Title
Chief Administrative Office recommending the Board:
1) Receive a presentation from the Emergency Medical Service Agency on Ambulance Services in County Service Area (CSA) 3;
2) Direct staff to return in January with updated ambulance rates and a plan for Fiscal Year 2024-25 Budget for CSA 3 Ambulance Services;
3) Provide direction to staff to work with CalTahoe JPA on cost savings measures; and
4) Provide direction to 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.
FUNDING: Fee for Service, Federal American Rescue Plan Act Funding, and General Fund.
Body
DISCUSSION / BACKGROUND
The County is responsible for ensuring the provision of 911 emergency medical services as set forth in the County’s ambulance ordinance.
El Dorado County Transport and Dispatch Services Structure
Transport and dispatch services for CSA 3 South Shore area are contracted to the California Tahoe Emergency Services Operations Authority, herein referred to as Cal Tahoe JPA. Cal Tahoe JPA has been under contract to provide transport operational services since 2001, and their current contract expires August 31, 2031. Transport and dispatch operational services for the area of Meeks Bay in CSA 3 are contracted to the North Tahoe Fire Protection District. North Tahoe has a current contract that expires June 30, 2026.
The contract for services in CSA 3 must be awarded through a competitive process. The last Request for Proposal process was conducted in the Spring of 2021, and the contract was awarded that Fall. Cal-Tahoe JPA was the only provider to respond. The proposal provided for the continuation of the same hybrid model which includes a combination of fire-based civilian personnel; however, the prior contract had been a fixed fee agreement, and the new proposal and resulting contract reflect the cost increases that have occurred within the healthcare industry in the past several years. The Board approved an increase to CSA 3 ambulance fees in June 2022, with Legistar item 22-0380. The Board approved a $1.03 million use of General Fund Contingency to fund CSA 3 operations in Fiscal Year (FY) 2022-23 and $2.2 million use of American Rescue Plan Act funding to fund CSA 3 operations in FY 2023-24.
Transport and dispatch services for County Service Area 7, which covers the West Slope, are provided by the El Dorado County Emergency Services Authority. 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, 2025.
Ambulance Services Funding Structure
Ambulance services are primarily funded through a combination of revenues from service fees and special taxes. In addition, CSA 7 receives ad valorem property tax revenue and revenue from the Shingle Springs Band of Miwok Indians. These two additional revenue sources equal approximately 45% of the revenue received from ambulance service revenue. These additional revenue sources in CSA 7 result in a much higher subsidy in that area than in CSA 3. Consequently, CSA 3 is much more dependent upon billing revenue. Billing revenue accounts for 80% of total revenues in CSA 3, but only 60% of revenues in CSA 7. The taxpayer subsidy in CSA 7 is 39%, compared to 19% in CSA 3.
Ambulance Service Fees
The rate schedule for CSA 3 was last reviewed and updated in 2022, increasing ambulance fees to within the 75th percentile of comparison agencies, including base rates for resident and non-residents. It should be noted, that as with any fee increase, the amount of increased revenue is not guaranteed. Revenue collection depends on many factors, such as payer mix and call volume, which are not within the control of the County. While the fee increases in 2022 realized a slight increase in revenue, CSA 3 still required discretionary funding beginning in FY 2022-23.
Chief Administrative Office staff and a consultant are currently conducting an in-depth assessment of the ambulance billing system to find process improvements and increase revenue. This assessment has resulted in increased communication with service providers and an initial increase in revenue.
New legislation (AB 716) requires ambulance rates be posted by the California Emergency Medical Services Authority (EMSA) and California Department of Insurance. AB 716 addresses balanced billing related to ground emergency medical transport which will impact ambulance billing operations.
Recommended Next Steps
Due to new legislation, staff are requesting the Board direct staff to return in January with updated ambulance rates and a plan for Fiscal Year 2024-25 Budget for CSA 3 Ambulance Services. Staff are working to develop updated ambulance rates that comply with new State legislation. These new rates will be used to project revenues for FY 2024-25.
Staff will continue to find process improvements to increase revenue in CSA 3. In addition staff are requesting direction from the board to work with CalTahoe JPA on cost savings measures that would reduce the amount of discretionary resources needed for Ambulance Services in CSA 3.
Lastly, staff are requesting direction from the Board 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. The current agreement expires on June 30, 2025, and staff would like to begin discussions with the El Dorado County Emergency Services Authority so that there is sufficient time to develop a successor agreement.
ALTERNATIVES
The Board could provide alternate direction on prehospital advanced life support, ambulance, and dispatch services in El Dorado County.
PRIOR BOARD ACTION
See above.
OTHER DEPARTMENT / AGENCY INVOLVEMENT
CAO Central Fiscal Unit
CAO RECOMMENDATION / COMMENTS
Approve as recommended.
FINANCIAL IMPACT
There is no direct financial impact from this item except for the staff time required to fulfill Board direction. If approved, staff will develop updated ambulance fees and the financial impact of the updated fees will be outlined at that time.
CLERK OF THE BOARD FOLLOW UP ACTIONS
N/A
STRATEGIC PLAN COMPONENT
Healthy Communities
Good Governance
CONTACT
Kristine Guth, Acting Manager of Emergency Medical Services and Emergency Preparedness and Response
Sue Hennike, Assistant Chief Administrative Officer