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Emergency Medical Services, a division of the Chief Administrative Office, recommending the Board approve and authorize the Chair to sign a budget transfer, based on a mid-year review of the Fiscal Year (FY) 2025-26 Budget, for the following:
1) Increase budgeted revenues and expenses by $174,000 in the County Service Area 3 Ambulance fund;
2) Increase budgeted revenues and expenses by $285,000 in the County Service Area 7 Ambulance fund;
3) Increase budgeted revenue and expenses by $78,000 in the Maddy/Richie Emergency Medical Services Fund;
4) Transfer of $20,000 of appropriations in General Fund EMS Function from Salaries and Benefits to Intrafund Transfers;
5) Increase budgeted revenue and expenses by $240 within the Public Health Emergency Preparedness (PHEP) special revenue fund (SRF) and increase budgeted revenues and expenses within the Hospital Preparedness Program (HPP) General Fund account by the same;
6) Increase budgeted revenues and expenses by $90 within the Cities Readiness Initiative (CRI) SRF fund and increase the budgeted revenues and expenses within the HPP General Fund account by the same, and;
7) Establish budget for the Pandemic Influenza (Pan Flu) SRF fund balance for $2,636, revenues for $150, and expenses for $2,786, and increase the budgeted revenues and expenses within the HPP General Fund account $2,786 (4/5 vote required).
FUNDING: Ambulance service fees, traffic violation fines, and interest revenue.
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DISCUSSION / BACKGROUND
The Emergency Medical Services (EMS) Division is recommending the Board approve a budget transfer based on a mid-year review of the Fiscal Year (FY) 2025-26 Budget. The recommended budget changes are as follows:
County Service Area No. 3
County Service Area No. 3 (CSA 3) provides ambulance services to South Lake Tahoe and the Tahoe West Shore. CSA 3 ambulance revenues and taxes are deposited into the CSA 3 Ambulance account, which is a non-General Fund account. These funds are utilized to cover costs of providing ambulance services within the CSA, and to partially fund the EMS program.
The CSA 3 ambulance fee revenues for Fiscal Year 2025-26 are expected to be higher than budgeted. As a result, the commission-based payments to the contracted billing processor and to the contracted ambulance provider for the West Shore are projected to exceed budget. Payments to the state for the Public Provider Ground Emergency Medical Transport Intergovernmental Transfer (PP-GEMT IGT) program are also projected to exceed budget. Staff are recommending that the Board approve a budget transfer amending the Fiscal Year 2025-26 Budget to increase budgeted revenues by $174,000 and increase expenses in the CSA 3 Ambulance account by the same.
County Service Area No. 7
County Service Area No. 7 (CSA 7) provides ambulance services to the Western Slope of El Dorado County. CSA 7 ambulance revenues and taxes are deposited into the CSA 7 Ambulance account, which is a non-General Fund account. These funds are utilized to cover costs of providing ambulance services within the CSA, and to partially fund the EMS program.
The CSA 7 ambulance fee revenues for Fiscal Year 2025-26 are expected to be higher than budgeted. As a result, the commission-based payments to the contracted billing processor are projected to exceed budget. Payments to the state for the PP-GEMT IGT program are also projected to exceed budget. Staff are recommending that the Board approve a budget transfer amending the Fiscal Year 2025-26 Budget to increase budgeted revenues by $285,000 and increase expenses in the CSA 7 Ambulance account by the same.
Maddy/Richie EMS Fund
The Maddy/Richie Emergency Medical Services Fund (Maddy Fund) provides funding to local physicians/surgeons, hospitals, and a portion for EMS related expenses. The Maddy Fund receives revenues generated from local penalty assessments on traffic violation fines. This revenue is deposited into the Maddy EMS Special Revenue Fund (Maddy SRF) and dispersed as a percentage of total Maddy/Richie revenue, in alignment with the approved use of these funds.
The Maddy Fund penalty assessment disbursements in Fiscal Year 2025-26 are higher than anticipated. As a result, the percentage-based hospital and physician payments will exceed the budgeted amounts. Also, staff time spent working on Maddy Fund related tasks is projected to exceed budget. Staff are recommending that the Board approve a budget transfer amending the Fiscal Year 2025-26 Budget to increase revenue by $78,000 and increase expenses in the Maddy Fund SRF by the same.
EMS and Ambulance Billing Functions
The Emergency Medical Services (EMS) function includes the Local Emergency Medical Services Agency (LEMSA) and serves to coordinate emergency response and transportation services to victims of illness or injury within the county. The Ambulance Billing function oversees billing for ambulance services provided by the county’s contracted ambulance providers. These functions are funded by combination of property taxes, certification fees, and ambulance revenue.
The EMS function has seen an increase in County Counsel charges and is projected to exceed the budgeted amount for these fees. The Ambulance Billing function has salary savings due to vacancies. The recommended budget transfer decreases the budgeted salary for Ambulance Billing by $20,000 and increases the budgeted Intrafund transfers in EMS for the same amount to cover County Counsel charges.
Grant Programs
The Division receives grant funding from the California Department of Public Health to run the Hospital Preparedness Program (HPP). This funding is utilized for local emergency response planning and preparedness, and to partially fund the EMS program. Per the grant agreement HPP funds are required to be deposited into a separate account, which is the HPP Special Revenue Fund (SRF), a non-General Fund account. At the end of each fiscal year, the funds are transferred from the HPP SRF account to the General Fund account to reimburse the division for HPP expenses.
Beginning in FY 2024-25 the Public Health Emergency Preparedness (PHEP) program, the City Readiness Initiative (CRI) program, and the Pandemic Influenza (Pan Flu) program were transferred from EMS to the County’s Health and Human Services Agency (HHSA). At the end of FY 2023-24, the EMS PHEP, CRI, and Pan Flu SRFs had remaining balances and interest has continued to accrue on these balances. The recommended budget transfer establishes budget for interest revenue in the SRFs and the corresponding transfers to the HPP General Fund account. This is the first step in closing out these SRFs.
The recommended budget transfer does not increase Net County Cost, and will result in minor interest revenue being transferred into the General Fund.
ALTERNATIVES
Without a budget amendment, the County will not be able to pay CSA 3 and CSA 7 contractual payments to the ambulance billing contractor or the GEMT payments to the state, pay hospital and physician Maddy Fund payments, cover the full amount of EMS legal fees, transfer the interest revenue from the unused grant SRFs to the HPP General Fund account, and the PHEP, CRI, and Pan Flu SRFs will continue to hold a fund balance. No alternative is recommended.
PRIOR BOARD ACTION
April 23, 2024, Legistar File 24-0219 - Transfer of CRI and Plan Flu grants from EMS to HHSA
September 30, 2025, Legistar File 25-1596 - FY2025-26 Adopted Budget Resolutions
OTHER DEPARTMENT / AGENCY INVOLVEMENT
N/A
CAO RECOMMENDATION / COMMENTS
Approve as recommended.
FINANCIAL IMPACT
The recommended budget transfer does not have a General Fund cost.
CLERK OF THE BOARD FOLLOW UP ACTIONS
Obtain signature of Chair on budget transfer and forward to the Chief Administrative Office for processing.
STRATEGIC PLAN COMPONENT
N/A
CONTACT
Kristine O. Guth, MPH, EMS Manager