COMPLETED BOARD ORDER"�|E\��Before the Board of Supervisors in and for the
County of Monterey, State of California
Agreement No. A-11610
Approve and authorize the Director of Health to
sign and execute Amendment No. 2 to Agreement
No. A-11610 for the second one 1) year
Agreement extension with American Medical
Response West AMR) for the period of
February 01, 2016 through January 30, 2017......
Upon motion of Supervisor Parker, seconded by Supervisor Armenta, and carried by those
members present, the Board hereby;
Approved and authorized the Director of Health to sign and execute Amendment
No. 2 to Agreement No. A-11610 for the second one 1) year Agreement
extension with American Medical Response West AMR) for the period of
February 01, 2016 through January 30, 2017.
17
PASSED AND ADOPTED on this 7th day of February, 2012, by the following vote, to-wit:
AYES: Supervisors Armenta, Supervisor Calcagno, Salinas, Potter and Parker
NOES: None
ABSENT: None
I, Gail T. Borkowski, Clerk of the Board of Supervisors of the County of Monterey, State of California, hereby
certify that the foregoing is a true copy of an original order of said Board of Supervisors duly made and entered in
the minutes thereof of Minute Book 76 for the meeting on February 7, 2012.
Dated: February 9, 2012 Gail T. Borkowski, Clerk of the Board of Supervisors
County of Monterey, State of California
By
Deputy
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COMPLETED BOARD ORDER"�|E\��Attachment C
AMENDMENT No. 2
TO COUNTY OF MONTEREY
AGREEMENT TO PROVIDE ADVANCED LIFE SUPPORT AMBULANCE
SERVICE FOR THE COUNTY OF MONTEREY Agreement No.: A-11610
This Amendment No. 2 to County of Monterey Agreement to Provide Advanced Life Support
Ambulance Service for the County of Monterey Agreement) effective January 30, 2010, is made
by and between American Medical Response-West Contractor) and the County of Monterey
County).
Whereas, County and Contractor wish to amend the Agreement to better define Contractor
requirements regarding response time compliance by county region, allow Behavioral Health
defined transports be provided by an entity other than Contractor and better refine county
response time requirements and
To agree to a second one year extension of the current agreement allowing the term of this
agreement for a period of five 5) years beginning January 30, 2012. This shall be the second one
1) year earned extension of the five 5) annual that may be applied for and approved annually.
Now, therefore, County and Contractor herby agree the Agreement is amended as follows:
A. Amend section 4.1.2.4 to read:
Certain requests for ambulance transportation services
Dun
may be made by the Monterey County Health Department, Behavioral Health Bureau.
The CONTRACTOR shall not be responsible for those ambulance responses except for
emergency transports only. Such requests shall be made utilizing an authorization process
established and approved by the CONTRACTOR and County under this AGREEMENT.
CONTRACTOR shall provide all sueh emergency ambulance services
according to the response-time and other performance requirements of the
AGREEMENT. The Behavioral Health Bureau shall only pay for authorized services
that it requests in an amount that is equivalent to the current approved MediCal rates for
ambulance services in effect on the date that the transport is completed. and only for
those transports that are not reimbursable by MediCal, Medicare or the patient's private
insurance plan.
B. Amend Section 6.1.1 to read:
To earn each extension, the CONTRACTOR must meet or exceed the minimum
requirements of the AGREEMENT absent any declaration of breach during the previous
term that is not cured as determined by the EMS Director. Extensions must be applied
for and approved annually. The procedure for evaluation of renewal requests shall at a
minimum require that the CONTRACTOR has been, a) in compliance with the
performance requirements, b) in compliance with financial requirements, and c) in
compliance with the clinical performance requirements, and d) able to limit response-
time disparity by region of the county of the AGREEMENT. During each year of the
contract, the CONTRACTOR may apply for a renewal by submitting a written request to
the County no later than the last day of October of the current AGREEMENT year. The
EMS Director shall determine if the request is to be granted no later than the last day of
November of the same year.
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COMPLETED BOARD ORDER"�|E\��Attachment C
C. Add section 18.1.2.1 to read:
The EMS Boundaries, as referenced in Exhibit D to the agreement, are utilized by the
county to monitor the CONTRACTOR'S response-time performance by region of the
county. The CONTRACTOR shall in good faith limit response-time disparity by region
of the county regardless of priority class.
