Recommendation to receive supporting documentation into the record, conclude the public hearing, and adopt resolution amending the Master Fee and Charges Schedule by adopting the Fire First Responder Fee.  (Citywide)
Report from fire recommendation to receive supporting documentation into the record. Conclude the public hearing and adopt a resolution amending the master fee and charges schedule by adopting the fire first responder fee citywide. Okay. Thank you. I'm going to turn this over to our city staff. Thank you, Mr. Mayor. Members of the council. The staff report will be given by Mike Terry, our fire chief. Good evening. Mayor Garcia, members of the City Council. At the last Public Safety Committee meeting, we were given direction to come up with some various cost recovery and efficiency solutions to offset budget deficits proposed for fiscal year 17 and beyond. At that time, I mentioned that the fire department would be considering or has been considering implementation of a first responder fee. That would soon be we would soon be proposing to the city council. Tonight, we are proposing implementation of the first responder fee. Over the years, fire agencies from throughout the state of California have implemented first responder fees to recover costs and minimize the impact of budget deficits. This fee would help bridge the gap between costs of providing emergency medical services, which are approximately $22.1 million per year, and the revenue received for ambulance transport services, which is approximately $11.3 million a year. Additionally, as you are aware, there are projected general fund deficits that will need to be addressed in fiscal year 17 and beyond. The first responder fee is a proposed $250 fee that would be assessed for patients who are medically evaluated by the fire department staff on a first responder unit such as ambulances or fire engine or fire truck. There are significant costs associated with an emergency medical response, which includes a fire engine and an ambulance, and the six fire staff members associated with that apparatus or those apparatus. A patient evaluation and assessment involves a medical history and the taking of vital signs such as blood pressure, pulse, breathing, body temperature, and often includes monitoring heart activity and measuring blood sugar. Patients are often treated on scene as well. For example, we often evaluate and treat all diabetic patients with the intravenous administration of glucose or dh50. The first responder fee would help us recover costs of first responding personnel, as well as the cost for the use of emergency apparatus, equipment and emergency medical supplies. Currently, ambulance bills, which would in the future include first responder fee, are typically sent to insurance companies such as Medicare, Medi-Cal and private insurance companies for payment. Only about 30% of the bills that we send out go to individuals, and the bulk of those are typically not collected, as you can see. Other California fire agencies have implemented first responder fees. And this is not a complete list. But at the time we put this together, this was a good example across the board of many other agencies that have have this in place. These fees range in this grouping from $143 on the low end to $433 on the high end with an average fee of approximately $305. Agencies, as you can see, include Sacramento Fire departments, Sacramento Metropolitan Fire, Alameda County, Folsom, Novato, Contra Costa County, and in our neck of the woods, the city of Anaheim. Since this is a new revenue, it is difficult to project annual revenue amounts. Our best estimate is that the first responder fee will generate approximately $1.8 million annually. This would be partially offset by about $200,000 in additional annual costs associated with the billing and collection of fees, including staff supplies, postage and software maintenance. The net annual revenue is estimated to be $1.6 million once the program is established. If the fee is approved, we would only budget enough funds in fiscal year 16 to cover the $200,000 in additional billing costs. A year from now, when building the fiscal year 17 budget. We will then be able to evaluate the revenue patterns and collection rates to determine how much to budget for fiscal 17. Future revenue opportunities may also become available as a result of this fee under the states. Ground Emergency Medical Transborder GMT program. Under this program, the city is reimbursed for a portion of the difference between the full cost of providing medical transportation services to individuals covered by Medi-Cal and the amount of Medi-Cal revenue received for those services. Future GMT legislation has been introduced, and there's other legislation that will be introduced that will allow us to claim reimbursement for the evaluation and treatment of Medi-Cal patients when there is not a transport. However, we would only be able to recover costs under this program if we are currently charging customers for the response. The implementation of the first responder fee would satisfy that requirement. In a nutshell on that. We can't basically we basically can't build the federal government for something that we don't bill everybody for. So with that, that concludes my presentation. Council members, Mr. Mayor and council members and I stand ready to answer your questions. Okay. Thank you. Councilor Richardson, did you chime in or is that from the last time? Okay. Councilor Richardson. So what happens if this doesn't get a second? If this motion doesn't get a second? What happens? Well, I don't think you made a motion, but there isn't a second. I don't think you had. Is that right? Yeah. So it's not working, so. Yeah, that's. That's. But can we debate it without a motion. People are trying to. Press to get. Hold on. Well, if somebody does voice motions a second I want to. Okay. There is a second by Councilmember Andrews. Okay. So. I have a number of questions about this. I want to begin by just thanking our fire fighters, our both rank and file, as well as management for really anticipating. What we all know is that as city management says, winter is coming and we know that there are a number of tough decisions that are going to need to be made by the city council in the years to come. I have some concerns about this, some deep concerns about how this might disproportionately impact disadvantaged communities that I think we should consider as we move forward. I also want to want to have a better understanding on what the next steps are as this progresses. So first, I understand that Medicare, Medi-Cal and Insurance, this is something that they commonly cover. Is that correct? Yes, sir. So folks on Medi-Cal and I'm not sure that there's 100% certainty there, but how do we know that they that they actually cover this public. You know, covered California just insurance companies. How do we know that we cover that. The councilmember the the research that we did included reaching out to a number of the agencies you saw listed on that sheet there and asked that very specific question specifically related to Medi-Cal at the time and the ACA Affordable Care Act. Whether or not this would be reimbursed, we know, in fact, looking at our own health insurance here in the city of Long Beach, Anthem offers reimbursement for first responder fee. But we were unsure about the Medi-Cal and apps, but we did confirm it by reaching out to people who already have it in place. Okay. So so as of today, there is a potential benefit on insurance that we're not taking advantage of. I think that a better way to to look at that well. Councilmember I think yeah yeah I think that that's a good way to look at it. It's it's something that the insurance companies will pay for, but we are currently not charging them for. Okay. So I guess for the uninsured residents, what what sort of benefit? Can we is there some way that we can put in place a program or a mechanism for low income residents that are not insured? Is that something we can legally do or wrap your mind around as a part of this? Councilwoman Ramona, I'm going to let our director of financial management, John Groce, talk to that piece. I'm happy to. Councilmember