HomeMy WebLinkAbout2013/03/26 Item 08~~~~~~r ~j~~(13
CITY COUNCIL
AGENDA STATEMENT
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'~" CHULA VISTA
March 26, 2013 Item
ITEM TITLE: RESOLUTION OF THE CITY COUNCIL OF THE CITY OF
CHULA VISTA APPROVING A REVISED AGREEMENT.
WITH AMERICAN MEDICAL RESPONSE AMBULANCE
SERVICE, INC. FOR BASIC AND ADVANCED LIFE
SUPPORT SERVICE WITHIN THE- -CHULA VISTA,
IMPERIAL BEACH AND BONITA/ SUNNYSIDE FIRE;
PROTECTION DISTRICT EXCLUSIVE OPERATING AREA
WAIVING THE PREVAILING RATES LIMITATION FOR
EMERGENCY SERVICES PROVIDED IN MUNICIPAL
CODE SECTION 5.10.340; AND APPROPRIATING FUNDS
FOR PROGRAM START UP COSTS
SUBMITTED BY: FIRE CHIEF
CITY ATTORNEY
REVIEWED BY: CITY MANAG
4/STHS VOTE: YES ~ NO
SUMMARY
For the past three years, the City and AMR have been developing an Advanced Life
Support ("ALS") program whereby City pazamedics would provide ALS services as
"first responders" using City Fire Engines. This program is referred to as First
Responder Advance Life Support, or "FRALS." This item presents for City Council
consideration an amended agreement with AMR that would implement the FRALS
program starting on July 1, 2013. This amended agreement, among other things, would
provide a quarterly reimbursement payment to the City for a portion of its FRALS
services costs, and allow an increase in AMR's maximum allowed rates to cover such
costs.
ENVIRONMENTAL REVIEW
The Director of Development Services has reviewed the proposed activity for compliance
with the California Environmental Quality Act (CEQA) and has determined that the
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activity is not a "Project" as defined under Section 15378 of the State CEQA Guidelines
because the proposal consists of a governmental plan of action related to the City's
preparedness in the event of a natural or manmade disaster and which will not result
in direct or indirect significant physical impacts on the environment. Therefore, pursuant
to Section 15060 (c) (3) of the State CEQA Guidelines the activity is not subject to
CEQA. Thus, no environmental review is necessary.
BOARDS/COMMISSION RECOMMENDATION
Not Applicable.
RECOMMENDATION
That Council approve the proposed agreement between the City and AMR for
Emergency Medical Support Services implementing the FRALS program and providing
reimbursement to the City for same.
DISCUSSION
Background
Chula Vista, Imperial Beach and the SunnysideBonita Fire District (collectively, the
"Participating Agencies") have all been under contract with AMR, or its predecessors,
since 1977 for the provision of Emergency Medical Response services within their
territories. The most recent extension of this agreement was approved by City Council
on September 27, 2011 and runs through September 30, 2014.
Each Participating Agency also has "side letter" agreements with AMR to address service
standards, cost recovery and/or rate schedules unique to their respective jurisdictions.
Chula Vista for example, has an existing "side letter" agreement with AMR that
reimburses the City for several services that the Fire Department provides AMR. These
services include Dispatch, BLS Equipment, Defibrillators, and Contract Administration.
Maximum allowed rates that can be charged by AMR to its Emergency Medical
Response patient/customers reflect these costs. This Side Letter Agreement was
approved by City Council on September 13, 2011 and also runs through September 30,
2014.
Proposed Implementation of FRALS Services in Chula Vista
While the other Participating Agencies provide FRALS themselves in different forms under
their "side letters" with AMR, in Chula Vista Paramedic or Advanced Life Support services
are currently provided by AMR.. These services include responding to medical calls within
10 minutes, 90% of the time. The Chula Vista Fire Department provides initial Basic Life
Support to all medical calls and then once AMR amves with Paramedics, supports AMR's
efforts. To provide these services, commonly known as BLS, all Chula Vista firefighters are
trained to the level of Emergency Medical Technician (EMT).
With the implementation of the FRALS program, one firefighter on each of the responding
engines, trucks, and rescues, will be trained to the Paramedic level. Since the Fire
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March 26, 2013, Item `b
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Department is able to respond to emergency calls within 7-8 minutes, 90% of the time,
implementation of the FRALS system will significantly reduce, on average, the time it takes
to have a Paramedic at the scene of an emergency administering care to a patient.
Phased Implementation
In order to allow for training and/or hiring more paramedics, full implementation of the
FRALS program will be phased in over 5 years. Using existing paramedic forces, the City
will, nonetheless, be able to implement a significant initial phase deployment, projected to
commence on July 1, 2013. This first phase will consist of providing Paramedics and
FRALS services at 5 of the 9 stations within the City. The full FRALS implementation
schedule is below:
Phase 1 (FY 13-14): Five Companies:
• Engine 55
• Engine 56
• Engine 57
• Engine 58
• Engine 59
(FY 14-15) No FRALS expansion
Phase II (FY 15-16): Three Companies:
• Engine 54
• Engine 51
• USAR-53
Phase III (FY 16-17): One Company
• Engine 52
Phase IV (FY 17-18): Two Companies
• Truck 51
• Truck 57
Addifional Benefits
Once fully implemented, the program will provide at least 11 more Paramedics on shift each
day. The new system will provide Paramedics at every fire scene as well, delivering
advanced life support to victims and firefighters that may be injured. Currently, Chula Vista
is the only city in San Diego County that does not provide First Responder Paramedic
services. As a result, our neighboring jurisdictions that assist us on calls provide a different
level of service. This program will provide consistent delivery of medical response in the
South Bay.
