Can a Virginia locality direct Four-for-Life EMS funds to its own fire department instead of a private emergency crew?

Plain-English summary

Code § 46.2-694(A)(13) collects a $4.25 add-on to vehicle registration fees, with $4 going into a special state fund for emergency medical services purposes. That is commonly called the "Four-for-Life" fund. Subsection (e) returns 26% of the fund to the locality where the vehicle was registered, to train EMS personnel and buy necessary EMS equipment and supplies. The statute limits the locality to spending the money on "nonprofit emergency medical services agencies that hold a valid license issued by the Commissioner of Health."

The City of Hopewell wanted to redirect its Four-for-Life allocation from Hopewell Emergency Crew, Inc. (the previous nonprofit recipient) to the Hopewell Fire Department (also known as the Hopewell Bureau of Fire). Delegate Ingram asked whether that was permitted.

The AG said yes, provided three things are true: (1) the fire department meets the regulatory definition of an "emergency medical services agency" under 12 VAC § 5-31-10, (2) it has a valid license from the Virginia Department of Health's Office of Emergency Medical Services under Code § 32.1-111.6, and (3) it qualifies as nonprofit. The fire department is a government agency, which fits the regulatory definition of "person" (the regulatory definition expressly includes government agencies). A government agency by its nature does not operate for profit. The AG reported those licenses and, assuming the stated determinations were accurate, concluded Hopewell Fire appeared eligible for Four-for-Life funds. The funds must still be spent on EMS personnel training or necessary EMS equipment and supplies, consistent with OEMS guidelines for the 26% return-to-locality share.

Currency note

This opinion was issued in 2018. Subsequent statutory amendments, court decisions, or later AG opinions may have changed the analysis. Treat this page as historical context, not current legal advice. Verify current law before relying on any specific rule, deadline, or remedy mentioned here.

Background and statutory framework

The Four-for-Life program has been part of Virginia's EMS funding for decades. The structure: drivers pay a $4.25 surcharge at vehicle registration, $4 goes into the state EMS fund, the Office of EMS administers the fund, and 26% is returned to the locality where the vehicle is registered. Localities then disburse that returned share to qualifying nonprofit EMS agencies under their jurisdiction. The opinion addresses the 26% return-to-locality share.

Two regulatory pieces frame eligibility. First, the definition of "emergency medical services agency" in 12 VAC § 5-31-10: "any person engaged in the business, service, or regular activity, whether or not for profit, of transporting or rendering immediate medical care and providing transportation to persons who are sick, injured, or otherwise incapacitated or helpless and that holds a valid license as an emergency medical services agency issued by the commissioner." Second, the definition of "person" in the same regulation includes any "firm, partnership, association, corporation, company, or group of individuals acting together for a common purpose or organization of any kind, including any government agency other than an agency of the United States government."

So a state or local government EMS agency qualifies as a "person" that can be an "emergency medical services agency" if it provides EMS and is licensed. The opinion reported Hopewell Fire Department licenses for ALS ground ambulance and ALS non-transport first response.

The AG reasoned that a local government agency does not operate for profit and therefore meets the nonprofit condition in Code § 46.2-694(A)(13)(e). Use of the funds is still limited to EMS personnel training and equipment/supplies for EMS purposes, and OEMS issues guidelines for the 26% return-to-locality share that further specify allowable expenditures.

Common questions

What is the Four-for-Life program?
A funding stream for EMS in Virginia. A $4.25 add-on to vehicle registration; $4 goes into a state EMS special fund; 26% of that fund is returned to localities to spend on training and equipment for nonprofit EMS agencies licensed by VDH.

Does the fund cover only volunteer rescue squads?
No. The statute covers nonprofit EMS agencies. The training-and-equipment limit applies to "volunteer or salaried" personnel, so paid EMS personnel can also be supported by the program. The key is that the agency be nonprofit and licensed.

Why does a government fire department count as "nonprofit"? The AG reasoned that a government agency by its nature is not operating for profit. The statute's nonprofit limitation excludes for-profit ambulance services and similar private commercial operations, not government departments.

