Title
a. Approve Amendment No. 11 to the Agreement between the County of Monterey and American Medical Response West for the provision of Advanced Life and Basic Life Support Ambulance Services for the County of Monterey (Agreement No. A-110610) to extend the Agreement term to June 30, 2025, implement an ambulance service rate adjustment of 29.6%, replace Exhibit B (Monterey County Ambulance Rate Table) to said Agreement, and to make other substantive amendments to various sections of the Agreement,
b. Authorize the Director of Health, the Assistant Director of Health, or the Emergency Medical Services (EMS) Director to execute Amendment No. 11 to the Agreement between the County of Monterey and American Medical Response West for the provision of Advanced Life and Basic Life Support Ambulance Services for the County of Monterey.
Report
RECOMMENDATION:
It is recommended that the Board of Supervisors:
a. Approve Amendment No. 11 to the Agreement between the County of Monterey and American Medical Response West for the provision of Advanced Life and Basic Life Support Ambulance Services for the County of Monterey (Agreement No. A-110610) to extend the Agreement term to June 30, 2025, implement an ambulance service rate adjustment of 29.6%, replace Exhibit B (Monterey County Ambulance Rate Table) to said Agreement, and to make other substantive amendments to various sections of the Agreement,
b. Authorize the Director of Health, the Assistant Director of Health, or the Emergency Medical Services (EMS) Director to execute Amendment No. 11 to the Agreement between the County of Monterey and American Medical Response West for the provision of Advanced Life and Basic Life Support Ambulance Services for the County of Monterey.
SUMMARY/DISCUSSION:
On December 15, 2009, the Board of Supervisors awarded the Agreement for the provision of Advanced Life and Basic Life Support Ambulance Services for the County of Monterey to American Medical Response West (AMR). This Agreement is set to expire on January 30, 2022. EMS staff negotiated with the incumbent contractor, AMR, Amendment No. 11 to the existing Agreement. The amendment includes an extension to the contract term to June 30, 2025, a 29.6% rate increase, replacement of Exhibit B (Monterey County Ambulance Rate Table), and substantive changes to various sections of the Agreement. This rate increase is in large part due pay raises to AMR staff necessary to retain the workforce needed to continue to provide ambulance service within Monterey County.
The procurement for an Exclusive Ambulance Service Provider for the Monterey County Exclusive Operating Area conducted in 2020-2021 resulted in no bids being submitted, in part due to challenges of providing service such as stringent response times, high-cost, low utilization services, a large geographical area, and challenging payor mix. The COVID-19 pandemic has added a new set of challenges to all EMS systems due to several factors such as longer offloading times due to additional COVID-19 protocols that must be followed and bed shortages at hospitals, longer ambulance turn-around time due to additional time needed to disinfect ambulances, unanticipated expenses of Personal Protective Equipment (PPE) needed to minimize EMS personnel exposure to the COVID-19 virus and equipment needed to disinfect ambulances, and a general shortage of paramedics and EMTs. For these reasons, the EMS Agency recommends extending the current ambulance service agreement with AMR until June 30, 2025. The longer term will ensure continued ambulance coverage within Monterey County, will allow the EMS Agency to address factors that have made it challenging to provide services in Monterey County, and allow time for the COVID-19 impacts to be minimized.
The 29.6% rate adjustment is comprised two parts. An 11.10% which represents AMR’s annual rate adjustment to which AMR is automatically entitled pursuant to Section 17.2 of the County of Monterey and AMR Agreement (Agreement). The 18.50% is an extraordinary rate adjustment AMR requested to cover a 27.90% wage increase given to paramedics and EMTs and a 7.8% wage increase given to dispatch staff. EMS systems everywhere are experiencing a shortage of paramedics and EMTs. In Monterey County, the shortage of paramedics had been experienced before the COVID-19 pandemic due in part to the low wages paid to Paramedics. The 27.90% increase brings the Paramedics wages in Monterey on par with other counties.
Lastly, Amendment No. 11 amends sections of the Agreement to:
1. Further expand the use of BLS ambulance service for special events, interfacility transfers, and Alpha and Omega calls when deemed appropriate.
2. Better define instances when Behavioral Patients may be transported by means other than an ambulance staffed by paramedics or EMTs.
3. Eliminate dispatch penalties by changing the way response time is measured to include dispatch time and queue time as part of response time compliance.
4. Eliminate certain per-minute response time penalties
5. Add language to allow changes to call priority assignments to be implemented on a trial basis for six months to better asses the impact of the change prior to a permanent implementation of the change.
6. Add Unscheduled Critical Care Transport-Transports with a non-scheduled immediate response, as Priority 7.
7. Add definition of Transfer Overload to address situations when the provider has multiple requests for transfers.
8. Add a penalty for each day the provider does not staff the CCT Nurse position.
9. Add force majeure language to agreement.
This work supports the Monterey County Health Department 2018-2022 Strategic Plan initiatives 2. Enhance public health and safety through prevention and 4. Engage MCHD workforce and improve operational functions to meet current and developing population health needs. It also supports one of the ten essential public health services, specifically, 7. Link people to needed personal health services and assure the provision of health care when otherwise unavailable.
OTHER AGENCY INVOLVEMENT:
The Office of the County Counsel and Risk Management has reviewed proposed Amendment No. 11 to Agreement A-11610 as to form.
FINANCING:
There are no General Fund Impacts resulting from this Board action.
BOARD OF SUPERVISORS STRATEGIC INITIATIVES:
Check the related Board of Supervisors Strategic Initiatives:
☐Economic Development:
• Through collaboration, strengthen economic development to ensure a diversified and healthy economy.
☐Administration:
• Promote an organization that practices efficient and effective resource management and is recognized for responsiveness, strong customer orientation, accountability and transparency.
☒Health & Human Services:
• Improve health and quality of life through County supported policies, programs, and services; promoting access to equitable opportunities for healthy choices and healthy environments in collaboration with communities.
☐Infrastructure:
• Plan and develop a sustainable, physical infrastructure that improves the quality of life for County residents and supports economic development results.
☐Public Safety:
• Create a safe environment for people to achieve their potential, leading businesses and communities to thrive and grow by reducing violent crimes as well as crimes in general.
Prepared by: Teresa Rios, EMS Director/Bureau Chief, 7082
Approved by: Elsa Jimenez, Director of Health, 4526
Attachments:
Amendment No. 11 is on file with the Clerk of the Board
Exhibit B (Monterey County Ambulance Rates) is on file with the Clerk of the Board
Advanced Life and Basic Life Support Ambulance Service Agreement is on file with the Clerk of the Board
Amendment No. 1 is on file with the Clerk of the Board
Amendment No. 2 is on file with the Clerk of the Board
Amendment No. 3 is on file with the Clerk of the Board
Amendment No. 4 is on file with the Clerk of the Board
Amendment No. 5 is on file with the Clerk of the Board
Amendment No. 6 is on file with the Clerk of the Board
Amendment No. 7 is on file with the Clerk of the Board
Amendment No. 8 is on file with the Clerk of the Board
Amendment No. 9 is on file with the Clerk of the Board
Amendment No. 10 is on file with the Clerk of the Board