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Cost and Rate Analysis
This enhancement of services is funded through payments by AMR to the City for "FRALS
Services" under the contract, and a corresponding allowed increase in AMR's "Maximum
Authorized Rates" collected through the Ambulance Transport and EMR Service rates
charged to customer/patients. As a result, there is no net impact on the City's General Fund.
Itemized below in Chart 1 is amount that AMR will be reimbursing the City for the services
defined in the agreement. Chart 2 indicates the corresponding AMR Transport rate for each
service. The rate changes are reflective of the AMR contractual adjustment in Oct. 2013 and
the program cost change in July 2014. Chart 3 reflects the comparison Transport Rates
among the contract jurisdictions in San Diego County with AMR. Implementation of this
program will result in Chula Vista being third highest of the eight contract jurisdictions.
Chart 1, FY 13-14 Total Annual I Quarter
~LS Equipment /Supplies ~ $ 54 000.00 ~ $ 13,500.00
nafihrillatnrc $214.000.00 $ 53,500.00
Contract Administration $219,407.00 $ 54,851.75
FRALS Services $1,120,015.20 $280,003.80
71
*FRALS (First
AMR
14 TOTAL: ~ $2,569,267.02
Advanced Life Support)
Rate
101112012 7/1/2013 10/1/2013 7/1/2014
Descri tion CV CV CV CV
AMR Base Rate $921.17 $921.17 $985.65 $985.65
First Responder - 577.75 577.75 618.19
Monitor Lease 118.58 118.58 118.58 118.58
Dispatch Fees 246.84 246.84 246.84 246.84
BLS Equipment Costs 34.09 34.09 34.09
City Contract Adm 138.51 138.51 138.51 138.51
Total Base Amount $1,459.19 $2,036.94 $2,101.42 $2,141.86
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Chart 3. Cmm~arisnn Rates in County
San Diego County Transport Rates with AMR
Saz' National
$]167.26 Bonita $1844.20 La Mesa $2107.95 Miguel $1828.16
City
FPD
Imperial
$1792.56 Lemon
$2283.24
$1964.57 Alpine Chula
$2036.94
Beach Grove Vista
Note: As an interim step towazds implementation of the FRALS program you will recall
that a labor agreement with the Firefighters Union, Local 2180 was negotiated by staff
and approved by City Council on September 11, 2012. That agreement provides Fire
Department employees directly involved with providing ALS services additional
consideration related to their proposed expanded role. As contemplated, these costs aze
accounted for and recovered as part of the City's reimbursement for FRALS Services
under the proposed agreement.
Kev Contract Provisions
Other than the provisions that implement the FRALS program, which obviously are new,
the proposed contract is substantially similar in form and content to the Side Letter
Agreement previously approved by City Council in September of 2011. Key contract
provisions include the following:
1. The addition of FRALS services to the list of City provided "EMR Support
Services" (Section 1.1.1)
2. An implementation schedule and map of FRALS stations (Section 1.1.3 and
Exhibit A).
3. Provisions relating to the "transition period" from AMR provided ALS to
FRALS, including:
(a) adjustments in AMR allowed response times to relax response standards in
FRALS areas and enhance response time requirements in non-FRALS areas in order to
provide improved overall service throughout the City (Section 1.2.2); and
(b) provisions clarifying City and AMR paramedic decision-making authority
regarding medical and transport issues (Section 1.2.3);
4. Increased payments to the City for newly provided FRALS Services raising the
City's reimbursement amount to $2,569,267 in year one (including substantial recapture
of previously incurred program ``start up" costs), and $2,341,547 in year two (Sections
2.1 through 2.3)
5. Reimbursement paid to AMR out of "start up costs" of $16'7,000 related to the
initial program feasibility study prepared by Citygate consultants (Section 2.6).
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6. Increased "Maximum Authorized Rates" to allow AMR to recover the costs of the
enhanced FRALS services (Section 3).
LeealIssues
The City Attorney's office has been substantially involved in the analysis and preparation
of the proposed agreement. The primary legal issues and risks are similar to those that
were presented by the previous Side Letter agreement back in September 2011, including
possible challenges to the agreement under Proposition 26 and Federal Anti-Kick Back
Statutes. Our conclusions now with respect to this agreement and these issues are the
same, if not stronger, to our conclusions back then: there is a low risk in either case of a
successful challenge to the City's approval or implementation of this agreement.
CVMC Section 5.10.340 provides for ``emergency service" rates not to "exceed the rates
prevailing in the county" but allows the City Council to waive this limitation by majority
vote. Although staff believes the maximum rates authorized by the agreement are
reasonable given the costs and quality of service provided, an argument can be made that
the rates exceed "prevailing rates" under the code. Accordingly, we are recommending
that City Council approval of the proposed agreement authorizing the maximum rate
increase be accompanied by City Council waiver of this code limitation. The attached
resolution provides this waiver.
DECISION MAKER CONFLICT
Staff has reviewed the decision contemplated by this action and has determined that it is
not site specific and consequently the 500 foot rule found in California Code of
Regulations section 18704.2(a)(1) is not applicable to this decision.
