AGENDA
ITEM
16 AGENDA
CALEXICO California ITEM
WHERE CALIFORNIA
16 CITY COUNCIL
AGENDA STAFF REPORT
DATE: November 5t, 2025
TO: Mayor and City Council
APPROVED BY: Benjamin Martinez, City Manager Bu
REVIEWED BY: Karla Chaparro, Finance Director Je
PREPARED BY: Juan Contreras, Fire Chief JAe
SUBJECT: Public Hearing on the Proposed Emergency Medical Services (EMS) User Fee Schedule per the EMS Rate Study Dated April 2018 and Adoption of Updated EMS User Fee Schedule with CPI/ECI Adjustments through 2025 and Approval of a Resolution of the City Council of the City of Calexico, California, Adopting Fees and Charges for Emergency Medical Services, and Making Certain Findings and Taking Certain Actions Relating Thereto.
Recommendation:
It is recommended that the City Council adopt a resolution approving the updated Emergency Medical Services (EMS) User Fee Schedule, including annual Consumer Price Index (CPI) or Employee Cost Index (ECI) adjustments for the seven-year period 2019-2025.
Background:
In June 2018, the City Council adopted Resolution No. 2018-30 establishing new EMS user fees based on full cost recovery, and authorized annual adjustments tied to CPI/ECI. This action was taken to reduce the deficit in EMS cost recovery, which exceeded $3.3 million at the time. The adopted 2018 base rates for EMS services were:
- ALS Level 1: $1,268
- ALS Level 1 Emergency: $1,307
- ALS Level 2: $1,326
- BLS: $1,073
- BLS Emergency: $1,131
- Against Medical Advice (AMA): $410
It is recommended that the City Council adopt a resolution approving the updated Emergency Medical Services (EMS) User Fee Schedule, reflecting CPI/ECI adjustments through 2025, and acknowledging revenue recovery estimates based on the City's CY 2024/25 payer mix.
While the 2018 Council-approved rate structure included annual CPI/ECI adjustments for five years, the City Council has now taken decisive action to authorize adjustments through 2025, ensuring the EMS fee schedule keeps pace with today's economic realities. By proactively updating these fees, the city demonstrates its commitment to fiscal responsibility and high-quality emergency medical services, making certain that fees remain fair, sustainable, and truly reflective of the costs required to deliver essential care to our community.
Despite the proposed adjustment, the City's EMS transport fees remain approximately 20-25% lower than comparable rates charged by private ambulance providers operating in the region. This ensures that the city continues to offer high-quality emergency medical services at a cost that is still below prevailing market rates, while aligning the fee schedule more closely with actual service delivery costs.
Discussion and Analysis:
The Table provides a detailed listing of 2018 base fees, 2025 adjusted fees, and CY 2025 payer mix- adjusted projected collections.
YEAR 2018 2019 2020 2021 2022 2023 2024 2025
CPI % 3.80% 3.10% 1.60% 3.80% 7.40% 3.50% 3.30%
FEES
ALS Level 1 1,268 1,316 1,357 1,379 1,431 1,537 1,591 1,643 ALS Level 1 Emergency 1,307 1,357 1,399 1,421 1,475 1,584 1,640 1,694 ALS Level 2 1,326 1,376 1,419 1,442 1,497 1,607 1,664 1,718 BLS 1,073 1,114 1,148 1,167 1,211 1,301 1,346 1,391
BLS Emergency 1,131 1,174 1,210 1,230 1,276 1,371 1,419 1,466 Against Medical Advice (AMA) 410 426 439 446 463 497 514 531 Payer Mix Calendar Year 2025:
- Medicare: 53%
- Medi-Cal: 7%
- MCAL HMO: 23%
- Insurance (Commercial): 8%
- Private Pay: 9%
As costs associated with the provision of services fluctuate over time, there is a significant element in the development of any fee schedule is its ability to remain flexible with the current cost factors. We recommended that the City include authorization for a seven (7) year annual inflation adjustment in the ordinance adopting the new fee schedule.
Delivery Cost Alignment:
The Willdan EMS Rate Study identified the following delivery cost drivers:
• Personnel: Firefighter/Paramedic salaries, benefits, and overtime costs. • Operations: Fuel, medical supplies, vehicle maintenance, and dispatch. • Overhead: Administrative support, insurance, and compliance.
The updated fees remain tied to these cost categories. As costs rise with inflation and labor agreements, the CPI/ECI adjustment ensures that fees do not lag actual delivery expenses. 2 Conclusion:
The EMS fee adjustments provide a consistent, formula-driven mechanism to ensure user fees keep pace with service delivery costs. The 2018 base fees, when combined with CPI/ECI adjustments, bring annual EMS revenue projections into closer alignment with providing ambulance services.
This approach:
• Improves cost recovery.
• Provides financial stability for EMS operations.
• Minimizes the structural deficit in the General Fund
• Creates a predictable, transparent framework for future fee adjustments.
This will authorize the Council, either by ordinance or resolution, to increase or decrease the fees based upon published information such as (i) the Consumer Price Index (CPI) Los Angeles - Riverside - Orange, All Urban Consumers or (i) the Employee Cost Index for State and Local Government Employees, Total Compensation as released by the United States Department of Labor's Bureau of Labor Statistics. In accordance with an annual inflation factor, and starting on July 1, 2026, of each fiscal year, the City may consider increasing or decreasing fees based on the percentage change in the selected adjustment factor.
