City of Sacramento
Budget and Audit Committee Report
915 I Street Sacramento, CA 95814
www.cityofsacramento.org
File ID: 2025-00773 3/25/2025 Discussion Item 6.
Proposed Emergency Medical Services Fee Adjustments
File ID: 2025-00773
Location: Citywide
Recommendation: 1) Review the proposed Emergency Medical Service Fee adjustments; and 2) pass a Motion forwarding to City Council for consideration.
Contact: Tilden Billiter, Deputy Chief, (916) 808-1603; David Charron, Emergency Medical Service Assistant Chief, (916) 808-1650, Fire Department.
Presenter: Tilden Billiter, Deputy Chief, (916) 808-1603; David Charron, EMS Assistant Chief,(916) 808-1650, Fire Department
Attachments:
1-Description/Analysis
2-Regional Fee Comparisons
3-Resolution
4-Exhibit A (Current & Proposed SFD EMS Fees)
5-Exhibit B (Sacramento County 2024 Ground Ambulance Fee Schedule: Assembly Bill 716) Description/Analysis
Issue Detail: On February 7, 2006, City Council formally adopted a Citywide Fees and Charges Policy (Resolution No. 2006-103) to ensure that City fees and charges reflect Council’s direction regarding recovery cost related to programs and services. The Emergency Medical Services (EMS) program is a fee supported program. On December 5, 2017, the City Council formally adopted the proposed Advanced Life Support Fee Adjustment and Amended Policy for EMS Revenue Recovery and Fee Waiver (Resolution No. 2017-0468). This Resolution adoption included: a 26% increase in the base rates and procedures, addition of a First Responder Fee, provision to adjust fees annually based the Consumer Price Index (CPI) Series Title: Medical Care in the U.S. City Average, All Urban Consumers, Not Seasonally Adjusted, as published by the U.S. Department of Labor, Bureau of Labor Statistics for the twelve (12) month period ending December 31 of the preceding year and a financial hardship program.
In July 2024, the Fire Department contracted with a third-party consultant, MGT of America
File ID: 2025-00773 3/25/2025 Discussion Item 6.
In July 2024, the Fire Department contracted with a third-party consultant, MGT of America Consulting, LLC dba MGT Consulting, to conduct an EMS user fee study, which was completed in March 2025. Based on the consultant’s findings, the staff is recommending fee adjustments to the existing fees for service. In addition to the proposed fee adjustments, staff recommend the adoption of new fees including: Bariatric Unit Usage, extra attendant fees, lift assist (at medical facilities), medical-assisted treatment, and mobile crisis services (per hour). The Fire Department has expanded its scope of services to meet the demands and needs of the community it serves. These additional fees will offset associated expenses with providing City of Sacramento’s EMS Program.
The changes to the City’s EMS program fees are summarized in the following chart (new fees are listed as N/A in the current fee column).
Fee Description Current Fee Proposed Fee 1 Change
Advanced Life Support Fees: effective July 1, 2025
ALS 1 Bundled Transport Fee $ 2,069.65 $ 3,108.00 $1,038.35 ALS 2 Bundled Transport Fee $ 2,069.65 $ 3,108.00 $1,038.35 BLS Bundled Transport Fee $ 1,848.26 $ 2,851.00 $1,002.74 Treated / Non-Transports $ 320.97 $ 388.00 $ 67.03 Mileage $ 37.94 $ 38.00 $ 0.06
Night Charge $ 116.05 $ 131.00 $ 14.95
Oxygen $ 158.07 $ 179.00 $ 20.93
New First Responder Fee $ 320.70 $ 363.00 $ 42.30 CPAP* $ 213.98 $ 242.00 $ 28.02
Chest Decompression* $ 156.64 $ 177.00 $ 20.36
EKG Monitoring* $ 182.74 $ 207.00 $ 24.26
Cardioversion* $ 182.74 $ 207.00 $ 24.26
Defibrillation* $ 182.74 $ 207.00 $ 24.26
Intubation* $ 151.51 $ 171.00 $ 19.49
EZ Interosseous* $ 369.34 $ 418.00 $ 48.66
Needle Cricothyrotomy* $ 256.79 $ 290.00 $ 33.21 Bariatric Unit Usage N/A $ 111.00 $ 111.00
Extra Attendant Fee N/A $ 122.00 $ 122.00
Lift Assist at Medical Facility N/A $ 31.00 $ 31.00 Medical-assisted Treatment Service N/A $ 86.00 $ 86.00 Mobile Crisis Services (per hour) N/A $ 122.00 $ 122.00 * Fees apply when used for ALS2 transports or Medical Assessment
File ID: 2025-00773 3/25/2025 Discussion Item 6.
Policy Considerations: The changes are consistent with Council’s adopted Fees and Charges Policy and support the City’s budget sustainability and fiscal responsibility goals. This charge is not a tax under Proposition 26, as it falls under Exception 2, a fee for government services. Each fee is a charge imposed for a specific government service or product provided directly to the payer that is not provided to those not charged and which does not exceed the reasonable cost to the local government of providing the service or product.
Economic Impacts: Not applicable.
Environmental Considerations: This report concerns administrative activities that will not have a significant effect on the environment and does not constitute a “project” as defined by the California Environmental Quality Act (CEQA) [CEQA Guidelines Section 15061 (b) (3); 15378 (b) (2)].