CURRENT YEAR FISCAL IMPACT
The General fund costs associated with startup of the FRALS program are anticipated to
total approximately $713,556 (see table below), of which $48,365 were incurred in a
prior fiscal year. These costs will not be offset in the current fiscal year, resulting in a
negative General fund impact of $714,000 in the short term. With approval of the
agreement, the City will recoup these startup costs from AMR over the first two years of
the agreement; with $570,845 collected in fiscal year 2013-14 (80%) and $142,711
collected in fiscal year 2014-15 (20%). The reimbursement fully offsets the initial
General fund impact.
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March 26, 2013, Item
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FRALS Start-Up Costs
AMR Startup Costs (ALS Study)
EMS Staff'
ALS Training & Education
ALS Materials & Equipment
Vehicle Acquisition
Vehicle Maintenance
Total
FY 2012-13
FRALS Startup
$ 167,000
$ 38,312
$ 164,185
$ 268,639
$ 72,000
$ 3,420
$ 713,556
Startup recouped in FY 2013-14 (80%) $ 570,845
Startup recouped in FY 2014-15 (20%) $ 142,711
Notes:
1. Council previously approved the addition of a Nurse Coordinator position to the
authorized staffing of the Fire Department. This resolution will appropriate the
personnel costs for this position for the remainder of the fiscal year.
Approval of the resolution will result in the appropriation of $665,191 (startup costs of
$713,556 less expenses incurred in a prior year $48,365) to the Fire Department's fiscal
year 2012-13 budget from General Fund reserves. Per the agreement with AMR, the
General Fund will recoup these initial startup costs by the end of fiscal year 2014-15.
ONGOING FISCAL IMPACT
With approval of the agreement, AMR will pay the City $2,569,267 in fiscal year 2013
14 and $2,341,548 in fiscal year 2014-15, as summarized in the table below.
:,.ITEM FY' 2013-14 FY 2014-15
Dispatch $391,000 $391,000
BLS Equipment /Supplies $ 54,000 $ 54,000
Defibrillators $214,000 $214,000
Contract Administration $219,407 $219,407
FRALS Services $1,120,015 $1,320,429
FRALS Startup Costs $570,845 $142,711
TOTAL: $2,569,267 $2,341,548
At the end of fiscal year 2014-15, the City will have fully recouped the negative General
fund impact resulting from startup costs incurred in the current fiscal year. For the
remaining years of the contract the City expects to be fully reimbursed for all costs
associated with providing FRALS services. This program will be added to the City
Manager Proposed Budget and be considered as part of the normal budget process.
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March 26, 2013, Item
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ATTACHMENTS
AMR Agreement
Exhibit A -Implementation schedule maps
Exhibit B -Additional Services (no exhibits at this time)
Exhibit C - FRALS Phases
Prepared by: Dave Hanneman, Fire Chief, and Glen Googins, City Attorney
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RESOLUTION NO. 2013-
RESOLUTION OF THE CITY COUNCIL OF THE CITY OF
CHULA VISTA APPROVING A REVISED AGREEMENT
WITH AMERICAN MEDICAL RESPONSE AMBULANCE
SERVICE, INC. FOR BASIC AND ADVANCED LIFE
SUPPORT SERVICE WITHIN THE CHULA VISTA,
IMPERIAL BEACH AND BONITA/SUNNYSIDE FIRE;
PROTECTION DISTRICT EXCLUSIVE OPERATING AREA
WAIVING THE PREVAILING RATES LIMITATION FOR
EMERGENCY SERVICES PROVIDED IN MUNICIPAL CODE
SECTION 5.10.340; AND APPROPRIATING FUNDS FOR
PROGRAM START UP COSTS
WHEREAS, the City is authorized by California Government Code Section 38794 and
Municipal Code Sections 5.10.310-5.10.340 to contract for ambulance services within its
jurisdiction; and
WHEREAS, American Medical Response Ambulance Service, Inc. ("AMR"), formerly
known as Laidlaw Medical Transportation, Inc. is currently providing Emergency Medical
Response Services within the City under the terms of that certain Amended and Restated
Original Agreement for Basic and Advanced Life Support Ambulance Services dated December
11, 2007 (the "EOA Agreement"), whereby AMR agreed to provide ambulance services for the
City, the City of Imperial Beach and the Bonita/Sunnyside Fire Protection District (collectively,
the "Participating Agencies"); and
WHEREAS, as it relates to all the Participating Agencies (including the City), the EOA
Agreement has been extended multiple times, most recently through September 30, 2014
pursuant to the terms of that certain Revised and Restated Agreement for Basic and Advanced
Life Support Ambulance Services by and between AMR and the Participating Agencies effective
July 1, 2011; and
WHEREAS, as it relates to the City only, the EOA Agreement has been amended
multiple times, most recently pursuant to the terms of an agreement entitled Side Letter
Agreement for the Provision of Emergency Medical Response Support Services (Chula Vista)
("EMR Support Services Agreement") in order to provide for compensation to the City for
certain emergency medical response support services provided to AMR, and to help fund system
enhancements; and
WHEREAS, for the past three years, the City and AMR have been developing an
Advanced Life Support program that provides for the first responder paramedic level
"Assessment" Engines within the Fire Department ("FRALS"); and
WHEREAS, in order to implement the FRALS program the parties have negotiated an
amended and restated EMR Support Services Agreement ("Administrative Agreement"); and
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Resolution No.
