Calling for an ambulance in Isle of Wight County could soon become costlier.

Isle of Wight Fire and Rescue Chief Garry Windley told county supervisors June 5 that he’s recommending the county increase its billing rates to keep pace with neighboring localities and a change in federal law that has made it more expensive for emergency medical services agencies to dispense drugs.

The county currently bills $550 for basic life support, $650 for Level 1 advanced life support and $925 for Level 2 advanced life support, plus $11.25 per mile an ambulance transports a patient. Windley has proposed raising the basic rate 9% to $600, the Level 1 rate 30% to $850 and the Level 2 rate 21.6% to $1,125. The per-mile rate would increase 17% to $13.25.

Windley is also proposing a $1,325 “specialty care” fee he said is tied to the anticipated January opening of the 50-bed Riverside Smithfield Hospital being built on Benns Church Boulevard.

“With Riverside opening in January, it’s inevitable that we are going to get called to transport patients that are on ventilators and more advanced IV (intravenous) pumps. … This is a category that we currently do not have in our fee schedule,” Windley said.

The proposed rates would put Isle of Wight roughly in line with the city of Portsmouth and James City and York counties, which each charge roughly $675 for basic life support, an $801 Level 1 fee and a $1,160 Level 2 fee. Portsmouth also charges $1,371.69 for “specialty” transports.

A memorandum from county staff states that while the opening of Riverside Smithfield will have an “overwhelmingly positive” impact on the county, it will also bring the “unintended consequence” of reducing EMS billing revenue by reducing the mileage ambulances travel to the nearest hospital.

Windley said the recommended rate increases are also partly driven by the cost Isle of Wight incurred last year to operate in-house pharmacies at its rescue stations in compliance with changes in federal law. In 2013, Congress enacted the Drug Supply Chain Security Act, which originally set a Nov. 27, 2024, enforcement date for the required electronic tracking of prescription drug containers stored and dispensed by EMS agencies. Isle of Wight announced in October it had beaten the deadline, which has since been extended to Nov. 27 this year.

By the specified enforcement date, ambulance crews will no longer be allowed to exchange used containers for Schedule II through V drugs for unopened ones at hospitals. 

“The cleanest way to recoup some of the money for the IV and drug kids and the medications that we have to buy now going forward is to increase your fees,” Windley told the supervisors.

Raising Isle of Wight’s ambulance fees would require the county to hold a public hearing, which will likely be scheduled for the supervisors’ July 10 meeting, before a vote can be taken.

 

Who pays the new rates?

Windley said the rate increases would only affect private health insurance companies, not people insured through Medicare or Medicaid. The two federal insurance programs, the former for people age 65 and up and the latter for those with limited income, have their own fixed reimbursement rates they pay to county EMS agencies.

Medicare pays $450.20 for basic life support, while Medicaid pays $134.62, Windley said. Medicare pays $534.61 for Level 1 advanced life support and $773.77 for Level 2, while Medicaid pays $159.86 for the former and $231.37 for the latter.

Isle of Wight’s per-mile reimbursement is capped at $9.15 under Medicare and $2.74 under Medicaid, Windley said.

Isle of Wight is also bound by the federal Safe Harbor Act, which Windley said means the county does not bill its residents for the out-of-pocket co-pay not covered by Medicare, Medicaid or private insurance. The idea behind the Safe Harbor Act, County Administrator Randy Keaton said, is that county residents are already partially paying for ambulance service through their local taxes.

Windley said the new fees would bring in an estimated $109,500 in additional revenue for fiscal year 2025-26 based on 2024 billed ambulance calls.