DATE: February 25, 2025
TO: Board of Supervisors
SUBMITTED BY: David Luchini, RN, PHN, Director of Public Health
SUBJECT: Agreement for Paramedic Ambulance Services with the City of Selma
RECOMMENDED ACTION(S):
TITLE
Approve and authorize the Chairman to execute an Agreement that supersedes the existing Agreement with the City of Selma for paramedic ambulance services, effective upon execution through June 30, 2029, which includes two optional one-year extensions, total not to exceed $6,750.
REPORT
Approval of the recommended action will continue paramedic ambulance services in the Fresno County Ambulance Zone G, granting the City of Selma a Grandfathered Exclusive Operating Area (EOA). Zone G - Selma Response Area includes the City of Selma and the surrounding area. The recommended agreement satisfies the requirements under Title 22 of the California Code of Regulations (Title 22) for the County to have a written agreement with paramedic provider agencies. The services will be funded with Health Realignment, with no increase in Net County Cost. This item pertains to District 4.
ALTERNATIVE ACTION(S):
If your Board chooses not to approve the agreement, the City of Selma will continue to provide ambulance services within Zone G on a non-exclusive basis and the County will need to continue to provide compensation for uncompensated care costs.
FISCAL IMPACT:
There is no increase in Net County Cost associated with the recommended action. The maximum amount of the recommended agreement with the City of Selma is $5,625 for the remaining months in fiscal year 2024-25 through June 30, 2025. Compensation for estimated runs and uncollected charges are being ended by the Department under this Agreement, and Selma has requested that they continue under the original agreement through the end of the 2024-25 fiscal year, as they have the revenue budgeted for fiscal year 2024-25.
The recommended agreement will be fully offset with Health Realignment funds. Sufficient appropriations and estimated revenues are included in the Department’s Org 5620 FY 2024-25 Adopted Budget and will no longer be needed for future budget requests.
DISCUSSION:
The County, through the Department, has been designated as the Local Emergency Medical Services (EMS) Agency of the County pursuant to the California Health and Safety Code, section 1797.200.
Since 1978, the County has provided monthly payments to local rural ambulance service providers to assist with estimated uncompensated care costs. Many improvements have occurred with ambulance service reimbursement and the proposed agreement will end this reimbursement process with the City of Selma effective July 1, 2025. Since 1986, the agreement included the provision of dispatch services by the County through the Fresno County EMS Communications Center. The consolidation of dispatch services benefits the County since all medical 9-1-1 requests for medical assistance are received at one location and allows the closest ambulance to the incident to be dispatched. The new Agreement continues the requirement to use the EMS Communications Center.
On July 9, 2024, the Board approved Agreement No. 24-389 with the City of Selma to authorize Selma Fire to provide ambulance services on a non-exclusive basis. This superseding agreement will establish a Grandfathered EOA, as requested by the City of Selma and approved by the State EMS Authority. The proposed agreement continues the established response and performance requirements, imposing further requirements as a Grandfathered EOA. California Health and Safety Code Section 1797.224 allows Counties and EMS agencies to designate exclusive operating areas, and limit competition, by designating an ambulance provider that has provided services continuously since prior to January 1, 1981. The State EMS Authority encourages the designation of these areas. The City of Selma Fire Department has been providing ambulance services since 1969 and they have consistently met response time standards and contract requirements.
Approval of the recommended agreement will provide continued paramedic ambulance service in Fresno County Ambulance Zones G - Selma Response Area.
In 2023, the City of Selma responded to 7,286 requests for service and performed 5,137 transports.
With your Board’s approval, the proposed agreement supersedes the existing agreement, expands the existing response and performance requirements and authorizes the Grandfathered EOA in Zone G for the City of Selma. The recommended agreement contains a mutual indemnification clause and satisfies the requirement under Title 22 for a written agreement with local paramedic provider agencies. The recommended agreement also contains indemnification clauses for 5150 holds put in place by law enforcement as well as requires the City of Selma to indemnify the County as a Grandfathered EOA.
REFERENCE MATERIAL:
BAI #53, July 9, 2024
ATTACHMENTS INCLUDED AND/OR ON FILE:
On file with Clerk - Agreement with the City of Selma
CAO ANALYST:
Ronald Alexander