in the back with the patient. Is that correct? r] SPECIAL KENAI CITY COUNCIL MEETING MINUTES FEBRUARY S, 1995 PAGE 25 BURNETT: It depends on the type of injury. WATERS: But those were the figures that you did give . And so I'm wondering when I heard that, it really set off bells, ambulance personnel will capture the info on insurance, perhap was Charlie who said that, I don't recall. But, the reasoi concerns me is, gosh, I'd sure rather they'd be taking temperature and taking my vitals instead of worrying about, fins out if Barbara is insured. She's not. Mark it down guys. if Ism - insured, if somebody's going to pay my bill, I will. I've lived here for a number of years. I've never escaped on any of my bills. We've gone through braces, we've gone through broken bones, we've gone through a number of things. Emergency or otherwise and we have always, always paid. It may be ten dollars a month. Or twenty dollars a month. But you're going to get your money. And that was why I' d like to see what Mr. Gibson said about the 90 days applying to a ten percent interest fee. Because I may not be able to come up with, well, I know I can't come up with 1500 bucks tomorrow unless I call in all of the markers that are out there. Um, I think is coming for user fees. I sure hate to see it, but I think it's there. You play, you pay. They started that at the School District a number of years ago. Ah, there've been a number of complaints about that. So. I guess we're looking at if I ride,. I pay too. I will say, I'm very thankful I've never had to use the Fire Department for ambulance fees. We did have a minor fire in 192 at our home and ah, we did have to have the Fire Department out and I was thankful that they were there and that we were close enough that they got there. And ah, that brings up another concern. What's next? Fire calls, police calls... WILLIAMS: No, but we do have an awful lot of concerns about animal control. WATERS: Well, yes, and I spoken about Mr. Godek about that. He's always on call and I have to say, kudos to the man. If you don't give them to him, please do. I do constantly because he's always been there when my kids have needed them when they've been chased by a dog. But that's a totally different subject. But is a. serious subject when you think about are fire calls next? Are we going to start charging for fire calls? If your house only has smoke damage,, are we only going to charge you $ 3 2 5 , but if it burns SPECIAL KENAI CITY COUNCIL MEETING MINUTES FEBRUARY S. 1995 PAGE 26 to the ground, sucker, you've got 1500 bucks coming in your mailbox bill. That's quite facetious and it's meant to be, it's meant.to be. But I think that the concern is there. My major concern is the money going in to the General Fund. I think the concern is there with a lot of people. if you put it into the General Fund, please use it wisely because not only I, but a number of other peoplti are watching. And, I said I'd be here tonight with bells on. I forgot my bells. I apologize. Thank you very much. WILLIAMS: With regards to fire. There's been some comments here about the fire station always seems to get what they want. Ah, as I said here earlier, we've prided ourselves on the fact that we have a good service here. We've always maintained and funded that. fire department. This year alone to the tune of better than three- quarters of a million dollars in new equipment which we managed to get and paid for in cash, let me say the City did without having to, you know,,- worry about where we were going to get the money. We've been very fortunate in that respect. The result in investing better than three-quarters of a million dollars in our fire department this year is that there is a very good potential for lowering the fire rating within the city again. Jim had talked about the days when it was a rating of ten. I remember those days too. Generally speaking, across the City we're setting at a five, I believe, now. We have every hope to bringing it down to a four. That, in itself, is a tremendous savings to the taxpayer who owns his home and is insuring it. A tremendous savings in fire insurance costs. So, what we're really saying here is that we're trying to keep the best departments on the Peninsula going up to full speed and we're not going to let them backslide. We want to make sure that they're funded properly and that the proper equipment is there when it's needed. So, when you say we're going to do that. With regard to the number of people without insurance. As I recall my figures correctly, nationally the average is about 17%. Locally, through the research that was done by the Borough, I believe it hit 19% of people who are uninsured. And that was one. of the reasons that prompted to pick the figure 20% as a known fact that we would probably have to write off 20% of the calls