To: County of Sonoma Board of Supervisors
Department or Agency Name(s): Department of Health Services
Staff Name and Phone Number: Nolan Sullivan, 707-565-4774; Amelyn Olson, 707-565-2696
Vote Requirement: 4/5th
Supervisorial District(s): Countywide
Title:
Title
Emergency Medical Services Specialty Care Hospital Agreements
End
Recommended Action:
Recommended action
A) Authorize the Director of Health Services, or designee, to execute the Emergency Medical Services Base Hospital Agreement with Providence Santa Rosa Memorial Hospital for a term of July 1, 2025, through June 30, 2035, and a total revenue amount of $567,150 with an annual inflater of Consumer Price Index or 3% whichever is higher.
B) Authorize the Director of Health Services, or designee, to execute the Emergency Medical Services Receiving Hospital Agreements with Healdsburg District Hospital, Kaiser Permanente, Sutter Medical Center of Santa Rosa, Sonoma Valley Hospital, and Petaluma Valley Hospital for a term of July 1, 2025, through June 30, 2035, and a total revenue amount of $207,470 per agreement, with an annual inflater of Consumer Price Index or 3% whichever is higher, for a total of $1,037,350 for all five hospitals.
C) Authorize the Director of Health Services, or designee, to execute the Emergency Medical Services ST-segment Elevation Myocardial Infarction Receiving Center Agreements with Providence Santa Rosa Memorial Hospital and Sutter Medical Center of Santa Rosa for a term of July 1, 2025 through June 30, 2035 and a total revenue amount of $320,000, per agreement with an annual inflater of Consumer Price Index or 3% whichever is higher for a total of $640,000 for both hospitals.
D) Authorize the Director of Health Services, or designee, to make modifications to the agreements referenced in this board item, including increases to the total revenue amount, provided the changes do not significantly alter the scopes of service, and are reviewed and approved by County Counsel.
E) Adopt a Resolution authorizing budgetary adjustments to the Department of Health Services Fiscal Year 2025-2026 Adopted Budget in the amount of $54,064 to reflect revenues and expenditures associated with the eight hospital agreements.
end
Executive Summary:
The Department of Health Services seeks Board approval to enter into agreements with designated hospitals to support the delivery of emergency medical services (EMS) from July 1, 2025, through June 30, 2035. These agreements are a continuation of the County’s statutory responsibility, under state law, to regulate and oversee the local EMS system through the Sonoma County EMS Agency, which operates as the Coastal Valleys EMS Agency (CVEMSA) in coordination with Mendocino County. The EMS system relies on collaborative partnerships with Base Hospitals, Receiving Hospitals, and ST-segment Elevation Myocardial Infarction (STEMI) Receiving Centers to ensure timely and high-quality emergency medical care throughout the region.
Under these agreements, Santa Rosa Memorial Hospital will continue to serve as the Base Hospital, providing 24/7 medical consultation to field paramedics and supporting EMS education, data analysis, and quality improvement initiatives. Receiving Hospitals, including Kaiser Santa Rosa, Sutter Medical Center, and others will accept EMS transports and participate in training, disaster preparedness, and data sharing. STEMI Receiving Centers, including Providence Santa Rosa Memorial Hospital and Sutter Medical Center, will provide specialized cardiac care and submit outcome data to support ongoing quality monitoring. The County will be reimbursed by each participating hospital for reasonable regulatory oversight costs, as detailed in the FY 2025-2026 budget. These contracts ensure continued compliance with state EMS regulations and promote coordinated, high-quality emergency care in Sonoma County.
Discussion:
As part of CVEMSA standard contract renewal process, CVEMSA and the Department of Health Services fiscal team scheduled review meetings with all of our hospital partners to ensure a clear, informed understanding of the financial increases presented in our new agreements. These meetings were a critical step to maintain transparency and identify opportunities for improvement or adjustment before entering into a renewed contract. These meetings brought together hospital Chief Executive Officers, Chief Financial Officers, department managers and contract division staff.
The Department requests approval of several revenue agreements through which CVEMSA will provide regulatory oversight of local hospitals for compliance with emergency medical services laws for the period July 1, 2025 through June 30, 2035. First-year revenue from these agreements is $224,450 with future year revenue based on first year’s revenue with adjustments based on the Consumer Price Index (CPI) or 3% whichever is higher. Agreement revenue amounts have been established to fully cover the County’s cost of providing services. Refer to Attachment 10 for the fiscal breakdown.
