DATE: September 9, 2025
TO: Board of Supervisors
SUBMITTED BY: Joe Prado, Interim Director, Department of Public Health
SUBJECT: Retroactive Amendment to Agreements for Emergency Medical Services Administration with the Counties of Kings, Madera, and Tulare.
RECOMMENDED ACTION(S):
TITLE
1. Approve and authorize the Chairman to execute a retroactive Amendment No. 5 to Agreement No. 90-257 with the County of Kings, for Emergency Medical Services Administration, to modify compensation terms effective July 1, 2025 with no change to the term of unlimited annual renewals and increasing the annual maximum by $7,005 to $60,880;
2. Approve and authorize the Chairman to execute a retroactive Amendment No. 5 to Agreement No. 90-258 with the County of Madera, for Emergency Medical Services Administration, to modify compensation terms effective July 1, 2025 with no change to the term of unlimited annual renewals and increasing the annual maximum by $7,005 to $60,880; and
3. Approve and authorize the Chairman to execute a retroactive Amendment No. 2 to Agreement No. 04-104 with the County of Tulare, for Emergency Medical Services Administration, to modify compensation terms effective July 1, 2025 with no change to the term of unlimited annual renewals and increasing the annual maximum by $7,005 to $60,880.
REPORT
There is no additional Net County Cost associated with the recommended actions. Approval of the recommended actions will provide for a 13% increase to the base rate for the counties of Kings, Madera, and Tulare for the Department of Public Health’s administration and oversight of emergency medical services (EMS). This item is countywide.
ALTERNATIVE ACTION(S):
Should your Board not approve the recommended actions, the cost ($53,857) agreed to in 2019 as part of the Fourth Amendment for Kings and Madera, and First Amendment for Tulare, would remain unchanged and the Department would adjust oversight services and corresponding expenditures based on existing revenue.
RETROACTIVE AGREEMENT:
The recommended amendments are retroactive to July 1, 2025 due to delays in approval by all parties in getting to their respective Boards, along with internal review of all documents. Initial requests to Counties of Kings, Madera, and Tulare for the increased compensation were sent by the Department in early April.
FISCAL IMPACT:
There is no increase Net County Cost associated with the recommended actions. The recommended amendments will increase the base rate by 13%, or $7,005; increasing the annual maximum from $53,875 to $60,880 for all three counties. Sufficient appropriations and revenues are included in the Department’s Org 5620 FY 2025-26 Recommended Budget and will be included in budget requests for the duration of the term.
DISCUSSION:
California Health and Safety Code, section 1797.200 requires that each County designate an EMS Agency to implement, monitor, and evaluate its EMS system. Since 1990, the Counties of Kings and Madera have contracted with the Department for administration and oversight of their EMS system. Since 2004, the County of Tulare has contracted with the Department for administration and oversight of their EMS system. Contracted oversight responsibilities include development of policies and procedures, certification/licensure of EMS personnel, designation of trauma centers, investigations/background checks, oversight of ambulance contracts, management of disaster medical services, approval of EMS training courses, designation of exclusive operating areas, and oversight of EMS system operations.
On June 19, 1990, the Board approved Agreement Nos. 90-257 and 90-258, which officially designated the County as the Local EMS Agency in accordance with Health and Safety Code, section 1797.200 for the Counties of Kings and Madera. On November 10, 1992, the Board approved the First Amendments, Agreement Nos. 92-594 and 92-595, which clarified approval of provider agreements and modified the compensation for services. On June 14, 1994, the Board approved the Second Amendments, Agreement Nos. 94-244 and 94-245, which allowed for EMS “on-call” services and added language that would trigger a renegotiation of compensation in the event of reduction in California Emergency Medical Services Authority (EMSA) funding. On May 11, 1999, the Board approved the Third Amendments, Agreement Nos. 99-171 and 99-172, which modified compensation due to increases in State EMSA funding. On August 20, 2019, the Board approved the Fourth Amendments, Agreements No. 19-414 and 19-415, which modified compensation due to static EMSA funding and rising personnel costs.
On March 16, 2004, the Board approved Agreement No. 04-104, which officially designated the County as the Local EMS Agency for Tulare County in accordance with Health and Safety Code, section 1797.200. On November 5, 2019, the Board approved the First Amendment, Agreement No. 04-104-1, which modified compensation due to static EMSA funding and rising personnel costs.
The Department’s administration and oversight of emergency medical services costs to the Counties of Kings, Madera, and Tulare has remained unchanged due to funding provided by the State EMSA, which has offset the costs to each of the Counties for the provision of services by the County. Despite an increase in State EMSA funds in 2022, County personnel and software costs have increased beyond that provided by State EMSA Funds requiring an increase in compensation from each of the Counties. The County is designated as the local EMS Agency for four counties: Fresno, Kings, Madera, and Tulare. The State EMSA recognizes the County as a regional EMS Agency known as the Central California EMS Agency. In accordance with Health and Safety Code, section 1797.108, the State EMSA supports the regionalization and inclusion of rural counties and assists the County with regional funding to support and offset the cost of EMS administration for the smaller counties.
With your Board’s approval, Amendment No. 5 to the Agreements with the Counties of Kings and Madera and Amendment No. 2 to the Agreement with the County of Tulare, will be amended to include an increase in costs for EMS administration and oversight.
REFERENCE MATERIAL:
BAI #36, November 5, 2019
BAI #35, August 20, 2019
BAI #44, March 16, 2004
BAI #41B, May 11, 1999
BAI #32C, June 14, 1994
BAI #18J, November 10, 1992
BAI #31L, June 19, 1990
ATTACHMENTS INCLUDED AND/OR ON FILE:
On file with Clerk - Amendment No. 5 to Agreement No. 90-257 with the County of Kings
On file with Clerk - Amendment No. 5 to Agreement No. 90-258 with the County of Madera
On file with Clerk - Amendment No. 2 to Agreement No. 04-104 with the County of Tulare
CAO ANALYST:
Ronald Alexander