We have an ambulance billing program now and it has not been a a program to date that has created substantial issues in terms of collections and people claiming hardships. We do have a hardship program in the city, monitored and done through the city attorney, where people who have a hardship can file a claim . We make the forms available. They are processed, reviewed by the city attorney. And then when when that is determined by the city attorney to qualify for hardship, we then follow up on that. So those that's probably our key mechanism. Again, history has not made it a huge problem because of Medicare, Medi-Cal and insurance. Most of our people who are unable to pay tend to be have had do not have a home address. We call them Jane and John Doe. Those people, as a matter of practice, it's not possible to collect from. And after a period of time, we write them off. Okay. So are you planning or preparing some a strategy to aggressively pursue those who can't pay? Are we going to put some guidelines in place that that provides some relief for those who have an economic hardship as a part of this? We have a program in place that already provides for that. We don't think that the situation will be significantly different, and we think our processes and procedures in place already provide for that and that we will be able to take care of those. Okay. So so if this were to move forward, I would I would like something more concrete. Then we have a program for this. I think it won't impact folks. I would love to see something more concrete that we can we can go out and educate our constituency on next. So I see that a number of city and county departments are utilizing first responder fees and they've seen some sort of a revenue increase. But I remember that the city council discussed the GM's funding, and we thought it was something that we could we could we could bank on. And and we thought we were going to be able to restore additional facilities and units into service. But but it didn't happen. So have we evaluated whether this is a stable revenue source that other cities have been able to depend on? And have they been able to restore services or maintain services as a result of implementing this first responder fee? Well, Councilmember, a couple of pieces there. So are our estimations on revenue generation with this program are very conservative. We are estimating the revenue at a 20% rate of return on our billing, which is a very conservative estimate. Traditionally, historically, we tend to do better than that with regard to our annual revenue in our billing. So the $1.8 million and if you take the $200,000 out to to offset the cost of additional people doing the billing, leaving 1.6 is a very conservative estimate based on based on what we know, it could very well materialize to a greater degree than what we're projecting. The as far as as far as the other agencies, when you talk about it being a stable fee source or a revenue generation. Yes. Our experience in talking with them or their experience has been that it's very stable. And I think the other point that I want to make clear is we're not necessarily talking about restoring anything when initially when we put this forward. We were very clear in saying that we don't want any of this revenue applied to our budget in fiscal year 16. Like I don't want to be in the same situation that we were in a few years ago with if recovery and some of the other programs where it didn't it didn't materialize like we thought it would, and then we were stuck with a negative hole in our budget. So what we want to do is we want to get one full year of experience. And so we know exactly what we're generating as far as revenue is concerned. And then have this discussion with the council again this time next year and say, here's a year of experience and this is what we would like to have applied to our budget, but it would be general fund revenue. So that would be a policy decision from the manager and the finance director and the budget manager and the council on how that gets applied. Certainly, we would like it applied to fire, though. Absolutely. And thank you for clarifying that you don't plan on actually spending these funds in the in the first year. You want to watch it and test it and see if this is something that we can bet our public safety on after a year of evaluation. And I think that that's smart, a smart thing to do if we move forward with this next. I know that there there's significant angst in the community in general and in certain communities about what the fiscal impact implications are when you dial 911. And there are some folks that. Might not press 911 because they're they're concerned about the cost of ambulance transportation fees. So I guess what can we or the fire department or just our city in general do to make sure there's an education component to a number of communities in court, including, you know, communities our diverse community that might not speak English? What can we do to educate and make sure that this there is an unintended consequence in terms of folks stop calling 911 because they're concerned about getting charged an additional fee. Have you done any thinking on that, Chief? Well, Councilmember, if if somebody needs to call 911, we encourage them to do that. I mean, I don't ever want anybody to not call 911. But the way this fee works is that if the firefighters, paramedics get on scene and we actually find a medical cause to do an assessment on somebody or find a cause to actually start to treat somebody with their consent, obviously then the fee would be applied. But for instance, one of the questions that we've had was, what if I what if, a, somebody is driving down the street and they see somebody down on the side of the street and they call 911 thinking, I think that person needs help. And we get there and the person says, I didn't call you. I don't want help. Would they have the fee applied to them? The answer is no. We will only if we provide the service. You know, I heard an analogy last week that I thought was pretty good. It's kind of like a toll road. You only pay for it if you use it. So I think that I think that's a fair enough analogy on on how this would work. I was joking. So so I guess the last thing I would say is so again, thank you for for doing the work and anticipating a solution to what we anticipate is some some challenging budget times. And personally, as a ninth District Council member, I've been able to watch and see the impacts when Rescue 12 was taken out of service and and sort of the feeling that you get when you know that this area of town has, you know, there's a perception that folks don't respond in a timely manner. When that when that happened. And, you know, I think is I think based on these these conversations, I'm comfortable with taking the next step in this direction. I definitely will watch those other things. But I hate I would hate to be in the position to cut to cut services in 1 to 2 years. That will that might impact the lives of our residents when we have an opportunity here today to make a meaningful step forward. And so that said, I guess my final question is, if this were to move forward tonight, what is the what are the next steps? Would this have to come back to city council at all? The end of that question. Is that question for me? Yeah, councilman. Or the city attorney or whoever can answer it? If this passes tonight, it would become effective immediately. Okay. I might want to think about it a little bit more, but but I think those are my questions that I have to make. Thank you. Councilwoman actually, Vice Mayor Lowenthal, to your second. I'll hold my comments for now. Councilman Price. Thank you. I have a couple of questions. First of all, I want to thank the chief for. Bringing this item forward for the following reason. We did ask, anticipating that we're going to have some difficult budget years ahead. We did agendas in our public safety committee, a budgetary item requesting that police and fire come to the Public Safety Committee with some recommendations and suggestions regarding how they might increase revenues and cut costs in anticipation of the budget situation that we have coming before us, really