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Health and Human Services Agency recommending the Board approve and authorize the Chair to sign Amendment 4 to Agreement for Services 164-S1211 with California Tahoe Emergency Services Operations Authority, for ambulance transportation services, for the term September 1, 2011 through August 31, 2019 with an estimated increase of $894,000 for an approximate maximum contractual obligation of $10,894,000. (Est. Time: 15 Min.)
FUNDING: County Service Area 3 - Benefit Assessment (South Shore Area); Special Tax (West Shore Area); and fee for ambulance services.
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DEPARTMENT RECOMMENDATION:
Health and Human Services Agency (HHSA) recommending the Board approve and authorize the Chair to sign Amendment 4 to Agreement for Services 164-S1211. This Amendment 4 defines the roles and responsibilities of the parties for implementation of electronic Prehospital Care Report (ePCR) software and tablets and increase the monthly funding for a part-time Inter-facility Transfer (IFT) ambulance to $21,000. In addition, authorize a one-time reimbursement to fund an immediate purchase of one new ambulance at $210,000, one remount of an ambulance at $110,000, and work expenses to facilitate integration of the ePCR software with the contracted dispatch agency not to exceed $7,000, for a total of $327,000.
In accordance with County Ordinance Section 3.13.030, HHSA determined that the nature of ambulance transportation involves emergency services, and the contractor will provide equipment, materials, facilities, administration, and support services related to providing work that may not be feasibly provided by the County.
DISCUSSION / BACKGROUND:
California Tahoe Emergency Services Operations Authority (Cal Tahoe) has provided contracted ambulance transport services via Agreement 164-S1211 since 2011 (originally approved under Legistar No. 11-0073).
Currently, Cal Tahoe utilizes a manual (paper) method of reporting Prehospital Care Reports. To maintain compliance with El Dorado County Emergency Medical Services (EMS) Agency Quality Improvement Plan and the ePCR requirements identified in Agreement 164-S1211, the EMS Agency has committed to implementing an ePCR.
The implementation of an ePCR System is a State requirement, identified in the California Health and Safety (H&S) Code, Section 1797.227, which requires each emergency medical services provider to use an electronic health record compliant with the current version of the National Emergency Medical Services Information Systems (NEMSIS) and the California Emergency Medical Services Information System (CEMSIS). As the emergency medical services provider for the County under the Public Utility Model, the EMS Agency is required to comply with H&S Code Section 1797.227, along with the ambulance transportation contractor(s). The electronic health record system must be integrated with the local EMS agency’s data system, and the local EMS agency must be able to collect data from the provider.
On September 13, 2016, the Board awarded Request for Proposals, No. 16-918-060, to the successful proposer, ImageTrend, Inc. for ePCR software licensing and support. As part of the implementation process HHSA needs to purchase mobile computing devices and other hardware for the EMS service agencies. In turn, the current Agreement with Cal Tahoe needs to be amended to reflect the new provisions and procedures for use and implementation of the ePCR system before training and distribution of the tablets to the emergency response vehicles.
This Amendment will require Cal Tahoe to be responsible for all maintenance, upgrades, repairs, and necessary replacements of the mobile computing devices and other hardware, and their accessories (hard cases, screen protectors, etc.). Furthermore, Cal Tahoe will be responsible to ensure ImageTrend software is integrated into the contracted dispatch agency CAD system. A one-time reimbursement for the expense of integrating the ePCR software with the contracted dispatch agency CAD system shall be provided for actual work expenses and not exceed a total of $7,000.
On April 24, 2017, the CAO’s Office received a letter from Cal Tahoe’s Executive Director, expressing concern over the sustainability of Cal Tahoe as a Joint Powers Authority (JPA) due to a large increase in the number of long distance interfacility transfers since the execution of the original agreement. Between 2011 and 2015, IFTs increased by 72% and accounted for 13% of their dispatch calls. This has resulted in increased costs to the JPA to maintain and replace medic units. The JPA is contractually bound to replace or remount medic units when they reach 150,000 miles. The JPA currently has 3 medic units that have over 130,000 miles on them.
The purpose of the letter was to establish a meet and confer regarding the terms of the Contract. In order to address the increased burden on Cal Tahoe related to increased IFT's, they are requesting: 1) $210,000 to fund the immediate purchase of a new ambulance; 2) $110,000 for one remount of an ambulance; and 3) an estimated increase of the monthly funding for IFTs to $21,000 effective upon execution of this Amendment. With the term of the agreement ending August 31, 2019, an increase of $21,000 per month is estimated to be approximately $567,000. Including the aforementioned one-time payments, this would increase the not-to-exceed by $894,000 for an approximate total maximum contractual obligation of $10,894,000.
ALTERNATIVES:
Disapproval of Amendment 4 to Agreement for Services 164-S1211 will result in HHSA’s inability to successfully implement the ePCR system, making HHSA out of compliance with requirements under H&S Code Section 1797.227. Additionally, disapproval may lead to Cal Tahoe’s inability to remain sustainable and fulfill the requirements of the Contract throughout the remainder of the term.
OTHER DEPARTMENT / AGENCY INVOLVEMENT:
County Counsel and Risk Management.
CAO RECOMMENDATION:
Approve as recommended.
FINANCIAL IMPACT:
There is no Net County Cost associated with this Agenda item. Sufficient appropriations are available in the FY 2016-17 budget, and appropriations for FY 2017-18 have been included in the Recommended Budget.
CLERK OF THE BOARD FOLLOW UP ACTIONS
1) Clerk of the Board to obtain signature of Chair on two (2) original Amendment 4 to Agreement for Services 164-S1211.
2) Clerk of the Board to return one (1) fully executed Amendment 4 to the HHSA Contracts Unit at 3057 Briw Road.
STRATEGIC PLAN COMPONENT:
Public Safety/Healthy Communities
CONTACT
Patricia Charles-Heathers, Ph.D., Director