To: County of Sonoma Board of Supervisors
Department or Agency Name(s): Department of Health Services
Staff Name and Phone Number: Tina Rivera, 565-4774
Vote Requirement: Majority
Supervisorial District(s): Countywide
Title:
Title
Emergency Ground Ambulance Services Agreement Amendment
End
Recommended Action:
Recommended action
Authorize the Director of Health Services to execute the fourth amendment to an agreement with American Medical Response West for emergency ground ambulance services, extending the end date to January 15, 2024, approving a rate increase, and authorizing the implementation of Tiered Advanced Life Support (ALS) and Basic Life Support (BLS) Emergency Medical Services Response.
end
Executive Summary:
Division 2.5 of the California Health and Safety Code (HSC) “the EMS Act” § 1797.224 allows Local EMS Agencies (LEMSAs) to enter into formal agreements for provision of ambulance service through the creation of Exclusive Operating Areas (EOAs). Sonoma County designates the Department of Health Services as the LEMSA for Sonoma County. Within the Department, EMS Agency functions are the responsibility of Coastal Valleys EMS Agency, which is organized within the Public Health Division of the Department.
On December 31, 2008, the County entered into an agreement with American Medical Response West (AMR) for emergency ground ambulance service in the exclusive operating area. The agreement was modified in November 2011, October 2013, and July 2019. The current agreement with AMR expires on July 1, 2022. The proposed amendment extends the current agreement through January 15, 2024 and includes approval of rate increases effective July 1, 2022 and July 1, 2023. The amendment also provides for Tiered Advanced Life Support (ALS) and Basic Life Support (BLS) Emergency Medical Services Response.
Discussion:
Division 2.5 of the California Health and Safety Code (HSC) “the EMS Act” § 1797.224 allows Local EMS Agencies (LEMSAs) to enter into formal agreements for provision of ambulance service through the creation of Exclusive Operating Areas (EOAs). HSC 1797.224 states:
A local EMS agency may create one or more exclusive operating areas in the development of a local plan, if a competitive process is utilized to select the provider or providers of the services pursuant to the plan. No competitive process is required if the local EMS agency develops or implements a local plan that continues the use of existing providers operating within a local EMS area in the manner and scope in which the services have been provided without interruption since January 1, 1981. A local EMS agency which elects to create one or more exclusive operating areas in the development of a local plan shall develop and submit for approval to the authority, as part of the local EMS plan, its competitive process for selecting providers and determining the scope of their operations. This plan shall include provisions for a competitive process held at periodic intervals. Nothing in this section supersedes Section 1797.201.
On December 31, 2008, the County entered into an agreement with American Medical Response West (AMR) for emergency ground ambulance services in the exclusive operating area. The agreement was modified in November 2011, October 2013, and July 2019. The current agreement will expire on June 30, 2022.
Nexus to Request for Proposal - Emergency Advanced Life Support Ground Ambulance Service
In anticipation of the above-mentioned June 30, 2022 contract expiration, the County engaged in a request for proposals (RFP) process to solicit proposals from qualified organizations for Ground Ambulance Service in Sonoma County EOA #1. On November 2, 2021, the Board of Supervisors approved the language and timeline of the RFP for Emergency Advanced Life Support Ground Ambulance Service in Sonoma County Exclusive Operating Area 1 (EOA1). The Board directed staff to publicly announce the RFP and solicit proposals for service consistent with the County’s purchasing policies. The RFP was publicly posted on November 8, 2021 with a proposal due date of March 1, 2022.
Risks Associated with RFP Timeline
On December 2, 2021, County staff hosted a mandatory proposer’s pre-bid conference, the purpose of which was to answer questions that proposers may have about the RFP process and timeline. At that conference, attended by six potential proposers, the County received nearly universal feedback about the very challenging timeline between contract award and start of service. The primary concerns expressed were the challenges with equipment procurement given the growing global supply-chain crisis, the competitive labor market for medical professionals, and the challenge of transitioning during the current declared emergency. Staff noted these concerns and committed to monitoring their potential impact over the next several weeks.
Supply chain problems in the durable medical equipment sector, and particularly in the ambulance chassis industry, have continued to escalate. In addition, availability of skilled medical personnel to staff ambulance service continues to worsen. As a result of these continued risks, County staff have determined that continuing with the RFP process and potential change in ambulance service providers will result in significant risk of disruption to the ground ambulance system of care in Sonoma County. With the current supply chain disruptions and skilled labor shortages, a new vendor cannot reasonably implement service prior to the current contract extension.