starting in 2017 and at the time that we agenda as the item, we did not know what 2016 was going to look like. I think we have a better sense of that in light of what we expect the budget to look like. And although I think this is a good item and I'm going to have a few questions to ask about it in a moment to clarify some of the concerns that we've received in our office. I do want to say that I hope that this item doesn't end our discussion regarding innovative ways that we might be able to increase revenue and or think about the potential deficits and their impact to our public safety structure, because I think that the proposed cuts to both police and fire are not the type of cuts that we can withstand in the city of Long Beach at this time in our city's status. So we're going to have to talk real seriously about that. And that conversation is not over. So I look forward to hearing some of the other proposals and they may be proposals that you would be recommending against, but I really would like to play those out a little bit more in detail in public safety in regards to this item. So thank you for coming up with this. I think the idea that we would. Have $1.6 million in our general fund as a result of this successful program is exactly the kind of innovative thinking process that we want our department heads to have. Now, going back to that. Where would you anticipate that that a $1.6 million going, would it go back into restoration of fire services? Well, Councilmember, it could it could go a couple of different directions. Initially, given given the budget projection that we were given a few months back, looking at a potential budget deficit of about a four fire, our share of about $1.7 million potentially in fiscal 17. If this were to material materialize tonight and we realized the $1.6 million over the next year, then our hope would be that those dollars would be applied to our deficit, which means we'd be able to keep our apparatus. The way it is today. If for whatever reason, the general fund rebounded and and we didn't have that kind of deficit next year and we had $1.6 million over and above, then we would apply that those dollars, if it was given back to fire, we'd apply those dollars directly toward our stated priority list that we had sent to the Council a year ago, roughly as far as the apparatus that we would restore. So it would go one of those two places. Okay. Now, we have received a few emails and inquiries from third district residents that I want to ask you a little bit about tonight. And I appreciate the time that you spent explaining some of these to me prior to council, but I do want to bring a few of these questions and answers to light so that the residents all have the same information as we continue to discuss this in a public forums and days and weeks to come. Some have said that this appears to them to be a tax and is a service that should be covered through property taxes. In response to that, has fire considered that argument and what would be the response to that? Council Member Property taxes pay for the fire department, fire suppression vehicles fire like fire engines and fire trucks, the active firefighting hazardous materials taking cats out of the tree, that sort of thing. That's what your property taxes pay for. Emergency medical service created in 1972 in Long Beach, was a fee for service business in addition to the regular line of business in the fire in the fire service. So their property taxes, although the general fund is subsidizing emergency medical service, emergency medical services meant to be a fee for service business. So none of your property taxes. Nobody should nobody should think that their property taxes are paying for paramedic service. Okay. In the staff memo specifically. We pull it up here? I think it's the second paragraph. Under the discussion section, you talk about a deployment model and the percentage of the responses, the deployment model that's used on 85% of the responses. Can you elaborate a little bit about that deployment model and what that paragraph means? So. Councilmember. I'm sorry. You want me to you want me to talk to you about how we deploy our paramedic service now and, like, how we respond on calls? So we have a tiered dispatching system in Long Beach. Basically three tiers for really, but three tiers of service and emergency medical service. Now, I want to start off by saying this. Of the nearly 70,000 calls for service, we get a year in Long Beach fire, 84.5, almost 85% of them are emergency medical calls. It has become the cornerstone of what we do. And it's it's not just a Long Beach thing that's a nationwide fire service thing. It's the paradigm has completely shifted. The way we dispatch calls is this if it's a non-emergent noncritical call, we call that an alpha response where we may just send the closest fire engine or truck to assess the patient and determine whether or not they should be upgraded and they should go to the hospital at all. A basic life support call, for instance, like a traffic accident or a broken leg possibly, or, you know, somebody falls, falls down or hurts himself. But it doesn't appear to be life threatening. We call that a Bravo response, where they'll get the first engine company or first truck company closest to them and the closest ambulance will respond as well. A charley response is the highest level of care that we have, and that's the first engine company and the first rescue ambulance. And those are the the calls like chest pains and shortness of breath and seizures and those things that are considered emergent calls. So that's that's how we respond. Now, one of the concerns that I've heard from constituents or from people in the community is how come we send the fire engine on these calls? Why don't we just send the ambulance? And that's a fair enough question. But the reality is we only have we have more fire engines than we have ambulances. And under the new paramedic program, I have a paramedic on every one of those engines so I can get an engine to the scene faster than I can get an ambulance to the scene. Now, if you had a different deployment model where I had 20 ambulances and and ten fire engines, then that would be that would be a completely different discussion. But the way we are deployed to to meet all risks in the community, it's faster for me to send a fire engine or a truck to the scene first and have the ambulance marry up with them on the scene. So that's why we deploy that way. I will tell you this, that my command staff are very smart, creative people, and they're constantly thinking about ways to for especially for the non-emergent calls. They're thinking about ways to to do kind of just that, where maybe we don't need to send a fire engine on everything. Maybe. Maybe instead of rolling the big red fire engine on the street, we can just send the ambulance on some things. And we're in the process of having that discussion now. And I actually think that sometime within the next year, we will we will see some progress in that respect. Okay, that's good. I look forward to that update because I think that would serve to, in terms of efficiency, at least what people perceive just to hear what the data is on that are on the non-emergent calls. Are there situations where the fire engine will respond and then if there's no transport necessary, the fire engine will just treat the patient and no ambulance will arrive on scene. Yes. So a good example would be the call that we get for someone who has fallen out of bed at 2:00 in the morning and they're unable to get themselves back into bed. So they'll call us, we respond out there, assist them back into the bed. We will evaluate them medically to make sure that the reason they fell out of bed was not because of a medical problem, put them back in bed, and then they often decline transport to the hospital. So yeah, that happens quite frequently. Okay, so, so it would be factually incorrect to make a statement that fire sends a fire truck and an ambulance and engine and an ambulance to every single medical call. That's that's not true. That's correct. That is not a true statement. Thank you very much. Thank you, Mr. Mayor. Thank you. Got somebody, Ringo? Thank