Fulton County applies for ambulance service license

JOHNSTOWN — The Fulton County Board of Supervisors on Tuesday voted to apply to the state Dept. of Health for a Certificate of Need, the license needed to either create an ambulance service or hire an existing ambulance company to provide that service within the county’s borders.

Before the board unanimously approved the resolution to apply for the Certificate of Need [CoN], Northampton Supervisor James Groff made a comment explaining why the county needs the CoN. He said over the Columbus Day weekend there was a medical emergency in Bleecker that required the Northampton Ambulance Service to send its ambulance to the incident, which also involved the Northville Fire Department. Bleecker is about 20 miles from Northampton and approximately a 30 minute drive.

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“There were only two ambulances out of [Lake Valley EMS] for Fulton and Montgomery counties, and they had no other ambulances and they put our ambulance on standby,” Groff said. “We’ve got to continue with this, looking for solutions, because one of these days we’re going to get caught without any ambulances.”

The move to acquire the CoN is aimed toward implementing Fulton County Emergency Management Services Coordinator Steve Santa Maria’s “County-Wide Ambulance Service Incentive Plan” to use the CoN to enable Fulton County to contract with existing ambulance services, providing them with an annual subsidy payment in exchange for giving the county oversight over the companies’ finances, enabling the county to know ahead of time if an ambulance company is close to closing down like the Ambulance Service of Fulton County did in 2019.

Fulton County Administrator Jon Stead said the availability of ambulances has become a serious problem in many areas of the U.S. but particularly in the rural counties of upstate New York, which has prompted a number of counties to begin programs to subsidize the service.

“I think we’re one of about eight to 10 counties that are actually jumping out and taking charge of the situation before it becomes an insurmountable crisis,” Stead said. “I think it’s a step that we have to take.”

Santa Maria said he believes the state Dept. of Health will approve the county’s application for a Certificate of Need [CoN] within a few weeks. He said his plan is then to negotiate contracts with three existing ambulance companies: the city of Johnstown Fire Dept. Ambulance Service, the St. Johnsville Volunteer Ambulance Corps [SAVAC] and Lake Valley EMS, formerly known as the Greater Amsterdam Volunteer Ambulance Corps [GAVAC].

Santa Maria said he can’t disclose yet the size of the budget the Fulton County Board of Supervisors has authorized him to use in his negotiations with the three companies, but said his intention is for them to use the funding to help bolster the pay of their ambulance service employees in a bid to retain and recruit more of them.

“I’m in the process of finalization of contracts with those agencies,” he said. “I’m still hoping for Jan. 1, that’s our goal.”

He said once Fulton County has the CoN it will give him the flexibility to hire additional ambulance companies beyond just the three the county intends to enter into annual contracts with, in order to provide coverage throughout the county when it is needed.

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Ambulance services require state authorization through a CoN license in order to provide ambulance coverage in different geographic territories. In 2019, when the Ambulance Service of Fulton County [ASFC] abruptly shut down in February when it ran out of money to meet its payroll obligations, Santa Maria was forced to cobble together a network of different ambulance companies to provide coverage for the county until GAVAC was able to obtain a permanent CoN to operate in Fulton County.

Shortly after the ASFC closed, so did the former Johnstown Area Volunteer Ambulance Corps, which had been disputing with GAVAC over the right to perform the more lucrative hospital transfer calls at Nathan Littauer Hospital. Both agencies claimed at the time that the hospital calls were necessary to remain financially viable in Fulton County where the Medicaid ambulance reimbursement rate is lower than the average cost of the ambulance calls to the companies providing them, forcing them to operate at a loss.

Santa Maria gave a presentation last month to supervisors explaining to them that GAVAC in 2020 responded to 5,942 ambulance calls in Fulton County, but 2,021 of them were non-billable, and 26.6% of them were paid by Medicaid.

During the meeting Tuesday, Fulton County Chairman of the Board of Supervisors John “Jack” Callery blasted the federal government for not providing more money to Medicaid, and then pivoted to further criticism of money spent by the state and federal governments on illegal immigrants.

“With all of this money that Washington is sending out, I don’t know why in Lord’s name they can’t find a way to raise that Medicaid rate for ambulances, that’s what put most of them out of the business,” Callery said. “They just can’t afford to take an ambulance out. I think a lot of this goes right back to Washington. I just can’t believe we can’t get help, both sides of the aisle. It’s critical, all across the country. That would certainly be a big step in the right direction. Throw some of that money there. They want to spend tons of money on illegals, but not our own people. To me it’s just disheartening.”

County ambulance Medicaid reimbursement rates are set by New York state not the federal government.

“Don’t forget to put New York state in there too Mr. Chairman,” Stead said. “Their policies and procedures have been pretty grey. They’ve mentioned in the last few years several major announcements where they were going to address this issue, and they’ve done nothing on the issue that I can determine.”

The Board also voted to contract with a company called Multi-Med Billing Services to provide billing services “related to emergency management services operations” for the Fulton County Emergency Management Office.

Santa Maria said his department will use the Multi-Med Billing Services to actually collect the revenue for the ambulance calls performed by the different companies the county contracts with to perform the service, and then turn the fees over to the companies, giving the county oversight of the money.

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By Jason Subik

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