Fire Department FTE Increase and Fire Cost Recovery FeeCity of Dubuque
City Council
ACTION ITEMS # 2.
Copyrighted
December 1, 2025
ITEM TITLE: Fire Department FTE Increase and Fire Cost Recovery Fee
SUMMARY: City Manager recommending City Council approval to create
a Fire Cost Recovery Fee and to create 5 firefighter
positions.
SUGGUESTED Receive and File; Approve
DISPOSITION:
ATTACHMENTS:
1. MVM Memo
2. Staff Memo
3. Supporting Document Copy of MVM Cost analysis 11-25-2025
4. Supporting Documentation Shift Staffing 2025 graph
5. Public Input_Uploaded 12.1.25
6. Presentation_Uploaded 12.1.25
Page 817 of 1214
THE CITY OF
DUBE
Masterpiece on the Mississippi
TO: The Honorable Mayor and City Council Members
FROM: Michael C. Van Milligen, City Manager
SUBJECT: Fire Department FTE Increase and Fire Cost Recovery Fee
DATE: November 26, 2025
Dubuque
AI WIN av
2007-2012.2013
2017*2019
I have approved adjustments in the Dubuque Fire Department's Emergency Medical
Services billing for Advanced Life Support and Basic Life Support effective January 1,
2026, based on recommendations from Fire Chief Amy Scheller. Current rates have not
been adjusted in more than 10 years and no longer reflect the true cost of service.
Fire Chief Amy Scheller is further recommending implementation of a Fire Cost
Recovery Fee and a budget amendment to create 5 additional Firefighter positions.
Updating these fees, and implementing a fire cost recovery mechanism, will help
support the request for 5 firefighter/paramedic positions in FY2026 and 9 firefighter
paramedic positions through the FY2027 budget process to improve minimum staffing.
I concur with the recommendations to create a Fire Cost Recovery Fee and to create 5
firefighter positions and respectfully request Mayor and City Council approval.
Y
Mic ael C. Van Milligen
I►VA [yT/►TA 110111111111111111111111
Attachment
cc: Crenna Brumwell, City Attorney
Cori Burbach, Assistant City Manager
Amy Scheller, Fire Chief
Jenny Larson, Chief Financial Officer
Shelley Stickfort, Chief Human Resources Officer
Laura Bendorf, Budget Manager
Page 818 of 1214
THE C
DUUB-.'&-TE
Masterpiece on the Mississippi
TO: Mike Van Milligen, City Manager
FROM: Amy Scheller, Fire Chief
SUBJECT: Fire Department FTE Increase and Fire Cost Recovery Fee
DATE: November 23, 2025
INTRODUCTION:
Dubuque
*Aneriea Qly
2007-2012-2013
2017*2019
This memo seeks your support to update the Dubuque Fire Department's EMS billing
rates for advanced life support (ALS) and basic life support (BLS) services. Current
rates have not been adjusted in more than 10 years and no longer reflect the true cost
of service. Updating these fees, and implementing a fire cost recovery mechanism, wil
help support the request for five firefighter/paramedic positions in FY2026 and nine
more firefighter paramedic positions in FY2027 contingent upon a successful SAFER
grant to improve minimum staffing.
Five firefighter paramedic positions will allow us to add an additional position to two
shifts to rebalance in line with the third shift and add an additional position to all three
shifts, allowing us to increase minimum staffing by two positions across all shifts. This
will ensure an additional two of the seven suppression vehicles are staffed with a
minimum of three personnel at all times and bring the total number of suppression
vehicles staffed with a minimum of three personnel to four of the seven suppression
vehicles.
Nine additional firefighter paramedic positions will allow us to increase minimum staffing
by an additional three positions across all three shifts and bring the remaining three
suppression vehicles to a minimum staffing of three personnel.
The city manager has the authority to establish the ambulance rates, but the city council
needs to approve the addition of 5 firefighter paramedic positions in the current fiscal
year and the city council will need to approve the establishment of the fire cost recovery
billing for vehicle accidents, vehicle fires, hazardous conditions, and special rescue
operations.
Page 819 of 1214
DISCUSSION:
The Dubuque Fire Department receives EMS payments from a payer mix representing
the various sources of reimbursement for services rendered. Payer mixes differ by
community.
Dubuque's current payer mix is:
• 52% Medicare — federal insurance for individuals 65 and older (no impact on rate
adjustment)
• 25% Medicaid / Ground Emergency Medical Transportation (GEMT) balanced
billing — federal insurance for individuals with limited income or resources
o The current annual GEMT cost report identifies the true cost per service
for Medicaid reimbursement. The FY cost report is $2,324 per incident.
This figure is used only for Medicaid/GEMT and is not applied to other
payer groups. (No impact on rate adjustment, already utilizing cost report)
• 13% Insurance — commercial insurance
• 10% Private Pay
• Remaining — workers' compensation, veterans' benefits, and other sources
Ground Emergency Medical Transportation (GEMT) is a program where publicly owned
or operated ambulance services can get state and federal payments for Medicaid
related EMS transport services. These payments help cover the gap between what it
costs to transport patients in emergencies and what they receive from Medicaid,
mileage and other reimbursements. It's a way to support ambulance providers in
delivering essential services.
Providers receive payments based on their costs for transporting Medicaid members in
emergency ground ambulances. This applies specifically to Medicaid Fee -for -Service
and Medicaid managed care members under Title XIX of the federal Social Security Act
and the Affordable Care Act. The payment is based upon the balance of the unpaid
portion and the cost report, which identifies the cost of providing the service.
To participate in the reimbursement program authorized by State Plan Amendment
(SPA 19-0002), each eligible publicly owned or operated emergency medical
transportation provider must submit their cost report to the Iowa Department of Human
Services, Iowa Medicaid Enterprise by November 30 of each Iowa state fiscal year (July
1-June 30). A cost report determines the actual costs associated with providing the
service. Many departments utilize this "cost report" to determine the "cost' of an
ambulance call. Dubuque Fire Department's current cost report identifies the true cost
of $2,324 per EMS transport, this is not an average.
