Sec. 21-23A. Emergency Medical Services Insurance Reimbursement Program.
Montgomery County, Md., Code § 21-23A (2026)
Sec. 21-23A. Emergency Medical Services Insurance Reimbursement Program.LinkCopy Citation
(a)
Obligation to Provide Service.
(1)
The Fire and Rescue Service must provide emergency medical services under applicable medical protocols to each individual without regard to the individual’s ability to pay.
(2)
Fire and Rescue Service personnel may only ask for information relating to an individual’s insurance coverage when it is reasonably necessary to provide transportation to an appropriate alternative destination, or to provide treatment in place.
(b)
Definitions. In this Section the following terms have the meanings indicated:
(1)
Alternative destination means a transport destination other than a hospital emergency department such as a behavioral health facility, primary care office, or urgent care.
(2)
Emergency medical services means medical care provided by the Fire and Rescue Service of an individual by ambulance or other Fire and Rescue Service vehicle used for a similar purpose. Emergency medical services does not include transportation of an individual under an agreement between the County and a health care facility.
(3)
Federal poverty guidelines means the applicable health care poverty guidelines published in the Federal Register or otherwise issued by the federal Department of Health and Human Services.
(4)
Fire and Rescue Service means the Montgomery County Fire and Rescue Service and includes each local fire and rescue department.
(5)
Out of pocket expenses means any co-payment, deductible, or uninsured portion of the cost of emergency medical services. Out of pocket expenses does not include funds recovered from a tortfeasor or their liability insurance.
(6)
Program means the Emergency Medical Services Insurance Reimbursement Program.
(7)
Treatment in place means medical treatment provided at the scene without transport and includes treatment provided in-person, via telehealth, or both.
(c)
Imposition of reimbursement. The County must impose a reimbursement charge for any emergency medical services provided in the County, and, unless prohibited by other law, outside the County under a mutual aid agreement.
(d)
Liability for Reimbursement. Subject to paragraph (e), each individual who receives emergency medical services is responsible for paying for the emergency medical services.
(e)
Hardship Waiver.
(1)
The Fire Chief must waive the emergency medical services reimbursement for any individual whose household income is at or below 300 percent of the federal poverty guidelines. An individual must request a waiver on a form approved by the Fire Chief.
(2)
The Fire Chief may deny a request for a waiver if the individual who claims financial hardship under this Section does not furnish all information required by the Fire Chief.
(f)
County Residents - Payment of Uninsured Portion of the Emergency Medical Services Reimbursement.
(1)
County residents must not be required to pay any out-of-pocket expense relating to any emergency medical services because residents are deemed to have paid any co-payment, deductible, or uninsured portion of the cost of emergency medical services through taxes paid to the County.
(2)
Tax revenues the County receives must be treated as payment, on behalf of County residents, of the balance of each resident’s portion of the emergency medical services charge that is not covered by the resident’s insurance.
(3)
The County Council must annually transfer from the General Fund to the Consolidated Fire Tax District Fund an amount that the Council estimates will not be covered by residents’ insurance as payment of all residents’ uninsured portion of the emergency medical services charge.
(g)
Restriction on Local Fire and Rescue Departments. A local fire and rescue department must not impose a separate charge for emergency medical services.
(h)
Use of Revenue.
(1)
Except for the transfer received from the General Fund under subsection (f), the revenues collected from the emergency medical services reimbursement must be used to supplement, and must not supplant, Fiscal Year 2013 expenditures appropriated in the annual operating budget resolution (not including any expenditures of revenue collected under this program in Fiscal Year 2013) for emergency medical services and other related fire and rescue services provided by the Fire and Rescue Service.
(2)
The Fire Chief must create a dedicated account in the fire fund for the revenues collected from reimbursements under this Program. This amount must only be used for increased or enhanced fire and rescue services above the level appropriated in Fiscal Year 2013, as provided in paragraph (1), including new field service positions related to expansion of 4 person staffing or opening of new fire stations; increased training classes or capacity; facility maintenance and repair; new or replacement apparatus, gear, or equipment. Not more than 30 percent of this account may be spent for personnel costs.
