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Ambulance District


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About Madison & Ruby Valley Ambulance District

On May 3rd, Madison County voters will be to support a mill levy to upgrade our emergency medical response capabilities by providing a sustainable funding source for the Madison and Ruby Valley Rural Ambulance District

Why Support The Mill Levy

The mill levy will allow us to meet the emergency medical needs of a growing community by providing a reliable, broad-based, equitable funding source. This will ensure the long-term sustainability of our medical response function by spreading the cost of care among all property owners.

Learn More About The Mill Levy


Frequently Asked Questions:

  • How will the Ambulance District improve emergency medical services? 
    • Response to 911 calls are almost instantaneous when EMS personnel respond from a hospital. Our Emergency Medical Technicians (EMTs) and more highly qualified paramedics are on staff 24 hours a day, 7 days a week, with a back-up crew available for multiple 911 calls and when our patients need to transfer to a larger hospital for specialty care. Our EMTs and paramedics receive advanced training and endorsements in management of airway, medications, trauma and cardiac care. They can provide Advanced Life Support transfers which includes cardiac monitoring, intubation and IV medication administration. When the EMS staff are not on an ambulance call, they work as emergency room technicians assisting our medical providers and nurses with assessing patients, starting IVs, blood draws, EKGs and patient education. This integration of pre-hospital and emergency department care ensures our EMS staff can provide the highest level of medical interventions possible.

  • Could you explain special districts and mill levies?
    • A special taxing district is created by the County Commissioners when a need is identified for a specific geographic area. You may have noticed; the special district boundary does not include all of Madison County. There are areas within Madison County to which Madison Valley Medical Center or Ruby Valley Medical Center do not always respond. For example, the Big Sky portion of Madison County is already covered by a special fire and ambulance district and is excluded. The northern most portion of Madison County is more often covered by the Jefferson County Ambulance Service and is excluded. Lastly, since the special district boundary was formed using a combination of already established special districts, there are other areas not included which may be annexed in the future. The Certified Taxable Property Value of the proposed ambulance district in 2021 is $38,787,977. Therefore, one mill is equal to $38,788. The proposed Madison and Ruby Valley Rural Ambulance District will be funded at $465,000. It will take approximately 12 mills to equal $465,000 which will cost a property owner approximately $16.20 per $100,000 of assessed property value. So, for example, if your assessed property value is $400,000, then that property would be annually assessed $64.80. This estimate is based on the 2021 Certified Taxable Property Values. To determine what the special district may cost you, review your most current Madison County tax bill. As property values change so does the calculation. If the special district is approved on May 3, 2022, it will become effective on January 1, 2023. This is a four-year, voted levy which will expire, if passed, on December 31, 2026. If it were to continue, an additional ballot initiative would be necessary.

  • For what will the $465,000 be used? 
    • Madison Valley Medical Center (MVMC) and Ruby Valley Medical Center (RVMC) are designated by the Center for Medicare and Medicaid Services (CMS) as critical access Hospitals and are also recognized and 501(c)3, non-profit corporations under the IRS regulations. Because of our status, we receive “cost-based” reimbursement for Medicare and Medicaid patients. Without this designation and this reimbursement model, hospitals like ours would not exist. Unfortunately, hospital-based ambulance services are not eligible for cost-based reimbursement at this time. This makes operating rural ambulance services very challenging. High fixed costs and low run volumes in rural areas, compared to the national average, result in significant operating losses. Insurance reimbursement covers only a portion of the fixed costs associated with 24/7 EMT and paramedic coverage. Although the combined operating losses for both ambulance services are expected to be much higher, $465,000 divided between both medical centers will help offset a significant portion of these losses. The Madison County Commissioners will annually determine the allocation of the mill levy funds between the two medical centers. It’s important to also note, the funding for the special district does not replace your health insurance coverage for ambulance services. Medicare Part B, Medicaid, and other outpatient, commercial insurances cover ground ambulance transportation when you need to be transported to a hospital, critical access hospital, or skilled nursing facility for medical necessary services. In addition, MVMC and RVMC’s financial assistance programs, for eligible patients, apply.

  •  What will RVMC & MVMC do if the ambulance district is not passed? 
    • RVMC and MVMC will endeavor to continue providing the best emergency medical services possible and keeping up with the needs of our community while also continuing to seek options for financial support. Our Medical Centers are committed to providing ambulance services because it is such a vital component to our community’s welfare. Without the ambulance district’s support, RVMC and MVMC will continue to prioritize the needs of our community and make changes, as necessary – potentially affecting other programs and services. Our goal is to provide the best services possible, especially those that are identified by our community as among the most important.