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CITY COUNCIL AGENDA REPORT
City of Anaheim
FIRE & RESCUE DEPARTMENT
DATE: NOVEMBER 18, 2025
FROM: FIRE & RESCUE DEPARTMENT
SUBJECT: PROFESSIONAL SERVICES AGREEMENTS FOR NURSE
PRACTITIONER SERVICES TO SUPPORT THE ADVANCED
PROVIDER RESPONSE UNIT (APRU)
ATTACHMENT (Y/N): YES ITEM # 08
GOVERNMENT CODE § 84308 APPLIES: NO
RECOMMENDATION:
That the City Council, by Motion:
1. Approve Professional Services Agreements (Agreement), in substantial form, with i) Affinity Care in the amount of $90,000 per contract year with a total contract amount not to exceed $270,000, ii) Christina M. Bowles in the amount of $75,000 per contract year with a total contract amount not to exceed $225,000, iii) Jacqueline Enfiedjian in the amount of $75,000 per contract year with a total contract amount not to exceed $225,000, iv) BlueWave Health Nursing in the amount of $75,000 per contract year with a total contract amount not to exceed $225,000, and v) KRV Nursing Medical, Inc. in the amount of $75,000 per contract year with a total contract amount not to exceed $225,000, for Nurse Practitioner Services, each for an initial one year term, with two, one-year optional renewals;
2. Authorize the Fire Chief, or designee, on behalf of the City of Anaheim, to execute the Agreements with Affinity Care, Christina M. Bowles, Jacqueline Enfiedjian, BlueWave Health Nursing, KRV Nursing Medical, Inc., and such other nurse practitioners as may be pre-qualified and on the RFP Eligibility List by the City in the future during the term of the Agreement; and
3. Authorize the Fire Chief, or designee, on behalf of the City, to take any and all actions as are necessary or advisable to implement, fund, and administer the Agreement, including any extensions;
4. Authorize de minimis changes that do not substantially change the terms and conditions of the Agreements, as long as such changes are determined to be de minimis by the City Attorney’s Office; and
5. Amend the Anaheim Fire & Rescue budget by $208,000 in the Opioid Abatement Fund.
Professional Services Agreements for Nurse Practitioner Services to support the Advanced Provider Response Unit (APRU) November 18, 2025
BACKGROUND:
On May 31, 2015, Anaheim Fire & Rescue launched the Community Care Response Unit (CCRU) as a pilot program. The CCRU was designed to respond to non-urgent, low acuity medical aide calls in place of a standard paramedic engine/truck and ambulance unit response. The CCRU was staffed by a full-time Nurse Practitioner (who was a City employee, working in the full-time job classification, Medical Care Provider) and an Anaheim Fire Captain/Paramedic. The CCRU provided a means to address some of the chronic users of the 911 system and provided a more effective and efficient method to respond and handle low acuity medical calls. In late 2019, the CCRU’s Nurse Practitioner left the City, putting the CCRU program on hold while a recruitment process was discussed to hire a new Nurse Practitioner. In 2020, due to the COVID-19 pandemic, recruitment efforts for a Nurse Practitioner were halted, and the pilot CCRU program ended.
In FY 2024/25, Anaheim Fire & Rescue was informed that Opioid Settlement Funds, managed by the Anaheim Housing and Community Development Department, were available for opioid abatement activities, including prevention, treatment, harm reduction, and recovery support efforts. In FY 2025/26, Anaheim Fire & Rescue’s adopted budget included a new Fire Captain/Paramedic position, funded by Opioid Settlement Funds.
Under the leadership of the Fire Captain/Paramedic, Anaheim Fire & Rescue has developed a new and improved version of the CCRU program, called the Advanced Provider Response Unit (APRU). Due to limited funding provided by the Opioid Settlement Fund, the APRU will be initiated as a pilot program for three years. If, after evaluation of the program during the three-year period it is considered successful, Anaheim Fire & Rescue will explore opportunities to continue and/or expand the program.
The APRU is an expanded Mobile Integrated Health (MIH) program focused on community-based responses to opioid use disorder and behavioral health crises. The goal of the APRU is to reduce opioid-related morbidity and mortality, enhance public health, and improve the quality of life for individuals and families impacted by substance use disorder in Anaheim, with a focus on innovative and accessible care delivery. In addition, the APRU will help divert calls from the 911 system and provide an alternative to hospital emergency departments in relation to repeat 911 utilizers, overdose interventions, distribution of Narcan leave-behind kits, fentanyl test strips, and survival support packs.