you, Mayor. I, too, have some concerns with the. With the. Given the emergency that we had last week, I'm pretty sure that the system was. Slightly overloaded, if not overloaded with the now one. One calls everybody needing a response of one type or another. So this feels a little bit untimely, I would say, at this point. But the only reason is that had we been able let me ask you first, I guess, is there a record of how many 911 calls we received within the LAT when we had our outage last week. In those three days that we were a councilmember? Yes, there is a there is a record of how many calls we received. I will tell you this, that fire on the fire side of things. We saw kind of a spike in calls and within the first 24 hours and a lot of those calls were related to people stuck in elevators and other things that would be considered non-emergent. Just kind of check the well type things from the first 24 hours on, a lot of the calls that we had there were kind of self-created, where we were out knocking and talking and trying to find out what people needed from us. But we didn't see we didn't see a tremendous spike in calls for service because of the of the power outage, if that's what you're asking. Well, related to that, it was I get my question wasn't clear in regards to calls that were that needed for an evaluation that states what that that would have triggered this feat. And I'm not sure. I'm not sure I understand the question, but. The numbers of calls that you receive and i11 that would have required a medical or a paramedic to evaluate a patient. So. And are you asking how this fee would apply to the people last week? First responder fee. The first responder fee. So if this is the way this this fee is structured, if somebody calls 911 and we respond out there to evaluate somebody, if that person that we're evaluating says, I'm good, I don't need I don't need to be evaluated. I don't want you here. I don't want to go to the hospital or whatever. There would be no fee assessed on them if if we went out for the stuck in the elevator example, if we went out and responded to somebody who was stuck in an elevator, opened the elevator, got the patient out and they said, Thank you very much, I'm fine. We are kind of checking there. Well, there's no first responder fee there. The only time we would ever apply the first responder fee is if we generated a medical report form on the patient and actually treated them or applied our medical training to their situation. So it wouldn't just be blanket application across the board to every patient that we see. My staff and I did a little bit of additional research on this and we found that there are some municipalities that have an opt in paramedic membership program that costs between 30 to $60 a year, and it's included in their utility bill, which equals out to maybe $3 to $6 a month. What was that consider or why is this an option here? A council member that was considered it's been considered a couple of times over the past ten or 12 years. And our last evaluations called the subscription fee. The closest example to us here in Long Beach that are doing that is the city of Huntington Beach. They do they attach an annual fee to their utility bills. And you literally in Huntington Beach at one time anyway, you had to go in and opt out. You were just automatically opted in. And if you wanted to opt out, you had to physically do that. The the when we looked at it here in Long Beach, our payer mix in Long Beach is different than in a lot of the other municipalities that have the subscription fee. And we felt that when we added it all together that we would end up it would end up costing us more money than we would generate on the subscription fee, because our payer mix is vastly different than Huntington Beach and many of the other places. So we didn't think it would be a feasible option to generate stable revenue. Well, and certainly that's that's the important issue here, because I know we're coming into a budget season and we are going to be evaluating budgets all across the city, all our departments. So I'm sure that this discussion is going to be coming up there. So I'm I'm a little concerned that that this is coming now right before we start actually crunching numbers for our departments. Also, my my district is very diverse. As you as you probably know, my district goes all the way from our Long Beach airport to the port of Long Beach. I have high income, low income, middle income, low income families there. I also have the highest number of senior citizens, senior citizen housing in my area. So those are real concerns of mine that would affect my my residents. So I'm hesitant right now on this and not too sure whether it would be something that we could implement immediately. I'd like to have it stated more often, more often, more thoroughly. I also really would want to see what kind of program we can have either to opt in or opt out any first responder fee. I think that would be I think that'd be more palatable in this situation. Thank you. Thank you, Councilwoman Gonzalez. Thank you, Chief. I know we have to always look creatively for a different budget option, so I just wanted to and for the body for presenting that to you. I also have a question about the hardship waiver. I'm still not clear. And so there's a few things. So it would be great to get some sort, like some sort of criteria as to what would qualify for a hardship waiver. Would it be income? What what what would it be exactly as to who could qualify for this? The form which I looked at today asks for any and all information that would would make a person qualify. We leave that up to the applicant because the conditions may be such that you don't want to specify specific types of situations. So we ask for any information that an applicant feels they may be qualified for. And we may also do credit check background checks. But we we feel that leaving it flexible is actually in the best interests of the applicant. Okay. Well, that that definitely concerns me. And I know with our parking enforcement, for instance, you can correct me if I'm wrong, but when we have someone who isn't able to pay, I know we go through, I think, an administrative review process. So perhaps that could be enacted here, I'm not sure. But it's basically you don't have to pay until you go through this review or you go through this hardship waiver income or. Review, I guess you can say. Would that be something we would be able to do here? The administrative review for parking tickets is a little different in that that's a process to determine whether the amount is actually owed or not as opposed to hardship. The hardship situation we have is consistent throughout the city dealing with the city attorney. So it's it is an administrative review. It's just through the city attorney. So there is an administrative review process. Not not quite the same for as the parking citation, but for parking in particular. There's both the review is the ticket valid? And then there's a hardship review that would be done by the city attorney. And they would that would be so they wouldn't have to come up with the funds first. They would go through this review and then if it was determined, then they would come up with the funds if they had to. So is that what I'm hearing or. I'm sorry, would you repeat that again? They would have to pay the amount first, though, correct? I don't think that's the case. I don't think they would have to pay it first. In fact, I will say they would not have to pay it first. It's not it's not the same where you have a situation where we might tow the car or do something like that. So there's no there's no there's no requirement for them to pay first. Okay. And would fees still be enacted during emergency situations? So, you know, the power outage was a perfect example. And I was at Plymouth West with many of our seniors. And every hour, probably every half hour, there were fire engines and ambulance there for a variety of reasons. They could you know, they got stuck in the elevator. They couldn't walk down. They ran out of breath. So I get concerned in situations like this where, you know, now we have resources being sent over constantly. So how does