What if the fire department is not licensed for EMS?
Then it does not qualify. The license issued by OEMS under Code § 32.1-111.6 is a precondition. A fire department that does only fire suppression (no EMS) cannot tap into Four-for-Life funds.

Must the city divide its allocation between the fire department and the rescue squad? The opinion does not decide how to divide the allocation. It addresses whether an eligible fire department may receive Four-for-Life funds and notes that Hopewell's budget allowed disbursement to the emergency crew or between the crew and fire department.

What are the limits on how the funds can be spent?
Personnel training (for either volunteer or salaried EMS personnel) and "necessary equipment and supplies" for EMS provided by the agency. OEMS publishes guidelines for the 26% return-to-locality share, and any expenditure must conform to those guidelines.

Citations

• Va. Code § 46.2-694(A)(13) (Four-for-Life add-on registration fee)
• Va. Code § 32.1-111.6 (OEMS licensure authority)
• 12 VAC § 5-31-10 (definitions of "EMS agency" and "person")
• 12 VAC § 5-31-300; § 5-31-410 (OEMS function; classifications of licensure)
• OEMS Guidelines for the Expenditure of the 26% Return to Locality Share of EMS Four-for-Life Funds

Source

• Landing page: https://www.oag.state.va.us/annual-reports-opinions/official-opinions
• Original PDF: https://www.oag.state.va.us/files/opinions/2018/18-017-Ingram-issued.pdf

Original opinion text

COMMONWEALTH of VIRGINIA
Office of the Attorney General
Mark R. Herring
Attorney General

September 21, 2018

The Honorable Riley E. Ingram
Member, House of Delegates
3302 Oaklawn Boulevard
Hopewell, Virginia 23860

Dear Delegate Ingram:

I am responding to your request for an official advisory opinion in accordance with § 2.2-505 of the Code of Virginia. Issue Presented You ask whether a locality is permitted to use Four-for-Life funds to provide funding for its local fire department pursuant to § 46.2-694 of the Code of Virginia.

Background
You relate that the City of Hopewell recently voted to provide Four-for-Life funds to the Hopewell Fire Department. Previously, these funds were used to provide funding to Hopewell Emergency Crew, Inc.[1]

Applicable Law and Discussion
Section 46.2-694(A)(13) sets aside a portion of vehicle registration fees to be placed in a special state fund for emergency medical services purposes:

An additional fee of $4.25 per year shall be charged and collected at the time of registration of each pickup or panel truck and each motor vehicle .... All funds collected from $4 of the $4.25 fee shall be paid into the state treasury and shall be set aside as a special fund to be used only for emergency medical services purposes.[2]

Monies in this fund are commonly referred to as "Four-for-Life" funds. Section 46.2-694(A)(13)(e) directs that a portion of the moneys in this fund be given to localities to provide funding for nonprofit emergency medical services agencies licensed by the State Health Commissioner:

Twenty-six percent shall be returned by the Comptroller to the locality wherein such vehicle is registered, to provide funding for training of volunteer or salaried emergency medical services personnel of nonprofit emergency medical services agencies that hold a valid license issued by the Commissioner of Health and for the purchase of necessary equipment and supplies for use in such locality for emergency medical services provided by nonprofit emergency medical services agencies that hold a valid license issued by the Commissioner of Health.[3]

Thus, the pivotal questions in determining whether the Four-for-Life funds may be directed to the Hopewell Fire Department, also known as the Hopewell Bureau of Fire, are: (1) whether the fire department is an "emergency medical services agency" as defined by state law; (2) whether the fire department is licensed by the State Health Commissioner as an emergency medical services agency, and (3) whether the fire department is a non-profit organization.

