DATE: December 6, 2022
TO: Mayor and City Council
FROM: Fire Chief
SUBJECT: Adopt a Resolution Authorizing the City Manager to Execute a Letter of Intent with the Alameda County Fire Department to Negotiate the Terms of a Proposal for Ambulance Services and/or Emergency Medical Services in Alameda County
RECOMMENDATION
That the Council adopts a resolution (Attachment I) authorizing the City Manager to execute a letter of intent with the Alameda County Fire Department to negotiate the terms of a proposal for ambulance services and/or emergency medical services in Alameda County.
SUMMARY
ACFD recently released a Request for Proposals (“RFP”) for private ambulance providers in order to develop a proposal that would be submitted to Alameda County in the summer of 2023 as a competitive bid for ambulance services in the County. Cities and Fire Departments within Alameda County have an opportunity to come together in negotiations with ACFD to refine this proposal and the terms and conditions of City participation in the model.
BACKGROUND
Currently, in Alameda County, 911 ambulance transport is provided in two ways: 1) by City fire departments that maintain “201” rights to provide ambulance transport (Berkeley, Albany, Piedmont, and Alameda); or 2) through a contract between the Alameda County Emergency Medical Services (EMS) Agency and a private ambulance provider (for the Cities of Oakland, Fremont, Hayward, Livermore, Pleasanton, and the contract cities of ACFD (Union City, San Leandro, Dublin)). This model has had varying levels of success and has struggled at times with financial viability over the years it has been in operation.
In April 2019, after concerns about the financial and operational viability of the private ambulance provider model arose, the Alameda County Board of Supervisors convened an Emergency Medical Services (EMS) re-design Task Force (“Task Force”) that was chaired by Hayward Fire Chief Garrett Contreras and EMS Agency Interim Director Anne Kronenburg. The Task Force evaluated these issues for over 18 months and had representatives from cities impacted by the Exclusive Operating Area (EOA) ambulance contract as well as hospitals, special districts, and long-term care facilities. The Task Force ultimately expressed overarching support for development of a Fire Based EMS delivery system, as explained further below.
The current contracted ambulance provider for Alameda County is Falck Ambulance. Falck has had the contract with Alameda County EMS Agency since July 1, 2019. For a variety of reasons (many of which were evaluated by the EMS re-design task force), Falck has struggled to meet contractual obligations, primarily related to ambulance response and transport times, at multiple points during the contract term. Falck was out of compliance in October, November, and December of 2021. The County placed Falck on a monitored performance improvement plan that included many factors to bring them into compliance. The Board of Supervisors has received information about these contract compliance issues during regular meetings and these issues have also been reported in the media.
In October of 2021, at the monthly Alameda County Fire Chiefs Association meeting, Falck, with the support of EMS Agency staff, asked the Fire Chiefs for help in the form of staffing ambulances with Fire Agency Paramedics. As a result, Fire Chiefs within the County, in partnership with ACFD and local firefighter unions, have been working together for approximately one year to bring to fruition the recommendations of the EMS Re-design Task Force. While Falck has supported partnerships that would make the system solvent within Alameda County, it is unknown whether they will bid on the new County contract or partner with ACFD on the new model. This new model would generally look similar to the model in Contra Costa County, whereby the County Fire Department contracts with a private ambulance provider (not yet identified) to provide primary response service to cities within in the County. Surge capacity units would be provided by City Fire Departments on an as needed basis dependent on predicted call volumes. This model would be more financially viable than the current “private provider only” model because cost recovery rates for public entities are higher (statutorily) than for private providers.
ACFD recently released a Request for Proposals (“RFP”) for private ambulance providers in order to develop a proposal that would be submitted to Alameda County in the summer of 2023 as a competitive bid for ambulance services in the County. Cities and Fire Departments within Alameda County have an opportunity to come together in negotiations with ACFD to refine this proposal and the terms and conditions of City participation in the model.
DISCUSSION
In order to submit a competitive bid, in partnership with ACFD, in response to Alameda County’s ambulance RFP in the summer of 2023, the Fire Chiefs within the County recommend that the Cities of Oakland, Hayward, Fremont, and Livermore/Pleasanton (represented by their Fire Department JPA) execute a letter of intent with ACFD. The Letter of Intent contemplated in this report will enable the City of Hayward and the Hayward Fire Department to enter into negotiations with the Alameda County Fire Department to develop the commitments and obligations of each City fire department in the model described in the Background section above. The key elements of these negotiations will include, but will not be limited to:
Development of the Countywide ambulance deployment model to be proposed in response to the County EMS Agency RFP, including identification of alternate transport locations ACFD’s plan for deploying ambulances within the Exclusive Operating Area (EOA), including system status management strategies and ambulance numbers, types, response times, and posting locations; this may include whether, to what extent, and on what terms, City of Hayward will provide ambulance services as an ACFD subcontractor The extent to which ACFD and City of Hayward will provide cross-jurisdictional automatic and mutual aid for FRALS and/or ambulance services In kind contributions of and/or access to facilities necessary to implement the deployment model, e.g. locating ACFD’s or its subcontractors’ ambulance units within the City of Hayward and associated fees Staffing obligations and/or requirements of City fire departments Shared use of technology, including access and sharing of data across the agencies Cost Recovery - Amounts and mechanisms for ACFD to recover City of Hayward costs from payors, including administration fees to be charged by ACFD ACFD is proceeding with this model and intends to submit a proposal in response to the County RFP for ambulance services in the summer of 2023. If the cities do not engage in these negotiations, there would be limited city input into the proposal and the terms and conditions of this model would be dictated exclusively by ACFD and their proposal. If negotiations are unsuccessful, there would be no obligation for a city to participate in the ultimate proposal, and the Alameda County EMS Agency would still be obligated to provide 911 ambulance response services to that community. However, the current service concerns and response time delays would likely continue.
The current milestones for this process looks like:
November 10, 2022: Proposals due for private partner with ACFD to submit for Countywide Ambulance proposal December 2022/January 2023: City Councils authorize execution of letters of intent January 2023: Countywide Ambulance RFP* released
April/May 2023: Countywide Ambulance proposals (including possible ACFD partnership) due*; State approval required prior to BOS award of contract June/July 2023: Countywide Ambulance award of contract* * All County RFP dates are subject to change
FISCAL IMPACT
At this stage of the process, there are no fiscal impacts other than the staff time needed to negotiate with the Alameda County Fire Department. Those negotiations will determine the ultimate fiscal, in kind, and/or staffing implications of the proposal for ambulance services. Once this proposal has been finalized, staff will share details of the proposal with the City Council and request authorization to enter into a formal MOU or other agreement with ACFD.
NEXT STEPS
If approved and authorized by Council, the City Manager will execute the Letter of Intent, and staff will begin negotiations with the Alameda County Fire Department on the terms of the proposal to be submitted to the County in response to the upcoming ambulance RFP. Once this proposal has been finalized, staff will share details of the proposal with the City Council and request authorization to enter into a formal MOU or other agreement with ACFD.
Prepared and Recommended by: Garrett Contreras, Fire Chief Approved by:
_________________________________________
Kelly McAdoo, City Manager
“201” Rights – http://emsaac.org/images/stories/2017-08-14_EMSAAC_Position_Paper_Grandfathering_and_Exclusivity.pdf 911 response times from Falck in Alameda County are 'a mess,' patients transported on fire engines - ABC7 San Francisco (abc7news.com)