that work out? Councilmember. The answer to that is no. They would not be assessed a first responder fee in situations like that. Plymouth West is a great example. Our folks were in and out of there over a 24 hour period last week assisting residents and checking on residents, knocking and talking, that sort of thing. They weren't doing medical reports on people. They weren't they weren't setting them up for transport to the hospital or any of that stuff there. They're just being firefighters. They're just doing good work, getting out, talking to people, making sure they're okay so the first responder fee wouldn't apply there. This will specifically apply to those situations where somebody calls 911 or the patient themselves calls 911 and says, I want I need the service. I need you to come take care of me. We get there. We work them up medically, work them up, do a medical report form on them and either transport them or not. That's when it would apply. But in the example that you use, no, it would not. But some of them were transported and did need medical and it was an emergency situation, you know, during the power outage. So that's what I'm concerned with. So we're still getting that treatment and it would fall under this and it was under the umbrella of emergency situation. So those patients that were transported have a bill would get a bill already for that transport. There's a there's a bill that goes along with ambulance transport, right. For both advanced life support and basic life support. So that wouldn't change. But as far as the first responder fee and just that kind of. Well checks on people. No, that's that's not what this is intended to do. And Marin County, if I may just add to that, we feel very comfortable that we do have a hardship provision already built into our system. What the chief was just mentioning is that we currently have a system where we are charging people who get transferred to the hospital a thousand, 1100, 1200 dollars, and this would be a fee in addition to that of 250. But we already are very comfortable that we don't have a problem where there are people that are needing hardship for the ambulance fee that we wouldn't be able to take care of. We have a process for that and we really don't see that that is going to be any different with this fee. We feel very comfortable that there is that process for them to apply for the hardship because we don't see on a daily basis us creating that hardship if there really is one out there that is justifiable . Sure. I just don't see any clear plan as to what the hardship would be, you know, so that it's just concerning to me. And there was another concern brought up by some of our property owners. So if, for instance, a resident couldn't pay or they just didn't acknowledge the letter, would property owners be billed? No, no. We will know what this has meant. This is actually meant to be implied, applied toward insurance, toward health insurance, homeowner's insurance, auto insurance, Medi-Cal, Medicare, ACA. No, we would not apply it toward like anybody in the apartment association shouldn't worry that we're going to apply this fee or put a lean on their on their building if their one of their tenants doesn't pay their medical bill. Okay. And then what about residents versus nonresidents? How does that work out? That from a fire service delivery. Some cities actually do differentiate between resident nonresident on how they apply the fees. We do not hear on any of the fees that we assess for treatment, transport or anything else we do. So this would be consistent with not differentiating between resident nonresident. Where we don't have a nonresident responder fee, it would just be resident responder fee. We just have this would just be a first responder fee for everyone, whether you're resident or not. Okay. And maybe I can make Councilman one more comment on on why we do not think there's there's an issue in addition to what Mr. Modica said. We're also have a practice which I'm reviewing really over the last month where, where, when we determine that bills are uncollectible and for, for the reasons that people can't pay, we have a process where we're, we're writing these bills off at at 180 days so that we do not continue to hassle people. And I think that's one of the reasons we also just historically have not had a problem in this area. Okay. Thank you. Thank you. Before I go, I. Before I go to counter prostitution, I just wanted to touch on something that councilman said. Think it's. It's been repeated. Something. It's an important point to city staff. And maybe it's something that Councilor Richardson can address in his motion. But I think what you're hearing very clearly is that there needs to be a very dedicated and deliberate process for there to be an opt out provision for those that are disadvantaged and for poor seniors that have needs when it comes to income. And so, I mean, I'm hearing obviously from from from from staff that that is part of this process. But I think what you're hearing from council is that it needs to be very clear. It needs to be a very progressive in a sense, of leaning first and giving the benefit of the doubt to the person that's that needs the medical attention and it needs to be those that are needed. The attention shouldn't have to pay upfront. So it needs to be where they're they're not required to pay. And if they have, they believe that they qualify as a as a low income or disadvantaged person, that they can make that case before they're ever charge or expected to pay that fee. So I actually want to make sure that if Mr. Richardson can actually clarify that issue. Sir, what I'm thinking is exactly along those lines, like maybe separately they can come back because all those elements you I heard that from Councilmember Ranga and Councilmember Gonzalez, but I want to make sure that that actually comes back to that element, can come back to the city council at some point. So we can talk about what that program, what that program looks like. Is that something we can do? Because I'd like to amend my motion include that. Could part of that motion be for this separately that's separate from the from the from the fee that this program would come back to council for for review and. Conversation within 30 days. Within 30 days. Mr. Modica. Yes. We can certainly come back and review that program. Part of that comes from your ranga would like. I would like to add as part of that program, a councilmember to also review his suggestion of the what did you call it, the opt in program. Could it be part of that as well? Absolutely. Okay. Thank you. Vice mayor. Vice mayor. You okay with that? Okay. Thank you. Just for clarification purposes, the opt in program is that the paramedic subscription fee and evaluation of that? Yes. The council re ranking wants to see the evaluation of that as well. Okay. Thank you, Councilmember Austin. Thank you. And I just had a few quick clarifying questions because I think a lot of the questions and concerns that I have have already been raised. But I heard a lot about there was much talk about Medi-Cal and Medicare and and and the need to establish just to be able to collect from Medi-Cal and Medicare first responder fees. But for those who have private insured or who are privately insured, if they if they are they are in need of a first responder, does their insurance pick up the first responder fee? For example, does Kaiser or a Blue Shield pick that up? Council Member Yes. The answer is yes. The insurance, you know that we have here in the city of Long Beach, Anthem pays a first responder fee if needed. Okay. And many public agencies have been suffering with budget issues over the last several years. You laid out a number of them who have instituted this this first responder fee, in your opinion. Why haven't other agencies felt the need to implement these first responder fees? Because it seems to be rather minimal. Councilmember, the that that is the list that we showed during the presentation is a fairly abbreviated list. Since we started putting this thing together, there have been a number of other municipalities in the state that are moving toward a first responder fee, and they're doing it primarily because