The APRU will be temporarily deployed from Anaheim Fire Station 5 until the completion of Anaheim Fire Station 12. The APRU will operate during peak demand hours, with scheduling designed to maximize impact and efficiency. The APRU is intended for all eligible patients citywide and is not restricted to any one healthcare system or payer group.
The APRU will help free up Anaheim Fire & Rescue’s other emergency resources, helping improve response times in support of the 911 system. The APRU will also fill a critical gap in the Anaheim Homeless System of Care in post-overdose follow-up and access to treatment options, connecting individuals to recovery and supportive services.
Rebranding the CCRU to the APRU aligns Anaheim Fire & Rescue with the intent and language of California Senate Bill 1180 (SB 1180). SB 1180 authorizes reimbursement for mobile integrated health (MIH) and community paramedicine services when provided by licensed advanced providers, such as nurse practitioners (NPs) or physician assistants Professional Services Agreements for Nurse Practitioner Services to support the Advanced Provider Response Unit (APRU) November 18, 2025
(PAs). The term “Advanced Provider” explicitly identifies the program as one staffed by billable, licensed medical professionals, distinguishing it from non-clinical community response models. By using the APRU title, the program reflects a higher level of medical capability, consistent with SB 1180’s requirement that reimbursable services must be delivered by qualified healthcare providers.
Under SB 1180, programs must obtain an organizational National Provider Identifier (NPI) and register their provider with Medi-Cal or managed care plans. The APRU designation allows Anaheim Fire & Rescue to register under clinical provider taxonomies that include mobile health clinic, advanced practice response, and community paramedicine, ensuring alignment with payer and the California Department of Health Care Services (DHCS) classifications. The APRU designation ensures that data collection, reporting, and documentation accurately reflect provider-level clinical encounters. This facilitates SB 1180 compliance by clearly defining APRU’s role as a medical service provider. It also supports alignment with research partners, such as Arizona State University (ASU), and DHCS evaluation criteria for MIH outcomes.
The APRU will be staffed by the Fire Captain/Paramedic, along with contract Nurse Practitioners (instead of a full-time Nurse Practitioner who is a City employee, which was the model deployed by the CCRU). Utilizing contract Nurse Practitioners will ensure additional resources are available to support the APRU in case a particular Nurse Practitioner is unavailable.
The APRU will operate three (3) shifts of ten (10) hours per day, Monday-Wednesday, 7 am – 5 pm for a total of thirty (30) hours per week or one hundred twenty (120) hours per month. Each Nurse Practitioner who supports the APRU will work on a part-time basis, with a minimum of two (2) or three (3) shifts per month, scheduled in alignment with the APRU’s staffing needs, patient volume, and operational priorities. Shift scheduling will be managed by Anaheim Fire & Rescue Administration to ensure adequate coverage and responsiveness. Anaheim Fire & Rescue decided to staff the APRU with contracted Nurse Practitioners (instead of one full-time Nurse Practitioner) to maintain consistent staffing.
Anaheim Fire & Rescue also considered market conditions, where most qualified Nurse Practitioners work full-time at a hospital but are open to flexible part-time opportunities.
The contracted Nurse Practitioners will function within standardized protocols that include obtaining health histories, performing physical examinations, diagnosing and treating acute and chronic conditions, prescribing medications, interpreting diagnostic data, and making appropriate referrals and follow-ups. The Fire Captain/Paramedic will continue to operate under the current Orange County Standing Orders, Policies, and Procedures as outlined by OCEMS. Program oversight of the APRU resides with Anaheim Fire & Rescue’s Emergency Medical Services (EMS) Section, under the authority of the Orange County Emergency Medical Services Agency (OCEMS) and the local EMS Medical Director. The APRU operates under clinically appropriate, legally compliant, and pre- determined emergency medical dispatch (EMD) protocols developed in coordination with OCEMS and stakeholder physician groups.
Professional Services Agreements for Nurse Practitioner Services to support the Advanced Provider Response Unit (APRU) November 18, 2025
DISCUSSION:
In support of the APRU, a Request for Proposal (RFP) for Contract Nurse Practitioner Services was issued on August 15, 2025. The RFP was advertised for over three weeks on the City’s online bidding platform, OpenGov. One thousand nine hundred thirty-two vendors (1,932) were notified of the RFP through the OpenGov system based on the vendor’s registration classification for similar services through the system, and fifty-four (54) vendors downloaded the RFP as a prospective bidder. On September 3, 2025, Anaheim Fire & Rescue received thirty-four (34) proposals from qualified Nurse Practitioners (individuals and companies), which the RFP review committee evaluated in accordance with Council Policy 4.1.