Page 2
WHEREAS, as with the original EMR Support Services Agreement, the negotiation of
the terms of this Administrative Agreement was based upon each party's consideration of the
following facts, as more specifically described in the agreement: (a) City's lawful authority with
respect to the delivery of emergency medical services within the EOA and the City; (b) City
projections that its annual cost for EMR Support Services to be provided (including FRALS)
exceed the Annual AMR Services Payment to be paid by AMR in consideration for such
services; (c) AMR's determination that the annual EMR Support Services add value to the
services that it delivers within the City under the EOA Agreement that is equal to or greater than
the value of the Annual EMR Support Services Payments; (d) the parties have determined that
the Annual EMR Support Payments are consistent with the types of payments approved in
advisory opinions issued by the Office of the Inspector General of the Department of Health and
Human Services and with the OIG's Compliance Program Guidance for Ambulance Suppliers;
and (e) a report from a qualified third party consultant based on a scope of work approved by the
parties that (i) reviews the City's cost methodology with respect to FRALS Services, (ii)
validates the fact that the City's Annual Support Services Payment with respect to FRALS
Services is equal to or less than the projected cost of such services; and (iii) determines the
corresponding amounts charges by AMR to customers for FRALS Services under this
Agreement are consistent with "fair market rates" for similar services provided elsewhere within
the EOA; and
WHEREAS, City staff presented the Administrative Agreement to the City Council for
consideration, along with substantial information regarding City staff estimates that the costs of
the services provided by City exceed the compensation City is receiving from AMR in
consideration for those services; and
WHEREAS, the proposed agreement recovers only a portion of City emergency medical
service expenses in order to assure that the maximum rates charged by AMR to ambulance
service patients remain at reasonable rates.
WHEREAS, the Administrative Agreement also allows for a corresponding increase in
maximum rates allowed to be changed by AMR in order to allow for the partial recovery of costs
incurred in order to implement the FRALS program; and
WHEREAS, Chula Vista Municipal Code ("CVMC") Section 5.10.340 provides for
"emergency service" rates not to "exceed the rates prevailing in the county" but allows the City
Council to waive this limitation by majority vote; and
WHEREAS, while City staff believes the maximum rates authorized by the agreement
are reasonable given the costs and quality of service provided, an argument can be made that the
rates exceed "prevailing rates" under the code; and
WHEREAS, accordingly, staff is recommending that City Council approval of the
proposed Administrative Agreement authorizing the maximum rate increase be accompanied by
City Council waiver of this code limitation.
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Resolution No.
Page 3
NOW THEREFORE, BE IT RESOLVED that the City Council of the City of Chula
Vista does hereby:
1. Approve the Administrative Agreement between the City and AMR in
substantially the form presented with such minor modifications or clarifications as .may be
authorized or required by the City Attorney, and authorizes and directs the Mayor to execute
same;
2. Find and determine in connection with such approval that, based on the
information presented by staff, that the costs of the services provided by City under the
agreement exceed the compensation that City is receiving from AMR as compensation for such
services; and
3. Waive the limitation on "emergency service" rates in excess of "prevailing rates"
in the county as provided in CVMC Section 5.10.340, to the extent applicable, with respect to the
maximum authorized rates allowed in the Administrative Agreement.
4. Approve an appropriation of $665,191 to the Fire Department's fiscal year 2012-
13 budget for startup costs related to the implementation of the First Responder Advanced Life
Support program as follows: a) $378,459 to Supplies and Services; b) $148,312 to Personnel
Services; and c) $138,420 to Capital Expenses.
Presented by:
~~~
Dave Hanneman
Fire Chief
Approved as to form by:
~L ~
1.~~~
len R. JJoogins
~it3LAttSrney
8-11
THE ATTACHED AGREEMENT HAS BEEN REVIEWED
AND APPROVED AS TO FORM BY THE CITY
ATTORNEY'S OFFICE AND WILL BE
FORMALLY SIGNED UPON APPROVAL BY
THE CITY COUNCIL
( _ ~~~
Glen . Goggins ~
y Attorn
Dated: 3' ~~ I ~~
~~
ADMINISTRATIVE AGREEMENT FOR THE
PROVISION OF EMERGENCY MEDICAL
RESPONSE SUPPORT SERVICES [CHULA VISTA]
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ADMINISTRATIVE AGREEMENT
FOR THE PROVISION OF
EMERGENCY MEDICAL RESPONSE SUPPORT SERVICES
[CHULA VISTA]
This ADMINISTRATIVE AGREEMENT FOR THE PROVISION OF
EMERGENCY MEDICAL RESPONSE SUPPORT SERVICES [CHULA VISTA]
("Agreement") is entered into effective as of March 26, 2013 (``Effective Date") by
and between AMERICAN MEDICAL RESPONSE AMBULANCE SERVICE, INC.,
formerly known as Laidlaw Medical Transportation, Inc., d/b/a American Medical
Response ("AMR") and the CITY OF CHULA VISTA, a chartered municipal
corporation ("City"), with reference to the following facts:
A. AMR is currently providing Emergency Medical Response Services
within the City under the terms of that certain Revised and Restated Agreement for
Basic and Advanced Life Support Ambulance Services dated July 1, 2011 (the
"EOA Agreement"), whereby AMR agreed to provide ambulance services for the
City, the City of Imperial Beach and the Bonita/Sunnyside Fire Protection District
(collectively, the "Participating Agencies") within their defined "exclusive operating
area" ("EOA"). AMR and its predecessor companies have been providing ambulance
transport in the same manner and scope within the EOA since prior to 1980.