it will help augment the amount of dollars that they receive under the EMT program. Should the state legislation be passed to allow for first responders? So there's a there's a lot of municipalities that are in the same process that we're in here today doing that. Okay. And I also want to echo Councilmember Price's comments to you, because to sit on the Public Safety Committee and we did ask you to come back with some creative new revenue ideas, and we certainly hope it doesn't stop here, like like to know that there's more more options out there. And and I guess for me, the options is really important. I'm hesitant to move forward tonight on this because, you know, I don't know that there may be something else, you know, a month from now or two weeks from now that that may be a better option in terms of, you know, fixing the fire budget and speaking to fire budget, if we are to collect 1.6 million, $1.8 million. I'm not sure that I was I'm not clear as to how that's going to be spent or where it would be dedicated. Is that going to be in the fire budget or is that going to go straight to the general fund? And just kind of before. Because this money was is part of the fee structure for the fire department, this revenue, from our view point would be fire department associated revenue just as just the way the chief described it. Okay. And I know also before this council, we we talked about and we do have the best, I think, fire department in in the state. And that's, to your credit, Chief, Terry, and to the men and women who work for the Long Beach Fire Department. We we want to maintain if we're going to add fees, I'd like to know that there's some guarantees that we're going to maintain the highest quality in terms of personnel that are responding to two calls. Is that something that you can guarantee for me tonight? Because what we have now, I mean, I know particularly for the blessed, there are there are paramedics and then there are EMT. And we changed that model recently. And we can talk about how that model is doing later on. But I'd like for for my resident residents to have some assurances that if we're going to be adding fees, that we're going to make sure that they have trained the highest trained paramedics responding to their needs because essentially we're asking them to do more. Yeah. Councilmember. Yes, fair enough. Every single. Every single. Patient that's evaluated in the city of Long Beach will be evaluated by the highest medical care possible under the in the California Fire Service. And we have no plans on changing that. Okay. We can revisit that. And and lastly, on the action here this evening. I just need some some clarity as to the timing and why tonight and not during our budget process. Well, Councilmember, thank you. But part of the reason we wanted to bring this up now is, as I mentioned earlier, we're not asking for any of these dollars, but for the $200,000 to go to financial management for billing purposes. We're not asking for any of these dollars to be applied to the fire department in fiscal year 16. What we want to do is we want to have it in place and have it work its way through an entire year so we can get some historical perspective on what we actually generate as far as revenue. And then this time next year, when we're sitting before you talking about the fiscal 17 budget, we can say it's generated this much revenue, it's stable and this is what we would ask be applied to fire. So we don't want to use any of it now. We just want to we in years past, we had asked for our budget to be reflective of a potential revenue generation idea, and then that revenue generation idea didn't materialize like we thought it would. We don't want to repeat that process. We want to take a more conservative approach. And secondarily, I do I do have I just want to remind you that the the numbers that we're putting forward to you are based on the 20% rate of return. It's a very conservative estimate on revenue generation. So we think that as we put it in place, as we go throughout the year, we'll have a better idea of what we're actually going to generate, which will give you the ability to discuss it and discuss how best to apply it this time next year. So it's a there's a possibility that the $200 responder fee, $250 for first responders could actually be less. If the projections are higher, we could come back and talk, have that conversation. It. I suppose. I suppose the answer to that is, is you could. We could. The other thing I might comment that you you mentioned is that one another reason for it not being received as revenue in 16 and only for 17 is that it also gives the city council an opportunity to see if the program works as well as the administration thinks it does in terms of being able to handle the hardship cases. So it's an opportunity to evaluate that. Again, we don't think there'll be a problem, but it's a perfect evaluation period. And I guess Mr. City Manager will discuss this if approved this evening. When will this go into effect? Is this something that goes into effect immediately? Katzmaier will be working with the city attorney's office to get this implemented, but it'll go into effect as soon as possible after we provide information to the public on how it's going to operate. And will it be reflected in the FBI 16 budget? No. So not just the $200,000. Okay. Thank you. Thank you. Councilmember Supernova. Thank you, Mayor, and thank you, Chief Dorey, for your presentation. I have two questions right off the bat from constituents, so I want to read them verbatim in case there any subtleties in it. One is, if a patient can't or won't pay, will the property owner? 20 to 40. Okay well the property owner of the location be build and or have a tax lien placed on their property. Can we be assured that will not happen? But that will not happen. Okay. The second question is, does research show that the fee will be an influence on a patient's decision to call 911? I will use the Sacramento Metro Metropolitan Fire Department as an example. I asked that very specific question whether or not their fee, which is higher, considerably higher than what we're proposing here, had any kind of effect on people, whether or not they were going to utilize 911 as their primary care providers in some cases. In some cases, they said that it did deter some people who were high propensity users of the system from continually using the system like they would find alternative methods to get to an urgent care to their doctor. But for the most part, they said that that the $250 first responder fee because there their first responder fee, because it's applied toward insurance, was not a deterrent for people to call 911 if they actually needed it. Okay. Thank you. The next question has to do with restoration of the cuts. And I think I heard maybe two answers. So I just want to have a lot of clarity here and I'll give you the background. And the reason why it's so important to the residents of Fourth District is we have four engine companies that are in mothballs. That's 1018, 17 and 18 and engine 121 is a secondary engine company to station one. The other three represent the three Eastern Council districts three, four and five. So to put that in perspective, Council District three has fire stations four, eight, 14, 22 and 21, and then 21 is a boat. So let's throw that out. 22 is on the border so we can throw that one out so we can count three fire stations in in in Council District three. Okay. And District five, we have station five, 16, 18 and 19, Station 16 to the airport. So that's not available for medical emergencies. Station 18 is without a fire engine. So if you those two districts, one third of their fire stations do not have a fire engine. The fourth district has one fire station and it is without a fire engine. So 100% of the fire stations in the fourth District are without a fire engine. Sorry for the long explanation, but the very first question I will be ask is do we get our engine company back in Station 17? And I think your answer is the definitive no. Councilmember We would go back and revisit the data that we use to put together our restoration list that we sent to the Council last year. But I will tell you, with