made because there won't be funding to cover it. And I think, think that we've looked at that as well. So, the City of Kenai definitely is not going to the position of being the masked SPECIAL KENAI CITY COUNCIL MEETING MINUTES FEBRUARY 8, 1995 PAGE 27 collector of bills from old folks and children. We're not going out and robbing anybody from the money that they may or may not owe us. We're going to be fair across the board about this whole thing and I guess the biggest single factor that the City of Kenai is, we're growing. We've grown into quite a little metropolitan area, if you will. We kind of a just a small rendition of a big city in that there are 7,000 of us here within the City compared to when I came here with about eight or nine hundred. And there is about 25,000 who are directly dependent upon the services of our city. That intersection right out here by the Dairy Queen, by official figures of the State Highway Department, is the busiest intersection on the entire Kenai Peninsula. There's an average of about 15,000 cars a day go through that intersection. It's absolutely unbelievable. And let me tell you, some of them hit each other and it causes us some concern. But ah, those are all things that are leading. I look back over some of the old times like you guys and I say, gee I remember when we were pushing hard to make this place grow because we wanted to make it bigger. And now we've made it grow and it's bigger and now we've got to come along and catch up and pay the bills for getting there. But, I kind of like it the way it is. I liked it the way it used to be, but I think I kind of like it a little better the way it is now. I don't have to go to Anchorage to shop at Kmart, I know that. MONFOR: We got to shop there first, right? BANNOCK: Anchorage came here to shop at Kmart. BROWN: On the penalty, I'm not sold on the 45 days versus 90. But that's not the point really. Earlier I said and I'll stand by this that I only intend to assess the penalty in extreme cases, such as refusal to acknowledge the debt or refusal to cooperate in any payment method at all. So it isn't the time period. If they're, if they say they need two years to pay it and all they can pay is 50 bucks a month or something, they're not going to get hit with a penalty to begin with. So, I don't, I don't that's a big issue. WILLIAMS: In answer to one more question. A question that seems to be filtering through the group about concerns of it going into the General Fund. There are seven people setting at this table who are elected by the people of this city. One of the reasons we were all elected is because we're concerned about what goes through that General Fund. I set up here at this table night after night concerned about that General Fund and as can be shown from the charts that I showed earlier this evening, we have controlled that SPECIAL KENAI CITY COUNCIL MEETING MINUTES FEBRUARY 8, 1995 PAGE 28 General Fund. Wee have controlled the budget of this. city and we have controlled the mil rate of this city, and, and, I really have to say to the Administration and the rest of the Council, I Personally think we've done a darn good job.. Cause it's remained flat and it's remained stable. Even in. the face of catastrophic failure of the economic system and growth on the other hand. So, we are concerned. We are the elected officials of this city and you folks elected us and that's one of the jobs we're here to do, to watch that General Fund. Further comments from Council? Further comments from the community? Councilwoman Monfor, H-i(a). Council Discussion MONFOR: Mr. Mayor, I, I appreciate the people who came forward and spoke tonight, whether they were pro or con because I came to this, meeting with a fairly open mind about the new fee system, how it would be approached by not only the Finance Department, but by the Chief and his staff and I think that everybody that spoke, either for or against, brought very valid points that make you stop and think. This is an issue that, I'm sure all of you are aware, has been before us for a, actually a number of years, and I find that it doesn't come easy to, to institute fees like this. But reality,_ . . like Mrs. Waters said, is, you don't get a free ride anymore. The time is coming where we'll be paying for many.things. I certainly hope it won't be to call the Fire Department to put our fires out or the police to come, if somebody's breaking into our house. We are the city now, between two entities, Nikiski, which charges a flat fee, and CBS which has aerate and I had two'calialfrom CBS members that thought that this was an excellent idea. That we would all be, at least somewhat, equal and I didn't have any calls against this and I had a total of five calls and everybody was in some support. But everybody that I talked to, except the two CBS