2
Page 820 of 1214
The federal government allocates Medicaid funds to the states, which then distribute
those funds to EMS providers in the form of reimbursement. In Iowa, this is done
through a "pass -through" process where the state administers and channels these
funds to eligible ambulance services.
Under Dubuque Code Section 6-3-1, EMS billing rates are set by the City Manager.
6-3-1: AMBULANCE SERVICE RATES: A. Established: Rates for ambulance service
shall be established from time to time by the city manager. (Ord. 67-06, 10- 16-2006) B.
Authority To Adjust: The city manager is hereby authorized and empowered, in the city
manager's discretion, to make adjustments in the rates and charges to be fixed for city
ambulance service in such cases where the need for such ambulance service is
required to repeatedly transport a person of limited financial means. The city manager
shall have the authority to require proof of the financial status of a person seeking the
benefits of this section for such service. (2007 Code § 23-33)
Nationally, municipal EMS base rates vary widely. Smaller communities often charge
between $500—$800 for BLS emergency transport and $700—$1,200 for ALS. Mid -sized
fire -based EMS systems commonly charge $1,200—$2,300. High -cost markets and cost -
aligned systems, frequently bill $2,300—$3,600 for ALS emergency transports, with
ALS2 and Specialty Care Transport ranging $3,800—$4,900+. These examples
demonstrate that Dubuque's current rate sits at the low end of national municipal
practice.
Regional comparisons further support the proposed adjustment. In Illinois, Northbrook
rates are ($1,950-$2,200), Rockford ($2,303 across all levels), and Skokie ($3,609—
$3,689), explicitly tied to GEMT cost -based provider rates provide strong examples of
municipalities aligning transport charges with actual service cost. In Wisconsin, publicly
posted base rates range from $700 in smaller communities such as Richfield to $1,500—
$2,000+ in suburban and district systems including Fitch -Rona EMS, Ashland,
Menomonee Falls, Lake Country, and Brookfield. The City of Waukesha bills $2,100—
$2,400 for BLS and ALS emergency transports. These examples sourced directly from
public city and district fee schedules show that many Midwestern municipal EMS
systems already charge at or above the $2,000—$2,400 range we are proposing.
Based on this verified data, adjusting Dubuque's EMS transport rate to approximately
$2,300 is both reasonable and consistent with the documented upper tier of municipal
fire -based EMS charges in comparable communities. This adjustment aligns our rates
with our true cost of service, supports compliance with GEMT cost -reporting
methodology, and positions the department alongside peer agencies that have already
modernized their billing structures to reflect actual EMS operating costs.
3
Page 821 of 1214
Current Dubuque rates are:
• ALS (Advanced Life Support) services: $735
• ALS2 (Advanced Life Support) Services $1065
• BLS (Basic Life Support) services: $620
Billing rates have historically been established through the evaluation of other EMS
transport providers rates, typically done through a voluntary statewide or countywide
EMS billing survey. Many providers align the rates with the in -network maximum
insurance payouts. Utilizing the cost report, which is a federally monitored and audited
process ensures the method is consistent and transparent.
This memo seeks approval to use the third -party cost report rate for all payer groups
when establishing EMS service fees.
-7_TS] 20] Z16111 LI 113
EMS Billing Rate Adjustment:
To comply with the (GEMT) program requirements, the department contracts with a
third -party vendor to complete annual cost reports. These reports calculate the actual
cost of delivering EMS services (personnel, equipment, fuel, maintenance, and
operational overhead). The cost report calculates the actual cost of service across all
EMS transport incidents.
The department proposes applying this true -cost rate (currently $2,324 per transport
incident) uniformly across all payer groups: Insurance, private pay, and others instead
of using it solely for Medicaid/GEMT billing.
Cost report history -per incident:
FY2021 - $1112.32 FY2022 - $1876.86 FY2023 - $1707.77 FY2024 - $1725.99
FY2025 - $2038.23 FY2026 - $2324.97 FY2027- TBD
Because the current ALS and BLS rates do not reflect this cost report, they create
inconsistencies across payer groups and prevent the department from billing equitably.
Updating rates based on the real cost of service ensures fairness, transparency, and
consistency in annual rate adjustments.
0
Page 822 of 1214
Proposed Adjustments:
• Increase ALS from $735 --> $2,324 (projected to increase 2.5% a year)
• Increase ALS 2 from $1065 --> $2,324 (projected to increase 2.5% a year)
• Increase BLS from $620 --> $1,162 (half the cost of providing an ALS-level
service) (Projected to increase 2.5% a year)
State average ranges:
• Illinois: 50,000-100,000 population: Wood Dale (high $5,800) Midlothian (low
$1,300)
• Minnesota: $2,062 ALS / $1,387 BLS
• Iowa: $959 ALS / $759 BLS
Projected Dubuque Revenue Impact for the adjustment to EMS billing:
Using FY2025 incident data and estimates from the billing provider, EMS billing
adjustments are expected to generate approximately $990,000 annually from the
proposed billing rate adjustment.
Fire Cost Recovery Billing addition:
The department also requests city council approval to add fire -related cost recovery for:
• Vehicle accidents
• Vehicle fires
• Hazardous conditions
• Special rescue operations
Projected annual revenue from cost recovery billing is $120,000.
While some communities also have fire cost recovery billing for structure fires and this
would generate an additional estimated $29,115 a year in Dubuque, this is not being
recommended at this time.
Emergency incident billing typically requires up to two years to reach full expected
revenue levels.
Contract Savings impact:
The department renegotiated the Public Consulting Group LLC (PCG) service audit
contract, reducing costs by 6%, saving $77,854 annually.
Page 823 of 1214
Combined Impact of all three adjustments:
In total, proposed changes are expected to generate $1,187,854 annually in cost
recovery, Fire Cost recovery is expected to take 2 years for full up ramp and should only
be applied 100% to FY2028 impacts and beyond, and 50% to FY2027.