B. As it relates to the City and AMR only, the EOA Agreement has
been amended pursuant to the terms of that certain Side Letter Agreement for
the Provision of Emergency Medical Response Support Services entered into
effective as of October 1, 2011 (the "BLS Side Letter Agreement");
C. The parties hereto desire to amend the EOA Agreement, as
previously amended, and incorporate the terms of the BLS Side Letter
Agreement, pursuant to the terms of this Agreement in order to provide for the
expansion of City's emergency medical response support services to include first
responder advanced life support services, and to make related modifications.
NOW, THEREFORE, in consideration of the foregoing premises, and for good
and valuable consideration, the receipt and sufficiency of which the parties hereby
acknowledge, the parties agree as follows:
1. Contract for Services.
1.1. City Services.
1.1.1 In General. In order to facilitate performance by AMR of its
obligations within the City under the EOA Agreement, and to improve the
availability of advanced life support services provided within the City, AMR
agrees to contract with City for City to provide to AMR certain emergency
medical response and transportation support services ("Support Services:"). City
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supplied Support Services shall include the following: (1) emergency medical
dispatch services which are purchased by City from the City of San Diego
("Dispatch"); (2) on-scene advanced life support equipment, and supplies ("ALS
Equipment and Supplies"); (3) Zoll Defibrillator/Monitors as standard equipment
on each of the first responder engines within the City ("Defibrillators"); (4) EOA
contract oversight and administration ("Contract Oversight and Administration");
and (5) first responder advanced life support services delivered using fire engines
and trucks ("FRALS Services").
1.1.2. Service Standards. City shall provide AMR with Support Services
in accordance with mutually agreed specifications and protocols. At a minimum,
all Support Services shall be provided in accordance with (a) all applicable
federal, state and local laws and regulations, including, without limitation the
Emergency Medical Services System and Pre hospital Emergency Medical Care
Personnel Act set forth in California Health and Safety Code Sections 1797, et
seq; and regulations thereunder, and (b) any and all applicable standards and
requirements set forth in City's agreement with the County of San Diego entered
into effective May 9, 1989 regarding the provision of "EMT-Paramedic Services"
within the EOA (the "County/City EMS Agreement").
1.1.3. Implementation Schedule for FRALS Services. AMR and City
shall work together in good faith in order to implement City's provision of
FRALS Services quickly and effectively throughout the City. The parties
currently agreed implementation schedule for City's provision of FRALS
Services and first phase FRALS Services locations within the City is attached
hereto as Exhibit A. Modifications to Exhibit A may be made during the term of
this Agreement with written approval of the City's Fire Chief and AMR's
designated local representative.
1.2 Coordination and Adjustments in AMR Services.
1.2.1 In General. At such time(s) that City begins to provide FRALS
Services within all or any portion of the City, AMR's required ALS service
standards as set forth under the EOA Agreement shall be modified as provided
herein.
1.2.2 Adiustments in AMR Services during Transition Phase.
(a) As a result of the Agreement, AMR's ambulance response time
requirements are amended as follows:
(1) In Response Area 1 (see map attached with Exhibit A ,
AMR will arrive on scene within 11 minutes and 59 seconds.
(2) In Response Area 2 (see map attached with Exhibit A ,
AMR will arrive on scene within 9 minutes and 29 seconds.
4821-0799-9762.2 2
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AMR will be considered compliant in any month where 90% or more of all
emergency EMS calls in the City of Chula Vista meet their respective response
standard.
(b) Upon the commencement of City's provision of FRALS
Services, these response time standards in this Section 1.2.2 shall replace the
response time standard set forth in Section 1.2 of the EOA Agreement.
Furthermore, with respect to AMR's response time requirements set forth Section
1.2.2(a)(1), above, the assessment of penalties provided in Section 4.1 of the EOA
Agreement will be triggered only if after the first month of City's provision of
FRALS Services AMR fails to meet such requirements for any two (2) months
(consecutive or non-consecutive) within any six (6) month period of the term.
1.2.3. Paramedic Coordination, Transport and Staffing. For emergency
medical service call responses in areas where City is providing FRALS, whenever
City's paramedic is the actual "first responder" that initiates care, City's
paramedic shall make clinical decisions until such time as an AMR pazamedic
arrives at the scene. Upon azrival, AMR's pazamedic shall assume medical control
and shall make decisions regarding the treatment, the transport destination and,
after consultation with the City's pazamedic, whether the City paramedic shall
ride along to the hospital with the patient. The City paramedic shall support the
care provided by AMR on-scene and in route. In the event of a dispute between
City's pazamedic and AMR's paramedic, such dispute shall be resolved through
base hospital medical direction. AMR shall be responsible for arranging and
paying all costs to transport City's paramedic(s) back to the station to which such
paramedic(s) are assigned, as soon as possible following amval of the ambulance
at the hospital; provided, however, City agrees that if a patient is transported to
Scripps Chula Vista or Sharp Chula Vista hospitals, City shall pick up City's
paramedic(s) at such facility at no cost to AMR.
1.2.4. Training Program. AMR shall notify City of any AMR specific
continuing education that it is providing to its employees which shall be open for
training City EMT-P's and EMT-B's at no cost. Notwithstanding the foregoing,
AMR shall not be responsible for paying City expenses for training manuals,
books or other materials, nor is AMR responsible for providing training in any
specific location.
