City Council Planning Sessions

1. City Council Planning Agenda Documents: 2016-02-08 CITY COUNCIL PLANNING AGENDA.PDF 2. City Council Planning Minutes Documents: 2016-02-08 CITY COUNCIL PLANNING MINUTES.PDF 3. City Council Planning EMS-Ambulance Service Fees Ps04 Documents: 2016-02-08 CITY COUNCIL PLANNING EMS-AMBULANCE SERVICE FEES PS04.PDF 4. City Council Planning Draft 2016-01-11 Minutes Ps02 Documents: 2016-02-08 CITY COUNCIL PLANNING DRAFT 2016-01-11 MINUTES PS02.PDF  WHEATON CITY COUNCIL PLANNING SESSION WHEATON CITY HALL – COUNCIL CHAMBERS 303 W. WESLEY STREET, WHEATON, ILLINOIS MONDAY, FEBRUARY 8, 2016 - 7:00 P.M. AGENDA I. Call to Order II. Approval of Minutes – January 11, 2016 III. Public Comment IV. EMS/Ambulance Service Fees V. City Council/Staff Comments VI. Adjournment During the Public Comment portion of the agenda, the presiding officer shall recognize any person requesting to be heard on any of the planning session agenda items only. Persons speaking during Public Comment shall not speak longer than three (3) minutes and shall be permitted to speak only once. Visitors must remain quiet and not engage in behavior that interferes with the Planning Session. The presiding officer may, or upon a majority vote of the council, request any visitor who violates any provision of this paragraph to leave the council chambers, and such visitor shall thereupon leave. Any person providing public comment shall address the presiding officer only and shall not proceed with remarks until recognized. When recognized, the person shall state his or her name and address. Cross floor discussions are prohibited. If a member of the City Council has questions of any person who has provided public comment, that person may address the specific question.  MEMORANDUM TO: Record FROM: Susan Bishel, Public Relations Coordinator SUBJECT: Feb. 8, 2016 City Council Planning Session Minutes DATE: Feb. 10, 2016 CC: Mayor and City Council, City Manager, City Clerk, Department Heads The Planning Session took place in the Council Chambers, Wheaton City Hall, 303 W. Wesley St., Wheaton, Illinois. Those attending the Planning Session included: Councilwoman Fitch, Councilman Prendiville, Councilman Rutledge, Councilman Saline, Councilman Scalzo and Councilman Suess. Mayor Gresk was absent. Also in attendance were City Manager Rose, Assistant City Manager Dzugan, Fire Chief Schultz, Director of Human Resources Duguay and Public Relations Coordinator Bishel. The session began at 7:00 p.m. and concluded at 7:22 p.m. The following items were discussed: I. Call to Order The Wheaton City Council Planning Session was called to order at 7:00 p.m. by Mayor Pro Tem Suess. II. Approval of Jan. 11, 2016 Planning Session Minutes The Council approved the Jan. 11, 2016 Planning Session Minutes. III. Public Comment There were no public comments. IV. EMS/Ambulance Service Fees Assistant City Manager Dzugan stated during the Council’s Jan. 11 discussion regarding emergency medical services and ambulance service fees, the Council requested more information. City staff looked at rate structures that would advance the current revenue/cost ratio from 70% to 100% using costs projected in the 2016-17 proposed budget. Assistant City Manager Dzugan summarized two options staff developed for the Council’s review. Option 1 provides a rate structure that would cover 100% of the estimated expenses. This option would not have a difference in cost of services for residents and nonresidents. Option 2 analyzed the rates Wheaton charges for EMS/ambulance service fees compared with rates of surrounding communities and estimated that charging a proposed “average” rate structure would cover approximately 90% of the program’s costs. Medical service level rates would differentiate between residents and nonresidents because local taxes would be necessary to fund part of EMS/ambulance services. Assistant City Manager Dzugan stated caps on Medicare/Medicaid reimbursement to the City and the difficulty collecting fees from users without insurance also affect the program’s costs. In response to Council questions, Assistant City Manager Dzugan stated approximately 40% of service calls are