REPORT/RECOMMENDATION TO THE BOARD OF DIRECTORS
OF INLAND COUNTIES EMERGENCY MEDICAL AGENCY
AND RECORD OF ACTION
October 26, 2021
FROM
LEONARD X. HERNANDEZ, Chief Executive Officer, County Administrative Office
DANIEL MUNOZ, Interim EMS Administrator, Inland Counties Emergency Medical Agency
SUBJECT
Title
Amendment to Contract with American Medical Response of Inland Empire for Ground Ambulance Medical Transportation Service
End
RECOMMENDATION(S)
Recommendation
Acting as the governing body of the Inland Counties Emergency Medical Agency, approve Amendment No. 9 to Contract No. 12-254 with American Medical Response of Inland Empire for ground ambulance services in various County Exclusive Operating Areas, extending the contract term by two years, for a total contract term of July 1, 2012 through March 31, 2024.
(Presenter: Daniel Munoz, Interim EMS Administrator, 387-3105)
Body
COUNTY AND CHIEF EXECUTIVE OFFICER GOALS & OBJECTIVES
Operate in a Fiscally-Responsible and Business-Like Manner.
Provide for the Safety, Health and Social Service Needs of County Residents.
FINANCIAL IMPACT
Approval of this recommendation does not impact Discretionary General Funding (Net County Cost) as ambulance services are billed to third parties and do not directly generate revenue or expense for the County.
BACKGROUND INFORMATION
In 1984, Inland Counties Emergency Medical Agency (ICEMA), acting in its capacity as San Bernardino County's local emergency medical service agency, established an emergency medical services (EMS) plan that included establishing exclusive operating areas (EOAs) for ground medical transportation services for emergency and inter-facility medical transportation needs, as allowed under California Health and Safety Codes Sections 1797.76, 1797.85, 1797.103, 1797.224, and 1797.226. A total of 26 EOAs currently exist within the County.
Between 2004 and 2006, ICEMA's Board of Directors (Board) approved and executed performance-based contracts with the majority of its existing ground medical transportation service providers. The agreements (memorandums of understanding and/or contracts) were primarily of two types: urban and rural. The urban agreements had an initial term and options for multiple extensions. The initial agreements that contain rural components contained a provision for three-year auto-renewal in perpetuity, or until such time as the entire geographical area by census was to change to an urban definition by population, or unless terminated earlier by the Board.
Currently, extended ambulance response times are being experienced across the county. This is due to a combination of factors including: a statewide EMS personnel shortage; ambulance patient offload delays at hospitals across the county; the ongoing effects of the COVID-19 pandemic, including the vaccine mandates that will likely have an impact on current staffing levels; and necessary pre-hospital care system enhancements that have not been implemented. American Medical Response of Inland Empire (AMR) has identified strategies to improve the current situation immediately, and other strategies for short- and long-term improvements to the current state of the pre-hospital care system, such as partnering with local fire departments to provide assistance during this unprecedented time. AMR’s approach also includes enhanced recruitment and retention efforts of its employees through increased wages, and heightened recruiting initiatives.
The recommended amendment to the contract with AMR will extend the term of the contract for an additional two years through March 31, 2024, for continued provision of ground ambulance services in various County EOAs. This amendment also includes additional language or provisions regarding mechanisms for enhanced compliance and contract monitoring, quality improvement, linkage with CONFIRE dispatch, on-time performance requirements, establishment of a County facilitated contract Performance Committee, and a new response time Exemption policy and approval procedure. This contract contains a cancellation provision with 90 days’ written notice, which includes notice in the event of the successful completion of a Request for Proposals process resulting in a contract(s) award during the contract term.
The County and AMR are committed to improving the current system, and additional contract enhancements will be developed to support improved contract performance and accountability. The contract includes a reopener provision triggered by system enhancement projects. An amendment to the contract with service enhancements will be presented to the Board.
On May 8, 2012 (Item No. 47), the Board approved Contract No. 12-254, which replaced the existing and expiring ground medical transportation service contract between ICEMA and AMR for its various (EOA Nos. 1-7 and 9) urban exclusive operating areas. This contract provided for a two-year term with provisions for two, one-year extensions.
On December 17, 2013 (Item No. 90), the Board authorized the Executive Officer of ICEMA to issue a notice of intent to not renew the contract in order to provide the required notice 180 days prior to the contract expiration date of June 30, 2014, to negotiate with AMR to amend Contract No. 12-254 to allow for six-month extensions rather than one-year extensions of the contract term, and to execute the amendment and exercise options to extend under the amendment. The notice of intent to not extend was issued and the contract term was subsequently extended to December 31, 2014. These changes and subsequent extensions were identified as Amendment Nos. 1-3.
On November 18, 2014 (Item No. 57), the Board approved Amendment No. 4 to Contract No. 12-254 with AMR allowing up to six, three-month extensions to the contract term end date of December 31, 2014, for ambulance services within the County. This allowed ICEMA to conduct an EMS Plan review and analysis. During the analysis, the Executive Officer of ICEMA exercised the options to extend the contract term to June 30, 2016.
On May 24, 2016 (Item No. 182), the Board approved Amendment No. 5 to Contract No. 12-254 with AMR which authorized the Executive Officer of ICEMA to extend the contract for a total of two, three-month extensions expiring on December 31, 2016.
On December 6, 2016 (Item No. 95), the Board approved Amendment No. 6 to Contract No. 12-254 with AMR extending the contract term end date to June 30, 2018 for ambulance services within the County. This allowed the Executive Officer of ICEMA to schedule a Study Session and receive input from stakeholders throughout the County, for emergency medical transportation services within San Bernardino County.
On November 14, 2017 (Item No. 47), the Board approved the assignment of Contract No. 12-254 to Air Medical Group Holdings, Inc., who acquired ownership control of AMR HoldCo, Inc., AMR’s parent company.
On June 12, 2018 (Item No. 101), the Board approved Amendment No. 7 to Contract No. 12-254 with AMR for a nine-month extension, extending the term of the contract through March 31, 2019, to allow for additional time necessary to evaluate either the negotiation of new provider agreements with existing EOA ground medical transportation providers, or to consider to develop and award a Request for Proposal for future ground ambulance services, while ensuring continuity of current ambulance services.
On March 19, 2019 (Item No. 46), the Board approved Amendment No. 8 to Contract No. 12-254 with AMR, extending the contract term for an additional three years through March 31, 2022, with the option to reopen for long-term projects that enhance ambulance service. This extension was requested to allow time for a workshop regarding ground ambulance services provided Countywide, and to receive and implement Board direction.
The recommended amendment with AMR incorporates revisions within the contract for necessary service-related enhancements to be implemented for better performance and accountability. Throughout the last several months it has become clear that the County needs to establish a much more proactive approach to effectively administer and monitor this contract. The County Administrative Office (CAO) and ICEMA will be taking a more active role to ensure compliance with contractual obligations and contractor performance. ICEMA and the CAO will continue to work with AMR on additional system enhancements over the next two years. The County is committed to working with various stakeholder groups to ensure open communication and transparency.
PROCUREMENT
Not applicable.
REVIEW BY OTHERS
This item has been reviewed by County Counsel (John Tubbs II, Deputy County Counsel, 387-5455) on October 18, 2021; Finance (Carl Lofton, Administrative Analyst, 387-5404) on October 18, 2021; and County Finance and Administration (Matthew Erickson, County Chief Financial Officer, 387-5423) on October 18, 2021.