a. In collecting the emergency medical services reimbursement authorized under Code Section 21-23A, the Fire Chief must comply with all applicable provisions of 42 CFR parts 410 and 414, Fee Schedule for Payment of Ambulance Services and Revisions to the Physician Certification Requirements for Coverage of Non- emergency Ambulance Services. b. The Fire Chief must impose the emergency medical services reimbursement according to the following schedule: i. $20.00 per mile, one way, from point of pick up to the health care facility; plus ii. • Basic Life Support - Non-Emergency* $700.00 • Basic Life Support - Emergency* $750.00 • Advanced Life Support - Level 1 - Non-Emergency* $850.00 • Advanced Life Support - Level 1 - Emergency* $900.00 • Advanced Life Support - Level 2* $1,200.00 • Specialty Care Transport* $1,500.00 • Mobile Integrated Health Visit $150.00 * The terms in the schedule are as defined in 42 CFR Parts 410 and 414. a. If required by the Fire Chief, each individual who receives emergency medical services must furnish to the County, or its designated agent: (i) information pertaining to the individual’s health insurer (or other applicable insurer); and (ii) financial information that the Fire Chief determines is necessary for determination of granting a waiver of the reimbursement. b. Each insured individual who receives emergency medical services must execute an assignment of benefits necessary to permit the County to submit a claim for the reimbursement to the applicable third-party payor. If a court of final appeal holds that any part of this regulation is invalid, that ruling does not alter the validity of other parts of the regulation. This regulation is effective on the date that the Council approves this regulation under Section 2A-15(f).