Author: Matt Zavadsky

Yakima considering $3M EMS levy, raising concerns about compounding tax hikes

Thu, February 5, 2026

https://www.everettpost.com/state-news/yakima-considering-3m-ems-levy-raising-concerns-about-compounding-tax-hikes/

The Yakima City Council is considering another tax proposal to keep a local fire station from closing this summer after resorting to significant public safety cuts to balance the budget.

The officials closed a $9 million budget deficit heading into January, largely by cutting public safety by $6 million. They put a $6 million property tax hike on the ballot last November, hoping to maintain the status quo, but more than 51% of voters rejected the levy.

The fallout included a $1.75 million reduction for the Yakima Fire Department, which planned to offset it by closing Station 92 and redistributing staff to other facilities. Last month, the council responded to concerns by allocating $150,000 in limited reserves for overtime to keep Station 92 open until August.

Fire Chief Aaron Markham returned Tuesday at the council’s direction with details on how an EMS levy could fill the gap. He said a levy of 25 cents per $1,000 of assessed property value could generate $3 million annually; $1.9 million would keep Station 92 open, with YFD using the rest to expand services.

“We have asked the parks to sacrifice. We’ve asked the police to sacrifice, and now we’re talking about increasing the scope of the firefighting,” Councilmember Rick Glenn said, raising concerns given recent struggles to fund basic obligations. “We need these services, but we don’t have an unlimited budget.”

Councilmember Patricia Byers offered similar concerns and hoped to direct any additional revenues to offset cuts to the Yakima Police Department and Parks and Recreation. If they put an EMS levy on the ballot, the city can spend that money only on relevant things, and it can’t supplant existing funding.

Councilmember Juliet Potrykus questioned whether expanding services through a levy would lead to future challenges.

State law limits annual property tax increases to 1%.

Markham acknowledged that, but said any future renewal would require only a simple majority, rather than a 60% supermajority.

“I’m curious if [the EMS levy] will beget another levy at a higher level, over and over,” Potrykus said.

Mayor Matt Brown said he wants to see a plan for how the city would distribute revenue from the levy if it goes on the ballot this year. Byers and Glenn suggested a public safety levy instead, since the city could use it for police services as well. But Potrykus said this levy is still only half of the last proposal.

The officials ultimately voted 4-2 to direct city staff to return with a financial analysis for the EMS levy.

Yakima County also has an EMS levy at the same rate, which expires in 2029. City staff said any EMS levy that the city puts on the ballot must expire at the same time. It typically runs for six years, but in this case, the city would have to run a shorter levy and renew it on a separate ballot from the county.

The council noted that the county will likely go after an EMS levy renewal in 2028, and if it fails, they could try again in 2029. That would push the city’s renewal timeline, potentially leaving a gap year.

If the county raises its levy to 50 cents, the city would receive some of that revenue based on population and other factors, but the city would be barred from setting its own levy due to a countywide cap.

“We’re basically at the mercy of the county,” Byers said. “They have the upper hand in making that decision.”

Great example of grass roots advocacy using DATA to drive decisions… Common response from the Kentucky Association of Health Plans.

And, an example of what information the profession should provide to MedPAC when they say things like ‘there is not an access issue here.’

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EMTs push for reform amid insurance reimbursement crisis

By: Karolina Buczek

Feb 03, 2026

https://www.lex18.com/news/covering-kentucky/emts-push-for-reform-amid-insurance-reimbursement-crisis

FRANKFORT, Ky. (LEX 18) — EMTs from across Kentucky are sounding the alarm about a growing crisis that could leave communities without ambulance services. The problem stems from insurance companies failing to adequately reimburse EMS agencies for their calls, forcing local taxpayers to shoulder the financial burden or local communities to stop ambulance services altogether.

Emergency medical technicians brought their trucks and stretchers to the Capitol Annex on Tuesday urging lawmakers to pass House Bill 447, which would reform ambulance reimbursement in Kentucky.

According to the Kentucky Emergency Response Alliance, insurance companies currently reimburse Kentucky EMS providers only a fraction of their actual costs. The groups says the average cost of an ambulance transport is $1,877, but the average reimbursement from insurance companies is just $635.

This funding gap means taxpayers in many Kentucky counties must cover the difference to keep ambulance services operational.

“Right now, 50, 60, 70, 80% of that (ambulance) bill is being paid by local government taxes offsetting the cost so that the commercial insurance companies can keep more of their money and post higher profits,” Jim Duke of the Kentucky Ambulance Providers Association said.