for nonresidents. Approximately 11% of residents served are uninsured, while approximately 39% of nonresidents are uninsured. In response to Council questions, City Manager Rose stated the contract for EMS/ambulance services was a competitive bidding process for a 3-year contract with a 2-year extension option. The bid selected was the lowest bidder. In response to Council questions, Fire Chief Schultz stated this contract includes an option to reduce staffing during very low call volume periods. However, this would mean that during these low call volume periods, only two of the City’s three fire stations would be staffed with ambulances, which could increase response times for some parts of the city. Some City Council members expressed concern with the significant increases for users in Option 1. The City Council expressed an interest in Option 2 so that the City is more in line with other communities in ambulance/EMS service charges while covering a greater percentage of the service costs. V. City Council/Staff Comments There were no City Council/staff comments. VI. Adjournment The meeting was adjourned at 7:22 p.m. 2/8/16 Planning Session 2  emorandum Michael G. Dzugan Assistant City Manager TO: Honorable Mayor and City Council DATE: February 5, 2016 SUBJECT: EMS/Ambulance Program Fees Update At the January ii, 2016 Planning Session, the City Council reviewed the staff’s January 6, 2016 rnernorandurn EMS/Ambulance Program Fees, attached as Appendix A. The City Council directed the staff to develop options for a rate increase that would advance the current revenue/cost ratio of 70% to a 100% ratio. The City Council was desirous of reviewing a rate structure that would therefore have revenues fund the cost of providing EMS/ambulance services. The proposed budget for fiscal year 2016/20 17 estimates total medical rescue expenses at $1,603,707. There are a few indirect costs not included in this amount such as a portion of the Chief’s salary, housing, and Du-Comm expenses. Based upon an analysis completed by Andres Medical Billing, subcontractor to Kurtz for billing ambulance service fees on behalf of the City, two options were developed for the City Council’s review Option 1 Option I provides a rate structure sufficient to cover the estimated fiscal year 20 16/2017 costs to provide medical rescue services. Provided below in Table 1 is the City’s current rate structure for the different medical service levels (BLS, ALS, and ALS2) and a proposed rate structure, based upon historical trends, that would be necessary to generate an estimated $1.6 million annually. The different medical service level rates do not differentiate between a resident and nonresident. Table 1 Resident Non-Resident Estimated BLS ALS ALS2 I mileage BLS I ALS ALS2 I mileage Revenue City’s Current Rate $444 $527 $763 $10 $700 $860 $1,000 $11 $1,200,000 Proposed Rate $1,000 $1,200 $1,500 $12 $1,000 $1,200 $1,500 $12 $1,640,000  Option 2 Option 2 provides a rate structure that is based upon the average rates from a Comparable Ambulance Rate Survey recentl.y conducted, attached as Appendix B. Table 2 shows the City’s current rate structure for the different medical service levels and a proposed “average” rate structure that would generate an estimated $1,432,000. The different medical service level rates do differentiate between a resident and nonresident given local taxes would be necessary to fund a portion of the medical rescue services. Option 2 would place the revenue/cost ratio at approximately 90%. Table 2 Resident Non-Resident Estimated BLS I ALS ALS2 mileage BLS I ALS I ALS2 mileage Revenue City’s Current Rate $444 $527 $763 $10 $700 $860 $1.000 $11 $1,200,000 Proposed Rate $655 $835 $1,022 $12 $820 $1,044 $1,255 $12 $1,432,000 Analysis Option I would raise sufficient revenue to cover the entire medical rescue expense as identified in the fiscal year 2016/2017 draft budget of $1.6 million; however, it would not cover some indirect cost such as Du-Comm, Chief salary, and housing. In reviewing the Comparable Ambulance Rate Survey, the rates suggested in Option 1 would place the City’s rates in the top tier of those rates assessed by others. Option 2 