Title
Adoption of Resolution Amending Master Fee Resolution No. 12191 to Increase the Ambulance Transportation Fees to Match Alameda County Approved Fiscal Year 2024-25 Emergency Medical Services User Fee Schedule. (Fire 34240)
Body
To: Honorable Mayor and Members of the City Council
From: Jennifer Ott, City Manager
EXECUTIVE SUMMARY
Under the terms of the Emergency Medical Services Ambulance Transport Services Agreement, the Alameda County Board of Supervisors is responsible for setting and approving any fees that apply to all Emergency Medical Service (EMS) providers related to ambulance transport. On July 1, 2024, the Alameda County Board of Supervisors approved increased user fees for the County's EMS providers. The City can increase its fees to match the County's rates, under Section 10.2 of its current Emergency Medical Services Ambulance Transport Agreement with the County. These fee adjustments reflect a 10.5% increase and add approximately $65,000 to the FY2024-25 budget over the next three months.
BACKGROUND
The City of Alameda operates under a Master Fee Schedule (MFS) that outlines the fees and charges for services provided by various departments. The MFS ensures that the appropriate collection fee accurately supports the City’s General Fund and other special revenue funds. Several fees included in the MFS are related to Emergency Medical Services (EMS) services provided by the Alameda Fire Department (AFD). The City’s current MFS was adopted in July 2024 and includes the Alameda County (County) fees approved in July 2023 by the Alameda County Board of Directors. Historically, the County distributes approval letters for fee increases in mid-July, after the City has adopted its MFS each June as part of the budget approval process. Past practice has been for the City to then adopt the County approved fees as part of the next Fiscal Year budget approval, approximately 11-months after they are made available, thus not capturing the associated revenues. Ambulance fees are primarily paid by private health care providers, Medicare, and MediCal and a policy is in place to waive part or all of the fees for low-income residents through a financial hardship procedure.
In Fiscal Year (FY) 2024-25, the Alameda County Board of Supervisors approved user fees for the Alameda County EMS Agency, setting the standard for EMS fees for cities within Alameda County. Section 10.2 of the City's current Emergency Medical Services Ambulance Transport Agreement (Exhibit 1) states that the city may increase user fees to match the County's approved EMS fees. The EMS Agency’s Updated City User Fees (Exhibit 2) reflects the approved rates. The City received the fee increase letter for FY2024-25 on July 16th, 2024, after adoption of the FY2024-25 MFS.
DISCUSSION
The Alameda County Emergency Medical Services is responsible for the procurement of emergency ambulance services for the local EMS system. The Alameda Fire Department has an agreement with Alameda County to be the emergency transport provider for Alameda. Albany, Piedmont, Berkeley, and Falck are the ambulance transport providers for other parts of Alameda County. Under the current agreement, all transport providers, including Alameda, are in the Alameda County Emergency Medical Services District. The Alameda Fire Department provides ambulance transport service at the Advanced Life Support (ALS) or paramedic level. Under the terms of the Emergency Medical Services Ambulance Transport Services Agreement, the Alameda County Board of Supervisors is responsible for setting and approving any fees that are applicable to all agencies that provide transport services. The fees are Consumer Price Index (CPI) based rate adjustments completed by the Alameda County Emergency Medical Servies Agency and submitted to Alameda County Board of Supervisors for approval
Historically, the current county-approved fees are not provided for adoption in the MFS since they are shared with providers after the MFS is adopted annually. Given the economic conditions and the need for fiscal prudence, it is recommended that the City approve this fee increase ahead of the FY2025-26 MFS adoption. Moving forward, the EMS fee increase will be presented to Council shortly after the Alameda County Health Emergency Medical Services provide the adjustments to the Fire Department. Staff intends to return to the City Council by July 2025 to adopt the County approved FY2025-26 EMS fees.
The table below presents the proposed user fee schedule changes to Exhibit G of the Emergency Medical Services - Ambulance Transport Services Agreement between the County and the City, as approved by the Alameda County Board of Supervisors for FY2024-25. These adjustments account for the increased cost of ambulance transport, paramedic services, and medical equipment/supplies. The proposed rates represent an overall fee increase of 10.5% over current rates.
|
City User Fees Schedule |
Current MFS |
Proposed Update |
|
Bundled Base Rage |
$ 3,664.87 |
$ 4,051.06 |
|
Mileage/Mile |
$ 82.69 |
$ 91.41 |
|
Oxygen |
$ 273.79 |
$ 302.64 |
|
** Treat, Non-Transport Rate |
$ 735.01 |
$ 812.46 |
|
|
|
|
These fees are recovered from Medicare, Medi-Cal, Insurance, and private payors, if they are not insured or if insurance does not cover the full cost. Medicare, Medi-Cal and Insurance cover 95.7% of EMS bills. The remaining 4.3% is billed to private payors. If any of these individuals cannot cover the associated cost of medical care provided by AFD, a policy and procedure is in place to provide them with a financial hardship application. The policy provides AFD with the ability to review and approve requests that are consistent and equitable to all utilizing the Department of Health and Human Services Poverty Guidelines to determine the percentage of reduction or if full waiving of the fee is appropriate. EMS services are never withheld based on a patient's ability to pay. AFD is committed to providing support for patients who experience financial hardships. Hardship waivers are only funded through the City’s General Fund and not from the fees paid by other individuals.
The proposed fee adjustments underscore the City's commitment to fiscal responsibility and the sustainability of its emergency medical services. The 10.5% fee increase will add approximately $65,000 to the FY2024-25 budget for the next three months. Cost recovery is critical, given rising wages, personnel costs, and medical equipment and supplies expenses. Staff conducted an analysis to confirm that the 10.5% fee increase will not generate additional revenue beyond the City’s costs in providing EMS services.
ALTERNATIVES
• Approve the EMS fee increases.
• Do not approve the EMS fee increase and reconsider it as part of the FY2025-26 MFS adoption with the FY2025-27 Biennial Budget approval or direct staff to return once the County provides the next allowable fee update in July 2025. If fees are not increased, the City will lose an estimated $65,000 in cost recovery associated with Ambulance services this year and possibly more, if a full cost recover fee is not approved as part of the Biennial Budget.
FINANCIAL IMPACT
This fee adjustment represents a 10.5% increase over the current EMS fees and is projected to increase General Fund revenue by $65,000 for the remainder of FY2024-25. Future projections indicate an increase in ongoing annual General Fund revenues of approximately $260,000.
MUNICIPAL CODE/POLICY DOCUMENT CROSS REFERENCE
This action is consistent with the Alameda Municipal Code and Articles XIII C and XIII D of the California Constitution.
This action supports the City Strategic Priority to “Practice Fiscally Responsible, Equitable and Inclusive Governance”.
ENVIRONMENTAL REVIEW
This action does not constitute a “project” as defined in California Environmental Quality Act (CEQA) Guidelines Section 15378 and therefore no further CEQA analysis is required.
CLIMATE IMPACT
There are no identifiable climate impacts or climate action opportunities associated with the subject of this report.
RECOMMENDATION
Adopt a resolution to amend Master Fee Resolution No. 12191 to increase the ambulance transportation fees to match Alameda County approved FY2024-25 Emergency Medical Services User Fee Schedule.
Respectfully submitted,
Nicholas Luby, Fire Chief
By,
Anne Iturraran, Fire Administrative Services Manager
Financial Impact section reviewed,
Ross McCarthy, Acting Finance Director
Exhibits:
1. Letter from Alameda County Health Emergency Medical Services regarding Ambulance User Fee Increase FY24-25
2. Emergency Medical Services Ambulance Transport Services Agreement and First Amendment