Title
Chief Administrative Office recommending the Board consider the following:
1) Authorize the CAO to issue a Request for Qualifications to select a consultant to perform a comprehensive assessment of the County’s emergency medical services and ambulance transport system, develop a strategic plan to address findings from the assessment and assist in the development of a Request for Proposals for prehospital emergency medical services and ambulance transport and dispatch services in County Service Area (CSA) 7 on the West Slope; and
2) Authorize the CAO to negotiate an amendment to Agreement 2298 with the El Dorado County Emergency Services Authority (JPA), the current prehospital ambulance transport contractor in CSA 7, to extend that agreement through June 30, 2025.
FUNDING: CSA 3 and 7 (ambulance transport fees, dedicated ad valorem property tax, special tax and benefit assessment).
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DISCUSSION / BACKGROUND
The County currently contracts exclusively with the JPA for the provision of prehospital emergency medical services and ambulance transport and dispatch services in CSA 7 on the West Slope of the County. The term of the current agreement is July 1, 2018, through June 30, 2023. The agreement provides for a flat annual rate that is inclusive of all services (“base rate”) and increases annually by the Ambulance Inflation Factor. The base rate for the first year was $11,300,000. The current rate for FY 2021-22 is $11,687,271. The agreement also provides for an additional payment of $500,000 per year for the first three years for the repair and replacement of capital assets.
On June 17, 2021, the JPA notified the County of its belief that the current agreement does not provide sufficient compensation to “administer the medic units and purchase appropriate capital assets.” In response to the letter, the CAO and County Counsel staff met with the Chair of the JPA and the JPA’s executive staff to ask for assurances that there was no immediate threat to public health and safety. The JPA provided verbal assurance of this, and the County and JPA have continued to correspond to ensure the JPA will be able to perform through the term of the contract. That correspondence is included here as Attachment A.
This discussion has highlighted some challenges with the current ambulance transport system. The challenges include the current structure of the system, as well as regulatory and funding issues related to the health care industry, which are not unique to El Dorado County. In addition, the JPA has indicated that it expects costs over the next five years to outpace projected revenues. Given these challenges and the fact that the EMS and ambulance transport delivery model on the West Slope has changed very little in the last 40 years, the CAO recommends a comprehensive system assessment, development of a strategic plan for the EMS System, followed by an RFP for ambulance transport services in CSA 7 to identify potential alternatives to the current delivery model. While the system assessment would encompass the entire county, the RFP would not include services on the East Slope in CSA 3, as an RFP was recently completed for the East Slope services in CSA 3, which resulted in a ten-year agreement.
It is recommended that a consultant be retained to conduct the system assessment, develop the strategic plan and help draft the RFP. A consultant would be selected through an RFQ process. This process would result in a list of qualified consultants, who would then be interviewed by a team consisting of County staff and staff from other EMS Agencies. Once a consultant has been selected, a scope of work and contract will be developed for approval by the Board.
The system assessment, strategic plan and RFP processes will likely take 3-4 years, which extends beyond the current term of the County’s agreement with the JPA for CSA 7. As a result, the CAO recommends negotiating a two-year extension to the current agreement so that there will be sufficient time to complete all processes. It is recommended that the negotiations and extension be completed before the system assessment begins, in order to maintain the integrity of the assessment process and allow all parties to focus on this important work. The system assessment requires the current ambulance transport contractors to participate as subject matter experts and stakeholders. Conducting contract negotiations concurrently with the assessment or RFP process would create a distraction and would not be conducive to a successful outcome.
ALTERNATIVES
The Board could choose to provide alternate direction; however, it should be noted that a new contractor for the provision of ambulance transport services may only be selected through a competitive process (RFP), pursuant to California Health and Safety Code 1797.224. If no competitive process is conducted, the only option is to continue with the current contractor.
PRIOR BOARD ACTION
N/A
OTHER DEPARTMENT / AGENCY INVOLVEMENT
N/A
FINANCIAL IMPACT
There is no direct fiscal impact related to approving these recommendations. The contract extension with the JPA and the contract for consultant services to conduct the system assessment, strategic plan and RFP would be brought to the Board for final approval and would be funded through the CSAs, with no impact to the General Fund.
CLERK OF THE BOARD FOLLOW UP ACTIONS
N/A
STRATEGIC PLAN COMPONENT
Healthy Communities and Public Safety
CONTACT
Sue Hennike, Deputy CAO