(a) An annual budget for the EMS department shall be approved by the Town Council such that all appropriate and discernible EMS costs, whether their nature is operating, maintenance, replacement or capital, shall be determined during the time period when the Town normally adopts its overall budget.

(b) The fire chief, the full and part time emergency medical technicians (EMT), paramedics, and billing clerk shall be paid as town employees as provided in the salary ordinance, as amended from time to time. All expenses of the EMS department shall be paid in accordance with the annual budget described above and the appropriate approvals by the Town Council as necessary.

(c) In addition to the fire chief, the full and part time EMTs and paramedics, and the billing clerk that serve as the primary staffing for the EMS department, it is expected that from time to time one (1) or more volunteer members of the St. John Volunteer Fire Department (SJVFD) may also be assigned to assist the EMS department when medical emergencies dictate the dispatch of the Town's ambulance service. In those cases where volunteer members of the SJVFD are assigned to assist the EMS department in such a medical emergency, those volunteer members of the SJVFD shall be paid as volunteers in the customary manner on a per call basis as provided in town salary ordinance, as amended from time to time.

(d) When either an emergency call is made to the Town of St. John requesting an ambulance by dialing 911 ("911 emergency call") or a telephone call is placed to the St. John Police Department (SJPD) or SJVFD requesting an ambulance (medical emergency call), the Town EMS department shall respond by dispatching its ambulance staffed with its EMTs, paramedics, and/or SJVFD personnel, or if a town ambulance is unavailable at that time, shall implement its backup procedures for the dispatch of an ambulance from another entity, whether public or private, for the stated medical emergency. In such a case, the Town shall not bill the patient/injured person for EMS activities, but such entity providing the ambulance will bill the patient/injured person in accordance with its procedures. Subject to the provisions stated herein, the Town EMS department shall send a billing for its services rendered on all 911 emergency calls and medial emergency calls where the Town ambulance is dispatched.

(e) As used herein, the term "medical supplies" includes bandages, braces and all such materials customarily used by EMTs and paramedics when administering aid to a patient/injured person.

(f) In all cases where the Town's EMS department is required to send a billing for its services in accordance with the provisions of this section, such billing for EMS activities shall be first sent directly to insurance carriers and/or other government insurance entities (such as Medicare and Medicaid), when such information has been provided, in order to seek reimbursement from such insurance entity for said EMS activities. If no insurance entity information is available or if the billing to the insurance entity remains unpaid from sixty (60) days after the initial billing, then such billing shall be sent to the patient/injured and the patient/injured shall pay the billing to the Town in accordance with the payment provisions described further below.

(g) As used herein, the term "basic life support" or "BLS" shall mean when medically necessary, the provisions of BLS services as defined in the National EMS Education and Practice Blueprint for the EMT-Basic, including establishment of a peripheral intravenous line.

(h) As used herein, the term "advanced life support, level 1" or "ALS1" shall mean when medically necessary, the provision of an assessment by an ALS provider or the provision of one or more ALS interventions. An ALS provider is defined as a provider trained to the level of EMT-intermediate or paramedic as defined in the National EMS Education and Practice Blueprint. An ALS intervention is defined as any procedure beyond the scope of an EMT-basic.

(i) As used herein, the term "advanced life support level 2", or ALS2, shall mean the following:

Advanced life support, level 2 (ALS2) is the transportation by ground ambulance vehicle and the provision of medically necessary supplies and services including (1) at least three (3) separate administrations of one or more medications by intravenous push/bolus or by continuous infusion (excluding crystalloid fluid), or (2) ground ambulance transport, medically necessary supplies and services, and the provision of at least one of the ALS2 procedures listed hereinafter.

(j) That a schedule of rates and fees (EMS fees) is hereby established to recover the EMS costs on a fee for service basis. "Resident" is hereby defined as any person who lives in the corporate limits of the Town and "nonresident" is hereby defined as any person who does not live in the corporate limits of the Town. Such EMS fees shall be assessed to those persons, or guardian for those persons, who directly benefit from the dispatch of the Town ambulance and the use of services from the EMS department as further described as follows:

All fees stated above shall automatically increase at a rate of three (3) percent annually, with the first increase beginning on January 1, 2022, without the need for any further amendment to this subsection.

(k) All billings not paid within ninety (90) days of the billing date shall accrue interest at the rate of one (1) percent per month on the unpaid balance, which shall be known as a late fee. In the event that the Town retains legal counsel to collect the unpaid billings for ambulance and related emergency medical services provided by the Town, and all other consequential costs and fees of collection efforts, which include, but are not limited to, costs for preparation and delivery of pre-suit notice(s), cost(s) of commencement and prosecution of litigation, and all related costs and expenditures incurred during subsequent proceedings, the Town is authorized to collect those costs and reasonable attorney's fees in addition to all other fees and costs sated herein.

(l) That every billing sent to a patient/injured person and/or insurance entity shall itemize the service performed, the medical supplies used, the mileage traveled, and any late fees, all in accordance with the provisions of this section. In addition, each billing shall also include at a minimum, level of care, the date and time of service, the hospital for transport (if transport to a hospital was performed), identification numbers for the EMTs and/or paramedics that performed the service, the Town ambulance number, and the due date for payment. Every billing shall include a notice that a late fee will apply if payment is received past the due date.

(m) The employees of the Town EMS department shall make a bona fide effort to bill and collect the EMS fees as stated in this division. Failure to do so shall be treated as a group II violation of the Town personnel policy, as amended from time to time.

(n) The fire chief is hereby authorized to issue and implement various orders (EMS directives) necessary for the daily functioning of the EMS department in an effective and efficient manner, provided however, that no such EMS Directives shall modify the provisions of this division. In all cases, in the event of a conflict, the state statutes shall apply.