REPORT/RECOMMENDATION TO THE BOARD OF DIRECTORS
OF INLAND COUNTIES EMERGENCY MEDICAL AGENCY
AND RECORD OF ACTION
September 22, 2026
FROM
DANIEL MUÑOZ, EMS Administrator, Inland Counties Emergency Medical Agency
SUBJECT
Title
San Bernardino County Ambulance Rate Adjustment
End
RECOMMENDATION(S)
Recommendation
Acting as the governing body of the Inland Counties Emergency Medical Agency, approve ambulance rate adjustment to San Bernardino County’s ambulance rates, effective October 1, 2026, as outlined in Attachment A.
(Presenter: Daniel Muñoz, EMS Administrator, 388-5807)
Body
COUNTY AND CHIEF EXECUTIVE OFFICER GOALS & OBJECTIVES
Operate in a Fiscally-Responsible and Business-Like Manner.
Provide for the Safety, Health and Social Service Needs of County Residents.
FINANCIAL IMPACT
Approval of this item will not result in the use of Discretionary General Funding (Net County Cost), nor will it affect the budget of the Inland Counties Emergency Medical Agency (ICEMA). Ambulance services are funded through user fees billed to patients and third-party payors, and the approval of maximum allowable rates does not directly generate revenue or expense to ICEMA or the County.
BACKGROUND INFORMATION
ICEMA is the Local Emergency Medical Services Agency (LEMSA) for San Bernardino, Inyo, and Mono Counties. ICEMA administers State and local codes and regulations governing the provision of emergency medical care to the sick and injured at the scene of an emergency and during transport to a care facility. One of the duties that ICEMA oversees is ground ambulance rate setting.
At the State level, Emergency Medical Services (EMS) are governed by California Health and Safety Code, Division 2.5, which authorizes LEMSAs to establish Exclusive Operating Areas (EOAs) and regulate ambulance services, including ambulance rates, pursuant to Sections 1797.85, 1797.224, and related provisions. Additionally, Assembly Bill 716 (AB 716), codified in Health and Safety Code section 1797.124, requires LEMSAs to establish and report maximum allowable ambulance rates by county.
At the local level, ground ambulance rates in San Bernardino County are established in accordance with County Code section 31.0820, which authorizes the setting of maximum ambulance transportation rates. ICEMA implements this authority through its Ground Based Ambulance Rate Setting Policy (Policy No. 3060), which establishes a structured process for rate adjustments based on Consumer Price Index (CPI) and local jurisdiction comparison methodologies and allows for additional adjustments when necessary to address system needs and contractual obligations.
On December 5, 2023 (Item No. 80), the Board of Supervisors (Board) approved Agreement No. 23-1282 (Agreement) with the Consolidated Fire Agencies (CONFIRE) for the provision of Advanced Life Support, Basic Life Support, ground ambulance services, and Interfacility and Critical Care Transport services within the County Comprehensive Service Area (CSA) EOAs for an initial term of October 1, 2024 through September 30, 2029.
As part of the Agreement, the Board approved the ambulance rate structure applicable to the CSA EOAs, including maximum allowable ambulance rates.
The Agreement was originally anticipated to become effective October 1, 2024; however, implementation was delayed due to litigation related to the contract award. The current anticipated implementation date is October 1, 2026.
Based on the Board’s previously approved rate structure as part of the Agreement, ICEMA is now formally establishing the updated countywide maximum allowable ambulance rates prior to implementation of the Agreement, consistent with state law, County ordinance, and ICEMA policy.
Due to the two-year delay in the Agreement implementation, ICEMA has applied cumulative CPI and County comparison rate adjustments in accordance with Policy No. 3060.
Policy No. 3060 authorizes the EMS Administrator to issue applicable annual rate adjustments within the limits established by Policy No. 3060. However, because the recommended adjustment is necessary to establish maximum ambulance rates in accordance with AB 716 and meet contractual requirements, Governing Board approval is required.
PROCUREMENT
Not applicable.
REVIEW BY OTHERS
This item has been reviewed by County Counsel (John Tubbs II, Deputy County Counsel, 387-5455) on August 13, 2026; and County Finance and Administration (Carl Lofton, Administrative Analyst, 387-5404) on August 27, 2026.