The department will continue offering and promoting the hardship waiver program which
identifies those who qualify based upon monthly income and an analysis of the federal
poverty level (FPL).
PERSONNEL REQUEST:
Immediate hire request (5 Personnel):
Fire Department staffing increases were identified as a Top Council Priority in 2025-
2027. The department is respectfully requesting approval to hire 5 firefighter paramedic
positions to increase the department's FTE from 104 to 109 and to adjust the minimum
staffing number for each of the three shifts from 24 to 26 to ensure two additional
suppression vehicles are always staffed with 3 personnel in FY2026. This
recommendation continues to improve the minimum staffing of the department's
suppression vehicles according to the National Fire Protection Association (NFPA) 1710
standards.
NFPA Chapter 5 under 5.2.3 Operating units- Fire company staffing shall be based on
minimum levels necessary for safe, effective, and efficient emergency operations. Fire
companies whose primary functions are to pump and deliver water and perform basic
fire fighting at fires, including search and rescue, shall be known as engine companies.
According to NFPA these companies shall be staffed with four on -duty members.
Personnel costs have been calculated to include all benefits and supplemental
payments for a new hire firefighter of $107,571 using FY2027 cost estimates. The
starting salary is $70,442 with benefits accounting for approximately $37,129.
If approved today, the positions would take approximately 4-5 months to hire with a
targeted date of April 1, 2026. Estimated FY2026 cost is $134,463. Estimated FY2027
cost is $537,855. This staff is projected to grow 8% a year.
EMS billing adjustments are anticipated to generate an additional $990,000 per year or
$82,500 a month. Initiating the EMS billing adjustments in January of 2026 would
generate 6 months of revenue in FY 2026 ($495,000) and offset the FY2026 costs of
the 5 personnel with a carry forward balance.
0
Page 824 of 1214
The Department of Homeland Securitv (DHS) Staffina for Adeauate Fire and
Emergency Response (SAFER) Grant Personnel (9 additional Personnel
The department would also seek approval for an additional 9 firefighter paramedic
positions through the FY2027 budget process to be approved and contingent upon a
successful federal (3-year) SAFER grant application in July -September of 2026. Based
upon my experience this would be a very competitive SAFER grant application. If
successful, the department would increase its minimum staffing for each of the three
shifts from 26 to 29 to ensure all suppression vehicles are staffed with 3 personnel on
all days and improve the number of days our suppression vehicles are staffed with 4
personnel in line with national standards. Four -person days would be achievable but
critically dependent on unpredictable/ unscheduled leave (sick, parental, military, injury/
workers comp, mandatory training).
Successful SAFER grant applications are expected to be notified, based upon last
year's Notice of Funding Opportunity (NOFO), in September -October of 2026. The
department would have a 90 day -recruitment period before the grants period of
performance would begin. Ideally, the department would want to hire these individuals
as soon as possible as the start of the period of performance will initiate the 3-year
period of performance. There is no way to estimate the impact of the government shut
down on future grant timelines. Estimates place a new hire date in December of 2026
(FY 2027) but could be as late as February of 2027. Utilizing the December 1, 2026,
date will split the grant award across each of our Fiscal budget years.
Year 1 grant personnel costs have been calculated to include all benefits and
supplemental payments for a new hire firefighter of $107,571 using FY2027 cost
estimates. The starting annual salary is $70,442 with benefits accounting for
approximately $37,129. The cost for 9 personnel for a full year is estimated at $968,139
or a monthly cost of $80,678.25, projected to grow 8% a year. Assuming the Dec 1,
2026 start date, the FY 2027 impact for 7 months is $564,747 (The city is responsible
for a 25% cost match in year 1, a cost of $141,186). Combining the anticipated costs of
the 5 personnel for FY2027 at $537,855, the total city cost for all 14 personnel is
expected to be $679,041.
The SAFER Grant covers the cost of the 9 firefighter paramedics at 75% in year 1, 75%
in year 2, and 35% in year 3.
7
Page 825 of 1214
**Bv1SBilling
Rate SAFER Grant revenue Cummulative
Fiscal Year *SFPMcost *9FPMcost Adjustments **FireCost Recovery Contract savi ngs beyond Dec 1,2026 Net annual city cost net city cost
2.5% 2.5%
FY2026 $134.463 $ - $ 495.000.00 $ - $ 77.854.00 $ - $ (438.391.00) $ (438,391.00)
F12027
$537,855.00
$ 564,747.00
$ 990,000.00
$
60,000.00
$ 77,854.00
$ 423,560.00
$ (448,812.00) $ (887,203.00)
F12028
$580,883.00
$ 968,139.00
$ 1,014,750.00
$
123,000.00
$ 77,854.00
$ 726,104.00
$ (392,686.00) $(1,279,889.00)
F12029
$627,354.00
$1,045,590.00
$ 1,040,118.75
$
126,075.00
$ 77,854.00
$ 440,222.00
$ (11,325.75) $(1,291,214.75)
FY2030
$677,542.00
$1,129,237.00
$ 1,066,121.72
$
129,226.88
$ 77,854.00
$ 57,638.00
$ 475,938.41 $ (815,276.34)
F12031
$731,745.00
$1,219,576.00
$ 1,092,774.76
$
132,457.55
$ 77,854.00
$ -
$ 648,234.69 $ (167,041.65)
FY2032
$790,285.00
$1,317,142.00
$ 1,120,094.13
$
135,768.99
$ 77,854.00
$
$ 773,709.88 $ 606,668.23
F12033
$853,508.00
$1,422,513.00
$ 1,148,096.48
$
139,163.21
$ 77,854.00
$
$ 910,907.31 -
*Personnel cost increasing 8 % a year beginning
in F12028
** BylSbiIli ngand fire recovery increasing2.5%
beginning in
FY2028
As mentioned above, aligning EMS billing with the yearly cost report, including a fire
cost recovery, and including savings from re -negotiating the cost reporting contract
should yield $1,187,854 annually. It is difficult to predict the potential changes in the
upcoming cost report and call volume but historically the cost report has increased as
well as call volume to continue to improve overall cost recovery year after year which
would decrease the predicted annual cost to the city.