In Fayette County, insurance reimburses only 38.4% of ambulance bills, leaving 61.6 % to the local taxpayers, balance billed to the patient, or left unpaid-jeopardizing ambulance service and EMS staff availability. In some areas of Kentucky, like Laurel County, the reimbursement rate is as low as 9, according to Rep. Rebecca Raymer, the sponsor of HB 447.

The lack of adequate reimbursement has created ambulance deserts in almost 92% of Kentucky counties, according to the Kentucky Emergency Response Alliance. This means residents are more than 25 minutes away from timely emergency medical response.

Areas that have temporarily lost ambulance services, like Lewis County, experienced significant stress during the gap in coverage.

“Our dispatchers were stressed when they answered the phones. Somebody called having a heart attack and they could not promise that they were going to have an ambulance there,” Lewis County Judge Executive George Sparks said.

Paramedics say House Bill 447 would require insurance companies to reimburse at the local ground ambulance service rate set by the local governing authority. This change could help keep more ambulance services operational across the state.

Raymer emphasized that many people don’t realize the importance of EMS until they need it themselves.

“You don’t think about EMS until you are the one on the other side of that phone and you need them to come for you or your family member. And then when you experience that and there’s a delay, you’re going to understand what an issue this is,” Raymer said.

The Kentucky Association of Health Plans voiced concern over the reform effort. According to a spokesperson for the group, the state’s actuaries estimate up to an additional $1.27 per person per month in premiums. For a family of 4, that could be another $60.96 a year in health care premiums. The group says this additional cost could be a concern for working families.

This final rule from CMS adopted last week may substantially change how Medicaid Provider Tax programs can be structured.
 
Although “Ambulance” or “EMS” does not appear in the rule, ambulance agencies participating in similar provider tax components as part of a GEMT program should pay particular attention to how this new final rule could be interpreted related to GEMT programs.
 
Link to the CMS News Release:
https://www.cms.gov/newsroom/fact-sheets/preserving-medicaid-funding-vulnerable-populations-closing-health-care-related-tax-loophole-final
 
Link to the published Final Rule:
https://www.govinfo.gov/content/pkg/FR-2025-05-15/pdf/2025-08566.pdf

Preserving Medicaid Funding for Vulnerable Populations – Closing a Health Care-Related Tax Loophole Final Rule Medicaid & CHIP   Section 1902(a)(2) of the Social Security Act (the Act) requires states to share the responsibility of financing the Medicaid program with the federal government, by providing at least 40 percent of the non-federal share of expenditures under the state plan. There are several ways states can finance the non-Federal share, including health care-related taxes under section 1903(w) of the Act. States have historically looked for ways to shift this responsibility more toward the federal government, and both Congress and CMS have sought to address these cases.[1]    On May 12, 2025, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule that would end states’ ability to exploit a health care-related tax loophole currently used by seven states to generate billions in federal Medicaid payments—without contributing their fair share or expanding care for Medicaid enrollees. These states impose higher taxes primarily on Medicaid business of managed care organizations (MCOs), although there are similarly situated current Medicaid loophole taxes on other providers, such as hospitals and nursing facilities. After imposing the tax disproportionately on Medicaid plans or providers, the states effectively reimburse these entities entirely with federal matching funds, while avoiding any state financial cost. This, in turn, allows the states to use the surplus for other purposes—including the expansion of healthcare coverage for illegal immigrants. This effectively means federal money is financing these other interests, instead of enhancing the state Medicaid program.    On July 4, 2025, President Trump signed the Working Families Tax Cuts legislation (Public Law 119-21) and adopted the policies of the proposed rule in section 71117. The legislation also authorized the Secretary to grant transition periods of up to 3 years. On November 14, 2025, CMS issues a Dear Colleague letter outlining the minimum transition periods available under section 71117(c). This final rule, displayed on January, 29, 2026, codifies the proposed provisions adopted by Congress and expands upon the transition periods granted in the Dear Colleague letter.   What the Rule Does  The rule prohibits higher tax rates on Medicaid than on non-Medicaid businesses to ensure states don’t exploit an inadvertent mathematical loophole in the applicable statistical test. The rule also bars the use of vague language or complex designs to disguise taxes that target Medicaid. Based on how recently the state’s tax waiver was last approved and the permissible class, the rule provides States at least until the end of calendar year 2026, and in some cases the full 3 years authorized by Congress.    How the Loophole Works  Tax Differential: Some states view this burden shift as a revenue stream from the federal government.[2]  Some states exploit this loophole by greatly increasing taxes on Medicaid business, but through tax structures that are designed to still pass the statistical test in Medicaid regulations at 42 CFR 433.68(e)(2). For example, in California MCO tax rates are set at $274 per member, per month (PMPM) for Medicaid while comparable commercial member months are taxed at $1.75 PMPM.    States may use these taxes to:  Trigger federal Medicaid match payments,  Repay taxpayers the tax amount, and  Pocket excess funds, which may or may not then go toward Medicaid uses.  These schemes technically pass the current statistical test for permissibility due to an inadvertent loophole but violate the spirit of the law that states must share in the responsibility for financing Medicaid. Apart from the burden on the taxpayers, when states must contribute, they have an incentive to monitor and operate their programs competently to ensure the best value for the dollars that they spend. It further violates the requirement under section 1903(w)(3)(E) of the Act that non-uniform taxes (taxes that do not have the same rate for all payers) be generally redistributive or generally move money from non-Medicaid payers to pay for Medicaid expenditures.    Financial Exposure  Current loophole taxes generate $24 billion in revenue for states. CMS estimates that closing the loophole will save the federal government over $78 billion over the next 10 years.  —————— [1] For example, the Medicaid Voluntary Contribution and Provider Specific Tax Amendments of 1991 (Pub. L. 102-234, enacted December 12, 1991) amended section 1903 of the Act to prevent States from shifting a disproportionate amount of tax burden to entities with a high percentage of Medicaid business, thus shifting the State responsibility for financing of the program to the Federal government.   [2] See for example the California Legislative Analyst’s Office report about California’s MCO tax: https://lao.ca.gov/Publications/Report/4992