California Health and Safety Code, Division 2.5, Article 1, Section 1797.200 <https://california.public.law/codes/health_and_safety_code_section_1797.220>, sets forth the County of Sonoma Emergency Medical Services Agency as the responsible entity for oversight and regulation of the local EMS system. The Board of Supervisors has designated the Sonoma County Department of Health Services as the local EMS Agency for Sonoma County and has authorized an agreement for EMS administrative services with Mendocino County. This regional organization is formally known as the Coastal Valleys EMS Agency (CVEMSA).
Base Hospital
The primary role of a base hospital is to guide the delivery of pre-hospital care by providing medical consultation to paramedics and directing ambulance transportation to appropriate receiving hospitals. Any hospital able to meet the requirements listed below may request designation as a base hospital by CVEMSA. In Sonoma County, the designated base hospital is Santa Rosa Memorial Hospital. Under this agreement, obligations as a designated base hospital include:
• Designate a Medical Director and a Pre-hospital Liaison Nurse
• Provide pre-hospital personnel with 24/7 on-line medical consultation services
• Participate in CVEMSA's quality assurance/improvement programs
• Provide CVEMSA approved continuing education and clinical experience program
• Conduct audits and critique cases handled by pre-hospital personnel
Under this agreement, CVEMSA's primary function as defined in statute is to provide oversight of Santa Rosa Memorial Hospital's performance as a base hospital, including monitoring the medical control program for adequacy and performance of required services and quality improvement activities. Monitoring of the medical control program and quality improvement activities is ongoing. An annual audit of base hospital scope of services will be performed by CVEMSA. The agreement reimburses the County for its reasonable regulatory oversight costs, including providing case reviews and assistance with training and education of hospital and pre-hospital emergency personnel. See draft Base Hospital agreement, Attachment 2.
Receiving Hospitals
The primary role of a receiving hospital is to receive patients requiring emergency medical services and maintain adequate staff and equipment to provide these services. In Sonoma County the designated receiving hospitals include Healdsburg District Hospital, Kaiser Permanente Santa Rosa, Sutter Santa Rosa Regional Hospital, Sonoma Valley Hospital, and Petaluma Valley Hospital. Sonoma West Medical Center was a previous designated receiving hospital and was closed in 2018 and is not included in the current receiving hospital contracts being renewed.
Under these agreements, the obligations of a receiving hospital include:
• Designate a medical director who will represent the hospital
• Participate on various EMS committees related to pre-hospital care and participate in Multi-Casualty Incident/Disaster exercises and program development
• Participate in CVEMSA's quality assurance/improvement programs
• Cooperate with CVEMSA in the collection and analysis of patient care data
• Participate in EMS education programs including clinical internships
• Participate in CVEMSA designated inter-hospital communications system
Under these agreements, CVEMSA's primary function as defined in statute is to provide oversight and ongoing evaluation of the regional EMS system, evaluate and monitor the adequacy of services and medical quality improvement of the receiving hospitals. Monitoring of the quality assurance programs and activities is ongoing. Data pertaining to trauma and STEMI patients received at these facilities will be reviewed on a case-by-case basis. An annual audit of receiving hospital scope of services will be performed by CVEMSA. The receiving hospital agreements reimburse the County for its reasonable regulatory oversight costs, including providing case reviews and assistance with training and education. See draft Receiving Hospital agreements, Attachments 3, 4, 5, 6 and 7.
STEMI (ST-Elevation Myocardial Infarction) Receiving Centers
The primary role of an ST-Elevation Myocardial Infarction receiving center is to receive patients requiring STEMI receiving center services and maintain adequate staff and equipment to provide these services. In Sonoma County the designated STEMI receiving centers include Providence Santa Rosa Memorial Hospital and Sutter Santa Rosa Regional Hospital. Under these agreements, the obligations of the STEMI receiving center include:
• Designate a physician and nursing liaison to interface with CVEMSA
• Maintain internal policies for the emergency department and cardiac catheterization lab pertaining to the care of STEMI patients
• Provide timely data to CVEMSA on an ongoing basis
• Participate in CVEMSA's STEMI quality assurance/improvement program and committees
Under these agreements, CVEMSA's primary function as defined in statute is to provide an ongoing evaluation of the regional EMS system, evaluate and monitor the adequacy of services and medical quality improvement of STEMI receiving centers. The adequacy of services and quality improvement is monitored on an ongoing basis. STEMI patient data is reviewed monthly from each facility and an annual audit of all components outlined in the scope of services for the STEMI receiving center will be performed by CVEMSA. See STEMI Receiving Center draft agreements, Attachments 8 and 9.