people, actually did have concerns and comments about either the fee schedule or how were, going to do the biliing. _ think that it's going to be something, whenever you go into anything now it will be your mistakes and by doing it. But, I.'11 tell you what, if anything ever happens to me, I sure hope it happens in the City of Kenai where these guys can save my life. • SPECIAL KENAI CITY COUNCIL M1R8TING MIMUTEB FEBRUARY 81 1995 PAGE 29 BANNOCK: I too would like to thank the people who came out tonight and..those that spoke. I would like to re -visit something that we, touched on briefly though in regards to the memo from tonight versus the original one where we struck the Level One fee of $100. Looking at the one from tonight, the entry level fee, I'll call it, is $325 for a Level One of basic life support. What did we do with the old Level One of transport? Did it, is it now $325 or did 'it go away? Um, because I'm from the concern on the abuse side of the ambulance where we were talking about the stubbed incident. Ah, did that, does that mean that one's still going to be a freebie or that one went to $325? MANNINEN: It went to $325. BANNOCK: Okay. So, regardless of anything less than basic life support still is basic life support. Thank you. WILLIAMS: Yes. Councilman Smalley? SMALLEY: Again, I appreciate the folks too that spoke this evening. Ah, I, I have to say right now to this body, I, I'm along with Mr. Doyle. Abs, I have insurance coverage.' I've had it forever. Ah, I can afford it as probably, probably 60 to 70% of ,the users that would use the service have. Ah, but on the other hand, times are changing and this body, this community has to look and see what's happening. Ah, if a fee is established, and, and I'll come straight forward, I particularly like the Mat -Su Borough's fee rate. To me, -that seems to be, that we have on our schedule here. To me, it seems more realistic. I would go on and make sure that we would add a standby fee if that's something that we want to consider, and under the special rescue section, ah, that. would be our technical rescue. And I'd put that at 350. Ah, I, I think the fees are, the suggested ones, are a tad bit high. I know when my son was picked up over on K-Beach it cost right around three hundred dollars. It was all paid by the insurance and, and I was very thankful that they were there. And,,, I agree with Councilwoman Monfor. If anything that happens to me or anybody that I know, or anybody else .out there, if they ever have problems, I hope it's in this town because they are going to get the services and the treatment ah, that's second to hone. Ah, it's number one and that's kind of where I an. WILLIAMS: Th ank you. Any further comment? Councilman Bookey. SPECIAL KENAI CITY COUNCIL MEETING MINUTES FEBRUARY 8, 1995 PAGE 30 BOOKEY: Thank you. i came in here this evening feeling not knowing which way to go. I, I was very strongly opposed to this when we talked about this in a work session several months ago. I insisted that the least that we do is have this public heating tonight. I, under certain circumstances, I have to go along with Mr. Doyle. And on the other hand, I have to go along with Mr. Meeks. We have declining revenues. We have the situations out there where, sooner or later, the City of Kenai's going to have to take the responsibilities upon themselves and do things for themselves because we're not going to be able to get them from the State and we're not going to be able to get them from the federal government. So, on one hand I'm saying to myself tonight, yes we need a fee. On the other hand, I agree with Mr. Doyle that this city has grown. I've been here 33 years. I've seen the town come from no ambulance to the fire department we have today. Ah, and I believe that it's a service that is viable and needed by everybody and it should be entitled to everybody. I would never want to see anybody ever have to make that decision on the phone to themselves that was a responsible citizen, that says, "I don't want to call that service because I can't afford it." Ah, so I would, if, if we do institute a fee, I want to be sure that everybody in this city understands that, that if they need it, they can call and they can go. Ah, I like Mr. Smalley's ah, proposal. I don't agree with our rates here tonight at all. Ah, I'm glad that this does not include the double standard of the citizens living in or out of the city because we have developed a, a core area in Kenai for retail that the City of Kenai has tried, tried and tried for years to build. I think it would be detrimental to that. Ah, so, in support of this tonight, I would support Mr. Smalley and that's as far as I would go. Thank you. WILLIAMS: Further comments from Council? Councilman Smalley, SMALLEY: I have a question. Working at the high school and taking. football