(3)
(A)
Fifteen percent of the net Emergency Medical Services Insurance Reimbursement Program revenue must be allocated under a procedure specified in the annual operating budget resolution for:
(i)
replacement or augmentation of apparatus used by one or more local fire and rescue departments;
(ii)
facilities used by one or more local fire and rescue departments;
(iii)
training for volunteers;
(iv)
gear and equipment for volunteers;
(v)
administrative staff, including administrative staff of the authorized LFRD representative, to support one or more local fire and rescue departments;
(vi)
volunteer recruitment and retention; and
(vii)
volunteer stand-by support.
(B)
Any administrative staff hired or retained by a local fire and rescue department or the authorized LFRD representative using revenue allocated under this Section is not a County employee or a member of the separate merit system referred to in Section 21-16(a).
(C)
The annual operating budget resolution under subparagraph (A) may require or authorize the distribution of revenue to either or both:
(i)
the authorized LFRD representative; and
(ii)
individual local fire and rescue departments.
(D)
The Executive may enter into one or more contracts on behalf of the County to effectuate the distribution of funds as specified under subparagraph (C).
(i)
Regulations; Reimbursement Schedule. The County Executive must adopt a regulation under method (2) to implement the emergency medical services reimbursement program. The regulation must establish a reimbursement schedule based on the cost of providing emergency medical services. The reimbursement schedule may include an annual automatic adjustment based on inflation, as measured by an index reasonably related to the cost of providing emergency medical services. The regulation may require each individual who receives emergency medical services to provide financial information, including all the individual’s insurance coverage, and to assign insurance benefits to the County.
(j)
Reporting. The Fire Chief must submit a report to the County Executive and County Council not later than January 1 and July 1 of each year regarding implementation of the Program. The report should include:
(1)
the number of calls for emergency medical services during the reporting period;
(2)
the number and type of emergency medical services provided during the reporting period; and
(3)
any other information relating to implementation of the Program that the County Executive or County Council request.
(k)
Patient Advocate. The Office of Consumer Protection must employ a Patient Advocate to:
(1)
develop and implement a program for customer service as a part of the Program;
(2)
develop and staff a help desk for questions regarding the Program; and
(3)
serve as a liaison with any vendor retained by the County to implement the Program to assure high quality customer service and prompt resolution of questions and concerns.
(l)
Outreach and Education Campaign. The County Executive must implement a public outreach and education campaign before and during implementation of the Program. This campaign should include:
(1)
informational mailers to County households;
(2)
distribution of information through County internet and web-based resources;
(3)
radio and television public service announcements;
(4)
news releases and news events;
(5)
information translated into Spanish, French, Chinese, Korean, Vietnamese, and other languages, as needed;
(6)
extensive use of County Cable Montgomery and other Public, Educational, and Government channels funded by the County;
(7)
posters and brochures made available at County events, on Ride-On buses and through Regional Service Centers, libraries, recreation facilities, senior centers, public schools, Montgomery College, health care providers, hospitals, clinics, and other venues; and
(8)
special outreach to senior and “New American” communities.
Sec. 3. Implementation. The County may collect the emergency medical services transport reimbursement authorized by County Code Section 21-23A, enacted by Section 1 of this Act, for any emergency medical services transport that occurs on or after July 1, 2012. The reimbursement may be collected retroactively to July 1, 2012, or any later date during the first fiscal year the emergency medical services transport reimbursement is implemented.
Sec. 4. Fire and Rescue Service Enhancements in Fiscal Year 2013. Subject to appropriation, the Council intends that, to the extent sufficient revenue is achieved, revenue generated by the Emergency Medical Services Transport Insurance Reimbursement Program authorized in County Code Section 21-23A, enacted in Section 1 of this Act, in Fiscal Year 2013 should be used to fund the following enhancements to the County Fire and Rescue Service in Fiscal Year 2013:
(a)
Service Restoration: Place one ladder truck in the first battalion back into service with dedicated 24- hour staffing.
(b)
Apparatus Replacement Funding: Buy one tractor drawn ladder truck, one Engine Company, and 5 EMS units for system unit response improvements.
(c)
Facility Maintenance and Improvements: Conduct a strategic facility assessment, develop a maintenance and improvement plan for all LFRD- and County-owned fire and rescue facilities and, to the extent possible based on available funding, begin initial maintenance and repairs to these facilities.
(d)
Training: Provide system training for career and volunteer personnel, including core fire, rescue, EMS, technical rescue, and driver training classes.
(e)
Fire and Rescue Equipment: Buy personal protective equipment, portable fire, rescue, technical rescue, and EMS equipment for career and volunteer personnel, the training academy, and operational units.