RECOMMENDATION:
The fire department respectfully requests approving the adjustments in billing for AILS
and BLS services to match the annual GEMT cost report conducted annually, a city
manager action. I respectfully recommend City Council approval to include a fire cost
recovery fee and hire 5 firefighter paramedic positions in this fiscal year, (FY2026). I
will also request approval to add 9 additional firefighter paramedic positions in the
FY2027 budget process contingent upon a successful SAFER grant application.
Page 826 of 1214
SAFER Grant
**EMS Billing revenue beyond General Fund Cummulative net
Fiscal Year *5 FPM cost *9 FPM cost Rate Adjustments **Fire Cost Recovery Contract savings Dec 1, 2026 Property Tax city cost
2.5% 2.5%
FY2026
$134,463
$ -
$
495,000.00
$
- $
FY2027
$ 537,855.00
$ 564,747.00
$
990,000.00
$
60,000.00 $
FY2028
$ 580,883.00
$ 968,139.00
$
1,014,750.00
$
123,000.00 $
FY2029
$ 627,354.00
$ 1,045,590.00
$
1,040,118.75
$
126,075.00 $
FY2030
$ 677,542.00
$ 1,129,237.00
$
1,066,121.72
$
129,226.88 $
FY2031
$ 731,745.00
$ 1,219,576.00
$
1,092,774.76
$
132,457.55 $
FY2032
$ 790,285.00
$ 1,317,142.00
$
1,120,094.13
$
135,768.99 $
FY2033
$ 853,508.00
$ 1,422,513.00
$
1,148,096.48
$
139,163.21 $
*Personnel cost increasing 8% a year beginning in FY2028
** EMS billing and fire recovery increasing 2.5% beginning in FY2028
77,854.00
$
-
$
(438,391.00)
$
(438,391.00)
77,854.00
$
423,560.00
$
(448,812.00)
$
(887,203.00)
77,854.00
$
726,104.00
$
(392,686.00)
$
(1,279,889.00)
77,854.00
$
440,222.00
$
(11,325.75)
$
(1,291,214.75)
77,854.00
$
57,638.00
$
475,938.41
$
(815,276.34)
77,854.00
$
-
$
648,234.69
$
(167,041.65)
77,854.00
$
$
773,709.88
$
606,668.23
77,854.00
$
$
910,907.31
-
Page 827 of 1214
35
30
25
20
15
10
5
0
35
30
25
20
15
10
5
0
40
30
20
10
0
Current shift staffing 2025
31 31 32
24 24 24
Shift 1 Shift 2 Shift 3
■ Current Shift Staffing 2025 Current FTE
■ Current Shift Staffing 2025 Minimum
94 Operational FTEs (current)
Shift Staffing with 5 added FTEs
33 33 33
■ 26 M 26 M 26
Shift 1 Shift 2 Shift 3
■ Current FTE ■ Minimum
99 Operational FTEs (5 added)
Shift Staffing with 14 added FTEs
36 36 36
29 = 29 = 29
Shift 1 Shift 2 Shift 3
■ Shift Staffing with 14 added FTE Current FTE
■ Shift Staffing with 14 added FTE Minimum
108 Operational FTEs (14 added)
Page 828 of 1214
Adrienne Breitfelder
From: City of Dubuque <noreply-dubuque@gscend.com>
Sent: Saturday, November 29, 2025 2:50 PM
To: Adrienne Breitfelder
Subject: A new Service Request has been created [Request ID #228372] (Contact City Council) -
Dubuque, IA
Caution! This message was sent from outside your organization. Never give your login Allow sender I Block sender
information and password over email! Report
Dubuque, IA
A new service request has been filed.
ID
228372
Date/Time
11/29/2025 2:50 PM
Type
Contact City Council
Address
2925 BURLINGTON ST, Dubuque
Origin
Website
Comments
I see the city manager want to raise
ambulance/EMS fees between 200-300% and he
can do this without council approval. I thought
the buck stops with the council. I also see
increases in fire department fees. I a person has
a auto crash with fire, hazardous clean up, and
ambulance will receive a total bill of $2987.
These increases are excessive to be applied
over 1 year, thwy should occur a more spread
out time frame. The public should not have too
make up for council errors in not graduallt raising
fees. Please table these increased fee so the
publux gas more time for input aftwr digging out
from our first major storm. My wife says she
would throw me in the back of the pickup truck
and take me to the hospital instead of payinf
those fees. These increases are why Medicare
Part B premimuns, Medicare Supplement
premimums, auto insurance get double digit
percentage increases.
Page 829 of 1214
Please share this with our new council members.
Clark Schloz P.E.
2925 Burlington Street
Dubuque, Iowa 52001
563-357-7214
Submitter Schloz, Clark A
2925 Burlington Street
Dubuque, IA 52001
563-357-7214
clarkscholz34@gmail.com
Dubuque, IA
Page 830 of 1214
Dubuque Fire Dept.