regard to Engine 18, it's a definitive no, not not right now. I mean, if we were to have dollars to restore things today, we would follow our restoration list that we sent to council before and we would go right down the list. And Engine 18 doesn't come in until until we restore three additional engines or at least two additional engines ahead of it. Okay. And then for engine 17, I'm sorry, I said engine 18, Engine 17. Right. And Station 17 is central to the Fort Dix. Not only is it our only fire station is central to the fourth district. So it covers the maximum amount of area in the fourth council district. Okay. Thank you, Chief. Thank you. Councilwoman. Councilman, Mongo. Thank you. I want to thank the staff for putting this together. I know that this was requested back when I was a part of the Public Safety Committee. And I, too, want to thank everyone for the hard work put in, because none of us want to see any more cuts to our fire department. And most importantly, as our medical calls for service are growing in their percentages. And we really need to have police and fire on hand to be able to respond. And our fire department is critical to that. My colleagues did an excellent job in outlining some of the things. I totally disagree that we are probably the best fire department in the country, not just the state, but just a small part. And thank you for Daryl, for asking the question related to our property owners, because I know that that's a big concern. With regard to our visitors and our recovery process on costs, a lot of the visitors that come into the city are here for events and such. And should those visitors. Receipt or if the calls are made by our hotel staff. How would that work? Well, Councilmember, we would we would approach that the same way, would approach any medical call for service. We we would obviously go to the scene and ask the patient whether or not they needed our assistance. If the patient were to decline and say, no, I don't need any assistance from you, there would be no fee assessed there . But if the patient did have a medical emergency, they were assessed. We did a medical report form part of that medical report form part of our our new system will be to collect insurance information. So that way we can assist financial management in getting the bill to the insurer. And so we would approach it the same way we would approach it. Every patient we respond on in the city gets approached will approach them the same way, whether they're resident visitor business. Whatever. And do you foresee any challenges with patients that are coming from other providers over state lines? Councilmember. I think that happens today where, you know, periodically we'll have conventioneers or somebody who's in town that has a medical emergency. They get transported to a hospital. I'm not familiar with any unique challenges associated with that. I mean, there may be that doesn't I'm just not familiar with any unique challenges there. We would still gather the same type of information to the best of our ability and and share that with financial management. And they would do their billing, I assume, the same way they always do. Well, thank you very much. Thank you. Councilmember Andrews. Yes, thank you, Mayor. You know, I really want to thank everyone on the diocese who really use some very thorough, you know, questions. And I want to thank you, cheap and also your staff, because the thing I really want to know about was the hardship program. And I think you explain that very, very well. So I really am in motion to agree with Mr. Ricks dealing with Rex. I will second that motion and go along with it, because I think you covered it very well. Thank you, sir. Thank you. And lastly, Vice Mayor Lowenthal thought will go to a vote with within public comment, obviously, as well. Thank you, Mr. Mayor. I also wanted to thank staff for their work. I know it's very difficult to have this conversation about fee for service when we regard the service that we provide in the city of Long Beach to be all inclusive, especially emergency services. But I feel comfortable and confident that we have a compelling argument for not only protecting those that may not be able to pay, but also be sure that our our department can run and provide continue to provide the services that they do. Just a couple of brief questions. I know they may have been answered, at least in our conversations during our briefings, but when we talk about insurance coverage, I know Councilwoman Gonzalez had mentioned that there may be a limit on some people's insurance coverage. So I will lean into the mike. Is there a cap that you that you're aware of on the basic coverage that people have, not the premium coverage necessarily, but those that might be on Obamacare, for instance, or any other basic level of coverage? Is it one two per year that someone can have a reimbursable call for service? Council Member I'm not aware of any cap on calls for service. I mean, I think if, if you can as a patient, if you're transported to the hospital and you demonstrate a medical necessity, I believe the insurance pays the fee. But sometimes it can be an arduous battle, correct, between the insured and the insurer. I don't know the answer to that. Quite possibly, but I don't know the answer to that for sure. And I think we've heard from residents who do find that to be the case. But but still, I don't feel that your policy recommendation, or at least the recommendation for council to take action is is an onerous one. The hardship exemption. I, too, am interested in that. I know that our city would not would not place this kind of a burden on those in need. And so I have seen us do that in nearly the last ten years that I have been working with our city team. And so I think you'll find a way to ensure that those in need will continue to receive service. And I appreciate your comments earlier about this not being a barrier to service. I think that's that's what I take away from your description. It's not intended to be a barrier for those who need the service and have to call. And just as anyone rendering medical services, whether it's at the hospital or on the at the street level, you would not deny service. And that is not a a benchmark to reach prior to receiving service. And if I can feel assured that that is always the case here, then I'm in support of those. Thank you. Thank you. Any public comment on the item? Please come forward. Please come forward. Very good you, Kirk, as the address. I'm glad I heard you. Just. Just the three rights I'm going to suggest. The three come forward. Look, go ahead, Mr. Goodhue. I'm glad the council said that you're open to looking at options. I think one of the options we have to examine and seriously consider. In terms of reducing our overall budget. Yes, we go back to work. What works so well for so many years? And not have a paid full time mayor and the staff that goes with it, period. One of the most ridiculous things that I saw in this outage over the weekend or last week. If we had a mayor. Out in the street with a podium and his and the seal of the city with a flight. You know, obviously, he's got a staff to do that. That's absurd. And that's an embarrassment to this city, period. There is nothing you know, you don't need a podium. You don't need a doctor in front of your name. Or if you do, you're in trouble. So I would suggest let's since we're not going to be getting any money this year, hold off. We will have that seismic change in management structure, both electric and otherwise, by mid-November period. And at that time, you can make we can make the decision. And hopefully I think you'll make the right decision as going back to what worked so well for so long. And have a part time mayor. There is selected. If not by the people, by the council, instead of a political hack using it for to build a political career which is devastating to this city or any city. Thank you. Thank you, period. Please come forward and be speaker. Good evening. My name is Jack Smith. I live at 50 Elm Avenue. That's in the East Village in the second district. Attacks as attacks as attacks. You can call it a fee, if you like, about this insurance coverage. There's never been the