|
DATE: |
May 05, 2026 and May 19, 2026 |
FP01 |
|
TO: |
Board of Directors, San Diego County Fire Protection District |
SUBJECT
Title
NOTICE OF PUBLIC HEARING:
AN ORDINANCE AMENDING ARTICLE XX OF THE SAN DIEGO COUNTY ADMINISTRATIVE ORDINANCE CODE, RELATING TO SAN DIEGO COUNTY FIRE PROTECTION DISTRICT GROUND AMBULANCE SERVICE AREA CHARGES AND FEES (05/05/26 - FIRST READING; 05/19/26 - SECOND READING UNLESS ORDINANCE IS MODIFIED ON SECOND READING) (DISTRICTS: ALL)
Body
OVERVIEW
On February 27, 2024 (FP01), the San Diego County Fire Protection District (SDCFPD) Board of Directors approved the ambulance transportation fee increase to maintain current services within the SDCFPD Ground Ambulance Service Area (ASA) for Fiscal Year (FY) 25-26. The ASA includes the entirety of the SDCFPD as well as the Deer Springs, Valley Center, Alpine, and a portion of the San Miguel Fire Protection Districts. Ambulance operating areas have historically relied upon insurance revenue from transports to hospitals to recover costs. However, rural communities with large geographic areas and small population centers are more costly to serve and generally are overrepresented by public insurance programs that reimburse at lower rates than private health plans. Public plans, such as Medicare and Medi-Cal, pay a fixed rate based upon regulation and statute that is below the actual costs for ambulance transport to the hospital.
San Diego County Fire (County Fire), on behalf of the ASA, recently conducted a review of fees to ensure compliance with Board of Supervisors Policy B-29, Fees, Grants, and Revenue Contracts - Department Responsibility for Cost Recovery (Board Policy B-29), which requires County departments to recover the costs to provide services to agencies or individuals. As a result, County Fire is proposing actions that support the cost of providing services, while ensuring fair and equitable fee levels for the public. After reviewing the current fees and rates, County Fire staff is proposing to increase three fees and decrease one fee. The Auditor and Controller reviewed and approved the supporting documentation and the methodology for establishing the fees in this proposal for FY 2026-27.
The proposed ambulance transport user fee received support from the SDCFPD Fire Advisory Board and would be consistent with County Service Area 17’s proposed fees, which is another ambulance service that is managed by County Fire. In the ASA, the average collection rate on fees assessed is about 28% due to various reimbursement rates from Medicare, Medi-Cal, commercial insurance, and patient private pay. Since 100% of the fees assessed on ambulance transports are not collected, full cost recovery for services will not be achieved in FY 26-27 and a waiver of Board Policy B-29 is being requested. The proposed fees in the ASA have a 5% escalator through FY 28-29, to align with the annual increase in contract costs that support the operations of the ASA.
Today’s action requests that the SDCFPD Board of Directors approve amendments to Article XX of the San Diego County Administrative Code to fees charged for services by the SDCFPD ASA.
RECOMMENDATION(S)
EXECUTIVE DIRECTOR
On May 5, 2026:
1. Approve the introduction of the Ordinance (first reading):
AN ORDINANCE AMENDING ARTICLE XX OF THE SAN DIEGO COUNTY ADMINISTRATIVE ORDINANCE CODE, RELATING TO SAN DIEGO COUNTY FIRE PROTECTION DISTRICT GROUND AMBULANCE SERVICE AREA CHARGES AND FEES
2. Waive Board Policy B-29, Fees, Grants, and Revenue Contracts - Department Responsibility for Cost Recovery which requires full cost recovery for services.
If, on May 5, 2026, the SDCFPD Board takes action as recommended, then on May 19, 2026:
1. Consider and adopt (unless ordinance is modified on second reading):
AN ORDINANCE AMENDING ARTICLE XX OF THE SAN DIEGO COUNTY ADMINISTRATIVE CODE, RELATING TO SAN DIEGO COUNTY FIRE PROTECTION DISTRICT GROUND AMBULANCE SERVICE AREA CHARGES AND FEES
EQUITY IMPACT STATEMENT
Advanced (Paramedic) and Basic (Emergency Medical Technician) Life Support ambulances are critical components to an emergency medical services system that seeks to reduce health disparities in our region. San Diego County Fire, on behalf of the San Diego County Fire Protection District, worked with outside consultants to establish a service plan and quality assurance measures to meet the minimum requirements for residents in rural communities. Updating the fee schedule will have minimum impacts to our lowest-income and most vulnerable residents.
SUSTAINABILITY IMPACT STATEMENT
The proposed action to update the ambulance transportation fees in the San Diego County Fire Protection District supports efforts for County programs, operations, and contracts that reflect the values and priorities, including equitable service delivery, to residents in our region. The proposed fee increase protects our lowest-income residents while promoting an equitable emergency medical services program that is closer to full cost recovery to operate the system.