Presentation
2025-2030 Community
Driven Strategic Plan
Ambulance Rate
Adjustment Background
Full Time Employee
Request
e 831 of 1214
2025-2030 Strategic Plan
Strategic Planning Process
Review of previous strategic plan (2019)
Open Community Survey - 310 responses (Is'
�I quarter of 2025)
External Community Stakeholder Working
Session and y Survey- February 26t" 2025
y ,
II1 LUfI M J LdKfdI1ULUlfdf St:bblUllS d[JU bUUVt:y- JULy
�14-16, 2025
Leadership Retreat in July and strategic wrap
up session in August
The 5 priorities for the next
five years
�W
Workforce and Leadership Capacity
y for
Modernize Facilities, Fleet, and Technology g
��� All -Hazards Readiness
Enhance Service Delivery- Response, Staffing,
EMS Capacity, Community Education and Risk
� � p y, y
Reduction
Expand Prevention Public Education
9__..
p , and
Code Compliance
Strengthen Communication, Accountability,
and regional Collaboration
EMS Billing update and
Fire Cost Recovery
Page 835 of 1214
•UI v"
AN
Current Dubuque Fire E
Transport billing rates
(user fees)
Basic Life Support- No invasive procedures
$620
Advanced Life Support- ALS- at least
1 ALS intervention (paramedic)
$73S
Advanced Life Support 2- AL52- 3 meds, IV,
surgical airway, chest decomp, defib/
cardioversion, etc.
$106S
Under Dubuque City Code Section 6-3-1, Ambulance service rates
are established and adjusted by the City Manager.
Page 836 of 1214
AMBULANCE BILLING PAYER MIX
Medicare
52.4%
$427 BLS, $507 ALS, $734 ALS2
Private Pay
O
10.2%
CITY OF DUBUQUE
Medicaid
22.5%
$114 BLS, , $127 ALS, $232 ALS2
Insurance
INSURANCE CARD
12.7% (7% in, 5%out)
In network Insurance $620 BLS,
$735 ALS, $1065 ALS2
Workers Comp/ Other
2.2%
Page 837 of 1214
Ground Emergency
Medical Transport (GEMT)
1
Cost of providing
EMS transport $ 2324
Defined
A program where publicly owned/ operated ambulance service can receive state
and federal payments for Medicaid related EMS transports. These payments help
cover the gap between what it costs to provide services and what they receive from
Medicaid.
Cost Report Requirement
Each eligible, publicly owned/operated EMS transport provider must submit their
cost report to the Iowa Department of Human Services by November 301". The cost
report determines the actual costs with providing the transport services. Subject to
federal and state audits.
3rd party Cost Report
To Comply with the GEMT program requirements the department contracts with a
third -party vendor to complete the annual cost reports (utilize the cost of personnel,
equipment, fuel, maintenance, and operational overhead to determine the cost of
providing EMS Service). Current Cost report is $2324.
Current average Medicaid _
payments are $114-$232
GEMT Payment $2110-$2092
Page 838 of 1214
History of billing rate adjustments
EMS Billing History/ Cost Report
S2,500.00
S2,038.23
S2,000.00 S1,876.86
S1,707.77 .5.1,72g:99
S1,500.00
$1,000.00
S2,324.97
S1,112.32S1,065.00 S1,065.00 S1,065.00 S1,065.00 S1,065.00 S1,065.00
......�........ ...... ........ ... ....... .....
5735. 5735. $735. 5735. S735. $735.1
$500.00
5-
FY2021 FY2022 FY2023 FY2024 FY2025 FY2026
Cost Report � EMS Billing BLS
EMS Billing ALS2 • • • • • • • • • Linear (Cost Report)
......••• Linear (EMS Billing ALS) ......••• Linear (EMS Bi(lingALS2)
� EMS Billing ALS
......••• Linear (EMS Billing BLS)
Page 839 of 1214
Cost recovery components
Include equipment, personnel, maintenance
Tied to changes in costs of equipment and improvements made in the delivery of services
Staffing Progression
120 99.16 102.16 104.16
92.16
100 .86 ...�................... * 93.0................... 9q. � .................. 94 .
:l
.0
We
20 6.160 6.160 8.16. M 10.1
I
FY 2022 FY 2023 FY 2024 FY 2025
Administration � Operations � Total ......••• Linear (Total)
A summary of the high level investments toward the fire department in the past three years include:
Two fire engines (two additional in FY2028), two ladder trucks, two ambulances, cardiac monitors, intubation
equipment upgrades, portable radios, fire station exhaust systems for each station, generators for each station,
fire boat replacement, HVAC at headquarters, fire gear replacement for all employees, small vehicle replacement
for staff, command vehicle and fire prevention vehicle, bunkroom remodel, technical rescue equipment, pre -plan
software, building maintenance at various stations, upcoming CAD implementation.
Page 840 of 1214
National Municipal Rates:
BLS: $500-$800 small towns, $1200-$2300 Mid size
ALS: $1200-$3600
Specialty Care: $3800-$4900
Regional Examples:
Illinois: ($1950-$3600)
Wisconsin: ($1500-$2400)
Minnesota ($1882-$2685)
d Regional EMS
g Comparisons
Average BLS $855.35
Average ALS $1037
Average ALS2 $1403
Approximately 50 participated (top 3 for Iowa)
Municipal (35,682 incidents) $1390 BLS, $1756 ALS, $2049 ALS2
Private (6456 incidents) $1300 BLS, $1500 ALS, $2000 ALS2
Municipal (1388 incidents) $1280 BLS, $1750 ALS, $2150 ALS2
Page 841 of 1214
Recommended EMS
Adjustments
Utilizing Annual Cost Report, rates align with actual costs of provid
BLS $620
rALS: Rate $735
(Y
�
ALS 2 Rate $1,06S
$17162
$21324
$2324
EMS Billing adjustments expected to generate $990,000 annually
January- June 2026 $495,000
Page 842 of 1214
Hardship Process
Cost recovery strategies are intended to pursue reimbursements for EMS
transports by recovering funds that may already be designated for the
purpose.
No one will ever be denied necessary medical transport service or
assistance due to an inability to pay or lack of insurance.
Any resident or non-resident may submit a waiver request for stating a financial hardship.
Personal information on financial status will be required as proof. Persons showing income
below the poverty level will qualify for waiver of fees based on hardship. The department
receives very few requests for hardship.