D. Amend section 18.4.2 to read:
Arrival at the incident" means the moment an ambulance crew notifies the
communications center that it is fully stopped at the location where the ambulance shall
be parked while the crew exits to approach the patient. In situations where the ambulance
has responded to a location other than the scene e.g., staging areas for hazardous scenes,
parking areas for parks, trailheads, etc.), arrival at the incident" shall be the time the
ambulance arrives at the designated staging location. The response-time standard to
staging shall not be relaxed. The EMS Medical Director may require the CONTRACTOR
to log time at patient" for medical research purposes. However, during the term of the
AGREEMENT, at patient" time intervals shall not be considered part of the
contractually stipulated response time, but can be executed at any time for research
purposes.
E. Amend section 18.4.3 to read:
In instances r the dispatcher takes longer
than 59 seconds to dispatch Priority 1, 2 or 3 responses) a transport capable ambulance
CONTRACTOR shall be fined $100 dispatch interval penalty"). CONTRACTOR shall
be required to report all failures to reps at scene" or dispatches taking longer than 59
seconds. Should the CONTRACTOR fail to o ort scene, the time of the next
F. Add section 18.4.3.1 to read:
n" I
18.4.3.1 In instances when the ambulance fails to report at scene," CONTRACTOR
shall be fined $100 report at scene penalty"). CONTRACTOR shall be required to
report all failures to report at scene". Should the CONTRACTOR fail to report on
scene, the time of the next communication with the ambulance shall be used as the time
of arrival at the incident." Arrival at scene must be reported by a manual action of the
ambulance crew at the scene either through voice communications or the use of manually
activated, digital status-reporting device approved by the EMS Director. Post notification
of scene time by crews when transmitting their next communication shall not be counted
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COMPLETED BOARD ORDER"�|E\��Attachment C
as the official on scene time. Arrival times automatically captured solely by Automated
Vehicle Locator AVL) position reporting may be used as a final back up to all other
reporting devices. However, the CONTRACTOR may request amendment of the
recorded arrival time when it can document the actual arrival time using the following
methods.
Voice communications on the MED Channels
Voice communications on the Fire Command Channels
Automatic Vehicle Locater system AVL)
All failure to report at scene incidents shall be reviewed by the CONTRACTOR in an
effort to reduce these occurrences.
G. Amend section 18.8 to read:
Response Time *empfieas Exclusions:
CONTRACTOR shall maintain mechanisms for reserve production capacity to increase
production should temporary system overload persist. However, it is understood that
from time to time unusual factors beyond the CONTRACTOR'S reasonable control may
affect the achievement of the specified response time standards. Unusual factors may
include
Declared disasters
EMS Agency directed ambulance strike team deployments
Extraordinary and unpredictable weather
Multiple casualty incidents
Periods of unusually high demand
Access issues i.e. gates, trails, large complexes, maritime incidents etc.)
Road closures
Other unknown circumstances must be fully documented)
If the CONTRACTOR feels that any response or group of responses should be excluded
from the calculation of the response-time standards due to unusual factors beyond the
CONTRACTOR'S reasonable control," the CONTRACTOR shall provide detailed
supportive written documentation to the EMS Director and make a written request that
the County exclude these responses from late penalties. Any such request must
demonstrate that at the moment the call was received an unusual factor beyond the
CONTRACTOR'S reasonable control existed. Requests must be made in writing and
received by the EMS Director no later than ten 10) calendar days after the end of the
month the call(s) occurred in. The EMS Director shall review the request and issue a
determination within ten 10) calendar days after receipt of CONTRACTOR'S written
request. Should the CONTRACTOR dispute the determination made by the EMS
Director, the CONTRACTOR may make a written appeal to the Monterey County
Director of Health for a definitive ruling within ten 10) calendar days of the receipt of
the response-time exemption determination by the EMS Director. The ruling of the
Director of Health shall be final and binding.
To request exclusion for a period of unusually high demand," the CONTRACTOR must
demonstrate that, at the moment the call was received, the number of emergency calls
dispatched and being worked simultaneously exceeds the sum of the following formula:
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COMPLETED BOARD ORDER"�|E\��Attachment C
Overload 1.5 X 1 Standard Deviation)) + The Mean
Rounded Up to the nearest whole call for the entire population of emergency ambulance
calls for that hour for the past 20 Weeks.
