AGENDA CAPTION:
Title
Receive a Staff presentation regarding the City of San Marcos’ Emergency Medical Services billing practice set-up; and provide direction to Staff.
Body
Meeting date: August 18, 2026
Department: City Manager’s Office/EMS
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Background Information:
As the City of San Marcos prepares to launch its municipally operated Emergency Medical Services (EMS) system, establishing a comprehensive billing framework is a critical operational milestone. This agenda item requests City Council approval of the City's initial ambulance fee schedule and the associated billing policies necessary to support compliant, transparent, and financially responsible EMS operations.
The proposed fee schedule is designed to align with current Texas reimbursement standards while recognizing that the amount billed is often different from the amount ultimately reimbursed. Federal programs such as Medicare and Medicaid, along with other regulated payers, determine payment amounts through statutory formulas that are independent of the City's adopted charges. The proposed rates ensure the City is appropriately positioned to receive the reimbursement allowed under applicable state law while maintaining a defensible and annually reviewable fee schedule.
In addition to adopting the fee schedule, Council is asked to establish key policy direction on several billing practices that will govern how the City's EMS program operates. These include resident and uninsured patient discounts, small balance write-offs, financial assistance participation, write-off authority, balance billing, employee billing practices, workers' compensation claims, and billing procedures involving deceased patients. Collectively, these policy decisions create a consistent framework that balances responsible stewardship of public resources with fairness to patients and compliance with federal and state regulations.
Approval of this agenda item will provide the operational foundation necessary for the City's EMS billing system to be fully configured and ready prior to service implementation. Establishing these policies before operations begin ensures consistent administration, supports long-term financial sustainability, and positions the City to recover eligible revenues while maintaining a patient-centered approach to billing and collections.
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