Thank you for the great discussion and thoughtful questions that followed PWW|AG’s Ground Ambulance Data Collection Systems (GADCS) Webinar. After the session, our team reviewed the questions submitted and pulled together a new resource:

Created by PWW|AG Co-Founder Doug Wolfberg and EMS & Mobile Healthcare Consultant Matt Zavadsky, this Q&A document addresses some of the most common situations agencies are working through, including:

• Why EMS is often left out of shared savings — and how some agencies are changing that
• How Treatment in Place and non-transport billing is being handled nationwide
• What the CMS data reveals about the growing gap between costs and FFS reimbursement
• Key operational and compliance questions agencies are facing today

This resource is designed to help agencies turn cost report data into practical understanding and informed decision-making.

Congratulations to AIMHI member agency REMSA Health on this agreement.

It epitomizes the mission and vision of AIMHI and High-Performance / High-Value EMS delivery!

High-Performance systems like REMSA demonstrate that high-value, innovation, transparency and public accountability – while at the same time, achieving a high level of financial efficiency – is possible, and should be a model for other EMS systems!

New EMS agreement in Washoe County emphasizes patient outcomes and public oversight

January 25, 2026

https://mynews4.com/news/local/new-ems-agreement-in-washoe-county-emphasizes-patient-outcomes-and-public-oversight

The District Board of Health on Thursday approved a modernized franchise agreement with REMSA Health, marking the first significant update to the contract governing emergency medical services in Washoe County in decades.

Board members said the revised agreement is designed to strengthen patient care, improve transparency, and provide long-term stability for emergency medical services, while ensuring uninterrupted EMS coverage for the community.

The previous agreement had not been substantially updated for many years. Under the new framework, the board placed increased emphasis on patient outcomes, responsible cost controls, improved access to data, and stronger public oversight. Officials said these changes are intended to better align the EMS system with current standards and community expectations.

The agreement also establishes a structure for ongoing evaluation and accountability. It includes regular five-year reviews, annual performance assessments, and timelines to further examine emergency dispatch practices. The board also committed to reconvening within six months to consider additional improvements to the system.

REMSA Health has provided ambulance services in the region for approximately 40 years and has operated without reliance on local tax dollars. The updated agreement maintains that model while expanding accountability measures and preserving the ability to study alternatives and implement changes if needed.

Public input played a key role in the discussion leading up to the vote. Board members acknowledged community feedback and said the questions raised helped shape the final agreement and reinforce the focus on patient protection and system stability.

The updated franchise agreement is intended to provide a more flexible and responsive framework for emergency medical services as Washoe County continues to grow.

