The Rural Ambulance Tax District is made up of the service area for which Lake Region is the Primary Emergency Services Provider for. In this region, we are asking the citizens to help maintain readiness of their emergency services by paying a yearly specified mill levy on their property tax. We know that increasing taxes is the last thing anyone wants to do, but emergency medical services are extremely important for the safety and health of our community.

Key Findings of Lake Region Ambulance Service, with fundamental components of the rural EMS systems, are challenged by the following issues: · Insufficient Payment by insurers to cover standby and fixed costs associated with EMS services · Prolonged response times, with increased distances to hospitals · a changing workforce that has historically relied on volunteers but increasingly must include paid personnel, many times paid staff is supplied from out of area employees · Insufficient State and Federal Policies · Lack of coordinated services within the EMS services in North Dakota · Lack of funding from area government agencies through donations, compensation, or taxations

To ensure that your ambulance service stays open, the ambulance will work directly with Ramsey County Commisioners. This next year, we will ask for 8 mils from the possible 15 mills a lowed. Each year, those mills are evaluated by the board of directors and the County Commissioners, and they will determine how many mills the ambulance receives to maintain operations. If reimbursements for services improve, the amount of mi ls will go down. We are only seeking what is required to keep our ambulance service running and efficient.

· Consider EMS in the state of North Dakota as Essential Services. (Only eleven (11) states in the union consider EMS to be essential services) · Increase ambulance fee-for-service payments that would adequately cover standby and fixed costs. · Collect data on other rural EMS services of similar sizes to better understand EMS workforce needs. * Due to demographic and economic factors, the potential rural ambulance crew workforce pool is shrinking. The rural population is both declining and aging. The commuting distance traveled for employed rural workers (residing in noncore, not adjacent counties) increased 25 percent from 2007 to 2016, compounding the potential ambulance crew workforce reduction. Lake Region Ambulance currently has 75% of our workforce commute here to work. · Federal and State funding is extremely low, for example, in 2002 and 2003, EMS providers received only 4 percent of the $3.38 billion allocated by the Department of Homeland Security to enhance emergency preparedness. · Unbilled costs and unpaid debt are higher for ambulance agencies than for all other health care providers. In 2016, it was reported that 43 percent of EMS charges were considered private pay (or out-of-pocket) – over 4 times higher than the national out-of-pocket health care expenditure rate. Unpaid debt is largely “written off” and considered to be unrecoverable.

The Department of Health and Human Services (HHS) along with the Center for Medicare and Medicaid (CMS) began collecting data in 2020. The collect, cost, revenue, utilization, or referred simply as the cost-data-collection, collecting information pertaining to EMS services from January 1, 2020, through 2024, EMS may find that the associated costs may start being covered and the reimbursement rates may increase. Which will ultimately mean more income for ambulance services and will lessen the amount of taxes that citizens will need to pay if the tax district is formed. The Cost-Data Collection was delayed because of COVID-19, and we are still 2 years away from completion.

After completion of the CMS Cost-Data-Collection, ambulance services may be able to take into considerations: · CMS may consider adjusting rural ambulance payments to cover reasonable ambulance standby and fixed costs. · CMS may consider adjusting the Ambulance Fee Schedule to reflect EMS as true healthcare providers and increase base payments. · CMS may also consider continuing ambulance add-on payments beyond 2024 until the study is completed and CMS is able to reflect reasonably on the newly collected data.

Voting will take place at the Memorial Building on Tuesday, June 11th from 8am till 7pm. For those that are mailing in their ballots, remember to mail both ballots in, as they are 2 separate ballots. We appreciate your support and would love to have your support.