season, there's a standard rule that the football will not be kicked off unless there's an ambulance there. When we've 4D postponed the start-up of games and there's been no fee, obviously, ah, how is this going to change? I know once an ambulance can be called and, and sent out on a call and returned when there's generally a medical technician of some type of training, a doctor, SPECIAL KENAI CITY COUNCIL 1KEETING MINUTES FEBRUARY 8, 1995 PAGE 31 nurse, etc., paramedic, or whatever, generally on the field. But what I s going to happen with schools that would be in Kenai required to have an ambulance there? BURNETT: Well, I think that's where the standby fee comes into play. I know that Emergency Services does charge a standby fee. I don't know that they've been standby at the This also can be set, I believe, by the Council too. SMALLEY: That would probably have to be, probably in the district budget too as well because I would imagine they have those budget items already proposed for Skyview, So -Hi or Nikiski. I, I don't know. We have a School Board member here, but, ah, it would probably have to be something to be established. WILLIAMS: My personal opinion about this. It's an area I haven't conferred with the Administration about, but I, 1 think that we could probably continue our present practice of supporting the Kenai Central High School on the same level we have been without a fee ah for now. I notice ah, here the other day, our manpower situation is stretched, this winter, to a point where when our guys, are out uncovering fire plugs, they take the ambulance with them so they can respond immediately to a medical situation. So. I think that ah, when you have the guys on board the ambulance and it's right there and we, if necessary, could respond from the field to an immediate need for the ambulance and get back is a part of the overall community policy. We probably shouldn't involve ourselves worrying about a standby fee at the high school. Is that a consensus of council? okay. I see Mr. Bannock thinking deeply. BANNOCK: Well, I, I, just don't know. I don't, 1 certainly don't have a problem with not charging a standby fee at a high school football game, but I don't know that if that, in what other circumstance ... could you give me another example of a circumstance where a standby fee would come into play? MANNINEN: I think that's why they could be standing at the station and, and not charging ah, ah, unless they rolled and unless they, they carry somebody to the hospital. SNALLEY: Air, airport transportation probably would be standby hospital to the airport. Standby. BOOKEY: What, are we going to charge then if we don't dispatch? On a standby? 6' SPECIAL KENAI CITY COUNCIL MEETING MINUTES FEBRUARY 8, 1995 PAGE 32 MANNINEN: I don't understand, BOOKEY: If, if somebody puts the system on a standby because of an aircraft coming in, ah, and then they don't respond, are we going. to charge standby then, too? BURNETT: The way the schedule's set up, it's strictly a charge only if we transport, see. And that's where standby at the high school or standby at the airport really is not addressed at this point. MEASLES: Right now there's no proposal for a standby fee in the proposal that's before us. SMALLEY., No. MANNINEN: Correct. It's only if we transport. MEASLES: And this is only for transport so unless you crawl in or get carried into that ambulance and moved from that location, you don't pay. BANNOCK: I don't have a problem with that idea at all. But, if we were talking about that, I just didn't understand, in what scenario, who would be charged for a standby. fee that the high school wouldn't be charged for a standby' fee. Again, as Mr. Measles pointed out, we're not discussing standby fees tonight. MEASLES: If we did have h standby fee, it maybe applicable in the case that was mentioned earlier about if one of our people was required to accompany a patient on an air-evac to Anchorage where he's not in the ambulance. He's in an airplane with a patient. That.... BANNOCK: So, that would be the technician, not, not.the ambulance itself. MEASLES: Right. BANNOCK: Got it. Okay. Thank you. MANNINEN: Some, some of the staff's discussion on this ah, with the Mayor and others as we were developing these rates, ah, revolved around what is a third party called. And there was SPECIAL KENAI CITY COUNCIL MEETING MINUTES FEBRUARY 8, 1995 PAGE 33 response, but there was no transport. The bottom line is if there is no transport, there is no bill. That would also apply for a standby fee. WILLIAMS: And in the early days of this, we may wind up finding ourselves responding to and reminding them that there's a fee and they might say, "Oh, well, if that's the case, I'll take myself." BANNOCK: Call a cab. WILLIAMS: All right. Council, you have before you a proposed change in our