Kathy Hochul vetoes legislation aimed at helping EMS providers. Here’s why

Jillian McCarthy

Binghamton Press & Sun Bulletin

Dec. 24, 2025

https://www.pressconnects.com/story/news/public-safety/2025/12/23/first-new-york-state-bill-in-rescue-ems-package-vetoed-by-hochul/87897086007

Key Points:

• New York Governor Kathy Hochul vetoed a bill that would have allowed local governments to fund emergency medical services outside of the property tax cap.
• The governor cited concerns that the bill could lead to substantially higher property taxes for homeowners and businesses.
• The vetoed bill was part of a legislative package aimed at addressing funding and service gap issues for EMS providers across the state.
• State Assemblymember Donna Lupardo, who introduced the bill, expressed disappointment that the governor did not offer alternative solutions to the EMS funding crisis.

Gov. Kathy Hochul has vetoed a bill designed to provide financial support to emergency medical services across New York state.

On Dec. 23, State Assemblymember Donna Lupardo (D-Endwell), who initially introduced the legislation as a part of her “#RescueEMS” legislative package, announced that it had been vetoed despite bipartisan support and receiving almost unanimous approval when it passed through both houses.

The bill would have removed expenditures for EMS from the limit on real property tax levies issued by local governments, allowing municipalities to fund EMS outside of the tax cap.

This, Lupardo said, would have given local governments the “flexibility needed to better support these vital services.”

Hochul: EMS bill vetoed to avoid higher property taxes

Hochul issued a statement after vetoing the bill, citing the potential for higher property taxes as a result of the legislation:

“This bill would exclude the costs of Emergency Medical Services from the calculation of the limit upon municipal property tax levy increases imposed by the General Municipal Law. The property tax cap, enacted in 2011, restricts the annual increase in local property tax levies by local governments and school districts to two percent or the rate of inflation, whichever is less. The tax cap has been effective in limiting local property tax growth, resulting in considerable savings for taxpayers. This bill, as written, could lead to substantially higher property taxes imposed on homeowners and businesses in communities throughout the state. Therefore, I am constrained to veto this bill.”

The “#RescueEMS” legislative package

In July, Lupardo and state assemblymember Joe Angelino (R-Norwich) joined Broome County EMS Coordinator Dave Tinklepaugh at a press conference to discuss the status of several bills within the legislative package.

Together, they looked to address issues with EMS ranging from underfunding to the Medicaid reimbursement rate, a decrease in volunteers, and the slow decline of access to EMS, especially in rural areas.

The second bill in the “#RescueEMS” legislative package initially designated general ambulance services as an essential service, an issue that first arose in 2020 during the COVID-19 pandemic. An amended version of the bill passed without that provision, but it does require every municipality to conduct “an exhaustive planning process” related to emergency medical system plans.

This bill was approved and signed by Hochul.

The process will require counties, cities, towns and villages to work together to assess current service levels, identify existing service gaps and estimate costs for providing such services.

The third and final bill in the package requires the Thruway Authority to issue emergency services permits to ambulance and fire vehicles, making them exempt from roadway tolls.

This bill, like the first, was also vetoed by Hochul.

EMS has ‘dangerous service gaps, especially in rural areas’

In the wake of the first bill being vetoed, Lupardo said she is disappointed that the veto message from Hochul did not include any “alternative suggestions” regarding the EMS “funding crisis.”

“For the last few years, we have worked tirelessly across party lines to raise the alarm about the need to #RescueEMS,” she wrote in a statement. “But in spite of our best efforts, there remain dangerous service gaps, especially in rural areas, and an uncertainty about what the future holds. The bottom line is that New Yorkers expect EMS to come to the rescue whenever needed − ironically, they are the ones in need of rescue now.”

New York State Senator Rachel May also responded to the veto, emphasizing the bipartisan agreement that the “need to fund emergency medical services was more important than an arbitrary tax cap.”

“I am disappointed that the Governor chose not to empower local municipalities, including many rural villages and towns in my district, to fund EMS as they see fit and as current economic realities demand,” May wrote in a statement.

The Academy of International Mobile Healthcare Integration (AIMHI) Excellence in EMS Integration Awards celebrates and promotes high-performance, high-value EMS, its partners, and leaders.

Nominations for the 2026 Awards will open on January 26, 2026, and run through February 20, 2026.

Start thinking about your nominees now for the following categories:

Excellence in EMS Integration

Recognizing a non-EMS organization that has developed and implemented a partnership with EMS organizations that have demonstrated enhancement of patient experience of care, improved patient outcomes, or reduced the cost of healthcare.