Current process- Contact the EMS Bureau Chief at 563-589-4160
Currently working on electronic version
AMBULANCE Billing Adjustment
Medicare
52.4%
$427 BLS, $507 ALS, $734 ALS2
Private Pay
n
10.2%
Impact
Medicaid
22.5%
Insurance
In network and out of network
INSURANCE CARD
12.7%
$114 BLS, , $127 ALS, $232 ALS2 In network Insurance $620 BLS,
$735 ALS, $1065 ALS2
Workers Comp/ Other
2%
Adjusted rates would not impact Medicare payments, Medicaid payments, or In -Network Insurance payments
Page 844 of 1214
Fire Cost Recovery Billing
From one
cost recovery vendor-
18
departments
in Iowa, 150 in Illinois, 44 in Wisconsin utilizing Fire Cost Recovery
Iowa Chiefs group
discussion presented
the
topic on MVA
(Vehicle
accidents)- with most utilizing Hat Mat recovery, several utilizing
car fire and vehicle accident recovery through the insurance company- no balance billing to the resident. There was interest in further investigation
and review of opportunities to implement.
Expected to generate $120,000 in cost recovery per year at full implementation.
Rates are established similar to the cost report (equipment, personnel, maintenance).
Page 845 of 1214
Incidents per year % collected Amount
MVA with fluids
115
90
$520.00
MVA no fluids
115
30
$520.00
Vehicle Fires
13
20
$605.00
Fires
116
60
$500.00
Hazardous
184
60
$700.00
Conditions
Special Rescue
24
60
$400.00
Total
567
Cost recovery After billing fee
$532820.00
$43,056.00
$172940.00
$14,352.00
$1,573.00
$15258.00
$77,280.00
$611824.00
$5,760.00 $41608.00
$1911173.00 $1201000-$1252098
Cost recovery billing takes up to two years for full "at plan" ramp up, year 1 may be 50%, is highly dependent
upon incident volume.
This represents an estimated forecast, vendor not selected.
Page 846 of 1214
It
EMS Billing
Adjustments
$9907000
0 ?"W" I It = 0
• F=
Added Fire Cost
Recovery
$1207000
•XV1=
•
Contract Re-
negotiation
Total Annual
Billing....
Improvements
Personnel Request
Page 848 of 1214
Fire Department Minimum Staffing
City Council Top Priority in 2025-2027
35 31
Goal: Increase the minimum staffing operational template where all suppression vehicles 30 24
have a minimum of 3 personnel at all times and improve days where 4 person staffing is 2520
achieved in line with NFPA1710 standards. 15
10
r � - o
I Request to hire 5 firefighter/ paramedics (EMTs) Estimated start
date April 2026, June 2026 impact on minimum staffing. Shift,
Increase the departments full time equivalent from 104 to 109.
10 Administrative and 99 (94 current) operational personnel.
Shift staffing will move from 31 to 33 (one shift currently at 32 max staffing, the
35
other two shifts at 31 max staffing)
30
1040
W
Move minimum staffing from 24 to 26 and improve the staffing on 15
two additional suppression vehicles from two personnel to three 10
every day. 4 of the 7 suppression vehicles minimum staffing. 5
0
Current shift staffing 2025
31
24
Shift 2
■ Current Shift Staffing 2025 Current FfE
■ Current Shift Staffing 2025 Minimum
Shift Staffing with 5 added FTEs
33 33
26
26
Shift 1 Shift 2
■ Current FTE ■ Minimum
32
24
Shift 3
26
Shift 3
Page 849 of 1214
LN
0 0
Placed a 3" ambulance in service
Approval of 5 Firefighter
Paramedic/ EMT positions
99.16 104.16 109.16
92.16 ..............99
93 ............. �4 9d
06 .......... ...... - ��
°0
60
40
20
6.1
0
FY 2022
Staffing Progression
inn in
6.1
FY 2023
w
FY 2024
10.1
FY 2025
10.1
FY2026
Administration � Operations � Total • • • • • • • • • Linear (Total)
99 = 33 per shift
minimum staffing to 26
Page 850 of 1214
Fire Department Minimum Staffing
FY2027 Additional 9 operational Firefighter/ Paramedic (EMT) Positions
(SAFER GRANT Application)
Request approval under the FY2027 budget process for an additional 9
firefighter/ paramedics (EMTs)- Estimated start in December -March 2026-2027.
Increase the departments full time equivalent from 109 to 118.
10 Administrative and 108 operational.
Shift staffing will move from 33 to 36 on each of the 3 shifts
Move minimum staffing from 26 to 29 and improve the staffing on
the final three suppression vehicles to a minimum staffing of three
personnel every day
36 personnel represent 4 person staffing and dependent upon scheduled time off currently utilizing 4
available days for benefit time scheduling and remaining days for unscheduled leave (parental, sick,
injury, military, bereavement)
35
30
25
20
15
10
5
0
Ic
10
Us]
U
0
Shift Staffing with 5 added FTEs
33 33
26
26
Shift 1 Shift 2
W
■ Current HE ■ Minimum
33
CO.,
Shift 3
Shift Staffing with 14 added FTEs
29
Shift 1
0
29
Shift 2
0.1
■ Shift Staffing with 14 added FTE Current FTE
■ Shift Staffing with 14 added FTE Minimum
29
Shift 3
Page 851 of 1214
140
120
100
80
60
40
20
0
Successful SAFER Grant
9 Firefighter Paramedic/ EMT
Positions
Staffing Progression
99.16 102.16 104.16 i l P
109.16 ._.,10
92.16 93 ............ 94 j ............ 94 * .............. 99-
6.1
FY 2022
6.1
FY 2023
FY 2024
10.1
FY2025
10.1
FY2026
10.1
FY2027
Administration � Operations � Total ......••• Linear (Total)
108 = 36 per shift
Minimum staffing to 29
Page 852 of 1214
SAFER Grant Explained
The Department of Homeland Security -Staffing for Adequate Fire and Emergency Response
The SAFER Program provides funding directly to fire departments to assist in increasing the number of firefighters to
help communities meet industry minimum standards and attain 24 hour staffing to provide adequate fire protection
from fire and fire related hazards, and to fulfil traditional missions of fire departments.