After the review process, the RFP review committee determined that twenty-two (22) of the thirty-four (34) Nurse Practitioners who submitted proposals displayed a thorough understanding of the RFP’s scope of work, exhibited appropriate qualifications, provided all required documentation, and demonstrated the proper level of work experience. Each of the twenty-two (22) Nurse Practitioners were invited to a two-phase interview process, where twelve (12) Nurse Practitioners moved to the second interview, and ten (10) Nurse Practitioners were placed on the RFP Eligibility List after the interview process was completed. In consideration of the needs of the APRU program, Anaheim Fire & Rescue recommends awarding a contract to the top five (5) Nurse Practitioners at this time, with the option to enter a contract with additional Nurse Practitioners on the RFP Eligibility List, based on the needs of the APRU program.
Based on the RFP review process, here is the RFP Eligibility List for Contract Nurse Practitioners:
Nurse Practitioner Rank
Affinity Care 1
Christina M. Bowles 2
Jacqueline Enfiedjian 3
BlueWave Health Nursing 4
KRV Nursing Medical, Inc. 5
Jennifer Ngo 6
Long Pham 7
Lisa Koser 8
Erin Boeskin 9
Brianna Weller 10
The Nurse Practitioners will respond to non-emergent calls, conduct field-based assessments, and integrate behavioral health screenings and referrals into each care plan.
Working alongside Paramedics, the Nurse Practitioners will act as the lead medical provider in Medication-Assisted Treatment (MAT) field operations to ensure that individuals experiencing opioid-related emergencies receive timely, compassionate, and clinically appropriate interventions without relying solely on hospital emergency departments. The proposed Agreement with each Nurse Practitioner is for an initial one- year term, with two, one-year optional renewals, with an annual contract not-to-exceed $90,000 for Affinity Care (the most experienced Nurse Practitioner) and an annual contract not-to-exceed $75,000 for the remaining Nurse Practitioners. Compensation is Professional Services Agreements for Nurse Practitioner Services to support the Advanced Provider Response Unit (APRU) November 18, 2025
based on a fixed hourly rate with potential annual increases that may not exceed the change in the Consumer Price Index (CPI) for the Los Angeles, Long Beach, and Anaheim, California areas for the most recent month period.
Anaheim Fire & Rescue has reviewed the pilot APRU program with the City’s Human Resources (HR) Department. On October 31, 2025, HR discussed with the American Federation of State, County, and Municipal Employees (AFSCME) Local 2002, the use of contract Nurse Practitioners. The discussion was scheduled to address questions regarding the AFSCME job classification, Medical Care Provider, the position previously used by Anaheim Fire & Rescue to staff a full-time Nurse Practitioner in support of the CCRU. As a result of the discussion, it was clarified that using contract Nurse Practitioners in support of the APRU will not result in any reductions in City of Anaheim employees.
AFSCME was in concurrence.
The Agreements with the Nurse Practitioners support two strategies from the citywide Strategic Plan. Goal B – Enhance Livability, Strategy 9 – Maintain and expand services to address homelessness and its impacts, and Goal E – Support Public Safety, Strategy 7 – Identify ways to reduce police and fire response times.
IMPACT ON BUDGET:
The projected cost to staff the contract Nurse Practitioners in support of the APRU is approximately $208,000 per year. Based on the availability of the Nurse Practitioners and APRU’s operational needs, the contracted Nurse Practitioners will work a varied number of hours in each contract year. Anaheim Fire & Rescue’s Fiscal Year 2025/26 budget will be increased by $208,000 from Opioid Settlement Funds. Future year renewals will be subject to the City Council’s approval of budget appropriations.
Respectfully submitted,
Patrick Russell
Fire Chief
Attachments:
1. Professional Services Agreement with Affinity Care
2. Professional Services Agreement with Christina M. Bowles
3. Professional Services Agreement with Jacqueline Enfiedjian
4. Professional Services Agreement with BlueWave Health Nursing
5. Professional Services Agreement with KRV Nursing Medical, Inc.