Contra Costa County fire board approves 5.71% ambulance rate increase effective May 1

The Contra Costa County Fire Protection District Board of Directors voted 5-0 to adopt Ordinance 2025-05, which raises the district’s emergency ambulance service rates effective May 1, 2025.

The ordinance implements an annual, contract-driven formula for rate changes. “This year the annual rate increase was calculated to be 5.71% and this was approved by the county EMS agency as the contract administrator,” Chief Richard told the board during the hearing.

Why it matters: The district’s ambulance system is largely funded by fees billed to patients and to payers; the largest single cost driver is the contractual payment to the district’s subcontractor, American Medical Response (AMR). Chief Richard told the board payments to AMR account for over 80% of the system’s annual costs.

Key details and scope - The contract between the county and the district ties annual rate changes to a formula based on the average medical Consumer Price Index over the most recent three-year period and a three-year average of dollars received from non-public payers. The ordinance text sets a minimum allowable increase of 5% and a contractual cap of 9%. - The district reported the following changes (current → new): response/base rate $3,029.33 → $3,202.30; mileage rate $73.22 → $77.40 per loaded mile; oxygen administration $253.93 → $268.43; on-scene treatment without transport $649.57 → $686.66. The ordinance lists these amounts in Exhibit A.

Board discussion and public-access programs Board members questioned the mechanics of the contract and how increases for the district’s subcontractor are determined. One board member noted the subcontract’s clause requiring hourly rates paid to the subcontractor to rise by the greater of the CPI or 3%, with no separate upper cap on CPI-based increases.

Several board members raised concerns about patients who may avoid calling 911 because of cost. Board member Chanel shared a personal example: “Before my mom passed away, she was one of those individuals who did not ever want me to call the ambulance because she didn't wanna pay the fee.” Chief Richard said the district operates a Compassionate Care program for low-income patients and explained the appeal process: when a patient receives an invoice the paperwork includes contact information to reach EMS division staff and the billing vendor to request forms and pursue forgiveness if they meet income criteria.

Chief Richard also explained that when patients are covered by public payers the district cannot balance-bill them: “If you are a public payer, Medi-Cal or Medicare, those programs are capitated, meaning those programs pay us X. We don't go to the patient and ask for the balance. We're not allowed to do that.”

Vote and next steps Board members moved and seconded the ordinance at the hearing; the motion carried 5-0. Staff said the new rates will take effect May 1, 2025, as stated in the ordinance.

What wasn’t decided or specified The hearing and ordinance implement the contract formula and the listed fee schedule; the board did not change the underlying contract with AMR during this meeting. The record did not specify whether the board established any additional outreach or targeted enrollment efforts for the Compassionate Care program beyond describing how patients currently apply for relief.

Ending District staff said they would be available to help residents with billing questions and to provide the forms needed to apply for Compassionate Care forgiveness. The ordinance and the exhibit with the full fee schedule are part of the public record for the district.