FISCAL IMPACT
There is no fiscal impact in the current fiscal year. If approved, this request will result in an estimated increase in revenue of $0.85 million in the ASA in Fiscal Year 2026-27. Costs and revenue for this request will be included in the Fiscal Year 2026-28 CAO Recommended Operational Plan for the ASA. The funding source is fees paid by entities or individuals for services.
A waiver of Board of Supervisor Policy B-29: Fees, Grants, Revenue Contracts - Department Responsibility for Cost Recovery is requested because the proposed fees will not cover the current operating costs for services in the ASA. The unrecovered cost, estimated at $10.0 million, will be funded with existing General Purpose Revenue and property tax revenue. There is no change in net General Fund cost and no additional staff years.
BUSINESS IMPACT STATEMENT
N/A
Details
ADVISORY BOARD STATEMENT
On March 2, 2026, with 7 of 8 advisory board members being present, the San Diego County Fire Protection District Fire Advisory Board reviewed the proposed ordinance updating the fees and voted unanimously in support.
BACKGROUND
San Diego County Fire (County Fire) is committed to maintaining the highest quality work product and customer service at the most efficient cost. Staff continually evaluate opportunities to streamline and improve processes. At the same time, County Fire annually evaluates the fees and rates it charges to align with current costs, as required under the San Diego County Board of Supervisors (Board) Policy B-29: Fees, Grants, and Revenue Contracts-Department Responsibility for Cost Recovery (Board Policy B-29).
On May 23, 2023 (FP 01), the Board of Directors authorized the Executive Director, or designee, to enter into a written contract with the County of San Diego for the SDCFPD to exclusively provide and/or manage emergency ambulance services in the areas where the County has, or will have, the responsibility for ambulance transportation services. On August 14, 2023, the County of San Diego and SDCFPD entered into a written agreement and on September 30, 2023, the new SDCFPD Ground Ambulance Service Area (ASA) became operational. The ASA includes the SDCFPD, Valley Center, Deer Springs, Alpine, and a portion of the San Miguel Fire Protection District.
The proposed fee schedule includes a 5% annual escalator through Fiscal Year (FY) 28-29 to keep up with costs established in existing contracts with American Medical Response and CAL FIRE, as well as vehicle and equipment replacement. Previously, in FY 23-24, the Board approved a 3-year 5% annual increase to the ASA fees through FY 25-26. The ordinance applies to the boundary of the current ASA, however, if new areas are added to the ASA, those areas would also pay these fees and associated cost increases.
Current and Proposed Fee Schedule
|
Fee Description |
FY 2025-26 Current Rate |
FY 2026-27 Proposed Rate |
FY 2027-28 Proposed Rate |
FY 2028-29 Proposed Rate |
|
Base Rate (per transport) |
$3,743 |
$3,930 |
$4,127 |
$4,333 |
|
Mileage (per mile) |
$48 |
$50 |
$53 |
$56 |
|
Treat, No Transport (per occurrence) |
$460 |
$483 |
$507 |
$532 |
|
Standby/Special Event (per Hour) |
$235 |
$229 |
$240 |
$252 |
A waiver of Board Policy B-29 is requested to provide ambulance transportation services in the ASA. The proposed fee increases are less than full cost recovery and a waiver is requested since the proposed fees do not cover all operating costs.
Today’s request is for the Board of Directors to consider adoption of an ordinance updating fees for the ASA. If the Board takes the recommended action today, then on May 19, 2026, the Board of Directors is asked to consider and adopt the proposed ordinance. The Auditor and Controller’s office has reviewed and approved the methodology for the proposed fees.
ENVIRONMENTAL STATEMENT
N/A
LINKAGE TO THE COUNTY OF SAN DIEGO STRATEGIC PLAN
Today’s proposed actions support the Living Safely Strategic Initiative in the County of San Diego’s 2026-2031 Strategic Plan. Periodically reviewing San Diego County Fire Protection District services and related fees ensures that the County is optimizing its operational delivery system to ensure efficiency, integration, and innovation while maintaining fiscal stability.
Respectfully submitted,
ebony n. shelton
Executive Director
ATTACHMENT(S)
Attachment A: An Ordinance Amending Article XX of the San Diego County Administrative Ordinance Code, Relating to San Diego County Fire Protection District Ground Ambulance Service Area Charges and Fees (Clean Copy)
Attachment B: An Ordinance Amending Article XX of the San Diego County Administrative Ordinance Code, Relating to San Diego County Fire Protection District Ground Ambulance Service Area Charges and Fees (Informational Copy)
Attachment C: Summary of Proposed Ordinance