Equipment failures, traffic congestion, ambulance failures and inability to staff units,
shall not be grounds for granting an exception to compliance with the response standards.
H. Delete section 18.9:
*80nm
CONTRACTOR'S reasonable control,,"theCONTRACTOR shall pr-,vide detailed
CONTRACTOR'S written request. Should theCO 44-RA-CTOOR dispute the
determination made byt;e EMS eetor, the CONTRACTOR fnay make a ritten
I. Amend and replace Exhibit D with attached EMS Boundaries maps.
J. All other terms and conditions of the Agreement remain the same.
County:
By:
Title: Director of Health
Date:
APPROVED AS TO FORM; County Counsel)
Contractor:
By:
Title:
Date:
By: Date:
Deputy County Counsel
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SIGNED BOARD REPORT"�|E]�Monterey County Board of Supervisors
MEETING: February 7, 2012 Consent AGENDA NO.:
SUBJECT: Approve and authorize the Director of Health to sign and execute Amendment No. 2
to Agreement No. A-11610 for the second one 1) year Agreement extension with
American Medical Response West AMR) for the period of February 01, 2016
through January 31, 2017.
DEPARTMENT: Health Emergency Medical Services Agency
RECOMMENDATION:
It is recommended that the Board of Supervisors:
Approve and Authorize the Director of Health to sign and execute Amendment No. 2 to
Agreement No. A-11610 for the second one 1) year Agreement extension and amendment with
American Medical Response West AMR) for the period of February 01, 2016 through January
31, 2017.
SUMMARY:
The Emergency Medical Services EMS) Agency is seeking Board of Supervisor approval to
authorize the Director of Health to sign and execute the second one 1) year ambulance
Agreement extension and amendment with American Medical Response West AMR) for the
period of February 01, 2016 through January 31, 2017.
DISCUSSION:
On December 15, 2009 the Board approved and authorized the Director of Health to enter into a
5 year Agreement, effective January 30, 2010 with AMR, to provide Advance Life Support
Ambulance Services that includes the option for five one-year additional extensions.
AMR submitted their second extension request on October 31, 2011 Attachment A), pursuant to
Section 6.0 of Agreement No. A-11610. Additionally, pursuant to Section 17 of the Agreement,
an annual rate increase is to be requested by November 1 of each year. AMR will not be
requesting a rate increase for 2012 at this time.
A contract compliance work group CCWG) has been established to provide a constituent's view
regarding the performance requirements of the Agreement and assist in development of
Agreement refinements. The CCWG consists of citizen representatives, a first responder
representative, a hospital representative and a representative from the Emergency Medical Care
Committee EMCC) with EMS agency staff and AMR leadership providing support. The EMS
Agency, with concurrence of the CCWG and EMCC, has determined under Agreement Section 6
Renewal Provisions" Attachment B) AMR has met and exceeded the minimum requirements
under the provision of earning the second one 1) year Agreement extension in the following
areas:
Has exceeded 90% Agreement response time compliance for each Priority each month of
the last contract year.
In compliance with clinical performance.
In compliance with financial requirements.
In addition, the EMS Agency is seeking to amend Attachment C) the Agreement to better define
Contractor requirements regarding response time compliance by county region, allow Behavioral
Health defined transports be provided by an entity other than Contractor and better refine county
response time requirements. The amendment language and updated response zone maps
Attachment D) was developed with input from the EMS Agency, AMR-West and the CCWG.
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SIGNED BOARD REPORT"�|E]�The EMCC provided a final review of the Agreement extension request including the minimum
requirements needed to earn an extension and Agreement amendments at its January 2012
meeting. The EMCC has recommended approval of both the second extension to the Agreement
and amending the Agreement as proposed.
OTHER AGENCY INVOLVEMENT:
County Counsel has approved this one year extension and Agreement amendment as to legal
form. Amendment and attachments are on file with Clerk to the Board.
FINANCING:
This one year extension will have no impact to the General Fund Contribution.
Prep
Kirk Schmitt,-EMS Agency Director
2?- Z,:)/a
Date
Date
Attachments: A- AMR-West letter dated October 31, 2011 on file with Clerk of the Board
B Agreement Section 6. Renewal Provision on file with Clerk to the Board
C Amendment No. 2 on file with Clerk to the Board
D Response Zone maps on file with Clerk to the Board
Cc: County Counsel
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