Carmel committee debates ambulance fund changes, proposed fee for lift assists to care facilities

The committee reviewed amendments to the ordinance governing the paramedic/ambulance capital fund and debated a proposed fee for so‑called “lift assists” to assisted‑living and extended‑care facilities.

Fire Chief Joel Thacker described the ordinance changes as language cleanups and statutory alignments. He said the amendments would (1) rename the fund the Paramedic Emergency Ambulance and Fire Service Capital Fund; (2) remove dated references (including a Hamilton County EMS tax that staff could not locate); (3) tie commercial insurer billing to the statutory maximum of 400% of current CMS (Centers for Medicare & Medicaid Services) rates established by recent state law; and (4) cap out‑of‑pocket charges for Carmel residents (the chief discussed an $800 limit as an example). Thacker also proposed giving the fire chief authority to adjust rates to remain compliant with changes in federal or state regulations.

On a separate item, Chief Thacker proposed a $500 lift‑assist fee charged to facilities (not to private residences) when trained facility staff are present but for whatever reason cannot or will not lift a fallen resident and instead call 911. “We respond, you know, 8 to 10 times a month on lift assist to extended care facilities,” Thacker said, noting the department clears patients and most require no transport. He offered first‑quarter 2025 data showing roughly 30 such calls in the quarter and used that to estimate about $15,000 per quarter (about $60,000 annually) if the fee were charged for those calls.

Thacker and staff provided a payer‑mix breakdown for ambulance billing: roughly 55% Medicare, 10% Medicaid, 30% commercial insurers and 5% private pay. He also said the department’s cost analysis put an average per‑transport cost in the neighborhood of $845 and used that figure when discussing the $800 out‑of‑pocket cap for Carmel residents.

Councilors pressed a range of concerns. Several members expressed support for clarifying fund language and tying rates to the statutory maximum, but many cautioned that a lift‑assist fee could inadvertently deter calls for needed help, shift liability or be passed on to vulnerable residents. Councilor Locke said she wanted more evidence that facilities would change behavior because of a fee and asked staff to consult local assisted‑living providers. Councilor Royal and others asked whether the fee would be billed to the facility (as proposed) and whether facilities could or already bill residents for similar services.

A motion to send the amended ordinance, as drafted including the lift‑assist fee, back to full council with a positive recommendation failed after committee members voiced unanswered questions and asked for more analysis and outreach. Committee members suggested alternatives including (1) approving only the non‑fee technical and statutory changes now and deferring a lift‑assist fee until staff complete outreach and a data review or (2) specifying the fee as discretionary (“may charge up to $X”) or making the fee subject to further administrative rulemaking. Chief Thacker said staff would reach out to facility owners and provide additional data about operational costs and the likely impact of a fee.

Why this matters: the amendments would affect how Carmel Fire bills commercial insurers, set consumer protections for Carmel residents and could create a new fee that targets long‑term‑care facilities. Supporters argued the fee would discourage inappropriate use of public emergency resources and recover costs; critics warned it could create perverse incentives that harm vulnerable people and shift costs to residents.

Next steps: committee asked staff to gather comparative data from other communities, consult local assisted‑living providers and return with clearer billing estimates, legal analysis of rate‑setting authority, and recommendations for whether and how to implement any lift‑assist fee. No final ordinance was forwarded to council.