Title
Emergency Medical Services, a division of the Chief Administrative Office, recommending the Board:
1) Make a finding that the Agreement 9651 requires specialty skills and qualifications, not expressly identified in County classifications, that are involved in the performance of the work per El Dorado County Ordinance Chapter 3.13, Contracting Out;
2) Waive formal bid requirements in accordance with Procurement Policy C-17 Section 3.3.1 (g) due to dispatch and Advanced Life Support (ALS) ground ambulance transport services within County Service Area 7 provided by El Dorado County Emergency Services Authority (EDCESA) are included in the EMS Plan and Settlement Agreement with the State,
3) Approve and authorize the Chair to execute Agreement 9651 with EDCESA for dispatch and prehospital ALS ground ambulance transport services within CSA 7 for the initial period of July 1, 2025, through June 30, 2035, in the amount of $93,407,041.92 for the first five years, with an option to extend the term for three additional five-year terms;
4) Establish an Emergency Medical Service (EMS) Ad Hoc committee and appoint two members to the Ad Hoc committee; and
5) Direct staff to work with the EMS Ad Hoc committee to explore countywide EMS System strategic planning.
FUNDING: CSA 7 - Ambulance fees, Ad Valorem Property Tax, Special Tax, Tribal Reimbursement.
Body
DISCUSSION / BACKGROUND
The County is responsible for ensuring the provision of prehospital Advanced Life Support (ALS) services to the residents of the County and does so by contracting for these services through County Service Areas. The County is divided into two County Service Areas (CSAs) for the provision of ambulance services. CSA 7 includes the entire western slope of the County (e.g. Cameron Park, Diamond Springs, El Dorado Hills, Georgetown, City of Placerville, Pollock Pines, Shingle Springs, Somerset, etc.). El Dorado County Emergency Services Authority (EDCESA) has been the contracted ambulance operator in CSA 7 operating area for 40 years.
The County’s Emergency Medical Services (EMS) System is authorized by County Ordinance Code Chapter 8.74 - County Emergency Medical Service and Medical Transportation Ordinance (“EMS Ordinance”), under the provisions of Title 22 of the California EMS Act and California Health and Safety Code. The County's Emergency Medical Services (EMS) Agency, housed in the Chief Administrative Office, is the local regulatory body for emergency medical services within the County, pursuant to the State EMS Act. The State Emergency Medical Services Authority (EMSA) provides oversight to the local regulatory bodies. The structure of the County's emergency medical transport system had been a point of discussion with EMSA for several years, resulting in a settlement agreement which was approved by the Board on July 16, 2019 (Legistar file 19-1089). The settlement agreement and EMS Plan affirms that the County may continue to provide ambulance transportation and prehospital EMS services in an exclusive manner in CSA #7 in the same manner and scope that it has been providing since January 1, 1981. EDCESA has been the County’s exclusive provider for CSA 7. On December 12, 2023, with Legistar file 23-1913, the Board directed “staff to begin discussions with the El Dorado County Emergency Services Authority on a successor agreement for prehospital advanced life support, ambulance, and dispatch services in County Service Area 7.”
Staff have met with representatives from EDCESA two dozen times over the past year and a half. This has included significant discussions on how to improve the ambulance system to more efficiently and effectively serve the western slope of El Dorado County and improve patient outcomes. From these discussions, small changes have already been implemented in the system to work towards fully implementing Medical Priority Dispatch System. Staff and EDCESA have committed to continuing these meetings after the new agreement is in place to continue to improve the ambulance system and services.
If approved, Agreement 9651 will be effective July 1, 2025, with a term that covers a period of ten years with an option to extend the term for three additional five-year terms. The first year's compensation is $17,589,798.28. The compensation schedule has been developed for the first five years of the Agreement and includes annual increases for costs beyond the control of EDCESA, such as dispatch services, medical supply costs, and fuel. The Agreement includes an additional ambulance to ensure an appropriate Unit Hour Utilization Ratio of the ambulances in the system. Additionally, the Agreement includes $500,000 annual compensation for capital assets. The County and EDCESA will initiate discussions by July 1, 2029, to determine the compensation schedule for the period of July 1, 2030 - June 30, 2035. The maximum obligation under this Agreement for the first five years is $93,407,041.92 for the period through June 30, 2030. Due to the prior Board direction, EMS Plan, and settlement agreement with the State, Agreement 9651 was not competitively procured. The Procurement Policy allows for the Board to waive the competitive bidding requirements when mandated by the State or other relevant authority. Dispatch and prehospital ALS ground ambulance transport services within CSA 7 provided by EDCESA are documented in the County’s EMS Plan with the State and the Settlement Agreement with the State. It is recommended the Board waive competitive bidding requirements to align with the EMS Plan and Settlement Agreement.
Staff recommends the Board establish an ad hoc committee to work with all stakeholders in the EMS system countywide to explore system enhancements and strategic planning to ensure the long-term sustainability of the system.
ALTERNATIVES
The current agreement expires June 30, 2025, and the County is responsible for providing ALS services in CSA 7. Should the Board choose not to extend the agreement, staff would need direction to either renegotiate with the EDCESA for a successor agreement or offer an alternate solution.
PRIOR BOARD ACTION
09/29/2009, Legistar file 09-0452, Board approved Amendment III to Agreement for Services 200-S0811
02/13/2018, Legistar file 18-0207, Board approved Amendment IV to Agreement for Services 200-S0811
06/12/2018, Legistar file 18-0884, Board approved Agreement for Services 2298
11/17/2020, Legistar file 20-1345, Board approved an update to the County Emergency Medical Service and Medical Transportation Ordinance as a result of the settlement agreement with the State.
11/16/2021, Legistar file 21-1669, Board authorized the negotiation to extend Agreement 2298
06/21/2022, Legistar file 22-1014, Board approved Amendment to Agreement for Services 2298
01/03/2023, Legistar file 22-1845, Board approved Agreement 6993 for EMS System Assessment
OTHER DEPARTMENT / AGENCY INVOLVEMENT
County Counsel and Risk Management have reviewed the agreement. The Auditor-Controller has been notified as outlined in Board Policy B-12 Fiscal Review.
CAO RECOMMENDATION
Approve as recommended.
FINANCIAL IMPACT
CSA 7 receives a portion of the ad valorem property tax, a special tax specifically for fire-based ambulance transport services and revenue from ambulance services fees billed to patients and their insurance companies. Additionally, CSA 7 has a fund balance of approximately $17,000,000. With the current rates, this contract will use approximately $9,900,000 of the Fund Balance in the first five years, however, staff plan to increase rates for CSA 7 in the next year so that will lower the amount of Fund Balance that we do use.
CLERK OF THE BOARD FOLLOW UP ACTIONS
Add the date of final approval to pages 52 and 55, obtain the Chair's and Clerk’s signature on the agreement on pages 41, 54, and 61, and forward a copy to the Chief Administrative Office.
STRATEGIC PLAN COMPONENT
N/A
CONTACT
Sue Hennike, Assistant Chief Administrative Officer