Request for Rate Increase
The current contract allows for an annual rate adjustment for inflation and for other rate adjustments as approved by the Sonoma County Board of Supervisors. This contract extension includes a rate increase for Advanced Life Support transport, mileage rates, and rates for consumable medical supplies. The rate increases are based on significant increases in labor costs, capital expenses such as ambulance purchases, fuel and maintenance costs, and the increased cost of consumable medical goods. The County’s third-party consultant, Endpoint EMS, participated in the rate increase negotiations and advised that the rates presented are reasonable and consistent with recent ALS contracts in other counties.
Development and Implementation of Tiered ALS/BLS Ground Ambulance Service
To improve system performance, staffing, and financial sustainability, the parties agree to design and implement a tiered Basic Life Support (BLS) and Advanced Life Support (ALS) ambulance response system using medical priority dispatch protocols developed by CVEMSA and the CVEMSA EMS Medical Director. Currently, the ground ambulance system in EOA-1 requires 911 operators to dispatch only (ALS) ambulance service to every call, regardless of medical necessity. Implementing the tiered BLS/ALS system by utilizing the Medical Priority Dispatch System (MPDS) establishes a universal standard for emergency dispatchers taking calls for a broad range of field and triage response.
The current market for skilled medical professionals is critically challenged and the ability to staff ground ambulances at the ALS (Paramedic) level is at risk. By allowing 911 dispatch to use the Medical Priority Dispatch System (MPDS) system to triage calls, ALS resources remain available for the highest level of response, while BLS resources respond to calls determined to be medically appropriate. This model has been tested over hundreds of millions of calls since 1979 and the protocols are updated regularly.
Implementation of Tiered ALS/BLS ground ambulance response will significantly reduce risk of disruption to the system of care due to skilled medical staffing shortages. The County Emergency Medical Services Agency (CVEMSA) will begin drafting policy for approval by the CVEMSA Medical Director for implementation as soon as possible, but no later than July 1, 2022.
Strategic Plan:
N/A
Prior Board Actions:
On November 2, 2021, the Board reviewed changes and approved an updated draft of the RFP which had been returned for editing by the California Emergency Medical Services Authority and approved the RFP for re-submission.
On April 13, 2021 the Board A) reviewed the Matrix of Public Comments and Staff responses and Recommendations; B) approved changes to be incorporated into the RFP; and C) approved the RFP for submission to California Emergency Medical Services Authority (EMSA).
On March 23, 2021 the Board deliberated on the proposed components of the draft RFP for Exclusive Operating Area #1 (EOA 1) for the purposes of submitting the RFP to the California EMS Authority for approval based on the provision of Sonoma County Code Chapter 28-17, adopted by the Board on November 12, 2019.
On October 22, 2019 the Board approved an agreement with Endpoint EMS Consulting, LLC for subject matter expertise and support in developing a request for proposals for an exclusive provider of emergency ground ambulance services in an amount not-to-exceed $161,000 through December 31, 2021.
On May 21, 2019 the Board approved the third amendment to an agreement with American Medical Response West for emergency ground ambulance services, providing for an extension of the term through June 30, 2022 with an additional two one-year options and authorizing service rate increases effective July 1, 2019.
On May 8, 2018, the Board authorized the Chair to submit a letter to the California Emergency Medical Services Authority in support of a one-year extension of the Exclusive Operating Area Ambulance Services Agreement through June 30, 2020.
On September 27, 2011, the Board authorized the Director of Health Services to execute an amendment to the American Medical Response West contract for emergency ground ambulance services increasing user fees effective October 1, 2011.
On December 16, 2008, the Board authorized the County Director of Emergency Medical Services Agency to execute the Emergency Ground Ambulance Services Agreement with American Medical Response West.
Fiscal Summary
|
Expenditures |
FY 21-22 Adopted |
FY 22-23 Projected |
FY 23-24 Projected |
|
Budgeted Expenses |
303,970 |
312,768 |
322,151 |
|
Additional Appropriation Requested |
|
|
|
|
Total Expenditures |
303,970 |
312,768 |
322,151 |
|
Funding Sources |
|
|
|
|
General Fund/WA GF |
|
|
|
|
State/Federal |
|
|
|
|
Fees/Other |
303,970 |
312,768 |
322,151 |
|
Use of Fund Balance |
|
|
|
|
Contingencies |
|
|
|
|
Total Sources |
303,970 |
312,768 |
322,151 |
Narrative Explanation of Fiscal Impacts:
Revenue of $312,768, which is included in the FY 22-23 recommended budget, will be received by County for contract management and monitoring activities provided by the Department of Health Services via Coastal Valleys Emergency Medical Services Agency. This amount is an increase of $8,798 over FY 21-22. The increase in the revenue will offset the amount of Maddy funding used to cover current expenditures. Revenue and associated expenditures for future years will be included in the appropriate year budgets.
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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 - Fourth Amendment to Agreement with American Medical Response West
Related Items “On File” with the Clerk of the Board:
None