mention tonight about the word deductible. Insurance will cover it, maybe. But you pay your deductible first and that's cash out of your pocket. So if your deductible happens to be if you're really, really got good coverage at 250 bucks, you pay that 250 bucks. If your deductible happens to be which one, a lot of people who have their own private insurance is as much as five $6,000. That fee comes out of your pocket. So it's not covered by insurance. It's covered by insurance after the deductible has been satisfied. The issue of does it delay call? Well, let me tell you about my own experience. I unfortunately had to avail myself of the services of our fire department and paramedics. And they did a great job and they cost a lot of money. When I had a serious injury here in the city a few years ago, I did not call the paramedics and refused for anybody else to call the paramedics because I knew it was going to cost me a lot of money out of my pocket because of my deductible. At that time, I heard 1100 dollars. I think the bill I got was about $600. Thank goodness. In that situation, I had a friend with me who was able to transport me to the hospital. The hardship process is cumbersome. I've been through that. It is a lot of paperwork. It is a lot of time. You reveal that stuff to yourself, to city staff that maybe you don't care to reveal. He says it's your choice, but there's a form there that gives you a list of everything you have to provide. And then it goes through the process. And my question would be, how much does that process cost? City attorneys involved. I would imagine it cost a significant amount. A question I would have with this, too, is does it if you don't pay, does it get turned over to collections? That has to come up tonight. Collection agencies are very nasty to deal with. Given all the questions and comments and suggestions that have come up tonight, my suggestion would be that you should table this for now, get those answers that you asked for earlier in this discussion and bring this back at a later time in the 30 days, if that's the time frame and make your decision at that point. Thanks. Thank you. Next speaker, please. Final speaker. Good evening. Thank you to the fire chief for the proposal and the Council for your wonderful questions. I just had a suggestion you might consider. It seems like you're adding $1.6 million to the general fund. It seems like your comments were that over the years, the efficiency of the system has changed such that you're responding 85% to medical calls. And I would just suggest that you might consider using some of that generated revenue to move the force in a direction that's more ready to respond to its its needs and invested in more ambulances for the city. Thank you. Thank you. So with that, we're going to Vice Mayor Lowenthal and we're going to go to work. Since it's been such a long discussion, can we restate the motion as well as the the part that is apart from the motion for the information coming back to us? Absolutely, Mr. Mason. Mayor, members of the city council, as I understand the motion, it is to approve the resolution adopting the fee and also request that the city manager come back with a report within 30 days providing more detail in regard to the fee waiver and also provide information about a program that has been referred to as either an opt in or opt out fee program. Thank you. Subscription fee. Thank you. Members, please cast your votes. Motion carries eight one. Okay. Thank you. No. But yes. Okay. Okay. Next up is we're gonna go back to public comment. And so we have Larry Goodhew, David Zink and Mr. Cromwell. Please come forward. Larry, could you if you can hold the cloud until we get a if I've got a transparency up there for the edification of the. Council members that have not seen it behind you or what you see here is the marine stadium to s which was nefariously raised about a year ago. This structure that you see is a repurposed structure, much needed, but was raised as a result of a criminal ruse that has the mayor's DNA all over it. And one of the things that has captured the attention of the Department of Justice. Is that the. Number of ring tones relative to this water fireside facility is remarkable, remarkably similar to a number of ringtones on a waterside facility 3000 miles to the east that sat on the Potomac. And which. In the year and 42 years ago. Engendered that 1011 word phrase by the late. Howard Baker. That forever changed the paradigm through which. Officers of the court and the Justice Department look at things. And I think you will find. That when they examine very closely. Their criminal roots and the DNA. Of Robert Garcia, who was then. Vice mayor. Coastal Commission member. You will find them looking and asking the same question that was posed by Howard Baker. The end result will be by November. Give or take a week or so, we will have that paradigm shift in management. Both on the 13th floor and the 14th floor. Thank you. Thank you, Mr. Goodhue. And I'm wondering if Mr. Zinke is here. David Zinke. Okay. If I might call Mr. Cromwell. Thank you. Thank you. For those of you who had your support that was self-initiated, that was not accompanied by the CFO conversation. So I would like to thank you for that support. First, I would like to know who will be held accountable. Amy Burdick wanted code enforcement in regards to the retaliatory illegal eviction. Want a code enforcement to kind of inspect our union? I did oblige her, and she said we'd take it from there. Code enforcement came out. They did discover 14 violations, many of which existed prior to my initial tenancy. Uh, that have yet to be remedied. Uh, they came out. Nothing has been done since. I have zero follow up from Amy Burdick. Since then, the landlord has locked us out of the unit, locked our cats and our turtle in the unit, boarded up the windows, shut the electricity off. The food in my fridge was probably spoiled. I don't know what the litter box is doing. It's disgusting. It's illegal. So where am I in mind you that in the retired formulation I just rendered to them 60 $500? I tried to put a bid on one of the Parsons parcels that you mentioned today. So my question again remains, why did Amy have code enforcement come out? I never called code enforcement to. I know the fines are minimal and I would call in years ago. I did it to oblige her and in return just had empty promises. Second, Mr. Mike Conway on. June 23rd assured me that the partnership with her strong Community Foundation Corp. the owners of the complex, they would contact the attorney and stop the eviction. Now, Mr. Mike Conway approached myself. In that room, in the hallway. Making these false promises and saying that he had a meeting to attend to the next day. And I have not heard anything from him since. Not once a little thing. June 2nd, City Council commented that they care about the tenants and retaliation and I would like them to prove it. There's no reason why we should not be placed back into our unit. We did absolutely nothing wrong. I should be able to go home tonight. Apologize to my cat. Apologize to the turtle. Clean the litter box. Clean the turtle cage and whatever else is going on inside of that unit. We did have food cooking as well. I was told it in regards to all of these events that it sounds bizarre. And that may be to some. However, Long Beach is no stranger to the misappropriation of funds at all. This is a fact. We did nothing wrong. Now the impact of the scope of this apartment complex owner. Thank you, ma'am. In Long Beach. Thank you. I have to wrap up. Time is up. Okay. Thank you very much. Do you have the rest of the speakers list, vice mayor? Yes, I do. Thank you, Robert Jackson. Lawrence Weathers. Georgie Rivera. I don't believe they're here, sir. Okay. Thank you. So we will move on now. Moving on from public comment, we do have I'm moving a couple items up because there's there's folks here. So I'm going to be moving at 1035 to the top of the regular agenda, which is going to be. Which is which is which is here. So 35 will get moved up if there's other requests of the council can come. Give it to me right now let's do consent calendar minus item four. Can you get a motion, please?