The Skagit County Board of Commissioners convened on October 6, 2025, for a public hearing led by Emergency Medical Services Director Josh Polonio. The primary focus was on proposed revisions to the ambulance transport fee schedule, specifically resolution number 20,170,124.

Director Polonio provided background on the fee schedule, noting that the last revision occurred in 2021, with rates last updated in 2017. The proposed changes aim to align Skagit County's rates with those of comparable public agencies, necessitating an increase of approximately 12-15%. The current rates, which are set to remain in effect until 2024, require updates to comply with recent legislative changes affecting ambulance transport billing.

Key legislative updates include the Balance Billing Protection Act, which prevents ground ambulance services from billing patients for costs not covered by insurance. Additionally, municipalities must submit their transport rates to the Office of the Insurance Commissioner (OIC) by November 1 for the following year. This timing is critical for ensuring that the county's rates are current and maximize cost recovery.

Polonio highlighted the potential impacts of HR 1, which could significantly affect Medicaid coverage and reimbursement rates, projecting a loss of coverage for approximately 26% of current Medicaid recipients in Washington. This could lead to a substantial financial shortfall for local hospitals and, by extension, the EMS system.

The proposed fee schedule will apply only to ambulance transport providers contracted with Skagit County as part of its coordinated EMS system. Notably, the recommendation includes eliminating the resident rate, establishing a single rate for both residents and non-residents. This change is intended to simplify billing and ensure compliance with new insurance reimbursement requirements.

Public comments during the hearing included support from local fire chiefs and EMS providers, emphasizing the need for updated rates to sustain quality pre-hospital care. Chief Brian Harris from the Mount Vernon Fire Department reported a significant gap between transport costs and revenue, urging the commissioners to act to stabilize the EMS system.

The hearing concluded with a motion to close, and the commissioners indicated that the proposal would likely be presented for consent in the following week, ensuring timely submission to the OIC before the November deadline. The meeting underscored the collaborative efforts among local agencies to maintain effective emergency medical services in Skagit County amidst evolving legislative and financial challenges.