1.2.5 Additional and Implementing Agreements. Any additional system
specifications or protocols, or agreements that modify or implement the
specifications and protocols already set forth in this Section 1 shall be agreed
upon by the parties, memorialized in writing and attached hereto as Exhibit B.
Modifications to Exhibit B may be made during the term of this Agreement with
written approval of the City's Fire Chief and AMR's designated local
representative.
aazi-mss-s~sz.z
8-15
2. Payments to City for EMR Support Services.
2.1 In General. In consideration of City's agreement to provide Support
Services, AMR agrees to make payments to City in the amount of $2,569,267 per
year (the "Annual Support Services Payment"), allocated as described below.
The amount and timing for the Annual Support Services Payment to the City is
based on City's costs for such services as reflected in the schedule attached hereto
as Exhibit C. The compensation payable to City pursuant to this Agreement for
the FRALS component of Support Services shall be phased in commensurate with
the phase-in of FRALS by the City. In the event the city fails to phase-in FRALS
as required by Exhibit A, the compensation payable to City shall be reduced
accordingly on a pro rata basis. Starting July 1, 2014 the Annual Support
Services Payment shall be adjusted to $2,341,547.
2.2 Pavment Schedule. AMR shall pay the Annual Support Services Payment
to City in equal quarterly installments of $642,316.75. The first quarterly payment
shall be due and payable in arrears on October 1, 2013, for the period July 1, 2013
through September 30, 2013. Thereafter, subject to any applicable reconciliation
adjustments provided in Section 4, below, each subsequent quarterly installment
shall be due and payable, in arrears, on each July lgt, October 1St, January lst and
April 1st thereafter, throughout the remaining term of this Agreement. Starting
October 1, 2014, to correspond with the adjustment in the Annual Support
Services Payment described in Section 2.1, above, the quarterly installment
payment shall be adjusted to $585,386.75.
23 Pavment Allocation. The Annual Support Services Payment for the first
year of the term has been allocated by the parties among the Support Services
provided by City as follows:
Dispatch $ 391,000
BLS Equipment and Supplies $ 54,000
Defibrillators $ 214,000
Contract Administration $ 219,407
FRALS Services $ 1.690.860
TOTAL $ 2,569,267
Note: The Annual Support Services Payment component allocated to
Defibrillators shall be continued at the same rate notwithstanding the termination
of City's Defibrillator lease payments in order to fund a defibrillator replacement
reserve fund.
2.4 Authority. The parties acknowledge and agree that the City's rights to,
and the amount of, the Annual Support Services Payment was negotiated and
agreed to based upon each party's consideration of the following facts: (a) City's
lawful authority with respect to the delivery of emergency medical services within
aazi-o~ss-s~sz.z 4
8-16
the EOA and the City; (b) the City projected its annual cost for the Support
Services it is providing AMR hereunder to be in excess of the Annual Support
Services Payment to be paid by AMR in consideration for such services; (c)
AMR's determination that the annual Support Services provide value to the
services that it delivers within the City under the EOA Agreement that is equal to
or greater than the value of the Annual Support Services Payments; (d) the parties
have determined that the Annual Support Payments are consistent with the types
of payments approved in advisory opinions issued by the Office of Inspector
General of the Department of Health and Human Services and with the OIG's
Compliance Program Guidance for Ambulance Suppliers; and (e) a report from a
qualified third party consultant based on a scope of work approved by the parties
that (i) reviews the City's cost methodology with respect to FRALS Services, (ii)
validates the fact that the City's Annual Support Services Payment with respect to
FRALS Services is equal to or less than the projected cost of such services; and
(iii) determines the corresponding amounts charged by AMR to customers for
FRALS Services under this Agreement are consistent with ``fair market rates" for
similar services provided elsewhere within the EOA.
2.5 Potential for Additional Cost Recovery and/or System Enhancements.
2.5.1 In addition to the Support Services for which City is compensated
hereunder, City provides additional EMR support services, and incurs additional
costs in connection therewith, for which, currently, City receives no compensation
hereunder. The parties agree to meet and confer in order to evaluate such
additional costs and to determine what, if any, additional compensation should be
provided to City as consideration therefor, consistent with all applicable laws,
generally accepted accounting principles, and the parties mutual desire to
maintain superior clinical care, meet changes in technology and clinical
advancements, and maintain competitive and reasonably priced medical transport
rates within City boundaries. Unless otherwise agreed, the funding for such
additional compensation shall come from increases in user fees. Any changes
under this Section shall be set forth in a written agreement between the parties.
2.5.2 In the event that City requests additional services or system
enhancements from AMR above and beyond that required by prevailing industry
standards or applicable laws and regulations, AMR may request additional
compensation to offset additional costs related thereto and City agrees to meet and
confer with AMR to negotiate same.
2.6 Payment Offset for AMR Advance that Funded City's ALS Study. City
acknowledges and agrees that City owes AMR $167,000 to reimburse AMR for
monies advanced by AMR to City to fund the preparation of a study and report on
the transition to a City FRALS program within City limits (the "ALS Study
Cost"). In order to satisfy this obligation, City shall pay AMR the amount of the
ALS Study Cost within 15 days following approval of this Agreement by the City
Council. In the event City fails to timely make full payment of such amount, the
obligation shall bear interest at the rate of five percent (5%) per annum until paid.
4821-0799-9762.2 5
$-~7
The parties acknowledge and agree that the ALS Study Cost is a valid and
reimbursable expense for the provision of FRALS by City hereunder and that,
accordingly, this amount has been included into the ALS Services component of
City's Annual Support Services Payment provided in Section 2.1, above.