would raise revenue sufficient to cover expenses less $170,000. Because of the short fall there is a differential in rates for resident vs. nonresident, recognizing the short fall will be covered by local taxes. Option 2 places the City rates in the middle of those rates assessed by others. Although some of the individual rate increases in Option 1 are more than double, especially in the resident category, the rate structure does not translate to a doubling of total revenue. This is because a significant portion of our medical services are provided to Medicare and Medicaid patients, and to lesser degree patients without insurance. Medicare and Medicaid regulations restrict the amount of ambulance rates that are reimbursable under law, so regardless of the rate established by the City, the City will only receive the MedicarelMedicaid rate approved by the Federal Government. At the January 11, 2016 Planning Session, the City Council questioned the difference in the bill patient resident/non-resident gross charge category and amount collected (Figure 1, Fee Pay Distribution, staff’s January 6, 2016 memorandum). The reason for the low collection rate is that the bill patient category are those patients without insurance which industry-wide has a very low collection rate. Appendixes  ernorandum Michael G. Dzugan Assistant City Manager TO: The Honorable Mayor and City Council DATE:. JANUARY 6, 2016 SUBJECT: EMS/AMBULANCE PROGRAM FEES OBJECTIVE In anticipation of evaluating current EMS/ambulance service rates (“Fees”), review to confirm or revise current policy established to set Fees Fees should raise sufficient revenue — to fund 70% of the City’s EMS program costs. The City last increased Fees in May 2011. HISTORY/BACKGROUND In 1986, the City initiated a City funded ambulance program. At the program’s initiation, Fees were established based upon costs, and surveying fees of other local municipalities and fire protection districts. At some point prior to 2011, a policy was established to capture 50% of the program’s cost through Fees. In a review of Fees in 2011, the City Council established a policy that Fees should fund 70% of the City’s EMS program costs. The 70% revenue/cost ratio was established at the time to move closer to having the EMS program be funded more like an enterprise fund which provides for fees or charges to cover the total cost of a program or service, e.g., water and sewer funds. The City, through contract, invoices users of the EMS services based upon the type of service delivered, plus a mileage amount for the distance to the hospital (payment is made only when transported). The Fee structure is different for residents and non-residents, with non- residents assessed a higher Fee. The resident/non-resident Fee differential is rooted in the concept that residents are funding 30% of the cost of the EMS program through local taxes and therefore should be assessed a lesser Fee. There are also different Fees for the four types of medical service levels Advanced Life - Support (ALS), representing 60% of call volume; Basic Life Support (BLS), representing 22% of call volume; Non-Transport/Refusals, representing 16% of call volume; and Advanced Life Support II (ALS II) representing 1% of call volume. These four types of service levels match the Medicare/Medicaid Fee Schedule used by the federal government and insurance companies. Fee Pay Source Distribution Pay Sources of Fees are private insurance, patients, - Medicare, and Medicaid. Figure 1, Fee Pay Distribution, shows the gross charges and amount of revenue collected by the City for each of these Pay Sources in the 2014 calendar year. During 2014, which is very typical of the City’s collection history, the City collected 63% of the gross charges. Uncollected Fees are mainly attributed to Medicare and Medicaid regulations which restrict the amount of ambulance rates that are reimbursable under law. So regardless of the Fee established by the City, the City will only receive the Medicare ‘Medicaid rate approved by the federal government from those individuals qualified under Medicare/Medicaid. The Medicare/Medicaid rates are provided in Appendix A. Figure 1 Fee