This opinion represents the views of the Office of the State Comptroller at the time it was rendered. The opinion may no longer represent those views if, among other things, there have been subsequent court cases or statutory amendments that bear on the issues discussed in the opinion.

AMBULANCE SERVICE -- Contracts (by town for a particular level of service) -- Fees (authority to collect from insurance companies)
FEES -- Collection of (ambulance service fees from insurance companies)

GENERAL MUNICIPAL LAW, §122-b; TOWN LAW, §184: In addition to ambulance service provided as part of a fire protection contract entered into by a town on behalf of fire protection districts, a town may contract for the provision of an additional level or type of ambulance service in the town and may specify the circumstances under which that service is to be available, provided that the service is available on a town-wide basis. The town or, if so provided in the town's rules and regulations, the ambulance service provider, may send to the user's insurance carrier a copy of the bill for the amount of the fee or charge imposed by the town for ambulance services rendered to the insured and may collect the fee or charge directly from the insurance carrier.

This is in reply to your letter concerning the town's authority to contract for ambulance service under section 122-b of the General Municipal Law. You indicate that the town currently contracts for fire protection on behalf of fire protection districts in the town and that these contracts also provide for ambulance services within the fire protection districts. You state that the town is considering the provision of supplemental ambulance service, in addition to that which is provided in the fire protection districts. The supplemental service would cover, among other things, locations which generate a high number of calls, such as nursing homes, and calls which require a greater degree of emergency medical treatment.

You ask whether, pursuant to section 122-b of the General Municipal Law, the town may contract with an ambulance service to provide service to supplement those services provided by the emergency rescue and first aid squads of the fire companies serving the fire protection districts. In addition, you ask whether the town may authorize the ambulance service, at the request of the user, to directly bill and collect from the insurance carrier of the user, any fees or charges imposed by the town pursuant to section 122-b.

Towns are authorized to contract for ambulance services on behalf of fire protection districts as part of fire protection contracts pursuant to Town Law, §184(1) (1991 Opns St Comp No. 91-7, p 15; 1986 Opns St Comp No. 86-13, p 22). In addition, General Municipal Law, § 122-b(1) authorizes towns to contract with certain entities, including private volunteer ambulance corps, to provide: 

an emergency medical service, a general ambulance service or a combination of such services for the purpose of providing prehospital emergency medical treatment or transporting sick or injured persons found within the boundaries of the municipality to a hospital, clinic, sanatorium or other place of treatment of such illness or injury....

"Prehospital emergency treatment" is defined as "that care provided by certified emergency medical technicians [EMTs] or certified advanced emergency medical technicians certified pursuant to the provisions of article thirty of the public health law" (General Municipal Law, §122-b[1][f]; see also, General Municipal Law, §122-b[1-a][a],[b]; Public Health Law, §3001[6],[7]).

Pursuant to section 122-b, the town has discretion in contracting for a particular type of service (i.e., emergency medical service, a general ambulance service, or a combination thereof) and the qualifications of the personnel who are to provide the service (i.e., certified EMTs, or advanced certified EMTs). In addition, section 122-b provides that a town must formulate rules and regulations relating to the use of ambulance equipment and apparatus in the provision of general ambulance or emergency medical service (General Municipal Law, §122-b[2]). It is our opinion that, pursuant to this requirement, a town may define and limit the level or scope of its ambulance service operations and, for this purpose, may specify the circumstances under which the service is to be provided (see, e.g., 28 Opns St Comp, 1972, p 74, in which we expressed the opinion that a town could limit the operation of its ambulance service to the two hospitals nearest the town).

Town Law, §184 and General Municipal Law, §122-b provide independent grants of authority to a town. Therefore, it is our opinion that, pursuant to General Municipal Law, §122-b, a town may contract for a particular level or type of service, in addition to the ambulance services provided as part of contracts on behalf of fire protection districts within the town. However, because section 122-b does not expressly authorize a municipality to contract for ambulance services on a part-town basis, the service must be provided on a town-wide basis and must be available to anyone within the town requiring that particular level or type of service (see Opn No. 91-7, supra; Opn No. 86-13, supra; 1980 Opns St Comp No. 80-85, unreported; 1974 Opns St Comp No. 74-1278, unreported; 23 Opns St Comp, 1967, p 287; cf. Town Law, articles 12 and 12-A, authorizing towns to establish ambulance districts). In addition, a contract of this nature should, at a minimum, identify the particular services to be provided and describe the terms under which services are to be provided (see 1987 Opns St Comp No. 87-76, p 113). Also, in negotiating multiple contracts for services, the town should make every effort to avoid duplication of services and coordinate the provision of services to the extent possible (see General Municipal Law, §122-b[4]; 1988 Opns St Comp No. 88-69, p 137; 1981 Opns St Comp No. 81-335, p 365; see also Public Health Law, §3003[4]).

As to the collection of fees by the ambulance service from insurance carriers, General Municipal Law, §122-b(2) authorizes towns to fix a schedule of fees or charges "to be paid by persons requesting the use of such facilities". Section 122-b further provides that the town "may provide for the collection of such fees and charges or may formulate rules and regulations for the collection thereof by the individuals, municipal corporations, associations, or other organizations furnishing service under contract..." (General Municipal Law, §122-b[2]; see 1982 Opns St Comp No. 82-26, p 33). Thus, the town, by rule or regulation, may authorize the collection of fees and charges by the ambulance service. The provision in section 122-b authorizing the collection of fees by persons or entities other than the contracting municipality was added by amendment in 1980 (L 1980, ch 303) and creates an exception to the general rule that municipal fees must be collected by the appropriate municipal officer or employee (see, e.g., 1990 Opns St Comp No. 90-53, p 120; 34 Opns St Comp, 1978, p 204; 25 Opns St Comp, 1969, p 90). Since these fees are imposed as municipal charges, however, the town's rules and regulations should require proper recordkeeping and accounting by the ambulance service of the fees collected.

An insurance carrier's obligation to pay for services provided to its insured, whether by direct payment to the service provider or by reimbursement to the insured, is generally governed by the terms of the insurance contract (see Shapira v United Medical Service, Inc., 15 NY2d 200, 257 NYS2d 150; Mercantile Credit Corp. v Downey, 37 Misc 2d 522, 238 NYS2d 630). Where the insurance contract provides for direct payment, however, it is our opinion that the municipality or, if so provided in the rules and regulations, the ambulance service, may accept payment from the insurance carrier in satisfaction of the claim against the user for fees and charges (see 82 NY Jur 2d, Payment and Tender, §33).

Section 122-b does not prescribe a procedure for users to designate a third party to receive a bill for fees and charges (cf. Real Property Tax Law, §954, prescribing a procedure for delivery of real property tax bills to mortgage investing institutions; General Municipal Law, §130, with respect to contracts by municipal hospitals with hospital service corporations). However, it is our opinion that the authority in section 122-b to provide, and formulate rules and regulations, for the collection of fees and charges, is broad enough to authorize a municipality, or if so provided in the rules and regulations, the ambulance service, to send, at the request of the user, a copy of the bill for fees or charges to the user's insurance carrier, where the user's insurance contract provides for direct payment by the carrier. The underlying liability for the fee or charge, however, remains with the user and the user remains responsible for the charge if it is not paid by the carrier. Further, because the user is ultimately liable for the fee or charge, we believe a copy of the bill should also be sent to the user.

May 23, 1991
Lynn A. Iacona, Esq., Deputy Town Attorney
Town of Babylon