Authority fees to fund EMS discussed at AMED meeting

Handful of services adopt new funding method; AMED not considering such fee

During a recent discussion about a modest decrease in call volume for AMED and the fiscal challenges connected with the fee-for-service model that agencies like AMED use to fund operations, agency Executive Director Gary Watters pointed out that a handful of ambulance services in Pennsylvania have adopted a new funding method.

That method involves creation of an ambulance authority -- AMED is already an authority -- and the subsequent imposition of an operational readiness fee on property owners in the authority's service area, based on powers granted in the Pennsylvania Municipality Authorities Act, according to online sources.

Watters cautioned that AMED is not considering the adoption of such a fee.

Three ambulance authorities statewide have set up such a funding mechanism, with a fourth starting in January: Aston Ambulance Authority in Delaware County charges $96 a year for homeowners and $10 a year for each full-time equivalent employee of businesses; Municipal Emergency Services Authority of Lancaster County charges $85 per household; Indiana County Municipal Emergency Services Authority charges $100 for businesses with up to nine full-time-equivalent employees, $200 for businesses with 10 to 99 FTE and $500 for businesses with 100 or more FTE; while Alle-Kiski Emergency Services Authority in western Pennsylvania plans to charge $85 a year per household and $150 or more for businesses, depending on the number of employees, come Jan. 1, according to online sources.

The Municipalities Authorities Act enables the establishment of municipal authorities for making business improvements and for provision of administrative services, according to online sources.

Under the act, authorities can charge for those improvements or services, but only based on actual measurable benefits, according to online sources.

While the act gives authorities the power "to do a number of things, including the authority to provide water service, sewer service, and storm water management; the power to operate incinerator plants and landfills; and operate several kinds of public transportation networks," it doesn't explicitly give them the power to operate an ambulance service, according to an article by the CGA Law Firm of York.

The municipalities that have used the act for EMS cite the provision on "administrative services" -- those that "improve the ability of the commercial establishments of a district to serve the consumers, such as free or reduced-fee parking for customers, transportation repayments, public relations programs, group advertising and district maintenance and security services" -- a listing that clearly doesn't include EMS, putting the EMS use in a "gray" area, according to the law firm.

Lawmakers have begun to consider making the authorization for EMS funding explicit to eliminate that gray area, according to CGA.

CGA cites the "precipitous drop" in volunteerism as one of the reasons that ambulance services are struggling.

Watters of AMED cited the nature of fee-for-service funding, where the services provided are for situations which ideally don't occur often or at all.

No one wants and few generally expect to need an ambulance, but it's in the interest of the community for ambulance service to be available when needed, he said.

So it becomes an issue when the number of calls are down, according to Watters.

They're down by about 600 compared to last year, he said.

The same principle applies to the fire service.

No one wants houses or businesses to burn, but a fire department needs to be ready when a fire happens, he said.

The same principle also applies with public utilities like the Altoona Water Authority, which in recent years has resorted to devoting more and more of its customer charges to pay for making water service available -- rather than as compensation for the actual volume of water used. Increases in the "volumetric" charges over the years were hard to keep current, because the more the authority charged, the more customers conserved, creating a diminishing returns situation.

The state Department of Health, which includes the Bureau of Emergency Medical Services, "is aware of the financial challenges facing many EMS providers across the state, wrote department spokesman Neil Ruhland in an email.

"The Bureau does not favor any particular municipal funding mechanism over another, but recognizes the need for fiscal strategies to evolve to adequately fund EMS in our communities," Ruhland wrote.

In recent years, the levying of property fees has become a way "to provide a sustainable funding stream for ambulance services," he wrote.

Another potential funding mechanism currently available only to municipalities in Bucks, Delaware and Montgomery counties as part of a two-year pilot authorized by Act 54 of 2024 allows eligible municipalities to raise their tax limits from the old cap of 3 mills for fire and 0.5 mills for EMS to as high as 10 mills for fire and 5 mills for EMS without a local referendum, Ruhland wrote. Additional legislation would be needed to extend and make those powers permanent, he wrote.

In addition to the recent drop in call volume, AMED has had issues with both government and private insurers, and the agency routinely writes off uncollected debt.

Still, AMED has run an efficient service, which is why it has not had to look at the new fee model, Watters said.

"We're stable here now," he said.

Mirror Staff Writer William Kibler is at 814-949-7038.