Sunday, January 7, 2018

from the MMA website (an organization that usually promote beneficial things for cities and towns.

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The Honorable James T. Welch, Chair
Senate Committee on Health Care Cost Containment and Reform
State House, Boston
Dear Senator Welch and Distinguished Members of the Committee,
On behalf of the cities and towns of the Commonwealth, the Massachusetts Municipal Association wishes to offer testimony on An Act relative to health empowerment and affordability by leveraging transformative health care (The HEALTH Act). Continually increasing health care costs pose a constant threat to municipal and state budgets, crowding out funding for other worthwhile programs and necessary services. The rising cost of health care also exacerbates long-term problems such as the multi-billion-dollar unfunded OPEB liability that will burden taxpayers for years to come. We applaud your Committee for the monumental task you and your Senate colleagues have undertaken in recent months, and for the work that you have put into generating this first draft of cost containment legislation.
While many of the proposals included in The HEALTH Act are designed to bend the overall cost curve down and benefit our cities and towns, we do have significant concerns regarding the proposed changes to the process for setting rates for Emergency Medical Services (EMS), found in Sections 98 and 109. Cities and towns set fees and charges for a wide variety of municipal services, and are required by state law to match fees to the cost of providing the service. These local officials know the various unique circumstances that result in the rates they set for EMS, including geography, services offered, and the most common types of calls received in their communities. Applying a statewide rate of not more than 160% of the Medicare rate would not take into account these different circumstances.
Given the variations in geography, labor rates, level of service, intensity of service, and other important factors, setting a one-size-fits-all cap would essentially misfit all. This is the reason why local rate setting is so important to ensure adequate funding and resources for life-saving EMS services. While the aforementioned sections would allow municipalities to apply for a waiver from this rate, the vast majority of municipalities would need to seek waivers, creating an unnecessary and burdensome administrative process. Further, there is always the prospect that waivers might not be granted, which would then create dramatic revenue problems for these cities and towns. This would then either force significant cuts to emergency services, or force communities to cut funding for other valuable municipal services. A waiver process is not feasible if most municipalities would need to seek relief in this manner. Our initial assessment is that the proposed rate would result in the loss of up to 40 percent of the fees collected for EMS in municipalities across the Commonwealth.
The MMA does support the proposed change found in these sections that would eliminate the practice of “pay the patient” by insurance companies. This practice undermines the ability of cities and towns to fund and operate responsive and efficient ambulance services that are at the core of emergency medical services in Massachusetts. “Pay the patient” would force communities to pursue their own residents to recoup thousands of dollars in ambulance expenses. Turning cities and towns into bill collectors is an inefficient use of municipal resources. Further, the “pay the patient” construct creates incentives for abuse and unnecessary requests for transport.
Thank you again for holding this public hearing and soliciting input and testimony from all stakeholders. Local officials across the state applaud your efforts to advance impactful legislation to reduce the cost of health care, and we look forward to working with you to ensure that the framework works for cities and towns. If you have any questions regarding the EMS reimbursement provisions or “pay the patient,” or would like additional comment on other aspects of the legislation, please do not hesitate to have your office contact MMA Legislative Director John Robertson at (617) 426-7272 at any time.
Geoffrey C. Beckwith
Executive Director & CEO

Seems like there could be a problem with relying on theory.
Another thing I noticed at the last special Town Meeting of Tempeton; the new fire chief did not speak with a great deal of knowledge concerning the fire department/EMS budget; when you hear "as I understand it" or "according to the town administrator", etc. When a position is characterized as a "strong chief" I would think (and hope) the individual would know how the process works, what is involved and what exactly the numbers are; perhaps because of the way the document budget versus actual or expense ledger is now presented with very little, if any, clarity with regards to dollar amounts and transparency, this is what happens. People who attend Town Meeting should have al the information needed to make good decisions concerning their money. That means clear, easy to find and understand numbers; not just one large dollar figure, but a good break down of a departmental budget. How much for fuel - gasoline and diesel, vehicle maintenance, salaries, building expense and supplies, to name a few. You get that with a good line item expense plan. You do not get good information with unnamed, just a number and one or two large dollar figures; example: we need one million dollars to operate the Templeton DPW department, a good business, especially a fortune 500 company knows what it is spending and on what. That is how they know or explain cuts in man power, equipment or moving service or production overseas or sub-contracting things out; they have to have an explanation to stockholders. If they fail to do this, they lose investment money, and that is the biggest reason companies go public with stock openings, to gain investment money, which translates into capital and/or assets, which is then used as leverage for things like borrowing and a good rate of interest on said borrowing payback.
Advisory Committee submits it's request budget for fiscal year 2019.

$80,000.00 is requested for the Town's reserve fund; response/question from Carter Terenzini, part time Town Administrator:

Good Day:
A few questions:
What is MMAQ listed in employee support?
What is the rationale for a .0098% reserve fund; that is an odd ratio I don’t think I’ve seen before.
Further given draws out of the Reserve Fund over the past few years FY ’12 through ’16 came from an email from a W. Spring email;  FY ’17  & ’18 came from our records here
History of Use of Reserve Fund
Per 11/27/16 W. Spring eMail
FY '12
FY '13
FY '14
No Record
FY '15
FY '16
FY '17
FY '18 YTD
What is the rationale for an $80k request if we are able to more properly budget sub accounts closer to need and slowly address the snow and ice deficit.
Many Thanks
Carter Terenzini
Town Administrator
Town of Templeton
160 Patriots Road
East Templeton, MA 01438
Answer from Advisory Committee via Chairman;

A few of the reasons for the desire of the Advisory Committee to establish a reserve fund in the amount of $80,000.00 is a multi faceted approach; The committee looked at the recommendations/guidelines from MA DOR/DLS. The committee did scale back some, otherwise the requested number would have been too much of a one time increase. The committee feels that slowly increasing the town's reserve fund demonstrates that the Town is heading towards a much better financial position than in the past. The Town is moving forward rather than backwards. (as in reducing the reserve fund, which in our opinion, shows the Town is spending more and does not have a sufficient financial cushion) Since there was no movement towards putting any of the recent certified free cash towards any of the Town's stabilization funds, which the committee feels would have been a positive move with regards to the Town establishing a bond rating. So with no apparent will on the part of the selectmen to increase or establish a savings plan, Advisory Committee feels there is justification for an increase to the Town reserve fund. Rather than a backwards move,, as was done last time around ( drop from $50,000.00 to $35,000.00) Advisory discussed and voted that the town should move towards an increase in reserve funding. It is the opinion of Advisory that this demonstrates the Town has sufficient revenue sources and numbers to not only operate the Town from a financially sustainable  position, it also has the financial ability to set aside an adequate amount for emergencies without multiple financial transfers that can jeopardize things from a budgetary viewpoint. ( remember the fire department pump issue)
Again, Advisory fees this move can and will aid the Town as it moves forward towards a bond rating. Since the selectmen left an amount of certified free cash on the table, Advisory hopes this year the selectmen will use some of that money to increase the Town's stabilization funds. Again, the committee this would be financially prudent, smart and demonstrate Templeton is on the move towards financial stability. The Advisory Committee understands you may recommend something else and the selectmen will vote on what to present to Town Meeting, the committee hopes we demonstrate strong agreement on the financial path for the Town as we move forward. Whatever the number turns out to be, I believe Advisory will make known it's recommendation (s) to Town Meeting by way of it's written report to the Town per Templeton by-laws. We hope this is one area where we agree on common ground.

Jeff Bennett
Chairman - Advisory Committee