Program goal: To enhance local fire departments abilities to comply with staffing, response
and operational standards established by the National Fire Protection Association (NFPA 1710)
Notice of Funding Opportunity -released 30-45 days prior to grant opening -Information from 2025 NOFO referenced
3 year period of performance after *180 day recruitment period -may begin earlier
Grant funding in year one and two is 75% (City match 25%), Funding in year three is 35% (City match 65%)
Anticipated release of the 2026 NOFO in July -August (dependent upon several factors)
Award notifications in September -October
Targeted hire date of December 2026 Impact on staffing March -May 2027
Page 853 of 1214
Firefighter Paramedic/ EMT
costs
Costs have been calculated to include all benefits and supplemental
Pay for a new firefighter of $107,571 (benefits accounting for
approximately $37,129) $70,442 starting salary.
Full cost of 5 personnel $537,855 FY2027 cost estimates
Full cost of 9 personnel $968,139 FY2027 cost estimates
Page 854 of 1214
Funding and Cost Recovery Breakdown
**EMS Billing Rate
SAFER Grant
Net annual city
Cummulative net
Fiscal Year
*5 FPM cost
*9 FPM cost
Adjustments
**Fire Cost Recovery
Contract savings
revenue beyond Dec
cost
city cost
1, 2026
2.50%
2.50%
FY2026
$1341463
$ -
$4951000.00
$ -
$77,854.00
$ -
$ (4381391.00)
$ (438)391.00)
FY2027
$537,855.00
$564,747.00
$990X0.00
$60,000.00
$77,854.00
$423,560.00
$ (448)812.00)
$ (887)203.00)
FY2028
$580,883.00
$968J39.00
$1,014,750.00
$123,000.00
$77,854.00
$726J04.00
$ (392,686.00)
$ (1127%889.00)
FY2029
$6272354.00
$1,045,590.00
$1,040,118.75
$126,075.00
$77,854.00
$440,222.00
$ (11)325.75)
$ (L291)214.75)
FY2030
$677,542.00
$1,129,237.00
$1,0661121.72
$129,226.88
$77,854.00
$57,638.00
$475,938.41
$ (8151276.34)
FY2031
$731,745.00
$1,219,576.00
$1,092,774.76
$1321457.55
$77,854.00
$ -
$648,234.69
$ (167,041.65)
FY2032
$790,285.00
$1,3172142.00
$1J20,094.13
$135,768.99
$77,854.00
$ -
$773,709.88
$606,668.23
FY2033
$8532508.00
$124222513.00
$1,1487096.48
$139,163.21
$77,854.00
$ -
$910,907.31
-
*Personnel cost increasing 8% a year beginning in FY2028
** EMS billing and fire recovery increasing 2.5% beginning in FY2028
Page 855 of 1214
Thank you
Page 856 of 1214
Fiscal Year
fy18 fy19 fy20
fy21
fy22
fy23
fy24
fy25 fy26 fy27
EMS Transport Volume
3509 3512
3663
4245
4920
4951
4904
4973 5023 5073
Annual Growth Rate
0.10%
4.30%
15.90%
15.90%
0.60%
-0.90%
1.40% 3yr Quarterly Avg. 1.00%
Growth:
Ambulance Fee Revenue
$1,168,118.09 $1,090,928.69
$1,375,572.07
$1,576,466.00
$1,894,062.08
$1,717,550.92
$1,660,443.43
$1,850,350.95 $1,770,644.47 $1,788,350.91
Average/EMS Call
$332.89 $310.63
$375.53
$371.37
$384.97
$346.91
$338.59
$372.08 3yr Average: $353
AUDITED COST PER
TRANSPORT
GEMT Add -on Rate/transport
Medicaid Transports
Annual Growth Rate
GEMT Revenue
BLUE= a projection based on
performance in previous 12
Billing Vendor Fee FY27
Equals 3.5% of Total Revenue
$137,897.94
$1,132.15 $1,112.32
$1,876.86
$1,707.77
$1,725.99
$2,038.23
$1,025.40
$1,008.71
$1,764.04
$1,579.13
801 788
985
1070
1176
1147
-2%
25%
9%
10%
-2%
$1,010,019.00
$1,523,439.37
$2,083,451.26
$1,844,514.59
GEMT Cost Report Fee FY27
Equals 6% of previous completed fiscal year GEMT revenue
$125,867.82
$2,324.97
$1,596.36 $1,909.60 $2,209.18 $1,905.00 3yr Average:
1075 1105 1117 1129
-6% 3% 3yr Quarterly Avg.
