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other governmental entities, including <br />Minnesota cities. Indian tribes are <br />extremely unique legal entities under federal <br />law and international treaties. The new law <br />was a broad brush authorization that did not <br />address important issues that uniquely arise <br />when dealing with Indian tribes related to <br />sovereignty, insurance liability and liability <br />limits (commonly called "tort caps"). <br />Previous laws, such as Minn. Stat. § 626.93 <br />(authorizing tribes to act as law enforcement <br />entities) explicitly addressed these concerns. <br />Since the new law passed, interest has been <br />expressed by public safety groups and <br />individual cities in entering into joint powers <br />agreements with federally recognized Indian <br />tribes. However, legislative guidance is <br />needed to address concerns related to <br />sovereignty, insurance and liability limits for <br />these agreements. <br />Response: Include in Minn. Stat. § 471.59 <br />(the joint powers statute) language <br />substantially similar to Minn. Stat. § <br />626.93 that clarifies that Indian tribes <br />entering into joint powers relationships <br />agree to: <br />a) Be subject to liability for its torts and <br />those of its officers, employees, and <br />agents acting within the scope of their <br />employment or duties arising out of <br />the joint powers agreement to the <br />same extent as a municipality under <br />Minn. Stat. ch. 466; and <br />b) Notwithstanding Minn. Stat. § 16C.05, <br />subd. 7, waive its sovereign immunity <br />with respect to claims arising from <br />liability under the joint powers. <br />SD-12. Ambulance Service Costs <br />and Liability <br />Issue: The cost of providing ambulance care <br />has increased steadily over the last several <br />years due in part to changes in Medicare <br />reimbursement. The federal Balanced <br />Budget Act (BBA) of 1997 made two <br />significant changes to ambulance billing. <br />First, the act mandated that all ambulance <br />services accept Medicare assignments as <br />payment in full; that is, ambulance services <br />cannot bill the Medicare patient for any <br />unpaid balance beyond the Medicare <br />payment. Second, the act mandated a <br />uniform fee schedule that was implemented <br />in April 2002. The new fee schedule <br />significantly reduced reimbursement levels <br />for many ambulance services. The BBA <br />mandates are impacting the ability of some <br />Minnesota ambulance service providers to <br />adequately fund their operations. <br />The loss of revenue due to Medicare <br />reimbursement changes, coupled with higher <br />insurance rates, is affecting the ability of <br />many non -government -based ambulance <br />service providers to deliver emergency care, <br />particularly in rural Minnesota. All <br />ambulance services and personnel are <br />regulated by Minn. Stat. ch. 144E and must <br />comply with the same licensing, training, <br />and equipment -related requirements, <br />regardless of ownership. However, non - <br />government -based ambulance service <br />providers are treated differently from <br />government -based service providers in terms <br />of exposure to liability. While government - <br />based ambulance service providers have <br />specific statutory caps on damages that limit <br />their liability, non -government -based <br />ambulance service providers are not <br />protected by such caps. Consequently, non - <br />government -based ambulance service <br />providers have experienced inordinate <br />growth in their insurance rates. <br />Non -government -based ambulance service <br />liability exposure is a concern for three <br />reasons. First, municipalities that contract <br />for ambulance service may be required to <br />purchase excess liability coverage in order <br />to protect non -government -based ambulance <br />service providers against claims. Second, it <br />League of Minnesota Cities <br />2015 City Policies Page 7 <br />