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									             Energy and Resources Group
        Spring 2011 Colloquium Series (ER295)

                            February 16, 2011


                                                    Malini Ranganathan
                                                  (Ph.D Energy and Resources, U.C. Berkeley)
                                                               Post-Doctoral Fellow
                                              Social Dimensions of Environmental Policy/Geography
                                            Beckman Institute, University of Illinois, Urbana-Champaign



                                               Fluid Hegemony: A Political Ecology of
                                                Water, Market Rule, and Insurgence at
                                                        Bangalore’s Frontier

                                                       110 Barrows Hall / 4:00 p.m.



Since the turn of the millennium, the city of Bangalore has been experimenting with a series of neoliberal,
market-oriented reforms to overhaul the governance of its urban services. The city’s water, in particular, long
considered a service that must be subsidized by the state, has been targeted under interventions that seek to
commercialize delivery and institute financial discipline. Supported by a melee of international development
actors and administered by parastatal experts, these policy changes have been especially focused on reforming
service delivery at the city’s peri-urban frontier, a landscape seeped in historical conflicts over land tenure.
Employing critical theories of power and a political-economic frame of analysis, my dissertation analyzes why
new urban water policy imaginaries are ascendant today and how they touch down at this dynamic frontier
zone. Drawing from my larger body of research, in this talk I argue that the grounded workings of new water
policies cannot be understood without grasping the politics of the peripheralized middle class—a sizeable
cross-section of the middle class that is propertied, but that nonetheless does not enjoy the same degree of
tenure security as its elite counterparts. Through collective organizing, members of this social grouping contest
and ultimate compromise over cost recovery-focused water pricing in a bid to legitimize their property claims
in this globalizing and increasingly exclusionary city. Overall, this research elucidates how the operation of
neoliberal hegemony—the reproduction of power relations in everyday life—is fluid and mutable, prone to
taking shape in and through insurgent struggles over urban space and citizenship.
 program. The policy addresses some
     of the concerns Council previously discussed and includes the fee schedule, fee
     applicability, fee waiver process, fee appeals process, billing and collections.
     The PSA with ADPI-Intermedix requires the contractor to adhere to the City’s
     policies and procedures of administering the program.
Agenda Item 4
February 16, 2010
Page 2


       If approved, it is estimated that it will take approximately four weeks to integrate
       the business processes of the program into ADPI-Intermedix’s system. The
       contract requires that performance commence no later than March 19, 2010.
       Staff will develop and administer the required processes for the EMS
       Membership program. The billing services and the membership program
       processes will be concurrently implemented.

FISCAL IMPACT

       The EMS Cost Recovery Program is designed to provide a means for the City to
       recover costs associated with providing emergency medical services and fire
       department user fees. By approving this agreement, the City will pay the
       contractor no more than 15% of net revenue collections. Net collections are
       defined as total cash collections less refunds. All costs for billing and collections
       are included in the 15% fee. No up front or on-going expenditures are required
       of the City.

       Revenue assumptions were made in the fiscal year 2009/2010 budget for the
       EMS Cost Recovery Program. The City has yet to realize revenue from this
       program due to the fact that billing services have not yet been procured.

RECOMMENDATION

       Staff recommends that Council, by resolution, approve the professional services
       agreement with ADPI-Intermedix for EMS Cost Recovery Billing Services and
       authorize the Mayor to sign the agreement.

Prepared by: David A. Bramell, Acting Fire Chief

Reviewed by: Maria Hurtado, Assistant City Manager

Approved by: R. Leon Churchill, Jr., City Manager

Attachments: 1. Professional Services Agreement – EMS Billing Services
             2. Emergency Medical Service Cost Recovery Program-Policy and
                Procedure
Tracy Fire Department 



Emergency Medical 
Service                  
Cost Recovery 
Program 
Policy and Procedure 




 
9/1/2009 ‐ Resolution 2009‐161 
 
                                Tracy Fire Department
                  Emergency Medical Service Cost Recovery Fee Program
                                 Policy and Procedure



   1. Policy Purpose

         This policy is adopted by the Tracy, California City Council to set forth certain
         provisions of the Emergency Medical Service Cost Recovery Fee Program
         (EMSCR).