3. Increase in Maximum Authorized Rate. In recognition of AMR's agreement to
pay City the Annual Support Services Payment, City agrees that AMR's
maximum ALS Transport Base Rate per transport may be increased above the
existing maximum base rate ("Maximum Base Rate Increase") for a total new
maximum ALS Transport Base Rate effective as of July 1, 2013 of $2,036.94 for
basic ALS services and $2,165.34 for ALS2 services. Exhibit "D" of the EOA
Agreement, as applicable to maximum base rates within the City, shall be
amended accordingly. This amount may be subject to additional adjustments as
provided in the EOA Agreement.
4. Reconciliation Based on Collections. The parties acknowledge and agree that the
allowed Maximum Base Rate Increase is based upon a projected ALS Transport
marginal collection rate ("Mazginal Collection Rate") within the City of sixteen
percent (16%). Every six months during the term AMR shall track and report to
City its Marginal Collection Rate. Such report shall include any and all back-up
data. In the event that AMR's Mazginal Collection Rate varies by more than three
percent (3%), up or down in the aggregate, over any consecutive two quazter
period (a "Material Variation"), the parties shall meet and confer in order to
determine and implement (a) a proportionate adjustment, going forwazd, in AMR
transport rates and/or fees paid to the City for Support Services in order to
account and compensate for this Material Variation; and (b) in the event that the
Material Variation is a Collection Rate increase, a reimbursement (to the extent
practical) and/or reinvestment program for any "surplus collections" resulting
therefrom.
5. Term. Unless earlier terminated as provided herein, the term of this agreement
shall run concurrent with the term of the existing EOA Agreement and any
extension thereof.
6. Relationshiu to EOA Agreement and Previous Side Letter Agreements. This
Agreement shall amend the EOA Agreement as it relates the City and AMR's
operations within City boundaries, but shall not amend the EOA as it relates to the
other Participating Agencies. In the event of any inconsistency between this
Agreement and the EOA Agreement, the terms of this Agreement shall govern.
This Agreement shall also supersede in its entirety the September 1, 2009 side
letter agreement between the parties regarding Defibrillators and the BLS Side
Letter Agreement. Further, this Agreement shall not modify the manner and
scope of AMR's services provided under the existing EOA.
4821-0799-9762.2 6
8-~8
7. Certification of Costs.
7.1 During the term hereof, on or before September 15th of each year, City
shall certify to AMR that the funding received for Support Services in the prior
fiscal year did not exceed the costs to the City of providing such services. In the
event that funding received from AMR for Support Services exceeds City's costs
incurred in connection therewith for the prior fiscal year by three percent (3%) or
more, up or down (a "Material Variation"), the parties shall meet and confer in
order to determine and implement (a) if warranted, a proportionate decrease,
going forward, in AMR transport rates and/or fees paid to the City for Support
Services in order to account and compensate for this Material Variation; and (b) a
system reinvestment or customer reimbursement program (to the extent practical)
for any "surplus collections" paid to the City for EMR Support Services for that
time period.
7.2 During the term of this Agreement, on or before September 15th of each
year, AMR will make available to City financial data showing for the 12-
month period, the payer mix, number of transports, current collection rate and
estimated marginal collection rate for any adjustment to fees. The parties agree
that this information will remain proprietary and confidential and shall be
utilized by City solely to verify AMR's compliance with the terms of the
EOA Agreement and this Agreement, and to determine if amounts being
charged are reasonable and necessary. Any statutory or case law exemptions
to the California Public Records Act will apply to any documentation
provided to the City hereunder.
8. Compliance. The parties will comply in all material respects with all
applicable federal and state laws and regulations including, the Federal Anti-
kickback statute. The payments set forth in this agreement and the EOA
Agreement shall be used only for City emergency medical response services or
system enhancements.. The City warrants and represents that the payments
made by AMR to City shall be less than or equal to the City's calculations of
its actual costs to provide those services or system enhancements. No funds
shall be. used by the City in a manner that may violate 42 U.S.C. Section
1320a-7b, the federal Anti-Kickback Statute.
9. Compliance Program and Code of Conduct. AMR has made available to each
party a copy of its Code of Conduct, Anti-kickback policies and other
compliance policies, as may be changed from time-to-time, at AMR's web site,
located at: www.amr.net, and each party acknowledges receipt of such
documents. AMR warrants that its personnel shall comply with AMR's
compliance policies, including training related to the Anti-kickback Statute.
10. Non-Exclusion. Each party represents and certifies that neither it nor any
practitioner who orders or provide services on its behalf hereunder has been
convicted of any conduct that constitutes grounds for mandatory exclusion
4821-0799-9762.2 '~
$-~9
as identified in 42 U.S.C.§ 1320a-7(a). Each party further represents and
certifies that it is not ineligible to participate in Federal health care programs
or in any other state or federal government payment program. Each party
agrees that if DHHS/OIG excludes it, or any of its practitioners or
employees who order or provide Services, from participation in Federal
health care programs, the party must notify the other party within five (5) days of
knowledge of such fact, and the other party may immediately terminate this
Agreement, unless the excluded party is a practitioner or employee who
immediately discontinues ordering or providing services hereunder.
