DATE: October 11, 2016
TO: Board of Supervisors
SUBMITTED BY: David Pomaville, Director, Department of Public Health
SUBJECT: Emergency Medical Services Exclusive Operating Area Provider Request for Proposal Overview
RECOMMENDED ACTIONS:
TITLE
1. Receive a report from the Department of Public Health on changes to the Fresno County Emergency Medical Services Exclusive Operating Area in preparation for a release of a Request for Proposals to select the designated provider agency for emergency and advanced life support (paramedic) ambulance services.
2. Adopt Resolution recommending that the Central California Emergency Medical Services Agency designate a single provider agency for all emergency ambulance services in the Exclusive Operating Area.
REPORT
The first recommended action will allow the Central California Emergency Medical Services (EMS) Agency to provide an update regarding changes to the EMS system. The changes will be included in the Request for Proposals (RFP), scheduled for release in September 2016, for an agency to provide emergency and advanced life support (paramedic) ambulance services within the County’s Exclusive Operating Area (EOA).
Approval of the second recommended action will provide a formal recommendation from your Board to the EMS Agency to designate the emergency medical services which include: 9-1-1 emergency responses, 7-digit emergency responses, advanced life support (ALS) ambulance, all critical care transport (CCT) services, ALS inter-facility transports, and stand-by services with transport authorization within the EOA to a single ambulance provider, with no Net County Cost. A resolution from your Board recommending the establishment of an EOA is required by the California Health and Safety Code, Division 2.5.
ALTERNATIVE ACTION(S):
There are no viable alternative actions. The existing EOA provider agreement will expire on December 31, 2017. If your Board declines to recommend that a single provider agency be designated for the area, the EMS Agency would need to draft agreements for a non-exclusive operating area with multiple provider agencies. An EOA often provides multiple advantages to residents when compared to non-exclusive systems including, but not limited to, improved cost effectiveness, reliability and quality of care.
FISCAL IMPACT:
There is no increase in Net County Cost associated with the recommended actions. The EOA provider selected through the competitive bidding process will charge user fees to patients and responsible third parties for ambulance transportation, medical transportation services and emergency medical care provided within the EOA. The RFP will be submitted to the State Emergency Medical Services Authority (EMSA) as an amendment to the local EMS Plan. The maximum base rate to be charged by the selected provider will be proposed through the RFP process. All other user fees are either fixed in the RFP or are calculated as a percentage relative to the selected bidder’s base rate. Some patients receiving services from the selected provider are the financial responsibility of the County and include individuals enrolled in the Medical Indigent Services Program (MISP), Fresno County Jail inmates, minors held at the Juvenile Justice Center and persons in the Sheriff’s custody. The RFP will allow the EOA provider to bill the County at current Medi-Cal rates.
Consistent with the existing Agreement, user fees will be regulated by the County and are adjusted only with the recommendation of the EMS Agency and your Board’s approval.
DISCUSSION:
On May 24, 2016, your Board approved the 18-month extension of Agreement No. 14-346 with American Ambulance, the existing EOA provider; the Agreement will expire on December 31, 2017. The EMS Agency has begun to draft the RFP to designate an EOA provider, effective January 1, 2018. Due to the large size of the County’s EMS system and support resources required to provide services, transition time for the new provider will be essential.
In order to maintain an EOA, the EMS Agency must implement a competitive bidding process to select the EOA service provider. The RFP must be submitted to the State EMSA for approval as an amendment to the local EMS Plan which provides for anti-trust immunity by the State when creating an EOA that restricts the provision of services to a single provider.
With your Board’s approval, the RFP process will result in the selection of a single EOA provider for the County. Once an EOA provider has been selected, an EOA Agreement will be presented to your Board for approval. The contract period outlined in the RFP is an initial five-year agreement, which would begin January 1, 2018, and include one (1) optional five-year renewal.
The RFP is very similar to the version used in 2006, which resulted in the current Agreement with American Ambulance. A brief summary of significant changes include:
• Increased performance standards for emergency calls in the metropolitan areas of Fresno, Clovis, and Kerman;
• Creation of suburban ambulance response zone to reflect the population of individuals residing adjacent to the metropolitan areas;
• Expansion of the First Responder Assistance Program to include a response stipend, training, and certification assistance;
• Modified agreement term to five years with one optional five-year renewal;
• Increase in performance bond from $2,000,000 to $5,000,000;
• Includes a rental/lease amount for Contractors use of the Fresno County EMS Communications Center;
• Inclusion of Fresno County Ambulance Zone N (North Central Fire District) into the EOA; and,
• Removed the three-way lease program for vehicles and equipment and replaced with an emergency takeover clause in case of default or breach.
The proposed resolution provides the EMS Agency with the documentation necessary to continue the existence of the County EOA; in accordance with California Health and Safety Code, section 1797.85, which requires the County to provide a recommendation to the EMS Agency that restricts operations to a single emergency ambulance and advanced life support EOA provider. With your Board’s approval, the RFP process would be implemented by the EMS Agency immediately following State EMSA approval, anticipated by October 2016.
REFERENCE MATERIAL
BAI #32, March 22, 2011, Agt. 11-106, Third Amendment
BAI #46, December 9, 2009, Agt. 08-668, Second Amendment
BAI #53, June 17, 2008, Agt. 07-292, First Amendment
BAI #39, July 10, 2007, Agt. 07-292
ATTACHMENTS INCLUDED AND/OR ON FILE:
Resolution
CAO ANALYST:
Sonia De La Rosa