MEETING DATE:
NOVEMBER 10, 2026
SUBJECT:
Title
RESOLUTION NO. 2026-9685 - APPROVING THE UPDATED AMBULANCE TRANSPORT RATE SCHEDULE
Body
Recommendation
Recommendation
ADOPT a resolution approving updated ambulance transport rates.
Body
Board or Commission Action
Not Applicable
Executive Summary
The San Marcos Fire Department contracted with NBS Government Finance Group (NBS) to complete an Ambulance Services and First Responder Fee Study. The study reviewed the city’s current ambulance fees, the costs associated with providing ambulance transport services, regional ambulance rates, and the feasibility of implementing a First Responder Fee.
Following its review, NBS recommended increasing the city’s ambulance transport and Treatment on Scene/Treat No Transport fees to better align with the cost of providing these services. The study also found that San Marcos’ current ambulance transport rates are below the median of rates of many agencies included in this study.
Staff recommend establishing one standard ambulance transport rate of $4,170 for both Advanced Life Support (ALS) and Basic Life Support (BLS) transports. The city currently charges $2,309 for ALS transport and $1,846 for BLS transport. The proposed rate utilizes the study’s recommended transport rate and incorporates standard medical supplies and medications that are currently billed separately.
Moving to one transport rate for both ALS and BLS services is consistent with the trend among surrounding agencies and provides a simpler and more transparent billing structure. NBS noted that the use of one transport rate is becoming the norm among ambulance providers.
Even with the proposed increase, San Marcos’ $4,170 transport rate is competitive and still below the transport fees of those agencies that have completed recent transport fee studies. The average transport rate among agencies included in the NBS comparison that have recently completed fee studies is approximately $4,586. The San Diego County comparison average is approximately $3,700, not including supplies and medications that may be billed separately.
Staff also recommend increasing the Treatment on Scene/Treat No Transport fee from $202 to $1,374 and updating several other ambulance-related charges to better reflect current costs and regional comparisons. The proposed fees are included in the Ambulance Transport Rate Schedule provided as Attachment 2.
NBS also evaluated the feasibility of implementing a First Responder Fee and found that the fee would provide limited cost recovery due to insurance reimbursement limitations, anticipated collection rates, and the administrative cost of billing and collection. Based on these findings, staff do not recommend implementing a First Responder Fee.
San Marcos currently has one of the strongest ambulance collection rates among agencies in North County. Total collections are approximately 40 percent of the original amount billed, however after required contractual and statutory write downs, the city collects close to 90% of the remaining balance.
NBS projects annual ambulance transport revenue of approximately $7.5 million following implementation of the updated fees. Based on the study, current collection trends, and approximately eight months of revenue under the updated rates, staff recommend increasing the FY2026-27 ambulance revenue budget by $1.17 million, from $6.1 million to $7.27 million.
Staff also recommend authorizing annual Consumer Price Index (CPI) adjustments to the ambulance fee schedule. Staff would evaluate the adjustments annually to ensure rates remain reasonable and aligned with the cost of providing ambulance transport services.
Discussion
The San Marcos Fire Department provides emergency medical and ambulance transportation services to the more than 90,000 residents that reside in the community. These services are also provided to the surrounding communities through mutual and automatic aid. In FY2024-25, the Department responded to 12,094 calls for service while in FY2025-26 there were 12,401 calls for service. Approximately 78% of calls in FY2024-25 required emergency medical services, while in FY2025-26 84% were found to be emergency medical service related.
The Fire Department contracted with NBS to conduct a comprehensive review of the city’s ambulance base transport rates and Treatment on Scene/Treat No Transport fees. The study also compared San Marcos’ fees with those of surrounding and comparable agencies and evaluated the financial feasibility and fiscal responsibility of implementing a First Responder Fee.
Following its analysis, NBS recommended increasing the city’s ambulance transport and Treatment on Scene/Treat No Transport fees to improve cost recovery. The study also found the city’s current ambulance transport and Treatment on Scene/Treat No Transport fees are lower than most agencies included in the comparison, with recent fee studies completed.
Based on current medical equipment supply costs and regional ambulance billing practices, staff recommend updating the city’s ambulance fee schedule as outlined in Attachment 2.
Ambulance Transport Rate
Historically, transport agencies maintained separate rates for Advanced Life Support (ALS) and Basic Life Support (BLS) services. However, industry practices have evolved toward a single, standardized transport rate. This approach, supported by recent fee studies and industry evaluations, simplifies billing practices, improves administrative efficiency, and provides greater transparency and consistency in ambulance transport fees. The city currently charges separate rates for ALS and BLS ambulance transport. The current ALS transport rate is $2,309 and the BLS transport rate is $1,846. Medical supplies and medications used during treatment are billed separately.
Implementing a standardized transport rate also allows for a more equitable distribution of costs across the various types of emergency medical transport services provided. The rate accounts for both direct and indirect costs associated with delivering these services, supporting the city's goal of achieving 100 percent cost recovery.
Staff evaluated the current costs of medications and medical supplies associated with the most common emergency medical calls for service and patient problem types and determined an average cost of approximately $399 per transport. To simplify billing procedures, improve administrative efficiency, and provide greater transparency in ambulance billing, staff recommend incorporating these standard costs into the NBS-recommended transport rate of $3,771. This approach would eliminate the need to separately itemize and bill for standard medications and medical supplies, resulting in a proposed standardized ambulance transport rate of $4,170.
