DATE: August 19, 2025
TO: Board of Supervisors
SUBMITTED BY: Joe Prado, Interim Director, Department of Public Health
SUBJECT: Fourth Amendment to the Agreement with K.W.P.H. Enterprises, Inc., d.b.a. American Ambulance
RECOMMENDED ACTION(S):
TITLE
Approve and authorize the Chairman to execute Fourth Amendment to Agreement with K.W.P.H. Enterprises, Inc., d.b.a. American Ambulance to authorize an increase in maximum allowable user fee rates, with no change to the term of January 1, 2018, through December 31, 2027, or compensation maximum of $9,035,155.
REPORT
On June 23, 2025, American Ambulance submitted a written request to the Department of Public Health, which is the designated local Emergency Medical Services (EMS) agency for Fresno County, requesting approval to implement an increase to the maximum allowable user fees. This is due to increasing monitoring fees imposed by the Department of Public Health as a result of increasing Information Technology (IT) charges for radios and data processing by the County’s Information Technology Services Department (ITSD). The proposed represents an increase of approximately 5.8%. The County’s agreement with American Ambulance requires that the Board of Supervisors approve any user fee adjustments proposed by American Ambulance. There is no Net County Cost associated with the recommended action. This item is countywide.
ALTERNATIVE ACTION(S):
There is no viable alternative action. Should your Board not approve the recommended action, the Department will be forced to use realignment funds to cover the additional costs since American Ambulance would not be able to afford the County’s increase.
FISCAL IMPACT:
There is no increase in Net County Cost associated with the recommended action. The proposed Amendment only changes the user fees that American Ambulance is allowed to bill a patient. American Ambulance does not receive a subsidy from the County for the provision of ambulance services and is only funded through its user fees. Under the Agreement, the County compensates American Ambulance approximately $75,000 annually for transport of Fresno County Jail and Fresno County Juvenile Justice Campus inmates and patients eligible from the County’s Medical Indigent Services Program with 1991 Health Realignment funds, which will not be impacted by the user fee adjustment. This proposed increase will allow the Department to charge American Ambulance a higher monitoring fee, reducing the reliance on 1991 Health Realignment funds to fill in the gaps. Sufficient appropriations and estimated revenues will be included in the Department’s Org 5620 FY 2025-26 Recommended Budget and will be included in subsequent budget requests for the duration of the contract term.
DISCUSSION:
The Department of Public Health is the designated EMS Agency for Fresno, Kings, Madera, and Tulare counties, pursuant to Health and Safety Code, section 1797.200, acting as the Central California EMS Agency.
On May 16, 2017, the County entered into an exclusive operating agreement No. 17-218 with K.W.P.H. Enterprises, Inc., d.b.a. American Ambulance, for the provision of emergency ambulance services. The Agreement contains specific performance requirements for ambulance and dispatch services, including response times, dispatch center operations, and public education and training.
On October 20, 2020, the County executed the first amendment to the EMS Provider Agreement with American Ambulance for the relocation of the emergency services dispatching and dispatcher training operations, as well as to make clarifying revisions to the existing EMS Provider Agreement relating to the integration of the operation of the new EMS Communications Center.
On June 8, 2021, the County executed the second amendment to the EMS Provider Agreement with American Ambulance to extend the agreement for an additional five-year term from January 1, 2023 through December 31, 2027, and to allow American Ambulance to implement an Emergency Medical Technician training program.
On August 23, 2022, the County executed the third amendment to the EMS Provider Agreement with American Ambulance to increase maximum allowable user fees with the justification of increasing wages for EMTs, Dispatchers, and paramedics.
On June 23, 2025, American Ambulance submitted a written request to the EMS Agency Director requesting an increase to maximum allowable user fees due to an increase in monitoring fee requested by the Department as a result of a sharp increase in IT charges for FY 2025-26 for radio and data processing. There is a 65% increase in radio charges and 12.5% in data processing charges billed to the Department by ITSD for the EMS Communications Center from FY 2024-25 to FY 2025-26. The increased monitoring fee is necessary to provide for long-term budget stability of the Department. These increased costs will also be negotiated for other users of the EMS Communications Center when new contracts are up starting in FY 2026-27.
While American Ambulance’s proposed user fee represents an increase of approximately 5.8%, the result will affect less than 10% of payors, as more than 90% of patients transported by American Ambulance have fixed rates under Medi-Cal or Medicare, which will not increase under the recommended action. Patients with private insurance will be most impacted by the increase.
This is the second user fee increase that American Ambulance has requested since the ambulance agreement was implemented on January 1, 2018. The ambulance agreement will expire on December 31, 2027.
REFERENCE MATERIAL:
BAI #32, August 23, 2022
BAI #34, June 8, 2021
BAI #34, October 20, 2020
BAI #14, May 16, 2017
ATTACHMENTS INCLUDED AND/OR ON FILE:
On file with Clerk - Fourth Amendment to Agreement with American Ambulance
On file with Clerk - Fee Rate Increase Request
CAO ANALYST:
Ronald Alexander