Growth:
$1,534,267.77 $1,888,386.73 $2,467,996.48 $2,151,590.26
GEMT IGT Amount
Equals 1/3 of
GEMT Revenue
$717,189.58
$1, 905
1.10% 1
Page 857 of 1214
State
Ambulance
Iowa
Missouri
South Dakota
Nebraska
Wyoming
Illinois
North Dakota
Minnesota
National Average
PCC Recommended Rates
CMS Average Submitted Charge CY2023
Mileage (A0425) ALS Emergency (A0427)
$0.00
$17.44
$16.45
$15.79
$20.08
$31.45
$23.19
$21.68
$27.70
$20.50
$0.00
$959.26
$1,052.93
$1,123.92
$1,148.40
$1,573.02
$1,621.41
$1,639.00
$2,062.05
$1,318.53
BLS Emergency (A0429)
$0.00
$759.79
$830.70
$794.83
$785.99
$1,030.07
$1,286.59
$1,246.05
$1,387.04
$983.42
Low
$18.00
$1,050.00
$850.00
High
$25.00
$1,600.00
$1,200.00
Page 858 of 1214
9000
8000
7000
6000
5000 469
4000
3000
2000
1000
0
6312 6411
Emergency Medical
Dubuque Fire Department Call Volume
265 190 278
Structure Fire
261 304 229
IN■■■MM
Hazardous Materials
911 979 1031
28 — — 40 — 47
Other Rescue
0 2019 0 2020 0 2021 0 2022 0 2023 0 2024
7825 7996
616
Total Incidents
•
Page 859 of 1214
Financial Group
Transports
Actual Gross
Increased
ALS2E
Chrg
Gross Chrg
($2324)
ATTORNEY
2
$1,555.50
$4,720.79
$0.00
AUTO LIABILITY
50
$38,064.32
$85,483.75
$0.00
FACILITY
1
$766.41
$1,198.40
$0.00
INSURANCE
422
$322,681.58
$865,840.36
$8,134.00
WELMARK BCBS
180
$138,292.10
$138,292.10
$1,756.30
MEDICAID
26
$39,628.82
$39,628.82
$0.00
MEDICAID HMO
1103
$2,841,516.33
$2,841,516.33
$18,137.79
MEDICARE
1659
$1,245,395.18
$1,245,395.18
$20,677.45
MEDICARE HMO
1206
$899,387.71
$899,387.71
$9,088.75
MILITARY
2
$1,556.93
$4,720.79
$0.00
PATIENT 506 $370,952.97 $990,730.28 $20,916.00
VETERANS 49 $37,850.14 $100,553.36 $0.00
ADMINISTRATION
WORKERS COMP 28 $21,500.25 $59,119.06 $0.00
Grand Total 5234 $5,959,148.24 $7,259,299.30 $78,710.29
ALS2NER
ALSE ($2324)
ALSNER
ELSE ($1162)
BLSNER
DOA
TNT
Mileage
Total Paid
Increased
($2324)
($1162)
Total Paid
$0.00
$4,648.00
$0.00
$0.00
$0.00
$0.00
$0.00
$72.79
$0.00
$0.00
$0.00
$51,128.00
$0.00
$32,536.00
$0.00
$0.00
$0.00
$1,819.75
$27,588.01
$61,958.62
$0.00
$0.00
$0.00
$1,162.00
$0.00
$0.00
$0.00
$36.40
$0.00
$0.00
$0.00
$719,045.60
$4,880.40
$112,249.20
$3,253.60
$1,882.92
$1,035.96
$15,358.69
$255,033.20
$684,360.22
$0.00
$106,019.04
$678.17
$27,805.17
$782.48
$806.96
$443.98
$109,299.94
$109,306.08
$0.00
$20,389.22
$0.00
$19,239.60
$0.00
$0.00
$0.00
$15,162.36
$15,161.99
$0.00
$1,914,837.35
$820.50
$8951753.97
$8,679.37
$602.47
$2,684.88
$2,116,307.57
$2,116,361.36
$0.00
$897,008.89
$2,309.03
$249,010.93
$64,504.18
$8,584.70
$3,300.00
$742,756.14
$742,753.69
$0.00
$644,573.21
$0.00
$202,775.66
$39,485.78
$1,984.37
$1,479.94
$510,831.92
$510,852.22
$0.00
$4,648.00
$0.00
$0.00
$0.00
$0.00
$0.00
$72.79
$1,053.68
$3,195.03
$0.00
$778,540.00
$0.00
$158,032.00
$8,134.00
$2,017.41
$4,675.00
$18,415.87
$10,521.20
$28,136.74
$0.00
$83,664.00
$0.00
$12,782.00
$2,324.00
$0.00
$0.00
$1,783.36
$34,099.30
$90,588.52
$0.00
$51,128.00
$0.00
$6,972.00
$0.00
$0.00
$0.00
$1,019.06
$14,237.23
$39,148.64
$0.00
$5,275,629.31
$8,688.10
$1,718,318.53
$127,163.41
$15,878.83
$13,619.76
$21,291.08
$3,836,890.55
$4,674,262.82
$837,372.27
Transp Mix Coll% Gross
0.04% 0.00%
0.96% 72.48%
0.02%
0.00%
8.05%
79.04%
3.45%
79.04%
0.50% 38.26%
21.07% 74.48%
31.70%
59.64%
23.04%
56.80%
0.04%
67.68%
9.67% 2.84%
0.94% 90.09%
0.53% 66.22%
100.00% 64.39%
Page 860 of 1214
Budget Highlights
Expenses
Employee Expense
Supplies and Services
Machinery and Equipment
Debt Service
Total Expenses
Resources
Operating Revenue
DRA Gaming Abated Debt
Sales Tax Abated Debt
Total Resources
Property Tax Support
Percent Increase (Decrease)
Personnel -Authorized FTE
FIRE DEPARTMENT
FY 2024
Actual
$12,602t641
$1,954,995
$ 66,939
$ 398, 503
$15,023tO78
FY 2025
Budget
$13,885t953
$2,657,900
$ 324,116
$ 555,356
$17,423t325
FY 2026
Requested
$13.966t001
$2,8031100
$ 185,150
$ 908, 244
$17,8621495
$3,475,842
$4,680,634
$4,327,373
$
17,618
$
19,449
$
19,850
$
2 82, 071
$
4 37, 97 5
$
792, 97 3
$3,775,531 $5,138,058 $5,140t196
$11,247t547 $12,285t267 $12,722,299
101.16
104.16
104.16
% Change
From FY
2025 Budget
0.6 %
5.5 %
(42.9)%
63.5 %
2.5 %
437,032
3.6 %
Page 861 of 1214
Wellmark 2025
Avera e
Median
$666.60
$620.00
BLS (NE)
A0428
$620.00
$855.35
$760.00
BLS (E)
A0429
$465.00
$857.18
$755.00
ALS1 (NE)
A0426
ALS1 (E)
A0427
ALS2
A0433
$735.00 $1,065.00 $1,258.00
$1,037.83 $1.403.71 $1,702.90
$962.90 $1,311.00 $1,509.01
Metro/Rural
Mileage
$678.00 $14.00
$62.75 $296.11 $246.19 $18.94
$51.00 $300.00 $250.00 $18.00
Page 862 of 1214