Pay Distribution Non Residut Mutual Aid I\on Resident Gross . . Mutual Aid Resident Gross Resident Gross Charges Collected Collected Charges Collected Charges Medicare $81,988 $40,131 $504,729 $401,139 $22,697 $14,007 Medkaid $86,711 $19,275 $143,490 $54,660 $6,334 $1,778 Prvateins. $257,938 $210,074 $341,330 $292,889 $17,761 $14,097 BillPatent $120,358 $21,745 $122,455 $20,950 $12,660 $1,262 TOTAL $546,995 $291,225 $1,112,004 $769,638 $59,452 $31,144 Revenue and Expenditure History n 2011 (FY 201 1-12), the City increased Fees with — the goal of funding at least 70% of the program’s costs through Fees. Figure 2, History Revenues/Expenditures, provides 10 years of history/of audited revenues, expenditures and the percentage of expenditures recouped. Figure 2 History Revenues/Expenditures Fiscal Year Revenues Expenditures % of Cost 2005-06 $686,417 $1,212,634 56.61% 2006-07 $667,441 $1,289,277 51.77% 2007-08 $665,088 $1,355,475 49.07% 2008-09 $771,898 $1,405,563 54.92% 2009-10 $890,188 $1,535,395 57.98% 2010-11 $890,118 $1,589,621 56.00% 2011-12 $1,128,668 $1,460,367 77.29% 2012-13 $1,097,546 $1,480,458 74.14% 2013-14 $1,060,776 $1,531,381 69.27% 2014-15 $1,209,184 $1,573,995 76.82% 2015-16 $1,100,000 (est.) $1,617,689 (est.) 67.99% Fee Survey Figure 3, Fee Survey, shows that the City’s Fees are below the average or — median fees charged by other municipalities especially in the Residents category. ALS calls make up sixty percent of call volume, the City’s current Resident ALS Fee is 50% less than the average and Non-Resident ALS Fee is 1 6°/a less than the average. 7  Figure 3 Fee Survey No RESIDENT BLS ALS ALS II Transport Mileage Average $624 $791 $971 $137 $11.20 Median $550 $700 $925 $100 $10 Wheaton. $444 $527 $763 $75 $10 NON-RESiDENTS No NONRESIDENT BLS ALS. ALS H Transport Mileage Average $790 $995 $1,189 $194 $11.90 Median $797 $970 $1,150 $162 $10.25 Wheaton $700 $860 $1,000 $150 $11.00 Data is from Andre’s Medical, June 24, 2015, who provides collection services/or a number ofmunicipa/ entities and provides collection for the City as a subcontractor to Kurtz. A detailed list oft/ic municipalities included in the survey is provided i)i AppeiidLi B. ANALYISIS/RECOMMENDATION The City last increased EMS/ambulance service rates (Fees) in 2011. The City Council’s current policy regarding Fees, raise sufficient revenue to fund 70% of the City’s EMS/ambulance program costs, has been achieved since increasing Fees in 2011. Currently, it is estimated for the 2015-16 fiscal year the established ratio will be met. However, when the City’s Fees are compared to other municipal Fees within the area, the City’s Fees are below the average or median, and in the case of Resident Fees are significantly below in all three major categories (BLS, ALS, ALS II). Using the 70% revenue/cost ratio places a funding demand on General Fund revenues to cover the difference. Over the last few fiscal years, this difference has been over $400,000. It may be appropriate to consider establishing a higher revenue/cost ratio in an effort to reduce the revenue demand on the General Fund to fund this difference. The City Council may want to consider establishing the ratio at 100%, so the EMS program would be operated like a true enterprise fund similar to the City’s water and sewer funds. The Staff believes a fee structure could be developed to achieve the 100% ratio. Since there are a number of factors that affect Fee revenue (maximum Medicare/Medicaid approved rates being most significant), the Staff would provide further analysis with the 100% ratio being the goal and presenting fee structure options to the City Council within 60 days. 3  APPENDIX A Medicare Ambulance Fee Schedul:e 2015 Maxirnum Allowable Amounts) IL - Locality 15 - Urban code Service Description Rate Effective Date - — —r- F . [ Ground mileage, per A0425 Mileage statute mile $7.27 1/1/2015 Ambulance service, j advanced Life support, emergency transport, level A0427 — ALS I - Emergency 1 $446.66 1/1/2015 Ambulance service, basic Life support, emergency A0429 BLS Emergency - transport $376.13 1/1/2015 Advanced life support, level A0433 ALS II 2 _: $646.48 1/1/2015 Medicaid Ambulance