Staff recommend adoption of the updated EMS User Fee Schedule and the accompanying resolution.
Fiscal Impact:
Based on the findings of the 2018 EMS User Fee Study, the proposed increase in fee revenues moves the city closer to recovering the full cost of providing emergency medical services. While the City has historically subsidized a portion of these costs through the General Fund, the updated rates more accurately reflect the actual expenditures associated with personnel, equipment, supplies, and overhead required to deliver these critical public safety services.
Coordinated With:
City Manager Benjamin Martinez
Finance Director, Karla Chapparo
Attachments:
1. Draft Resolution - Adoption of Updated EMS User Fee Schedule with CPI/ECI Adjustments.
2. EMS Fee Adjustment Table (2018-2025).
3 ATTACHMENT NO. 1
RESOLUTION NO. 2025-
A RESOLUTION OF THE CITY COUNCIL OF THE CITY OF CALEXICO, CALIFORNIA, ADOPTING
UPDATED FEES AND CHARGES FOR EMERGENCY MEDICAL SERVICES (EMS), INCLUDING ANNUAL CPI/ECI ADJUSTMENTS (2019-2025), AND MAKING CERTAIN FINDINGS AND TAKING CERTAIN ACTIONS RELATING THERETO.
WHEREAS, the City of Calexico provides emergency medical and ambulance services ("EMS") and charges rate-payers fees for such services ("EMS Fees").
WHEREAS, EMS fees were previously updated by Resolution No. 2018-30 to reflect increased costs of providing EMS.
WHEREAS, the City Council authorized annual CPI/ECI adjustments for five years (2019-2025) to ensure fees kept pace with inflation.
WHEREAS, the adjusted EMS Fees do not exceed the City's reasonable costs of providing EMS services or products.
WHEREAS, the City Council has reviewed the updated EMS User Fee Schedule with CPI/ECI adjustments for 2019-2025.
NOW, THEREFORE, THE CITY COUNCIL OF THE CITY OF CALEXICO DOES RESOLVE AS FOLLOWS:
SECTION 1. Recitals. The above recitals are true and correct and are incorporated herein by this reference.
SECTION 2. Adoption. The City Council hereby adopts the updated EMS User Fee Schedule (2019-2025) attached hereto as Exhibit "A"
SECTION 3. Findings. The EMS Fees adopted herein are imposed for a specific government service provided directly to the payor, are not more than necessary to recover the reasonable costs and are allocated fairly to beneficiaries of such services.
SECTION 4. Rules & Regulations. The City Council may adopt rules and procedures for implementation, provided that no fee exceeds the cost of service.
SECTION 5. Severability. If any section or portion of this Resolution is held invalid, the remainder shall remain in full force and effect.
SECTION 6. Further Action. The City Manager and designated staff are authorized to take all necessary actions to implement this Resolution.
SECTION 7. Attestation. The mayor shall sign, and the City Clerk shall attest this Resolution, which shall then take effect immediately.
PASSED, APPROVED AND ADOPTED this 5th day of November 2025.
Mayor, Diana Nuricumbo
ATTEST:
City Clerk, Veronica Luna
APPROVED AS TO FORM:
City Attorney, Carlos Campos
ATTACHMENT NO. 2
EMS Fee Adjustment Table (2018-2025)
EXHIBIT "A"
PROPOSED EMS FEE SCHEDULE - 2025 CPI ADJUSTED WITH CY 2024/25 PAYER MIX COLLECTIONS Service 2018 Fee ($) 2025 Adjusted Fee ($)
ALS Level 1 1268 1651.28
ALS Level 1 Emergency 1307 1702.07
ALS Level 2 1326 1726.81
BLS 1073 1397.34
BLS, Emergency 1131 1472.87
Against Medical Advice (AMA) 410 533.93
Airways Nasal/Oral 12 15.55
Albuterol 12 15.55
Assessment at Scene 125 162
Atropine 12 15.55
Backboard 10 12.96
Bag Valve Mask 12 15.55
Bandages 10 12.96
Benadryl 12 15.55
Burn Pack 20 25.92
Cervical Collar 20 25.92
Combitube 75 97.20
CPR 30 38.88
Defibrillator 30 38.88
Diphenhydramine 12 15.55
EKG 70 90.72
Emesis Bag/Basin 12 15.55
Endotracheal tubes 10 12.96
EOA 35 45.36
Epinephrine 12 15.55
Extra Crew 50 64.80
Furosemide 12 15.55
Glucagon 100 129.60
Glucometer 10 12.96
Head Bed 15 19.44
Heat/Cold Pack 10 12.96
Intubation 15 19.44
Isolation Kit 18 23.33
6 EXHIBIT "B"
PROPOSED EMS FEE SCHEDULE - 2025 CPI ADJUSTED WITH CY 2024/25 PAYER MIX COLLECTIONS Service 2018 Fee ($) 2025 Adjusted Fee ($)
IV Solutions 20 25.92
IV start kit 12 15.55
Lidocaine 12 15.55
Linen/Gloves/Decon 15 19.44
MAST 50 64.80
MILE1 10 12.96
Naloxone Calexico 12 15.55
Night Call 20 25.92
OB Kit 20 25.92
Oxygen 35 45.36
Oxytocin 12 15.55
Pneumatic anti-shock 50 64.80
garment
Restraints 10 12.96
Splints card board 10 12.96
Suction 15 19.44
Wait Time (hr) 50 64.80
7