Bonner County EMS proposes 15% base increase, $200 nonresident surcharge and $288 paramedic-intercept fee; board okays publication for public review

Bonner County EMS presented a draft fee schedule at a meeting of the Bonner County Ambulance Service District that would raise base transport fees by roughly 15%, add a $200 surcharge for nonresidents and set a proposed paramedic-intercept fee of $288. The board directed staff to publish the proposed schedule for public review and to schedule a public hearing.

The proposal came from Chief Lindsey, who told the board she reviewed rates from about 50–200 ambulance services in Washington, Idaho, Alaska and Oregon and found nonresident rate differentials typically around $200. She said the 15% base increase and a $200 nonresident surcharge were the working figures staff is recommending for public review.

The fee proposal would also formalize charges for non-transport calls, which staff said can be billed though reimbursement depends on payers. Chief Lindsey said non-transport treatment calls and use of equipment can be billed even when no patient is transported, but payers may not reimburse every claim.

Board members and staff discussed paramedic intercepts — when a Bonner County paramedic boards another agency’s ambulance to provide advanced care. Chief Lindsey explained the intercept figure was derived by applying the proposed 15% increase to a prior contract figure of $250 and resulted in a proposed $288 intercept fee. Commissioners asked whether the district could instead capture insurance billing for transports when Bonner County personnel perform the intercept but the other agency conducts the transport; staff said billing rules (including Medicare/CMS vehicle VIN requirements) make that complicated and would require further work with the outside agencies and payers.

Commissioners debated whether nonresident fees address community equity concerns because local taxpayers shoulder infrastructure costs while tourists may use EMS resources. Chief Lindsey and other commissioners said the surcharge is intended partly to respond to those concerns and to recover some cost from people who use services but do not pay local property taxes.

Public commenters asked for projections tying the proposed changes to the district’s reserve and sustainability. Chief Lindsey agreed to ask the billing vendor to run example projections using last year’s call mix so the board could see likely revenue impacts before adoption.

The board agreed the draft fee schedule should be published for public review, with the nonresident rate shown as a separate line (for clarity) and with an estimated dollar difference (for example, “+ $200”) displayed in the published schedule. The board asked staff to return with the billing company’s projection and to put the proposal on a future agenda for a formal hearing and vote.

Next steps: staff will publish the draft fee schedule for public review, request revenue/impact projections from the district’s billing company using prior-year call data, and schedule a public hearing for potential adoption.