Fee Schedule 2015 (Maximum Allowable Amounts) DuPage County Code Service Description Rate Effective Date Ground mileage, per A0425 Mileage statute mile $2.63 7/1/2015 Ambulance service, advanced life support, emergency transport, level I A0427 ALS I - Emergency - 1 $180.71 7/1/2015 Ambulance service, basic life support, emergency A0429 BLS Emergency - transport $111.48 7/1/2015 Advanced life support, level A0433 ALS Il 2 — $180.71 7/1/2015 4  COMPARABLE AMBULANCE RATES APPENDIX B RES!PENTS NON-RESIDENTS No Transport BLS ALS ALS2 Milage No Transport bepartmentlOtgafli2atiofl BLS ALS ALS2 Milage $1,275.00 $1,650.00 $2,100.00 $16.00 (-) $1,275.00 $1,650.00 $2,100.00 $16.00 (-) Addison FED $15.00 (-) $850.00 $1,100.00 $13.00 $850.00 $1,200.00 $1,700.00 Bloomingdale FPD $650.00 $175.00 $700.00 $8.50 $650.00 $750.00 $925.00 $8.50 Buffalo Grove FD $475.00 $550.00 $1,400.00 $16.00 $800.00 $1,200.00 $1,400.00 $16.00 (-) Carol Stream PD $800.00 $1,200.00 $523.00 $697.00 $753.00 $9.75 (-) $635.00 $872.00 $928.00 $9.75 (-) Downers Grove PD $13.45 (-) $660.00 $947.00 $8.49 (-) j $821.00 $929.00 $1,225.00 lk Grove Village PD $551.00 $16.00 25-150 $1,250.00 $16.00 25-150 $850.00 $1,250.00 $1,350.00 Elmhurst PD $750.00 $1,150.00 $18.00 100-150 $904.00 $962.00 $15.00 50-1 00 $910.00 $1,200.00 $1,400.00 Glen Ellyn PD $725.00 $10.25 $400.00 $975.00 $10.25 $200.00 $625.00 $725.00 $975.00 Hanover Park PD $625.00 $725.00 $485.16 $576.13 $833.87 $9.50 () $776.26 $921.81 $1,334.20 $9.50 (-) Hoffman Estates PD $15.00 $200.00 $700.00 $900.00 $15.00 $100.00 $800.00 $1,100.00 $1,300.00 LisIeWoodridge FPD $500.00 $11.00 $120.00 $580.00 $700.00 $10.00 $110.00 $750.00 $970.00 $1,100.00 Lombard Pb $440.00 $8.28 $100.00 $94480 $8.28 $100.00 $817.28 $944.80 $1,130.30 Naperville PD $562.25 $689.78 $700.00 $800.00 $10.00 (-) $650.00 $800.00 $900.00 $10.00 (-) Oak Brook FD $550.00 $700.00 $950.00 $15.00 C-) $650.00 $950.00 $1,150.00 $15.00 (-) Patk Ridge PD $500.00 $100.00 $10.00 $100.00 $825.00 $1,000.00 $1,150.00 $10.00 St. Charles PD $615.00 $800.00 $925.00 $840.00 $1,120.00 $1,330.00 $9.62 $100.00 Wartenville, Pb $532.00 $67200 $910.00 $9.62 $100.00 $100.00 iöö $1,000.00 $1,200.00 $10.00 $100.00 West Chicago, PPD $650.00 $800.00 $1,000.00 $10.00 $1,250.00 $1,250.00 $1,250.00 $10.00 $300.00 Winfield FPD $1,250.00 $1,250.00 $1,250.00 $10.00 $300.00 $138.75 $819.71 $1,043.82 $1,255.13 $12.18 $177.22 Average $655.71 $834.42 $1,021.09 $11.60 $100.00 $800.00 $1,000.00 $1,225.00 $10.25 $120.00 Median $562.25 $70000• $947.00 $10.00 $700.00 $860.00 $1,000.00 $11.00 $150.00 WheatOn FD .00 $21.øO $ QQ....$.iP& . NOTE: St. Charles rates include Geneva and Batavia  MEMORANDUM TO: Record FROM: Susan Bishel, Public Relations Coordinator SUBJECT: Jan. 11,2016 City Council Planning Session Minutes DATE: Jan. 12, 2016 CC: Mayor and City Council, City Manager, City Clerk, Department Heads The Planning Session took place in the Council Chambers, Wpton City Hall, 303 W. Wesley St., Wheaton, Illinois. Those attending the Planning Sessiofr1ed: Mayor Gresk, Councilwoman Fitch, Councilman Prendiville, Councilmadge, Councilman Saline, Councilman Scaizo and Councilman Suess. Also in aere City Manager Rose, Assistant City Manager Dzugan, Director of Finance I hard Chief Schultz, and Public Relations Coordinator Bishel. The session began at 7!01 p.m. ancluded at 8:15 p.m. The following items were discussed: I. Call to Order The Wheaton City Council Plannin Iayor Gresk. II. Approval of Nov. 23, 2015 Planni The Council approved the Nov. 23, 20 Ill. Public Associates, Inc. Director request for proposal soliciting qualified firms rnce monitoring services for the City’s e expertise of an investment consultant to assist ‘s investment returns. The scope of iltant will include: 1) reviewing the current investment policy and guidelines, 2) Iect an investment manager(s), 3) monitoring and evaluating the perfor stment manager, 4) reporting on the investment portfolio’s performance, ttending meetings with City staff to discuss portfolio performance and investmen s. The City received eight proposals and evaluated the responses based on qualifications, approach, samples of work, and costs of