thinking in the form of a memorandum from the Chief to the City Manager with today's date. Therein is laid out the proposed fee schedule, proposed revenues. Keep in mind that ah, there is a proposed 20% loss factored here. Review it. Open it up for discussion. The Chair will ah, at any time, entertain a motion. All right. In conferring with the City Manager and the ah, City Attorney, then, a motion at this time is not needed. You may merely direct the Administration, who has the authority to set the fee, bring us a fee schedule at the next meeting, ah, and, or at whatever meeting you so choose. And then, if you have no concerns with the fee, no action is required. If you have concerns with the fee, you will` direct those concerns to the Administration. Councilman Smalley, SMALLEY: Then a motion is not needed, but... WILLIAMS: No. SMALLEY: ...I guess one of my suggestions, my concern was I would like to see us potentially look at Level One at $100, Two and Three at $200, and Level Four at $350. BOOKEY: And I would concur with that wholeheartedly. WILLIAMS: Okay. We have two councilpeople that would like to. see: the fee structure change to, opinion of the other Council? Councilman Measles. MEASLES: I disagree with that, some adjustment to it, but we with it if we do. that change. They may need to make certainly don't need to go that far • • SPECIAL KENAI CITY COUNCIL MEETING MINUTES FEBRUARY s, 1995 PAGE 34 WILLIAMS: I agree that ah, I don't believe that we should cut back on the fee as proposed. proposed I, I'm comfortable with the fee as here tonight. Any other comments of the Council? Councilman Bannock. BANNOCK: My only comment would be, if, if there's some cutbacks that need to be wade, I'd like to them apply only to Three and Four cause I'm real good with One and Two. WILLIAMS: Okay. What we might ask the Administration to do is bring back some fee schedules based on the conversation proposed this evening and the Council will act on it or will not act whatever they choose to do at the next meeting. Ah, with regard to the next meeting, I'm going to ask that Vice Mayor Measles to chair that meeting, since I will be out of state. So You'll have six members of the council. Yes, Councilwoman Monfor... MONFOR: Mayor, let's wait until that first meeting in March when You're back. WILLIAMS: All right. BOOKEY: I would, I would like to see if we're going to do thatf wait until the first meeting in April. MONFOR: Oh, that's right, you're going to be gone. SMALLEY: Cause he's gone. WILLIAMS: Okay. All right. MONFOR: And I would concur with um, I think it was Councilman Bannock, to look at Level Three and Level Four. WILLIAMS: Okay. All right, it's the desire of the Council then to have the Administration bring back three separate fee schedules. One that includes a fee based on the fi es that Councilman Smalley proposed. One based on the fee sch dule that Co ncilman Ah Bannock has proposed. And one based on the present fee schedule. MONFOR: And one other question. I haven't seen it in here, so I want to make sure that I'm clear on this. Residents and non- residents are all treated equally. Right? SMALLEY: Correct. • SPECIAL KBNAI CITY COUNCIL 148ffiTING MINUTES FEBRUAI2Y 8, 1995 PAGE 35 WILLIAMS: Yes. All right. And it's also the desire of the Council to have this come before Council the first meeting in April which will be April the fifth. April the fifth. By that, to ah the Finance Director will that schedule for the budget work sessions. BROWN: Ohhhh, I don't think we bring it tp fifth. o Council quite by April WILLIAMS: We'll have a schedule. We should have a schedule... BROWN: Oh, that's done. I just, I just haven't given it to you. Yeah. WILLIAMS: Okay. Good. toMONFOR: Mr. Mayor? WILLIAMS: Yes. MONFOR: If, on April fifth, if we come to consensus, does this have to wait thirty days or can it be, is this something that can be instituted immediately? I think my concern is, I don't want it instituted like June first, or May first, or sometime when all of a sudden tourists start coming in and it looks like, Ahat We have a captured audience! That... BANNOCK: And it probably wouldn't be a bad idea anyway... WILLIAMS: When the city manager sets the fee, he can also set the date subject to revocation of Council. That's not subject. to approval, but subject to revocation of Council. MANNINEN: The January 18th memo scheduled the fee starting on April Fool's Day... ZTXH C: o_aR r WILLIAMS: All right, It appears As though we've covered our business then for this evening. Do I see any further business to come before the Council? SPECIAL KENAI CITY COUNCIL MEETING MINUTES FEBRUARY S, 1995 PAGE 36 Seeing no further, business to come before the Council, this meeting is.adjourned. (Meeting adjourned at approximately 9:29 p.m.) Minutes transcribed bv: ON APPROVED BY COUNCIL JzAr DATE