   2. EMSCR Fee Applicability

         The City shall charge an EMSCR fee to any person who received Emergency
         Medical Services from the Fire Department and who is not entitled to the benefits
         of the Emergency Medical Service Subscription Program. The EMSCR fee shall
         also be charged to any person refusing treatment on whose behalf a call for
         Emergency medical Services was made at his or her request or by any person
         within the patient’s household or business. The EMSCR fee shall not be charged
         to any person refusing treatment where the call for Emergency Medical Service
         was not made at his or her request or was made by a person who is not within
         the patient’s household or business.

   3. EMSCR Fee

         The EMSCR fee shall be set originally at the amounts listed in the table below.
         The EMSCR fee shall be adjusted periodically by resolution of the City Council.



                 Potential Fee                                 Proposed Rate
                 EMS First Responder (ALS/BLS)                 $300
                 Non-resident EMS First Responder              $400
                 ALS Support                                   $100
                 Non-resident Motor Vehicle Incident           Actual Costs
                 Resident Motor Vehicle Incident               Actual Costs
                 Lockout Response                              $180

   4. EMSCR Fee Waivers

         A. In exceptional or unusual circumstances, the Chief of the Fire Department
            (Chief) may elect not to charge otherwise applicable EMSCR fee.
            “Exceptional or unusual circumstances” include, but are not limited to, the
            following: (A) cases in which the patient expires before Fire Department
            personnel arrive on scene; (B) cases in which the patient expires while Fire
            Department personnel are providing emergency medical services.

         B. The Chief may also waive the EMSCR fee for any patient whose insurance
            will not pay the amount of the fee if that patient demonstrates that the
            patient’s gross income is less than the amount established for eligibility in the
            PG&E CARE Program. The income exemption limit provided herein shall be
            revised annually by the City of Tracy to conform to the most current amount
            of income that is eligible for the PG&E CARE Program.

Page 2                                                                  Resolution 2009-161
                                Tracy Fire Department
                  Emergency Medical Service Cost Recovery Fee Program
                                 Policy and Procedure



         C. The Chief may not waive an otherwise applicable EMSCR fee by virtue of a
            patient’s relationship or friendship with any City employee, or by virtue of a
            patient’s employment by the City if the service received occurs while the City
            employee is off duty/not working. The Chief shall create a written record for
            each instance in which an EMSCR fee is waived, documenting the
            circumstances involved and the reason for the EMSCR fee waiver. Each such
            record shall be maintained by the Fire Department for a period of at least five
            (5) years.

   5.      EMSCR Fee Appeals Process

           A customer that is billed for services rendered may appeal the determination
           that the billed for services were provided to that customer or the Chief’s
           determination to deny a wavier request. The appeal process shall be that set
           forth in Section 1.12.010 of the Tracy Municipal Code. The appeals process
           will be identified on each invoice provided to the customer.

   6.      Billing and Collections

           The City, or a third party billing firm contracted by the City, will generate a bill
           for each patient who has incurred an EMSCR fee, except for patients for whom
           fees are waived pursuant to Section 5 above or as a result of the patient’s
           membership in the EMSCR program. Bills are due upon receipt by the patient.
           Bills which remain unpaid ninety (90) days after receipt by the patient may be
           referred to a collection agency unless a waiver is granted pursuant to sections
           4 or 5 of this Policy and Procedure. The City will make the final determination
           on collections, not the third party billing agency.

   7.      Definition of Emergency Medical Services

           Emergency Medical Services shall be mean Basic Life Support and/or
           Advanced Life Support, as those terms are defined in Sections 1797.60 and
           1797.52, respectively, of the California Health & Safety Code.

   8. EMS Membership Program

         A. The EMS Membership Program is a voluntary program open to residents of
            the City of Tracy, and any business located in and possessing a business
            license issued by the City of Tracy. Eligibility may be established through
            current utility bills, rent receipts, or other forms of identification which clearly
            reflect residence or business location within the City.