services and fees. City staff selected three consultants for interviews and recommends the City select Marquette Associates based on their qualifications and familiarity with state statutes that apply to the City’s investments. In response to a Council question, Director of Finance Lehnhardt stated the investment consultant would have oversight of approximately $50-55 million. Paul Marchese of Marquette Associates made a presentation to the Council. Mr. Marchese stated the Chicago-based consulting firm has approximately 250 clients, 44% of which are public funds. The company oversees finances for municipalities including Naperville and Elgin and for the Wheaton Firefighters Union. In response to Council questions, Mr. Marchese stated the firm charges a flat retainer fee of $30,000 per year. Mr. Marchese stated the company has 68 employees, and the City would have direct access to the firm’s research department. He reviewed their process focting investment managers and the type of reporting they would provide. He stated thQj cbjectives are security and liquidity. The consultant would work to find the gr the City without a lot of risk, and its focus would be on selecting investment man the City’s needs. In response to a Council question about the made over the past year if it had used an investment consultant’ depending up on the City’s investments, he would have over the past 5 years, compared with approximately 1.5%. In response to a Council question holds the investment managers they select accountable, in frequent contact with managers, and if they arenat ierformir ciates expects, they have a four-step notification from p to termination, if necessary. Mr. Marchese an ,nt managers by stating the City should risk and performance purposes, and each would be if Marquette is selected as an investment consultant. nt management contract; determine the cash flow needs of the r time; determine the type of return they might be able to ient manager search; and provide monitoring services. In response to a C0L . , Mr. Marchese stated whenever there is a change in investment managers or al tions, Marquette would analyze the investment policy guidelines, which are always subject to the City Council’s approval. The City Council expressed interest in selecting Marquette Associates as an investment consultant. City Manager Rose stated City staff will prepare a contract for the Council’s formal consideration at an upcoming City Council meeting. V. EMSlAmbulance Service Fees 1/11/16 Planning Session 2 Assistant City Manager Dzugan stated the City last increased EMS/ambulance service rates in 2011, establishing a policy of collecting user fees equivalent to 70% of the City’s EMS program costs. The remaining portion of the program has been funded by the City’s General Fund. City staff sought the City Council’s direction as to whether it would like for the fees collected to cover 100% of the program’s costs. Such a change would make the program funding more like an enterprise fund, in which fees cover the total cost of a program or service. In response to questions about previous Council funding decisions, Assistant City Manager Dzugan stated the user fees previously only covered 50% of the program costs, so the City most likely selected the 70% funding level as a transition ste4jp 50% to 100% funding through user fees. Fire Chief Schultz stated EMS/ambulance service billiJ by Andres, a subcontractor of the EMS/ambulance service. In response to a Council question, Assistant anager Dzugan sta e amount the patient will be required to pay might or might no ease, djnding upo ir insurance. He stated that the amount that Medicareand Medicai the City fo ice will not change; the City writes off the ai p the difference b een what Medicare/Medicaid will pay the City mount. Assistant City Manager Dzugan stated there are several the amount the City will receive in the future, suchaathe Natic reduce call volume. Assistant City Man $400,000 annually to ird having fees cover 100% of the 1 City with more information about different options VI. City Coun There were no City mments. VII. Adjournment The meeting was adjourned at 8:15 p.m. 1/11/16 Planning Session 3