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20 <br /> Slide#21 <br /> Fee Study Review — Emergency Medical Services <br /> Staff Recommendations <br /> Costs can be increased incrementally to regional peer averages. This will not dramatically improve cost <br /> recovery due to constraints from Medicaid reimbursement and self-insured low payment rates. <br /> County cost to run this service is high, and based on current CIP&Operating model, county subsidy will <br /> increase in future years. While County has limited ability to offset these investments, the County can <br /> communicate the need for these investments during budget process. <br /> CIP includes significant investments in EMS services that will drive increases to debt service.These <br /> include a robust EMS vehicle replacement schedule, new CAD software, and two new EMS <br /> substations that will add staff and vehicles. New ES headquarters and VIPER radio towers are also <br /> significant capital investments in next 5 years. <br /> County currently uses grant funding to cover new EMS programs like PORT and CARES, that will <br /> eventually need to rely on county funding if they are maintained. <br /> One component for future review is external collections. County currently has staff in Tax Office collect <br /> EMS fees.All peer reviewed counties use external collection services. County added an FTE in Tax in <br /> 2025 to improve collection recovery. Staff will review alternative models and reach out to peer staff which <br /> use external collections. <br /> ORANGE COUNTY <br /> 21 NORTH CAROLINA <br /> Slide #22 <br /> Fee Study Review — Review and Questions <br /> • Questions about fee study, presentation and findings? <br /> Are there other types of information that the Board would want to see based on <br /> findings in this report? <br /> • Staff can move to studying other Fee generating departments based on this <br /> framework: Aging, Animal Services, Environmental Health and Solid Waste. <br /> Staff will have access to excel-based models for these departments, and so <br /> can periodically update models based on changes in fees, costs or volume. <br /> ORANGE COUNTY <br /> 22 NORTH C A.ROLINA <br /> Chair Hamilton said that they can evaluate the impact of fee changes on demand. She <br /> said changes with an adverse impact could be adjusted. She said this will be a foundation to <br /> making sure that the true cost of a service is being covered and that county can help those who <br /> can't pay. <br /> Commissioner Carter thanked staff for the report. <br />