         B. Participants in good standing of the EMS Membership Program will not be
            charged the EMSCR Fee if service is rendered. A paid membership waives
            the cost recovery fees listed above to the extent that participants do not have
            insurance or the participants’ insurance does not cover the costs for the EMS
            response.



Page 3                                                                     Resolution 2009-161
                               Tracy Fire Department
                 Emergency Medical Service Cost Recovery Fee Program
                                Policy and Procedure


         C. To be eligible, members must be at least 18 years of age and a legal resident
            or citizen of the United States.

   9. EMS Membership Program Fee

         A. The EMS Membership Program will be administered by City staff.

         B. The fee is assessed annually from date of enrollment. The annual fee for
            membership is established as follows:

         Home owner/Resident Rate $48.00
         Business Rate……………… $48.00 (covers first 10 employees)
                                  $ 3.00 (for each employee over 10, max. $100.00)
         Low Income Rate*……………$36.00 (PG&E CARE program eligibility required)

         For homeowner/residents, the EMS Membership Fee of $48 covers all persons
         who reside at the residence for responses that occur at home or anywhere within
         the City. In addition, all invited guests are covered while they are in the
         member’s home.

         For businesses that enroll in the membership program the EMS Membership Fee
         of $48 covers the first 10 employees. Additional employees may be added at a
         fee of $3 per employee over the initial 10. The maximum payment amount would
         be $100 regardless of number of employees. Business memberships cover
         employees anywhere within the City of Tracy city limits so long as the employees
         are acting within the scope of their employment.

         *Households meeting the PG&E CARE program eligibility will have a reduced
         rate of $36 for the voluntary membership fee.

   10. EMS Membership Program Enrollment

         A. To enroll in the EMS Membership Program, participants must complete an
            official program application. Applications are available at any fire department
            facility or via the City’s website.

         B. By becoming a member, participants are authorizing the City to attempt cost
            recovery through their insurance providers, if any.

         C. Enrollment into the program would be renewable on an annual basis from the
            date of original enrollment.




Page 4                                                                Resolution 2009-161
                                  RESOLUTION ________


  APPROVING A PROFESSIONAL SERVICES AGREEMENT WITH ADPI-INTERMEDIX TO
     PROVIDE BILLING SERVICES FOR THE FIRE DEPARTMENT’S EMERGENCY
   MEDICAL SERVICES COST RECOVERY PROGRAM AND FIRE DEPARTMENT USER
         FEES AND AUTHORIZING THE MAYOR TO SIGN THE AGREEMENT

        WHEREAS, On June 16, 2009 the City Council adopted resolution 2009-117 authorizing
a fee-funded emergency medical services (EMS) membership program and fire department
user fees, and

       WHEREAS, On September 1, 2009, the City Council adopted resolution 2009-161
approving the Emergency Medical Services Cost Recovery Policy and Procedure, and

       WHEREAS, There is a need to procure billing services from a professional billing
contractor experienced in processing cost recovery claims, and

         WHEREAS, On September 8, 2009 the City issued a request for proposals for the
billing services for the EMS Cost Recovery Program, and

         WHEREAS, the City received four proposals on September 22, 2009 and through review
staff identified ADPI-Intermedix as the firm best addressing the scope of work outlined in the
RFP;

       NOW, THEREFORE, BE IT RESOLVED, That the City Council approves the
professional services agreement for EMS Cost Recovery Billing Services between the City of
Tracy and ADPI-Intermedix and authorizes the Mayor to sign the agreement

                                   *****************

        The foregoing Resolution ________ was adopted by the Tracy City Council on the
________ day of ____________, 2010 by the following vote:



AYES:          COUNCIL MEMBERS:

NOES:          COUNCIL MEMBERS:

ABSENT:        COUNCIL MEMBERS:

ABSTAIN:       COUNCIL MEMBERS:


                                                      ________________________________
                                                                   Mayor
ATTEST:

__________________________
       City Clerk

								
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