Sustainability: Not applicable.
Commission/Committee Action: Not applicable.
Rationale for Recommendation: The EMS fees were last increased in 2024 by the percentage change in the Consumer Price Index. With the consistent increase in cost to provide the services, the Fire Department contracted a third party to conduct a department-wide fee study. The proposed new rates are reflective of the results of the survey findings and increased cost as well as within industry standards (Sacramento County Emergency Medical Services Authority - 2025 Approved Ambulance Provider Rates) (Exhibit B).
Financial Considerations: EMS revenue recovery is largely tied to the payer mix composition. The City of Sacramento has maintained a consistent payer mix, comprising 43 percent Medicare, 37 percent Medi-Cal, and 12 percent Private Insurance, with the remainder consisting of self-insured and/or uninsured individuals. There are federally mandated write-offs which allow the City to collect a small percentage of the actual billed amount from Medicare and Medicaid. With the recent passing of AB716, effective January 1, 2024, uninsured patients can only be billed at the Medicare or Medi-Cal Fee-for-service rate. Private insurance plans are required to pay the approved posted rates, thereby eliminating balance billing.
Revenue estimates for these fee increases total approximately $4.7 million annually, however this amount is dependent on the total number of transports. On November 19, 2024, Council approved a Letter of Understanding with Local 522 adopting a revised citywide salary schedule. Funds in the Intergovernmental Transfer (IGT) program were identified to initially cover the increased costs, and additional revenues from this fee increase were identified as an ongoing funding source. If these fees are not approved, the City will need to reduce additional General Fund expenses or increase other
File ID: 2025-00773 3/25/2025 Discussion Item 6.
General Fund revenues.
Local Business Enterprise (LBE): Not applicable.
Base Fee Comparisons of Local Fire Departments EMS Fees
RESOLUTION NO. 2025-XXX
Adopted by the Sacramento City Council
PROPOSED ADVANCED LIFE SUPPORT (ALS) FEE ADJUSTMENTS AND AMENDED
POLICY FOR EMERGENCY MEDICAL SERVICES (EMS) REVENUE RECOVERY AND FEE WAIVER
BACKGROUND
A. On July 27, 1993 (Resolution 93 -434), the city established the Advanced Life Support (ALS) program.
B. The Fire Department is responsible for providing Advanced Life Support (ALS) services and Basic Life Support (BLS) services and transporting patients by ambulance throughout the City. These se rvices are General Fund activities supported by fees charged for services.
C. Resolution 2017-0468 allowed for a 26% increase in EMS fees, the adoption of a first responder fee, annual fee increases based on CPI and a financial hardship program.
BASED ON THE FACTS SET FORTH IN THE BACKGROUND, THE CITY COUNCIL RESOLVES AS FOLLOWS:
Section 1. The City of Sacramento Fee and Charge Report for the existing Fire Department EMS Program fees is amended as shown in Exhibit A.
Section 2. Exhibit A is part of the resolution.
Section 3. The EMS Program fee adjustment will be effective July 1, 2025.
Section 4. Beginning July 1, 2026, and each July 1st thereafter, fees will be adjusted annually based on the percentage change in the CPI, Series Title: Medical Care in the U.S.
City Average, All Urban Consumers, Not Seasonally Adjusted, as published by the U.S. Department of Labor, Bureau of Labor Statistics, for the twelve (12) month period ending December 31 of the preceding year. A cost analysis will be conducted annually, and CPI-based increases will be applied, provided that the adjustment does not exceed the cost of providing services.
Table of Contents:
Exhibit A – Current and Proposed SFD EMS Fees
Exhibit A
Current and Proposed SFD EMS Fees
Fee Description Current Fee Proposed Fee 1 Change
Advanced Life Support Fees: effective July 1, 2024
ALS 1 Bundled Transport Fee $
2,069.65
$ 3,108.00 $1,038.35
ALS 2 Bundled Transport Fee $
2,069.65
$ 3,108.00 $1,038.35
BLS Bundled Transport Fee $
1,848.26
$ 2,851.00 $1,002.74
Treated / non -transports $
320.97
$ 388.00 $ 67.03
Mileage $
37.94 $ 38.00 $ 0.06
Night Charge $
116.05
$ 131.00 $ 14.95
Oxygen $
158.07
$ 179.00 $ 20.93
New First Responder Fee $
320.70
$ 363.00 $ 42.30
CPAP* $
213.98
$ 242.00 $ 28.02
Chest Decompression* $
156.64
$ 177.00 $ 20.36
EKG Monitoring* $
182.74
$ 207.00 $ 24.26
Cardioversion* $
182.74
$ 207.00 $ 24.26
Defibrillation* $
182.74
$ 207.00 $ 24.26
Intubation* $
151.51
$ 171.00 $ 19.49
EZ Interosseous* $
369.34
$ 418.00 $ 48.66
Needle Cricothyrotomy* $
256.79
$ 290.00 $ 33.21
Bariatric Unit Usage N/A $ 111.00 $ 111.00
Extra Attendant Fee N/A $ 122.00 $ 122.00
Lift Assist at Medical Facility N/A $ 31.00 $ 31.00 Medical-assisted Treatment Service N/A $ 86.00 $ 86.00 Mobile Crisis Services (per hour) N/A $ 122.00 $ 122.00 * Fees apply when used for ALS2 transports or Medical Assessment