Committee approves contracts for new Montgomery County EMS building; sheriff seeks $370,044 from fund balance

The Montgomery County public safety committee on May 20 approved a resolution authorizing the county executive to execute contracts for construction of a new county-run EMS building and garage and advanced the item to the full legislature for final approval.

The committee heard a presentation from the sheriff outlining operational and financial details for the county's EMS program and the facility. The sheriff said the county has identified “a critical issue, lack of available ambulances and frequent delayed EMS responses,” and described a multi-year effort to create an in‑county EMS capability, including procurement of ambulances and establishing billing for EMS responses.

The sheriff told the committee the county adopted an initial EMS operating budget of $533,447 for the program’s first year and that billing-based revenue began in June 2024. He reported year‑to‑date billing receivables of $591,332.01 that have been billed but not yet collected and said the program had roughly 800 responses as of February 2025 that represented cases of “no ambulance, extremely delayed response, or not the proper level of care.” He added the sheriff’s office returned approximately $405,000 to the fund balance at the end of its 2024 budget year because of vacancies and unspent personnel lines.

On facility funding, the sheriff said the county received a federal grant from Congresswoman Elise Stefanik’s office (described in committee as $1,570,000) to buy EMS equipment and to build the EMS house and garage. After procurement and expenditures (reported as $666,906.18 to date for ambulances, equipment, engineering and related costs), the low construction bid for the building and garage was reported at $1,360,044. Committee materials and the sheriff identified a funding gap of $480,044. The sheriff said he would return $110,000 that had been previously approved for other capital projects and requested $370,044 from fund balance to close the gap and proceed to construction.

The sheriff emphasized service goals as well as revenue prospects. “We’re not in this business to collect revenue. We’re in the business to provide a valuable service to the constituents who need help,” he said, while also noting billing can offset costs and that the county’s year‑to‑date revenue performance has improved since billing began.

Committee members pressed staff on billing details. The sheriff and EMR billing representatives described the payer mix (including Medicare, Medicaid and private insurance), coding challenges mapping prehospital conditions to ICD‑10 diagnosis codes, and the county’s partnership with a collections agency that specializes in EMS revenue recovery. The sheriff said some payments have been routed incorrectly to other county accounts because of multiple NPI numbers tied to the county tax ID and that staff are working to reconcile remittances so the sheriff’s office is credited correctly.

The sheriff also said the EMS program had saved the county about $25,000 by using county ambulances for jail transports and volunteer fire service standbys, and that DPW will perform site preparation if the legislature approves construction funding.

Committee members asked about alternatives, timing and budget oversight. The sheriff said remaining grant funds for the facility were available and that delaying construction could increase future costs. Treasurer Sean Graham and county budget staff clarified accounting language and transfer lines as the committee worked through amendments to add $40,000 to the C.T. Male line and $65,000 to a Westwinds general construction line (a combined additional $105,000 to be included in the total transfer from fund balance).

After discussion and several technical amendments to the resolution text and funding lines, the committee voted to approve the resolution at the committee level and move it to the full legislature for final action.

The committee did not adopt a final dollar amount for the full board at the committee meeting; the sheriff framed the $370,044 fund‑balance request as the amount needed after returning the previously approved $110,000 capital allocation and applying remaining grant funds and previously incurred expenses.