The Department is requesting approval of base hospital, receiving hospital, and STEMI receiving center agreements with a term of ten years. The state EMS Authority has established ten years as a standard agreement term cap for regulatory oversight agreements.
See Attachment 10 for further details regarding the proposed fiscal amounts as well as information about the Health Information Exchange.
Strategic Plan:
This item directly supports the County’s Five-year Strategic Plan and is aligned with the following pillar, goal, and objective.
Pillar: Healthy and Safe Communities
Goal: Goal 1: Expand integrated system of care to address gaps in services to the County’s most vulnerable.
Objective: Objective 2: Identify gaps in the Safety Net system of services and identify areas where departments can address those gaps directly, and seek guidance from the Board when additional resources and/or policy direction is needed.
Racial Equity:
Was this item identified as an opportunity to apply the Racial Equity Toolkit?
No
Prior Board Actions:
On July 21, 2015, the Board of Supervisors authorized the Director of Health Services to execute an agreement with Santa Rosa Memorial Hospital to accept revenue for providing EMS Base Hospital regulatory oversight; to execute agreements with Healdsburg District Hospital, Sonoma West Medical Center, Kaiser Permanente Santa Rosa, Sutter Santa Rosa Regional Hospital, Sonoma Valley Hospital, and Petaluma Valley Hospital to Receiving Hospital regulatory oversight; and with Santa Rosa Memorial Hospital and Sutter Santa Rosa Regional Hospital to provide STEMI Receiving Center regulatory oversight.
Fiscal Summary
|
Expenditures |
FY25-26 Adopted |
FY26-27 Projected |
FY27-28 Projected |
|
Budgeted Expenses |
$170,386 |
$231,184 |
$238,119 |
|
Additional Appropriation Requested |
$54,064 |
|
|
|
Total Expenditures |
$224,450 |
$231,184 |
$238,119 |
|
Funding Sources |
|
|
|
|
General Fund/WA GF |
|
|
|
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State/Federal |
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Fees/Other |
$224,450 |
$231,184 |
$238,119 |
|
Use of Fund Balance |
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|
General Fund Contingencies |
|
|
|
|
Total Sources |
$224,450 |
$231,184 |
$238,119 |
Narrative Explanation of Fiscal Impacts:
The FY 2025-2026 adopted budget includes $170,386 in revenues and expenditures. DHS is requesting an increase in both revenue and expenditure by $54,064 for all hospital contracts, bringing the total to $224,450. This adjustment is based on the results of a comprehensive fee study conducted in FY 2024-2025, which found that previous service contract rates were below the actual cost of services.
For FY 2026-2027 and FY 2027-2028, an annual CPI increase of 3% is included and will be incorporated into future budget requests.
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Staffing Impacts: |
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Position Title (Payroll Classification) |
Monthly Salary Range (A-I Step) |
Additions (Number) |
Deletions (Number) |
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Narrative Explanation of Staffing Impacts (If Required):
N/A
Attachments:
Attachment 1 - Budget Resolution
Attachment 2 - Draft Santa Rosa Memorial Hospital Base Hospital Agreement
Attachment 3 - Draft Healdsburg District Receiving Hospital Agreement
Attachment 4 - Draft Kaiser Permanente Santa Rosa Receiving Hospital Agreement
Attachment 5 - Draft Sutter Santa Rosa Receiving Hospital Agreement
Attachment 6 - Draft Sonoma Valley Hospital Receiving Hospital Agreement
Attachment 7 - Draft Petaluma Valley Hospital Receiving Hospital Agreement
Attachment 8 - Draft Santa Rosa Memorial Hospital STEMI Hospital Agreement
Attachment 9 - Draft Sutter Santa Rosa STEMI Hospital Agreement
Attachment 10 - Additional Proposed Fiscal and Health Information Exchange Information Details
Related Items “On File” with the Clerk of the Board:
None