11. Referrals. It is not the intent of either party that any remuneration, benefit
or privilege provided for under this agreement shall influence or in any way
be based on the referral or recommended referral by either party of patients to
the other party or its affiliated providers, if any, or the purchasing, leasing or
ordering of any services other than the specific services described herein or in the
EOA Agreement. Any payments specified herein are consistent with what the
parties reasonably believe to be a fair market value for the services provided.
12. General Provisions.
12.1 Authori Each party represents that it has the full right, power and
authority to execute this Agreement and to perform is obligations hereunder,
without the need for any further action under its governing instruments, and that
the parties executing this Agreement on behalf of such party are duly authorized
agents with authority to do so.
12.2 Counterparts. This Agreement may be executed in multiple copies, each
of which shall be deemed an original, but all of which shall constitute one
Agreement after each party has signed such a counterpart.
12.3 Entire Agreement. This Agreement, together will all other agreements
expressly referred to herein, constitutes the entire agreement between the parties
with respect to the subject matter contained herein. All prior or contemporaneous
agreements, understandings, representations, warranties and statements, oral or
written, are superseded.
12.4 Governing Law. This Agreement shall be governed, interpreted,
construed and enforced in accordance with federal law, as applicable, and the
laws of the State of California.
12.5 No other inducement. The making, execution and delivery of this
Agreement by the parties hereto has been induced by no representations,
statements, warranties or agreement s other than those expressed herein.
4821-0799-9762.2 8
8-20
12.6 Severability. If any term, provision, covenant or condition of this
Agreement is held to be invalid, void or otherwise unenforceable, to any extent,
by a court of competent jurisdiction, the remainder of this Agreement shall not be
affected thereby and each term, provision, covenant or conditions of this
Agreement shall be valid and enforceable to the fullest extent permitted by law.
[Signature Page Follows]
4821-0799-9762.2
8-21
SIGNATURE PAGE
TO ADMINISTRATIVE AGREEMENT
FOR THE PROVISION OF
EMERGENCY MEDICAL RESPONSE SUPPORT SERVICES
[CHULA VISTA]
IN WITNESS THEREOF, the parties have caused this Agreement to be
executed and effective as of the Effective Date.
"CITY"
CITY OF CHULA VISTA
Cheryl Cox,
Mayor
Attested By
Donna Noms,
City Clerk
Approved as to form By
Glen R. Googins,
City Attorney
"AMR"
AMERICAN MEDICAL RESPONSE AMBULANCE SERVICE, INC.
Michael Murphy,
General Manager
4821-0799-9762.2 1 ~
8-22
EXHIBIT A
Implementation Schedule and Deployment Maps for FRALS Services
C.V.F.D. ALS First Responder Implementation Plan:
FY Phase _: Location
13-14 I E55, E56, E57, E58, E59
15-16 II E54, E51, USAR-53
16-17 III E52
17-18 IV T-51, T-57
asz~-o~ss-s~sz.z 11
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EXHIBIT B
Additional Service Standards and Protocol
[To Be Inserted, if any]
4821-0799-9762.2 ] Z
8-31
EXHIBIT C
Schedule of Costs/Payments
[To Be Inserted]
4821-0799-97622 13
8-32
ALS Pass Through Quarterly Payment Schedule and
FRALS Phases
Exhibit C
A. Calculations for all ALS costs and pass-through amounts are based on the ALS
spreadsheet (FINAL) version.
Table 1: FY 12-13 ALS Operational Expenses'
Total Annual . FY 13-14 FY 14-15
'Expenses Amortization Amortization
("Startup Of Start up Cost Amounfof start
Costs" u Cost
$713,556.03 $570,844.82 $142,711.20
Table 2: FY 13-14 and 14-15 ALS Operational Expenses
FY Total Annual Expenses Quarterly
Pa menf Amount
13-14 $1,120,015.20 $280,003.80
14-15 $1, 320,429.44 $330,107.36
Table 3: FRALS Quarterly Payment Matrix:
'FY Quarterly
Pa ment Amortization
Amount Total Quarterly. ,
Amount Due
12-13 $0.00 $0.00 $O.OOI
13-14 $280,003.80 $142,711.20 $422,715.00'
14-15 $330,107.36 $142,711.20 $472,818.56
'FY 12-13 startup costs are amortized over the remaining 24 months (8 quarters) of the current EOA
agreement with American Medical Response. The monthly amount is then added to the quarterly
payment schedule with the FY 13-14 and FY 15-15 amounts.
Rev. March 20, 2013
Exhibit C
8-33
ALS Pass Through Quarterly Payment Schedule and
FRALS Phases
Table 4: FRALS Quarterly Payment Schedule:
FY Quarter Amount
13-14 Se tember $422,715.00
13-14 December $422,715.00
13-14 March $422,715.00
13-14 June $422,715.00
14-15 Se tember $472,818.56
Table 5: FY 13-14 Total Annual I Quarter Supply Payment
Dis atch $391,000.00 $ 97,750.00
BLS E ui ment /Su lies $ 54,000.00 $ 13,500.00
Defibrillators $214,000.00 $ 53,500.00
Contract Administration $219,407.00 $ 54,851.75
FRALS Services $1,120,015.20 $280,003.80
`FRALS Start up Costs $570,844.82 $142,711.20
FY 13-14 TOTAL: ~ $2,569,267.02 ~
'ALS Start up cost total = $713,556.40 that is amortized over the fi
.75
services
Rev. March 20, 2013
Exhibit C
8-34
Table 6: FY 14-15 Total Annual /Quarterly Supply Payment