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Accept and endorse the Solano Emergency Medical Services Cooperative (SEMSC) Exclusive Operating Area Emergency Ambulance Services Provider Contracting Process Policy, pursuant to California Health and Safety Code §1797.230(c)
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Published Notice Required? Yes ___ No _X _
Public Hearing Required? Yes ___ No _X _
DEPARTMENTAL RECOMMENDATION:
The County Administrator and the Department of Health and Social Services, Public Health Division recommend that the Board of Supervisors, in public concurrence with the SEMSC Board, accept and endorse the SEMSC Exclusive Operating Area Emergency Ambulance Services Provider Contracting Process Policy, as indicated in California Health and Safety Code section 1797.230(c).
SUMMARY:
On October 10, 2024, the SEMSC, the Joint Powers Authority serving as the county’s local emergency services agency, through adoption of Resolution 24-002, adopted the Exclusive Operating Area Emergency Ambulance Services Provider Contracting Process Policy. Due to concerns voiced by the current ambulance provider based on the wording of Health and Safety Code §1797.230(c), the Board of Supervisors is asked by the SEMSC Board to also accept and endorse this Contracting Process Policy.
The SEMSC Board is currently in the process of finalizing an RFP for ambulance services to be issued in the next few months
FINANCIAL IMPACT:
There is no direct financial impact to the County.
DISCUSSION:
On October 10, 2024, the SEMSC Board, which consists of the Solano County Administrative Officer, a City Manager, a City Fire Chief, an emergency department physician, two additional medical professionals and a consumer representative, adopted the Exclusive Operating Area Emergency Ambulance Services Provider Contracting Process Policy, which incorporated RFP Policy as SEMSC Policy 1900 through SEMSC Resolution 24-002. Public comment at that meeting indicated concern that the Board of Supervisors itself must also approve the RFP Policy based on the wording in §1797.230(c): “On and after January 1, 2022, a county shall not enter into or renew a contract for emergency ambulance services unless the county board of supervisors has adopted, by ordinance or resolution, a written policy setting forth issues to be considered for inclusion in the county contract for emergency ambulance services” (emphasis added). This language was added to state law by Assembly Bill 389, signed by Governor Newsom on October 4, 2021.The current ambulance provider, Medic Ambulance, stated as part of public comment that they would not apply for a new contract until they believed this language had been satisfied, as a failed bid may become public record in the event of a legal dispute and damage their ability to make a future competitive proposal. As a result, the SEMSC Board also voted to ask the Board of Supervisors to approve the RFP Policy in parallel to satisfy alternate interpretations of the statute in question, even though the Board of Supervisors has delegated its authority to SEMSC pursuant to Section 7.1-12 of the Solano County Code and the SEMSC Joint Powers Agreement. Staff and the County Counsel believe the recommended action satisfies this provision.
SEMSC is a Joint Powers Authority under Government Code §6500 and serves as Solano County’s local emergency medical services agency (LEMSA). SEMSC was established in 1996 pursuant to Health and Safety Code §1797.200 by the Solano County Board of Supervisors through the adoption of County Ordinance 1527. Under Health and Safety Code §1797.224, the LEMSA has the authority to designate Exclusive Operating Areas (EOAs) and select the ambulance service provider(s) to service the EOAs, through a competitive process.
The Master Services Agreement with the current ambulance provider expired in May 2020 and has been maintained through contract extensions since then. The Master Services Agreement is set to expire on May 1, 2025. One final extension is anticipated to allow for completion of the RFP process.
The County’s Public Health Division is administering a procurement process for a new 5-year agreement, with possible extensions, as set forth in a planned Request for Proposals (RFP). This RFP is being constructed by Public Health EMS staff in accordance with the SEMSC Exclusive Operating Area Emergency Ambulance Services Provider Contracting Process Policy (hereafter “RFP Policy”).
The RFP covers three service types: emergency ambulance services, i.e., all calls originating through the 911 system or a Public Safety Answering Point (PSAP), all calls made directly to the ambulance provider with an emergency room destination, all emergency transports between facilities, and all standby services; Advanced Life Support (ALS) services as defined in Health and Safety Code §1797.52, including non-emergency ALS interfacility transports; and Critical Care Transport (CCT) services as generally defined as “specialty care transport” in U.S. Code of Federal Regulations, Title 42 §414.605.
The Exclusive Operating Area for emergency ambulance services covered by the anticipated RFP is “Zone B,” which includes all of the County of Solano except for the territorial limits of the City of Vacaville, certain immediately contiguous areas surrounding the City of Vacaville (both serviced by the City of Vacaville as “Zones A and C”), and the territorial limits of Travis Air Force Base. The EOA for emergency ambulance services also includes portions of Sacramento County under the River Delta Fire District and Delta Fire Protection District, as well as the City of Isleton. For ALS interfacility transports and CCT, the EOA includes all transports originating from anywhere in Solano County.
In accordance with the statutory language of §1797.230, the RFP Policy requires that the contract resulting from the RFP shall include:
• Payment of comparable wages and benefits to all ambulance service employees consistent with compensation in the same geographic region
• Comparable staffing levels to the previous contract
• Coverage for the complete territory encompassed by EOA Zone B, which may occur by subcontract
• Coordination with local fire agencies, including with ALS first responders to extend ambulance response times
• Coverage for all service types and levels of care
• Requirement to meet response time standards and clinical care standards, with an active continuous quality improvement (CQI) plan
• Provision of an emergency medical dispatch (EMD) center for ambulance dispatch
• Requirement to meet radio/telecommunication standards, vehicle and equipment requirements, and data collection and evaluation requirements
• Requirement to meet all financial requirements, including sufficient capacity to commence and maintain services for at least five (5) years
ALTERNATIVES:
The Board may choose not to accept and endorse the Policy. This is not recommended due to concerns regarding the interpretation of §1797.230(c) and need for clarity in the RFP process.
OTHER AGENCY INVOLVEMENT:
This board item is based on SEMSC Resolution 24-002 and the amended motion to accept SEMSC Policy 1900 as voted upon by the SEMSC Board on October 10, 2024.
CAO RECOMMENDATION:
APPROVE DEPARTMENTAL RECOMMENDATION