DATE: November 5, 2019
TO: Board of Supervisors
SUBMITTED BY: David Pomaville, Director, Department of Public Health
SUBJECT: Retroactive Revenue Agreement with the California Emergency Medical Services Authority
RECOMMENDED ACTION(S):
TITLE
Approve and authorize the Chairman to execute a retroactive revenue Agreement with the California Emergency Medical Services Authority, for multi-county emergency medical services coordination, effective July 1, 2019 through June 30, 2020 ($405,729).
REPORT
Approval of the recommended action will provide State General Fund monies for continued emergency medical services coordination of the four-county region: Fresno, Kings, Madera, and Tulare, pursuant to Section 1797.108 of the California Health and Safety (H&S) Code. The funding may only be used to maintain the Emergency Medical Services (EMS) system, continue essential minimum program activities, and improve the EMS system. The recommended agreement provides the State General Fund monies and requires Local Fund program funding from the involved counties, with no increase in Net County Cost. This item is countywide.
ALTERNATIVE ACTION(S):
There are no viable alternative actions. Should your Board not approve the recommended action, the Department of Public Health would be unable to fund personnel and service costs associated with the administration of the EMS system in the four-county region.
RETROACTIVE AGREEMENT:
The recommended retroactive revenue agreement was received from the California Emergency Medical Services Agency (EMSA) on September 19, 2019, and is retroactive to July 1, 2019.
FISCAL IMPACT:
There is no increase in Net County Cost associated with the recommended action. The recommended revenue agreement will provide $405,729 in State General Fund monies, an increase of $322 from prior year’s award for Central California EMS Agency. This allocation supports County staff salaries and benefits associated with the administration of the EMS system in the four-county region. The allocation allows for full reimbursement of personnel ($266,055), fringe benefits ($98,440), and membership ($4,349) costs, but limits reimbursement of indirect costs up to 10% ($36,885). The County’s indirect cost rate is 25.42%; the remaining $56,875 will be covered with Health Realignment.
Additionally, the recommended revenue agreement requires that the County identify the total budget ($2,625,520) for the Central California EMS Agency in the agreement. This amount includes funding for programs not required by the recommended revenue agreement, but necessary to operate the EMS system. The Local Fund match ($2,219,791) is funded as follows:
• Kings, Madera, and Tulare Counties provide $53,874.60 each ($161,623 total)
• Health Realignment ($1,404,276)
• Fee and Emergency Medical Services Fund revenues ($653,891)
Sufficient appropriations and estimated revenues are included in the Department’s Org 5620 FY 2019-20 Recommended Budget.
DISCUSSION:
As the designated EMS Agency pursuant to H&S, section 1797.108, the Department’s EMS Division, also referred to as the Central California EMS Agency, has the responsibility to provide complete oversight and administration of emergency medical services throughout the four-county region: Fresno, Kings, Madera and Tulare. The County is responsible for all H&S Code, Division 2.5 local EMS agency functions. The EMSA identifies the following as potential benefits derived from a regional EMS Agency:
• reducing administrative and program costs;
• standardizing system coordination of emergency response and patient flow;
• focusing of regional EMS concerns;
• providing a more effective impact at the State level; and,
• matching administrative boundaries with natural systems.
The recommended agreement will support existing staffing, medical director support, and services to the entire EMS region.
The recommended agreement for multi-county emergency medical services coordination contains non-standard termination language as it allows the State to terminate the agreement immediately for cause and without cause upon giving the County at least 30-days advanced written notice. The County may submit a written request to terminate the agreement only if the State should substantially fail to perform its responsibilities in the agreement.
OTHER REVIEWING AGENCIES:
The Health Directors and Administrative Officers of Kings, Madera, and Tulare Counties support the continuation of the Central California EMS Agency.
REFERENCE MATERIAL:
BAI #54, September 25, 2018
BAI #44, March 16, 2004
BAI #31L, June 19, 1990
ATTACHMENTS INCLUDED AND/OR ON FILE:
On file with Clerk - State EMSA Agreement No. C19-015
CAO ANALYST
Sonia M. De La Rosa