Schertz EMS faces revenue shortfalls after billing and supplemental‑payment changes

Schertz EMS leaders told the council at a Feb. 7 strategic planning session that the ambulance enterprise fund has sustained revenue losses and faces a trajectory that may be unsustainable without changes to rates, service levels or cost structure.

City staff said three major factors have reduced EMS revenue: state balance‑billing restrictions (Senate Bill 2476), reductions in the Texas Ambulance Supplemental Payment (TASP) reimbursements and the city's own investment in compensation to lower turnover. Those changes together have reduced billing and supplemental revenues, staff said, and have increased the gap between operating costs and revenues.

An EMS leader said the city’s prior practice of billing insurers produced higher collections but that the balance‑billing ban and mirrored federal rules have curtailed that revenue. Another staff speaker said the city once received roughly $400,000 in TASP reimbursements in a strong year; the most recent receipts are “less than a hundred thousand dollars.”

City staff presented three general options for a long‑run fix: increase revenues (for example, by raising intergovernmental charges or transport fees), reduce service levels or some mixture of those approaches. Council members and staff discussed the importance of economies of scale: staff argued the current shared regional model keeps per‑service costs far lower than if each small neighboring city operated its own system.

Staff did not present a final proposal at the retreat but said they would perform follow‑up analysis and return with specific options for council consideration, including discussions with contract cities and partners about rate adjustments and financial contributions.

Ending: staff said the issue is time‑sensitive and would be brought back to the council with concrete recommendations on revenue options and service models.