To: Sonoma County Board of Supervisors
Department or Agency Name(s): Department of Health Services
Staff Name and Phone Number: Tina Rivera, 707-565-4774
Vote Requirement: Majority
Supervisorial District(s): Countywide
Title:
Title
Coastal Valleys Emergency Medical Services Agency Advanced Life Support Provider Memorandums of Understanding
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Recommended Action:
Recommended action
Authorize the Director of Health Services, or designee, to execute memorandums of understanding with local paramedic and Advanced Life Support providers associated with area medical control over local emergency medical services operations and any amendments that do not substantially change the terms and conditions of the agreements.
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Executive Summary:
The California Emergency Medical Services Authority (EMSA) requires all Local Emergency Medical Services Agencies (LEMSAs) to file an annual Emergency Medical Services (EMS) plan. Included with the EMS plan, LEMSAs are required by EMSA to show compliance with California Code of Regulations Title 22 § 100168 to include memorandums of understanding between each LEMSA and each paramedic service provider in the area under LEMSA jurisdiction that demonstrate the provider’s recognition of LEMSA medical control over EMS operations of the provider agency.
The Department of Health Services (hereinafter “DHS” or “the Department”) serves as the LEMSA for Sonoma and Mendocino Counties and is requesting authorization to execute memorandums of understanding (MOU) with local paramedic and Advanced Life Support providers associated with area medical control over local emergency medical services operations and any amendments that do not substantially change the terms and conditions of the agreement. The attached MOU template has been reviewed and approved by County Counsel.
Discussion:
The California Emergency Medical Services Authority (EMSA) requires all Local Emergency Medical Services Agencies (LEMSAs) to file an annual EMS plan. Sonoma County Code of Ordinances, Section 28-4(a), designates the Department of Health Services as the LEMSA for Sonoma County. EMS Agency functions are the responsibility of Coastal Valleys EMS Agency, which is organized within the Public Health Division of DHS. DHS also provides LEMSA functions for the County of Mendocino through an inter-County contract that designates the County of Sonoma as Mendocino County’s LEMSA.
Division 2.5 of the California Health and Safety Code (HSC) “the EMS Act” § 1797.224 allows Local EMS Agencies (LEMSA) to enter into formal agreements for provision of ambulance service through the creation of Exclusive Operating Areas (EOA). 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.
Approval of an EMS Plan is also required in order for the state to recognize the exclusivity of the provider operating in an EOA within the County. Sonoma County has two such EOAs. In 1991, the LEMSA, under direction of the Sonoma County Board of Supervisors, established an EOA, now known as EOA-1, to serve the cities of Santa Rosa, Sebastopol, Rohnert Park, Cotati, and the surrounding unincorporated areas. DHS utilized a competitive process to select the provider ALS services in EOA-1 pursuant to the LEMSA EMS plan. In addition to a competitive selection process, EMSA requires the County to have an approved EMS plan before it will recognize the EOA as exclusive.
Each LEMSA EMS plan is required to include documentation outlining the transportation plans and operating zones for all ALS providers. EMSA has signaled intent to audit EMS Plan submissions for compliance with the requirement in 22 CCR § 100168 to have paramedic service provider agreements between the LEMSA and all ALS providers in the LEMSA jurisdiction. The LEMSA has worked with the existing paramedic service providers within the LEMSA jurisdiction to come into mutual compliance with the law.
The Department is seeking this Board’s approval of the agreements between the ALS providers and DHS. The memorandum of understanding (MOU) template is provided as Attachment 1. All executed MOUs will be substantively similar to the attached template. Any non-substantive changes requested by providers will be approved by County Counsel prior to execution. Public provider MOU term is 3-years automatically renewable, with either party able to terminate with 30-day notice. Private provider MOU term is 1-year or until CVEMSA implements a permitting policy process pursuant to Sonoma County Municipal Code Sections 28-5 and 28-6 that applies to provider, whichever comes first. Either party may terminate this MOU with 30 days’ notice. The ALS providers are:
1. Adventist Health Mendocino Coast - Private
2. American Medical Response West - Private
3. City of Santa Rosa - Public
4. Cloverdale Ambulance - Public
5. Coast Life Support - Public
6. County of Sonoma Sheriff’s Office - Public
7. Laytonville Ambulance - Public
8. LIFEWEST Northern California - Private
9. Medic Ambulance - Private
10. Medstar - Private
11. Petaluma Fire - Public
12. Sonoma County Fire District - Public
13. Sonoma Valley Fire Department - Public
14. Ukiah Valley Fire District - Public
Sonoma County’s EMS plan needs to be approved by the state for the EOA provider contract in EOA-1 to execute.
If the proposed MOUs are not approved by the Board, EMSA may not approve the EMS Plan, which would mean the provider in EOA-1 would not have exclusive operating authority in EOA-1. In addition, all providers without a paramedic service provider agreement would be at risk for operating outside of the mandates for ALS provider agency medical control established in the California Code of Regulations.
Strategic Plan:
N/A
Racial Equity:
Was this item identified as an opportunity to apply the Racial Equity Toolkit?
No
Prior Board Actions:
On June 6, 2023 the Board A) authorized the Director of Health Services, or designee, to execute a 5-year contract for emergency ground ambulance service in Sonoma County Exclusive Operating Area 1 with Sonoma County Fire District in a form approved by County Counsel that includes an option to extend for an additional 5 years and B) adopted a Resolution Making Certain Findings and Adopting the County of Sonoma’s Written Policy Regarding Emergency Ambulance Services Contracts Pursuant to Health and Safety Code Section 1797.230.
Fiscal Summary
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Narrative Explanation of Fiscal Impacts:
There are no fiscal impacts associated with this item.
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Narrative Explanation of Staffing Impacts (If Required):
N/A
Attachments:
Attachment 1 - Memorandum of Understanding Template
Related Items “On File” with the Clerk of the Board:
None