Citrus County provides EMS Transition FAQ’s

The Citrus County Board of County Commissioners (BOCC) on Sept. 14 affirmed that providing timely, dependable, and fiscally responsible Emergency Medical Services (EMS) was paramount to the citizens of Citrus County. The Board, as a result, voted to end their partnership with Nature Coast EMS (NCEMS) and transition these responsibilities to Citrus County Fire Rescue (CCFR).

To assist the public in understanding this transition, the County has prepared this list of frequently asked questions (FAQ’s) related to the process:

What is the current Citrus County BOCC budget for EMS?

The budget for Fiscal Year 2022 is $12,980,722; however, this budget will be offset with patient revenues.

What was the budget for NCEMS prior to the changeover?

The proposed budget submitted by NCEMS for Fiscal Year 2022 reflected expenditures of $13,061,141, which would require NCEMS to request additional funding from the County.

Where does the money for EMS services come from?

EMS services are funded primarily by ambulance fees, Medicare/Medicaid reimbursement, (known as Public Emergency Medical Transportation [PEMT] Supplemental Reimbursement Program) and finally by the General Fund through ad valorem taxes.

What is the difference between the fire MSBU and the Fire Rescue EMS MSTU?

A Municipal Service Benefit Unit (MSBU) is a special assessment collected for fire protection services within the unincorporated areas of Citrus County.

A Municipal Services Taxing Unit (MSTU) is an ad valorem tax collected for first response Advanced Life Support (ALS) services and fire protection services within the unincorporated areas of Citrus County.

Neither of these funding mechanisms were used to support EMS services, as those services benefit the entire County.

How much CARES money did Nature Coast EMS receive? Where did it go?

In total, NCEMS received $619,103.32 through the County. NCEMS also received $1,055,300 from the Federal Government for the Payroll Protection Program. The County does not know how those funds were spent by NCEMS.

Why do I still see Nature Coast EMS branding on ambulances?

CCFR will rotate one ambulance unit at a time to the vendor to be rebranded from NCEMS to CCFR.

How did CCFR choose the ambulances it would take from NCEMS?

NCEMS had an aging fleet, with one ambulance having over 500,000 miles on it.  They had taken delivery on 6 new ambulances. Fifteen (15) ambulances are required to be able to account for peak times and mechanical breakdowns. CCFR chose the vehicles with the lowest maintenance and operating costs when compared to value and debt outstanding.

Why were 6 new ambulances purchased by NCEMS?

As a non-profit company, NCEMS was free to purchase new items as they deemed necessary. The County did not purchase the ambulances and had no control regarding ANY purchases made by NCEMS.

Why is it an issue that NCEMS asked for more money?

In September 2017, the County contracted with NCEMS to provide EMS services, with the County providing agreed upon subsidies from 2017 – 2027. NCEMS, in June 2020, presented a consultant’s report to the BOCC which outlined the need for an additional subsidy from the County in order for NCEMS to sustain services.

In September 2020, the BOCC amended the original contract between NCEMS and the County to increase the subsidy from the County, as well as to fund additional operational needs based on the consultant’s recommendation.

In May 2021, NCEMS presented an update to the BOCC and advised that an additional subsidy may be required from the BOCC in order for NCEMS to continue to perform. The BOCC inquired how much additional would be needed; NCEMS could not provide an answer at that time. The BOCC directed NCEMS to obtain a firm dollar amount needed and present the information at a future BOCC meeting.

NCEMS, in September 2021, provided the total dollar amount requested for FY21/22 to remain operational. The BOCC voted at that time to end their contract with NCEMS and assume EMS services under the Board’s direction. That transition has been completed.

How were staff transitioned from NCEMS to CCFR?

The County’s main priority was to get all full-time emergency medical technicians (EMTs) and paramedics onboarded with no interruption in service, followed by the full-time administrative staff positions that were retained. The County will continue to onboard paramedics, EMTs, and support staff positions as conditions warrant.

Why were NCEMS staff being paid a lower wage prior to the changeover?

Staff wages were the result of a contract negotiation issue between their union and NCEMS. The County had no input over the wages that NCEMS paid their paramedics and EMTs.

Why does an ambulance bill cost so much?

Many people are unaware of the costs associated with pre-hospital emergency care. These costs include well-trained and qualified personnel, dependable modern equipment, and a rapid response which must be available 24 hours a day, 7 days per week, regardless of the time of day or location. When you consider the cost of the people and equipment, in addition to the cost of sufficient rescue stations located throughout the County, this is an expensive but necessary service for our citizens.

What will the BOCC do with the profit earned from EMS service?

The #1 function of government is to provide public safety services such as fire, EMS, and law enforcement. The BOCC will not make a “profit” on these services; it will only offset the revenues and expenditures allowing a decrease in revenues supported by the general fund ad valorem taxes.

For more information about the transition of EMS services, please contact Citrus County Fire Rescue at (352) 527-5406.