Advocacy in Integrated Healthcare

Recognizing a legislator or regulator who has made significant impact on the integration of EMS, or the advancement of the integration of EMS into the healthcare system.

Excellence in Public Information or Education

Recognizing an EMS or non-EMS organization that has developed and implemented an effective public information or education campaign designed to encourage patients, members, or the public to develop or maintain healthy lifestyles, or to more effectively utilize healthcare resources.

Excellence in Value Demonstration or Research

Recognizing an EMS or non-EMS organization that created and implemented an analysis of data and/or research project to demonstrate the value impact of the services provided by the organization.

Leadership in Integrated Healthcare

Recognizing an individual who has made significant impact on the integration of EMS, or the advancement of the integration of EMS into the healthcare system.

Excellence in Medical Direction

Recognizing a physician Medical Director who has made significant impact on the integration of EMS, or the advancement of the integration of EMS into the healthcare system.

The Advocacy in Integrated Healthcare awardee will be recognized during NAEMT’s EMS on the Hill Day March 25-26, 2026 in Washington, DC. Other awardees will be recognized at the AIMHI Board Meeting during the American Ambulance Association Conference & Trade Show April 20 – 22, 2026 in Las Vegas.

Information about the 2025 Excellence in EMS Integration award winners can be found here: https://aimhi.mobi/awards/

Ambulance fleet management plays a critical role in ensuring operational efficiency, responder safety, and patient care reliability. High Performance/High Value agencies comprising the Academy of International Mobile Healthcare Integration (AIMHI) must employ state of the art practices to assure exceptional fleet reliability, as well as cost effectiveness.

In this webinar, an expert panel of fleet managers from AIMHI member agencies will explore proven strategies and innovative practices for managing emergency vehicle fleets—from procurement and maintenance to sustainability, technology integration, and lifecycle replacement planning.

Participants will gain practical insights into balancing cost control with performance, optimizing vehicle uptime, and leveraging data-driven decisions to enhance fleet operations. Whether your agency manages five ambulances or fifty, this webinar will provide actionable takeaways to strengthen your fleet’s reliability and readiness.

Join industry experts as we explore:

✅ Key components of an effective ambulance fleet management program, including maintenance scheduling, vehicle tracking, and lifecycle planning.

✅ Evidence-based strategies to reduce downtime and extend vehicle service life through preventive maintenance and data analytics.

✅ Procurement and replacement options to achieve the best balance between cost, performance, and long-term operational sustainability.

✅ Policies and performance metrics that support safety, compliance, and environmental stewardship within EMS fleet operations.

📅 Date: Wednesday, January 21, 2026
🕒 Time: 2p ET
📍 Location: Zoom Webinar
 
Register now to gain insights on how to better manage your ambulance fleet for maximum performance and reliability!

EMSA earns perfect score among EMS providers in CAAS accreditation

Terré Gables

12/4/25

https://kfor.com/news/local/emsa-earns-perfect-score-among-ems-providers-in-caas-accreditation/amp

OKLAHOMA CITY (KFOR) – EMSA officials are celebrating a rare distinction after landing a perfect score, placing it among the nation’s most elite emergency medical service providers.

According to EMSA officials, it has earned national accreditation from the Commission on Accreditation of Ambulance Services (CAAS), a distinction only 1% of all EMS agencies nationwide achieve.

“Earning CAAS accreditation is an incredible achievement, reflecting the skill, professionalism, and dedication of our entire organization,” said Johna Easley, EMSA President and CEO. “A perfect score demonstrates our unwavering commitment to setting the highest standards in patient care, quality, and continuous improvement across every aspect of our service.”

EMSA says CAAS accreditation represents the gold standard in the ambulance industry, and the process involves self-assessment and independent and external reviews of all areas of an organization’s operations.

“CAAS accreditation is the most respected benchmark in the EMS industry,” said Tammy Powell, Chairperson of the EMSA Board of Trustees and President of St. Anthony Hospital. “Earning a top score in such a rigorous independent evaluation of all areas of EMSA’s operation reinforces that our communities can trust they are receiving excellent EMS care every time EMSA responds.”

Only two ambulance services in Oklahoma currently hold CAAS accreditation, said EMSA officials.

EMSA is Oklahoma’s largest provider of pre-hospital emergency medical care and has held CAAS accreditation since 2010.