The term "emergency medical services agency" is defined in the state regulations governing the Virginia Department of Health's licensure of emergency medical services agencies:[4]

"Emergency medical services agency" or "EMS agency" means any person engaged in the business, service, or regular activity, whether or not for profit, of transporting or rendering immediate medical care and providing transportation to persons who are sick, injured, or otherwise incapacitated or helpless and that holds a valid license as an emergency medical services agency issued by the commissioner in accordance with
§ 32.1-111.6 of the Code of Virginia.[5]

The term "person" is also defined in the same regulation as follows:

"Person" means, as defined in the Code of Virginia, any person, firm, partnership, association, corporation, company, or group of individuals acting together for a common purpose or organization of any kind, including any government agency other than an agency of the United States government.[6]

I have been able to determine that the Hopewell Fire Department, a government agency, does indeed regularly transport or render immediate medical care to persons who are sick, injured or otherwise incapacitated, i.e., it regularly provides emergency medical services. I have also been able to determine that the Office of Emergency Medical Services of the Department of Health has issued a license to the Hopewell Fire Department to engage in emergency medical services described as Ground Ambulance Services ALS (Advanced Life Support) and Non Transport First Response ALS.[7] If these determinations are accurate, the Hopewell Fire Department falls within the regulatory definition of a licensed emergency medical services agency. Finally, as an agency of a Virginia local government, it does not operate for profit.

Under these facts, the Hopewell Fire Department appears to meet the statutory criteria in
§ 46.2-694(A)(13)(e) to receive Four-for-Life funds designated by the General Assembly for licensed non-profit emergency medical services agencies. It is important to note that the statute limits the use of these funds to "training of volunteer or salaried emergency medical services personnel" or "the purchase of necessary equipment and supplies for use in such locality for emergency medical services."[8]

Conclusion

It is my opinion that a locality may use Four-for-Life funds to provide funding for its fire department, provided the department meets the definition of an "emergency medical services agency" in Title 12 of the Virginia Administrative Code and is licensed by the Office of Emergency Medical Services as required by § 32.1-111.6 of the Code of Virginia. Because the Hopewell Fire Department appears to meet these criteria, it is further my opinion that it is eligible to receive Four-for-Life funds disbursed by the City of Hopewell, for purposes for which such funds may be expended. With kindest regards, I am, Very truly yours,

Mark R. Herring
Attorney General

1. The City's budget for FY2018-2019 contains a provision permitting the city manager to disburse Four-for-Life funds "to the Hopewell Emergency Crew for authorized expenditures or to disburse funds between the Hopewell Emergency Crew and the Hopewell Bureau of Fire." See CITY OF HOPEWELL, Agenda Packets and Minutes, http://hopewellva.gov/meetings-agendas-minutes/ (Agenda of June 12, 2018) (last visited September 11, 2018). This provision, however, has appeared in the City's budget for the past several fiscal years. See CITY OF HOPEWELL, Budget and Audit Reports, http://hopewellva.gov/budget-audit-reports/ (last visited September 11, 2018).
2. VA. CODE ANN. § 46.2-694(A)(13) (2017).
3. Section 46.2-694(A)(13)(e) (emphases added).
4. The function of issuing licenses to emergency medical services agencies is carried out by the Office of Emergency Medical Services, a division of the Virginia Department of Health. 12 VA. ADMIN. CODE § 5-31-300.
5. 12 VA. ADMIN. CODE § 5-31-10.
6. Id. (emphasis added).
7. See OFFICE OF EMERGENCY MEDICAL SERVICES, EMS Agency Search, VIRGINIA DEPARTMENT OF HEALTH, https://vdhems.vdh.virginia.gov/emsapps/f?p=200:2 (last visited September 11, 2018); see also generally 12 VA. ADMIN. CODE § 5-31-410 (setting out various classifications of licensure for emergency medical services agencies).
8. More specifically, the expenditure of such funds must conform to the Guidelines set forth by the Office of Emergency Medical Services, which administers the distribution of Four-for-Life funds to localities. See OFFICE OF EMERGENCY MEDICAL SERVICES, Guidelines for the Expenditure of the 26% Return to Locality Share of EMS Four-for-Life Funds, http://www.vdh.virginia.gov/emergency-medical-services/ems-funding/ (last visited September 11, 2018).