Moving to a single transport rate is consistent with the trend among surrounding agencies and provides a simpler and more transparent billing structure. It also supports consistency for patients receiving ambulance transportation throughout North County, where agencies regularly provide services across jurisdictional boundaries through mutual and automatic aid. NBS also found that the use of one transport rate for ALS and BLS services is becoming the norm among ambulance providers.
Even with the proposed increase, San Marcos’ $4,170 transport rate would remain below those rates established by several surrounding agencies. The average transport rate among agencies included in the study that have recently completed fee studies, or are in the process of completing a study, is approximately $4,586. The San Diego County comparison average is approximately $3,700, not including supplies and medications that may be charged separately.
Treatment on Scene/Treat No Transport
The city currently charges $202 for Treatment on Scene/Treat No Transport services. As part of the city's first formal ambulance transport fee study, NBS evaluated the costs associated with providing these services and determined the existing fee was significantly undervalued, recovering only approximately 15 percent of the actual cost of service. Although transport does not occur, these calls still require Fire Department personnel, apparatus, medical equipment, and other resources. Based on its cost recovery analysis, NBS recommended increasing the fee to $1,374 to better align with the actual cost of providing the service. The fee would only apply to calls requiring an advanced level of medical care where treatment is provided without transport. Staff recommend adopting the proposed fee to improve cost recovery.
Other Ambulance Fees
Staff also reviewed the city’s other ambulance-related fees. Several fees are recommended for adjustment based on current supply and equipment costs and regional comparisons. The proposed changes are included in the Ambulance Transport Rate Schedule provided as Attachment 2.
Ambulance Revenue and Collections
The amount billed by the city for ambulance services often differs significantly from the revenue ultimately collected, as Medicare and Medi-Cal reimbursements are subject to established payment limits and mandatory write-downs.
Despite the impact of mandatory write-downs, San Marcos maintains one of the strongest ambulance collection rates among North County agencies. The city collects approximately 40 percent of the original amount billed and nearly 90 percent of the remaining balance after required contractual and statutory adjustments. This distinction is important when evaluating ambulance revenue, as the difference between billed and collected amounts is largely attributable to mandated payer adjustments and reimbursement limitations rather than collection performance.
The city’s payer mix also impacts revenue. In FY 2025-26, Medicare represented approximately 56 percent of ambulance transports, Medi-Cal approximately 19 percent, commercial insurance approximately 15 percent, and private pay approximately 10 percent.
NBS estimates annual ambulance revenue of approximately $7.5 million following approval and implementation of the updated rates. The revenue estimate accounts for the city’s payer mix and reimbursement limitations that affect the amount ultimately collected.
Based on the fee study findings, the city’s historical collection data, and current revenue trends, staff recommend increasing the FY 2026-27 ambulance transport revenue budget by approximately $1.17 million, from $6.1 million to $7.27 million. The revised revenue estimate accounts for approximately eight (8) months of collections under the proposed rates during FY 2026-27.
Actual revenue will continue to vary based on the number of transports and Treatment on Scene calls, payer mix, Medicare and Medi-Cal reimbursement limitations and write-downs, commercial insurance reimbursement, private-pay collections, and other factors affecting ambulance billing and collections.
Staff will continue to monitor ambulance revenue and collection trends following approval and implementation of the updated rates.
Annual CPI Adjustment and Future Fee Study
The cost of providing ambulance services will continue to change as personnel, medical supplies, equipment, vehicles, fuel, and other operating costs increase.
To keep ambulance fees aligned with increasing service costs, staff recommend authorizing annual Consumer Price Index (CPI) adjustments beginning July 1, 2027, and each July 1 thereafter. Adjustments would be based on the percentage change in the Consumer Price Index for Medical Care in the U.S. City Average. Staff would evaluate the adjustments annually to ensure rates remain reasonable and consistent with the cost of providing ambulance transport services and submit the adjusted amounts to City Council for approval.
Consistent with NBS’ recommendation, the Fire Department plans to complete a comprehensive ambulance fee study every five years or as needed. NBS recommends periodically updating ambulance fee studies to account for changes in service delivery, cost structure, and the reimbursement environment.
The next study will also provide an opportunity to evaluate the impact of Fire Station 5 and any associated changes in staffing, equipment, response resources, or cost of providing ambulance and emergency medical services.
Annual CPI adjustments between comprehensive fee studies will help keep the fee schedule current, while the periodic fee study will provide a more complete review of the city’s ambulance service costs and fee structure.
Environmental Review
Not Applicable
Fiscal Impact
Approval of the proposed ambulance fee schedule is expected to increase ambulance transport revenue.
NBS estimates annual ambulance revenue of approximately $7.5 million following implementation of the updated fees. Approval of this action will increase the FY 2026-27 General Fund (Fund 100) ambulance revenue budget by approximately $1.17 million, from $6.1 million to $7.27 million.
Actual revenue will vary based on transport and Treatment on Scene/No Transport activity, payer mix, Medicare and Medi-Cal reimbursement limitations and required write-downs, commercial insurance reimbursement, private-pay collections, and other factors affecting ambulance billing and collections.
Attachment(s)
Resolution
Attachment 1: NBS Ambulance Services and First Responder Fee Study
Attachment 2: Ambulance Transport Rate Schedule
Prepared by: Heather Todd, Fire/EMS Administrative Services Manager
Submitted by: Heather Todd, Fire/EMS Administrative Services Manager
Reviewed by: Dan Barron, Fire Chief
Approved by: Michelle Bender, City Manager