AGENDA CAPTION:
Title
Receive a Staff presentation and hold a discussion regarding approval of an Emergency Medical Services (EMS) rate structure that supports the City’s municipal EMS system, promotes appropriate cost recovery, and aligns with current Texas Reimbursement standards and provide direction to the City Manager.
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Meeting date: September 15, 2026
Department: EMS
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Background Information:
As the City of San Marcos prepares to implement its municipal Emergency Medical Services (EMS) system, staff is developing an EMS billing and financial assistance framework to establish how patient responsibility, residency-based adjustments, charity care, and delinquent account collections will be administered.
The proposed framework defines a city resident as an individual whose primary residence, on the date EMS services are provided, is located within the incorporated boundaries of the City of San Marcos. Residency would be verified through documentation connecting the patient to a primary residential address and confirmation that the address is located within the city limits.
Under the proposed approach, verified residents would receive certain billing protections and adjustments, while applicable insurance deductibles, copayments, or coinsurance may remain the patient's responsibility. Uninsured residents may also be eligible for resident adjustments, private-pay discounts, payment arrangements, financial assistance, or charity care based on eligibility. Nonresidents would remain subject to balance billing when legally permitted but may continue to qualify for private-paying discounts and financial-need assistance.
Staff is also seeking Council direction regarding the appropriate income threshold for charity care. Options presented include a full write-off for qualifying uninsured patients with household income at or below 400% of the Federal Poverty Level (FPL), or a sliding-scale approach providing varying levels of assistance between 200% and 400% FPL.
Additionally, staff recommend utilizing a third-party collection agency for eligible delinquent EMS accounts after required notices, financial assistance and charity-care screening, and an appropriate account-aging period. Exclude active payment plans, disputed accounts, and pending financial-assistance applications from collection referral.
Council direction is requested on the definition and verification of residency, application of resident adjustments, availability and level of income-based charity assistance, and the proposed approach to collecting delinquent EMS accounts.
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