Douglas County staff propose 28% increase to emergency ambulance fees; 2026 revenue projected at $3.5–4.0 million

County emergency medical services staff on June (presentation date) told the Douglas County Board of Commissioners they plan to raise certain ambulance rates and to standardize standby charges ahead of the 2026 budget process.

In a presentation to the board, John Darling, LDC FM medical director, said the department proposes a 28% increase to emergency transport fees (basic life support, advanced life support and ALS‑2), an increase in the per‑mile charge to the market average and establishment of a specialty care transport code. He told commissioners: “at a 67% collection rate, we’re projecting 3,500,000. And at a 76% collection rate, we’re projecting 4,000,000 in 2026.”

Why it matters: the revenue projection will be used in the county administrator’s proposed 2026 budget and affects how much the county counts on EMS fees to fund operations. County Administrator Sarah Plinske told the board she prefers conservative revenue estimates for budgeting and recalled that in prior years the revenue cycle lengthened, producing late collections that distorted year‑to‑year results.

What staff presented: Darling said the department is below regional market averages for emergency service fees and for mileage, and that Medicaid and Medicare often set lower “allowable” reimbursement amounts. He described three main changes: raise emergency transport rates to reflect inflation and the market since 2018; raise mileage to the market average (Medicaid would allow a higher mileage reimbursement than the county currently charges); and add a specialty care transport fee for higher‑complexity interfacility transfers. The department also plans to charge standby fees (events, athletic contests) at rates that recover full costs, including apparatus wear and FEMA per‑unit vehicle cost calculations.

Collection math and risk: staff explained that “collection rate” is revenue collected divided by net claims (charges remaining after Medicare/Medicaid write‑downs), not gross charges. For 2024 the department reported roughly $5.8 million in gross charges, an adjustment of about $1.2 million for Medicare/Medicaid allowed amounts, leaving about $4.5 million in net claims; of that, staff said they collected $3.4 million (a 76% collection rate). Darling showed historical collection rates of 67% (2023) and 76% (2024) and used those two points to produce the 2026 scenarios. Sarah Plinske said the administration will choose a revenue percentage to include in the proposed budget and cautioned that historically the county has not always met budgeted LDC FM revenue.

Protections for low‑income residents: staff emphasized several safeguards. The department said it will not require minimum monthly payments to remain in good standing, charges will carry no interest or late fees, unpaid ambulance debt will not be sold to private collectors, the county does not report medical debt to credit agencies (and Kansas law now limits reporting of small medical debts), and unpaid balances are referred to the Kansas set‑off program so recovery is pursued only if the person later receives a state refund, wage garnishment as a state employee, or similar offset. Staff also proposed a low‑fee “treatment but not transported” code (about $100) to replace prior full ALS billing when crews treat but do not transport a patient.

Next steps: commissioners heard the briefing as an informational item only; no vote was required. Staff said the ordinance language approved earlier this year gives the county administrator and the city manager authority to set the joint ambulance fee schedule, which will allow the county to update fees annually without amending county code. Plinske said staff will present a recommended fee schedule to the county administrator and city manager for approval and that the county can petition for mid‑year changes if necessary.

Public comment and board reaction: no public commenters spoke in support or opposition during the item. Commissioners asked about the sources of the market‑comparison rates, the mechanics of collections (including Medicaid/Medicare allowed amounts), the size and variability of standby fees (KU football and other events were cited), and whether rate changes discourage 911 calls; staff repeatedly said the increases are not intended to deter needed emergency calls and that roughly two‑thirds of transports are Medicare or Medicaid patients whose reimbursement rules are not affected by the county’s list price.

Ending: staff recommended the board treat the presentation as budget preview material for the upcoming proposed 2026 budget. The commission did not take action during the meeting.