WHEREAS municipalities are responsible for the provision of ambulance service and must finance that responsibility in a cost efficient and sustainable manner;AND WHEREAS the Government of Alberta is a very significant “user” of ambulance services through the clients of its social programs, notably senior citizens and those on social assistance; AND WHEREAS the provincial government makes no contribution to ambulance service, other than as a “user” through the payment for services rendered to its clients;AND WHEREAS Blue Cross should have no role other than to administer payment for ambulance service on behalf of clients, including but not limited to the provincial government;AND WHEREAS the current unilateral positions taken by the provincial government and its agent, Blue Cross, regarding ambulance rates and the provision of direct billing privileges are placing a significant and unfair burden on municipalities which fund and deliver ambulance services;

THEREFORE BE IT RESOLVED that the Alberta Association of Municipal Districts and Counties urge the Government of Alberta to: advise Blue Cross that its continued role as administrator for the claims of provincial government clients is contingent on the direct billing service being provided to all Blue Cross clients requiring ambulance services, regardless of the rate structure of the ambulance service in question and its utilization of “extra billing”, and establish a multi-stakeholder committee with the power to negotiate appropriate ambulance rates for provincial government clients in a timely fashion and on an annual basis, ensuring that all stakeholders are fairly represented but giving veto power to none.

What is the history behind ambulance fees and the provincial government?A major portion of the users of municipal ambulance services have their ambulance expenses covered by the provincial government through its social programs. These include seniors and those on social assistance. From 1992 to 1997, the Province froze ambulance fees for these social program clients. The rates established in 1992 were already below the cost of service delivery as reflected in an Ambulance Operators survey completed in 1991. As time progressed, inflation and the costs associated with provincially imposed regulations added significant additional costs. Rates were raised by 3% in 1998 and a further 3% in 1999. However, the rates are still substantively below the costs of providing the service in most municipalities.Both the level of compensation set by the provincial government and the unilateral and unpredictable fashion in which those rates are set have caused increasing difficulty for municipalities as they struggle to maintain service levels to all clients. Municipalities have, in fact, been increasingly subsidizing the social programs, which are the responsibility of the Province. Inevitably, other municipal services have had to suffer.There is rapidly increasing concern among municipalities that the burden of subsidizing provincial government clients will result in deterioration in the standard of care offered or the sustainability of the service itself. The issue is further complicated by the role played by Blue Cross, the insurance company which administers ambulance coverage for the provincial government.Who is Alberta Blue Cross and why are we asking the Province to get involved?Alberta Blue Cross is an independent insurer providing insurance coverage for many medically related expenses. Its clients include many Albertans (i.e. private citizens, employers and the Province of Alberta) who pay premiums to Alberta Blue Cross. Alberta Blue Cross is the Provinces agent, contracted to administer payment for the clients of provincial social programs.Blue Cross allows ambulance providers to bill services directly to them, rather than billing clients who then must seek reimbursement. Direct billing allows for greater convenience to the client and the service provider and is also common practice with other medical service providers. However, ambulance service providers must adopt Blue Cross specified rates in order to maintain this direct billing arrangement. The rate is unilaterally determined without reference to the cost of that service and providers are not allowed to “extra bill” in order to meet their costs. Further, Blue Cross insists this must be followed for all of its clients — private citizens, employers and the Provinces social program clients. The rate for provincially funded clients is unilaterally set by the provincial government.There is no legal restriction on the ability of an ambulance provider to set its own rates and charge the additional “uninsured” amount directly to the client. In fact, other service providers, such as dentists, do this on a regular basis without interference from Blue Cross. The provincial government has stated that “municipalities have the authority to establish ambulance services, the level of service and the rates they charge for service”. However, Blue Cross uses its direct billing arrangements as a tactic to discourage ambulance providers from extra billing. The provincial government has given its tacit approval by failing to intervene in what providers regard as the unfair business practice of its agent. The result for most municipal ambulance providers is heavy subsidization of all Blue Cross clients, including provincial government clients who represent a significant portion of the client load.So what can the Alberta Association of Municipal Districts and Counties do to change things?In 1997-1998, a group of municipalities and ambulance providers came together to seek a solution to the problems noted above. They prepared a report to the provincial government, met with the Minister of Health and, at his request, with the Ambulance Advisory and Appeal Committee.Despite numerous requests for a provincial response to the task force recommendations, there has been none. A much needed increase in ambulance rates for provincial government clients was included in the 1998 and 1999 budget, and a further increase is anticipated in both 2000 and 2001. However, there has been no response to the two key recommendations of the municipal task force. Blue Cross clients continue to be heavily subsidized and the provincial government continues to passively support Blue Cross position. Further, there is no guarantee that the gap between costs of service and provincially set rates will not increase significantly again in the future.This resolution calls for the Alberta Association of Municipal Districts and Counties members to urge the provincial government to take direct action to resolve the issues noted above, as follows:- require its agent, in this case Alberta Blue Cross, to provide the same administrative services (specifically direct billing) to all ambulance operators serving their clients, regardless of the rate structure implemented by that ambulance service to meet its business needs.- agree to establish a process of consultation and negotiation with all stakeholders to determine the rates paid for clients covered under its social programs. The municipal task force has recommended a committee appointed by the Minister of Health with representation from all stakeholders, each to be fairly represented but not hold veto power. The Committee would develop a mechanism where adjustments to emergency ground ambulance rates could be negotiated in a timely fashion, on an annual basis, to meet the needs of all stakeholders.We have graphs that show the history of rates for ALS and BLS response fees for emergency ground ambulance provision since 1989. The provincial rates have been adjusted to reflect a 3% increase per year from 1999-2001. Blue Cross rates have no adjustments for 2000 and 2001. The Position Paper rates have adjustments based on a yearly increase of 1.2% CPI for 1998-2001.